Nursing tweeters (or should that be, tweeting nurses) were out in force when the International Council of Nurses (ICN) held its 25th Quadrennial Congress in Melbourne recently. This analysis by nurse, educator and social media enthusiast Paul McNamara gives some useful insights into why conference organisers generally should build Twitter into their planning. Over the […]

Nursing tweeters (or should that be, tweeting nurses) were out in force when the International Council of Nurses (ICN) held its 25th Quadrennial Congress in Melbourne recently.

This analysis by nurse, educator and social media enthusiast Paul McNamara gives some useful insights into why conference organisers generally should build Twitter into their planning.

Over the ten days from May 14, 288 individual Twitter participants used the #ICNAust2013 hashtag, collectively generating 3,973 Tweets. Conversations on Twitter continued well after sessions had ended, extending the reach and influence of conference discussions.

Interestingly, five prolific Tweeters from one school of nursing – James Cook University in Far North Queensland – were responsible for over 30 per cent of the activity.

Meanwhile, Sydney GP Dr Tim Senior explores in the post below how social media can help clinicians and researchers with an interest in evidence-based practice.

This article was first published by the Centre for Informing Policy in Health with Evidence from Research (CIPHER) – a member-based website for health policy and program leaders hosted by the Sax institute.

(And beneath his article are links to other recent developments in social media and health).

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Social Media and Health Evidence: oil and water or marriage made in heaven?

Tim Senior writes:

The most valuable skill I was taught at medical school was a Medline search. Much has changed since I graduated. There are some treatments we were told were dangerous that we now know are beneficial. Some, of course, have moved in the other direction.

The technology has moved on amazingly – that Medline searching I learnt was done by asking the librarians for the CD-ROMs to insert in the computer. However, the use of evidence to inform patient care is dependent on the ability to call on the relevant research findings at the point where you need to make the decision.

And I’m sure that challenge is the same for those at the frontline of health service planning who want to use research in their work. For me, this recall is partly dependent on my memory, but is increasingly influenced by Random Access Memory.

Those early days of using Evidence Based Medicine in clinical practice involved pulling a portable computer along on a cart at ward rounds, and using paper summaries of the evidence.

Since then, just about every doctor has a computer on their desk, used for prescribing, investigation requests, transmission of results and letters and data collection for quality improvement. And now our phones have more power than that original portable computer on the evidence cart (and probably more power than the poor intern pulling it along!)

With the increased use of computers, and the ability to connect to the internet from almost anywhere, it becomes easier and easier to access Medline and hunt down relevant evidence.

Going where the people are

But with increased access and connectivity comes the risk of information overload; it also becomes easier and easier to tweet a photo of your breakfast and hunt down the latest videos of piano playing cats, too.

The technology that makes it easier to find the evidence you need also makes it easier for everything else that humanity might want to use its time for. So should we leave humanity to it, and go back to the library to cuddle our evidence?

What happens if we don’t engage on social media? The world doesn’t look that different. Papers will appear in journals, they’ll get discussed at conferences. Researchers might e-mail a few people about their research, have meetings. It’s perhaps not clear what effect it’s having on the ground and indeed whether it might be of any use to anyone involved in the planning and delivery of health services.

As a researcher, if you’re really lucky, it’ll be written about in mainstream media, and more people will read it. But quietly, imperceptibly, all around us people and organisations are gradually moving to social media, because that’s where the other people are. Including me, sometimes reluctantly! Here’s why I’m there.

As a young medical student, there were two things that really appealed to me about evidence-based medicine. The first was that it might give me some certainty about how to manage medical conditions I saw. It didn’t!

The second was the potential to level a hierarchy. It was quite legitimate for a young medical student like me (or actually, like my more confident friends) to question the professor if you had evidence to back it up.

No longer was wisdom handed down on tablets of stone from the mind of a Professor. Potentially, we could all access, interpret and use the evidence, no matter where we sat in the hierarchy. The hierarchy has regained its position – wisdom is now handed down from the minds of professors in the form of Evidence Based Guidelines.

The swinging pendulum

And now the pendulum swings back the other way. With my Medline CD-ROMs in the library, and the use of the Internet up until recently, using the evidence was about finding and reading static research papers. Discussions about it would happen on the wards and in Grand Rounds.

Now the Internet is social – it’s not just about finding information for me. I discover what other people are reading, I can show them my reading, I can discuss the implications and implementation in real time with experts, and I can think out loud in blog format.

For me, social media is quite simple – Twitter for real time updates and discussion, and blogging for more considered longer form writing. I use Citeulike as an online library of my reading, which anyone can see.

I do much more reading of other people’s blogs than writing of my own, which exposes me to some quite profound thinking across a wide variety of disciplines. I hear from other GPs, doctors in other specialties, other health professionals, policy makers, governments, historians, educators, musicians, journalists and, of course, patients.

This bumping of multiple perspectives is the strength of social media. It is easy to get trapped into thinking that implementing evidence is just about getting the evidence out there – that the implementation gap is an information gap.

Everything we know about behaviour change tells us this is just not true. Social media allows conversations about how evidence might be implemented – and whether it might be worth implementing.

For example, at the moment on Twitter I am following discussions on screening and when it does more harm than good – related to policy around dementia screening and PSA screening; discussions highly critical of DSM-V, suggesting it probably overmedicalises many normal uncomfortable symptoms.

I would suggest that wherever you see people discussing evidence passionately like this, you’ll also see people who are working to improve the quality of care, and implement best evidence.

On the other side of this coin, for researchers who would like their research to make a difference, how heartening it must be to be able to see people discussing it in real time. (And I know that those taking part in a discussion are always thrilled to have the researchers join in).

Getting started: What do I do?

Social media can be used in just about any way you can imagine – in fact, imagination is probably the only limit. The health sector probably has a small, but active user base currently. No one is sitting around with spare time, wondering what to do with it. Legitimate concerns about patient confidentiality on social media make many in the sector nervous. There is uncertainty about what social media is actually for.

The best way to find out is actually just diving in. My comments are most relevant for using Twitter and blogging, as that is what I know. The principle of dive in and join in conversations holds with any social media tool, though – it’s social media, not social media.

Often, a conference is a good place to start, as there is an active, fast flowing Twitter conversation to get involved in, and plenty of people in real life who will be only too happy to help out newbies.

Away from conferences, you’ll need some people to start following. You’ll get a feel fairly quickly for accounts you find useful or interesting.

In general, those which have a sense of personality behind them are more fun to follow. Some people are worth following because they are the leaders in their field, others will connect you frequently to other information or people.

Here’s a start:

I have had online discussions with Clare Gerada (President of the Royal College of GPs in the UK), Trisha Greenhalgh (Professor of General Practice in London, and one of the best thinkers on everything from Evidence Based Medicine, to the use of narrative in care, to policy rhetoric.

Simon Chapman, the influential public health researcher has made very good use of Twitter to promote and discuss his research, and describes how far it can go.

Rachael Dunlop has won awards for her science communication work in social media and broadcasting.

The Conversation is a website funded by several universities as a way for academics to write about their work for a wider audience.

There is even a Real Scientists rotation curation Twitter account, with a different scientist tweeting every week.

Pockets of good practice

There are many pockets of good practice in the health sector – the Aboriginal health sector is using social media well for engagement and there are some research institutes highlighting aspects of their work.

For these pockets to spread, I think two things are required. The first is just for more people to be there, having a go. Whatever you happen to want to talk about, there is an audience for it on social media. The second is for us to highlight the discussions, the new contacts made, the new ideas and new perspectives generated through its use.

Obviously, social media is one place to do this, but it does tend to preach to the converted. Conversations are also needed in the real world as well as the social one.

So, do have a go at diving in. Say hello to me on Twitter, comment on some blogs and see what happens.

You’ll find a lot of interesting people there. Not being on social media misses out on engaging a lot of people in your work.

Don’t rely on social media as your sole engagement strategy though. There are still barriers to its use, so there are some times where you will need to turn up at real life events – perhaps pulling an evidence trolley and a pile of CD-ROMs.

For further thought provoking comment on this topic, as well as more examples see this recent Guardian article from the UK.

• Dr Tim Senior is a GP at Tharawal Aboriginal Corporation and is Medical Advisor in the National Faculty of Aboriginal and Torres Strait Islander Health at the Royal Australian College of General Practitioners. He is a Senior Lecturer at the University of Western Sydney School of Medicine. His Twitter handle is @timsenior

• CIPHER, the Centre for Informing Policy in Health with Evidence from Research, investigates the tools, skills and systems that might contribute to an increased use of research evidence in policy. It is a collaboration between the Sax Institute and the University of Western Sydney; the Australasian Cochrane Centre; The University of New South Wales; The University of Newcastle; University of Technology Sydney; and University of St Andrews in the UK. More about CIPHER here: https://www.saxinstitute.org.au/our-work/cipher/

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Social media and health governance: an international perspective

The impact of social media upon health governance was noted at the 66th World Health Assembly (the supreme decision making body of the World Health Organization) in Geneva last week.

Agenda papers describe several factors that “have been instrumental in both broadening the health governance agenda and making it more complex to manage”.

They state:

“Health governance is no longer the exclusive preserve of nation states. Civil society networks, individual nongovernmental organizations at international and community level, professional groups, philanthropic foundations, trade associations, the media, national and transnational corporations, and individuals and informal diffuse communities that have found a new voice and influence thanks to information technology and social media – all of these actors have an influence on decision-making that affects health.”

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May 30 deadline for feedback to AHPRA

The Australian Health Practitioner Regulation Agency’s (AHPRA) preliminary consultation paper on a social media policy for health professionals generated a lot of concern last year, as previously covered at Croakey.

The National Boards are now seeking public comment, via the AHPRA website, on a consultation paper that covers social media, advertising, and related matters. Their statement says: “Anyone with an interest in health practitioner regulation, including health practitioners and members of the public, is strongly encouraged to read and respond to the consultation paper.”

You can read one doctor’s take here (the short version: the social media policy is better than it was but still needs work, particularly its advice on testimonials).

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How patients and caregivers are using social media

A scoping review, published recently in BMJ Open, “provides a map of the existing literature evaluating the use of social media in patient and caregiver populations”.

Researchers from Canada and Charles Sturt University reviewed 284 studies, most of which were using tools such as discussion forums and blogs to facilitate selfcare. About two-thirds of studies concluded there was evidence for the utility of social media while five per cent concluded there was not.

However, the review suggests that some of the reporting of studies has been overly positive. Among the randomised controlled trials examined, almost three-quarters presented positive conclusions, although only 46 per cent reported a statistically significant effect in relation to the primary outcome.

The researchers said:

“Social media is a relatively new concept that is continually undergoing transformation. As such, there is no universal definition, adding complexity to the process of determining study eligibility. The constantly changing nature of social media also proved challenging in defining the literature search, and the novelty of the topic made it difficult to keep the search updated due to a steady influx of new reports.”

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Social media handbook coming soon

One of the leading international proponents of social media in healthcare, Dr Bertalan Meskó, says he has been working day and night over the past ten months to finish this book, Social Media in Clinical Practice.

It aims to introduce medical professionals to the digital world through real-life examples, suggestions and step-by-step instructions.

The table of contents includes:

Social media is transforming medicine and healthcare

Using medical search engines with a special focus on Google

Community sites Facebook, Google+ and medical social networks

The world of e-patients

Establishing a medical blog

The role of Twitter and microblogging in medicine

Collaboration online

Wikipedia and Medical Wikis

Organizing medical events in virtual environments

Medical smartphone and tablet applications

Use of social media by hospitals and medical practices

Medical video and podcast

Creating presentations and slideshows

E-mails and privacy concerns

Social bookmarking

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Tweeting for public health

In this blog, researcher Dr Cameron Webb describes how he has used Twitter as a useful adjunct to his work with more traditional forms of media in disseminating information about mosquito control.

He highlights the importance of engaging in discussions rather than simply using Twitter as a broadcast medium (which is the way most health departments seem to use it).

He is confident that Twitter “can assist in getting the community more engaged in public health issues”.

From where Croakey sits, it seems that Twitter is also helping public health and other professionals become more engaged with the wider community…

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