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Using Twitter to Facilitate an Allied Health Professional Continuing Education Program
LNR/18/SCHN/272 LNRSSA/18/SCHN/306
2 | P a g e
Summary ........................................................................................................................................................ 3 Introduction .................................................................................................................................................. 4 Methods and Technologies ................................................................................................................... 10
Research Question ............................................................................................................................................. 10 Primary Objectives ............................................................................................................................................. 10 Ethics ......................................................................................................................................................................... 11 Participants ............................................................................................................................................................. 11 Materials/resources ............................................................................................................................................ 12 Procedure ................................................................................................................................................................ 12 Statistical Analysis .............................................................................................................................................. 13 Privacy ...................................................................................................................................................................... 14
Results .......................................................................................................................................................... 15 1. Participants .................................................................................................................................................. 15 2. Use of Twitter .............................................................................................................................................. 17 3. Advantages and disadvantages of Twitter use .......................................................................... 22 4. Strategies for facilitating Twitter ........................................................................................................ 24 a. Strategies of continuing need for education ................................................................................ 24 b. Clear guidelines for Twitter use ......................................................................................................... 25 c. Need for support by employing organisations ............................................................................ 25 5. Twitter Analytics ........................................................................................................................................ 25
Discussion ................................................................................................................................................... 29 Principle Findings ................................................................................................................................................ 29 Advantages and Disadvantages of Twitter Use ................................................................................... 31 Limitations ............................................................................................................................................................... 32 Future research .................................................................................................................................................... 33 Conclusion .............................................................................................................................................................. 33
References .................................................................................................................................................. 35 Appendix One: Twitter Pre-Survey ............................................................................................................. 43 Appendix Two: Twitter Post-Survey........................................................................................................... 47 Appendix Three: AHTVE Sessions from July 2018 to April 2019 ............................................... 51
3 | P a g e
Summary
The introduction of social media has lead to the development of modalities such as
Twitter. Twitter, a micro blogging platform, has the potential to enhance health
professionals’ networking and exchange of resources and ideas without the
boundaries of time, space or geography. This research aimed to explore the benefits
of Twitter within the context of allied health professions by examining its use in
relation to Allied Health Telehealth Virtual Education (AHTVE).
The goal of this research was to analyse the integration of Twitter with the existing
education modality AHTVE. Demonstration of the potential use of Twitter in bringing
together allied health professionals across a broad geographical area to discuss and
share resources, best practice and experiences around nominated session topics
was the aim.
The research identified that in terms of professional development benefits, Twitter
was perceived as being helpful for improving knowledge and problem solving. The
majority of allied health professionals, however, remained unsure of the benefits of
the integration of Twitter into AHTVE. The findings of the study suggested that
Twitter has the potential to be a useful tool at future AHTVE sessions, but there are
pitfalls that should be recognised including many technological challenges.
4 | P a g e
Introduction
Contemporary communication and the evolution of social media have ensued from
the establishment of the Internet and rapid technological advances (Casella, Mills, &
Usher, 2014; Chretien, Tuck, Simon, Singh, & Kind, 2015; McKee, 2013; Rolls,
Hansen, Jackson, & Elliot, 2016). Social media is a communication mode that
utilises web-based applications that allow people to create and exchange online
content (Kaplan & Haenlein, 2010; Kung & Oh, 2014; Usher, 2011). The introduction
of social media has enabled the access of information by a large number of people.
This has included the facilitation of professional networking and knowledge sharing
by health care professionals (Rolls et al., 2016). Facebook and Twitter are the two
social media platforms experiencing the biggest growth as social media becomes an
increasingly important part of our lives (NSW Government, 2016).
Twitter is a free micro-blogging platform, optimised for mobile application that permits
information to be exchanged in 140 characters or less (Bolderston, Watson,
Woznitza, Westerink, Di Prospero, Currie, Beardmore, & Hewis, 2018; Chretien et
al., 2015). The forced limit on character numbers requires the author to be succinct,
although the use of pictures and links enable greater information to be shared (Mills
& Kohl, 2016). Since the introduction of Twitter in 2006 its usage has increased.
During the month of April 2019, Twitter had approximately 4,700,000 monthly active
Australian users (Cowling, 2019). Further to its use in the general population, Twitter
is also reported to be widely used amongst health professionals (Chan & Leung,
2018). Twitter provides a modality that enables users to connect with their colleagues
and professional networks, providing an opportunity to exchange ideas, share
5 | P a g e
learning, and engage in critical debate regardless of distances (Forgie, Duff, & Ross,
2013; Maclean, Jones, Carin-Levy, & Hunter, 2013).
Health professionals utilising Twitter are able to exchange resources, ideas and
communicate with peers, mentors and leaders within their discipline (Forgie et al.,
2013). Twitter is currently being utilised by a range of health professionals to
facilitate virtual communities of practice that enhance professional networking and
knowledge sharing (Barry & Pearson, 2015; Forgie et al., 2013; Rolls et al., 2016).
Professional networking is a process of developing mutually beneficial relationships
with other like-minded professionals (Rolls et al., 2016). Virtual communities of
practice are groups of people who interact regularly and share a common interest for
something they do (Wenger, 2004). The advancement of social media and the
development of modalities such as Twitter may enhance health professionals’
networking and virtual communities of practice by facilitating professional interactions
not restricted by time, space or geography (Ardichvili, Maurer, Li, Wentling, &
Stuedemann, 2006; Barry & Pearson, 2015; Camden, Rivard, & Hurtubise K, 2017;
Ellison, Steinfield, & Lampe, 2007; Lai, Pratt, Anderson, & Stigte, 2006).
A narrative literature review exploring the impact of Twitter use in health professional
education was completed in 2018. The educative potential of Twitter was identified,
although the review provided varied results regarding the uptake of this modality
(Blayden, 2018). The key concepts of the papers examined encompassed the age of
Twitter users, its uses, integration of Twitter in an educational context, benefits and
barriers. The papers reviewed varied in methodological approaches with a number of
international perspectives, including a number of papers originating in Australia
(Ferguson, Inglis, Cripps, MacDonald, & Davidson, 2014; Usher, Woods, Casellac,
Glass, Wilson, Mayner, Jackson, Brown, Duffy, Mather, Cummings, & Irwin, 2014;
6 | P a g e
Wilson, Ranse, Cashin, & McNamara, 2014). Research into Twitter has generally
utilised survey-based tools to investigate health professionals’ use of Twitter
exploring both the benefits and risks. Twitter Analytics and thematic analysis of
tweets have also been used to further explore the quality of this use (Kember, Tse, &
McKay, 2008; Mckay, Steiner Sanko, Shekhter, & Birnbach, 2014; McKendrick,
Cumming, & Lee, 2012).
Generally the adoption of Twitter for professional use is more prevalent amongst
younger professionals with less professional experience (Alsobayel, 2016; Chan &
Leung, 2018; Hart, Stetten, Islam, & Pizarro, 2017). Gender did not appear to be a
causal factor in the professional use of Twitter. In a number of studies a greater
number of males utilised Twitter (Kung & Oh, 2014; Patel, Hawkins, Rawson, &
Hoang, 2017) which contrasted with a study of public health professionals where the
majority of users identified as female (Hart et al., 2017). Twitter has been widely used
across the educational continuum of health professional learning including
undergraduate, postgraduate and continuing professional development. The majority
of the studies focused on nursing and medical applications with very few studies
addressing the professional education uses of Twitter in the context of allied health
professionals (Barry & Pearson, 2015; Kukreja, Heck Sheehan, & Riggins, 2011).
Papers exploring the use of Twitter for specific educational purposes tended to focus
on five main categories including: journal clubs (Bolderston et al., 2018; Currie,
Woznitza, Bolderston, Westerink, Watson, Beardmore, Prospero, McCuaig, &
Nightingale, 2017), facilitation of professional networks (Ferguson et al., 2014), push
notifications for learning nuggets (Pisano, Pettit, Bartlett, Bhagat, Han, Liao, &
Landon, 2016; Reames, Sheetz, Englesbe, & Waits, 2016), assessment tools
(Gagnon, 2015; Lipp, Davis, Peter, & Davies, 2014) and online targeted resources
7 | P a g e
(Mason & Batt, 2018). The incorporation of Twitter has been a beneficial adjunct to
journal clubs in assisting facilitation of professional networks or virtual communities of
practice (Ferguson et al., 2014; McKendrick et al., 2012). Apart from the beneficial
use of Twitter at medical conferences (Ferguson et al., 2014) there is no evidence of
its use to support stand-alone education sessions with the focus on both facilitating
education and professional networking.
The potential benefits and strengths of Twitter and its integration into continuing
professional development were explored in a number of papers (Forgie et al., 2013;
Rolls et al., 2016; Wilson et al., 2014). Common themes acknowledged the absence
of geographical and temporal boundaries, the facilitation of virtual communities, and
the potential to facilitate learning and promote change through social dialogue.
Constructive aspects of Twitter usage were described as the capacity to use Twitter
to stay connected with other professionals, share knowledge, and engage in
continuing education (Hart et al., 2017; Panahi, Watson, & Partridge, 2016; Rolls et
al., 2016). Health professionals identifying as utilising Twitter for professional
purposes reported “following” a variety of individuals and organisations, including
other health professionals, medical journals, professional advocacy and health care
organisations (Barry & Pearson, 2015; Kukreja et al., 2011). These studies did not
comment on the “active” interactions or evaluate the postings of these health
professionals.
It is not possible to explore the integration of Twitter into health professional
education without candid discussion of potential risks and barriers. A number of
papers discuss the risks and barriers including issues around maintaining
confidentiality, lack of time, workplace acceptance and support, and difficulty
separating personal and professional lives (Bolderston et al., 2018; Chan & Leung,
8 | P a g e
2018; Panahi et al., 2016). Educators also identified perceived barriers in utilising
Twitter for education purposes including lack of understanding of how to integrate
Twitter into learning programs and lack of technical skills to use social media
(D'Souza, Henningham, Zou, Huang, O'Sullivan, Last, & Ho, 2017).
The effectiveness of Twitter in facilitating education is being evaluated across
different levels of the educational continuum and various health professions (Curran,
Matthews, Fleet, Simmons, Gustafson, & Wetsch, 2017; Hart et al., 2017; Roberts,
Perera, Lawrentschuk, Romanic, Papa, & Bolton, 2015). Current literature details
how this can be achieved including collaboration at professional conferences,
creation of virtual communities in journal clubs or promoting student engagement,
active learning in courses shown through the production of assessments or delivery
of educational material. Based on this information it appears evident that Twitter has
potential to be integrated into continuing professional development of health
professionals and positively impact on educational practices. The barriers and
limitations identified need to be further explored and addressed when integrating this
medium into educational initiatives (D'Souza et al., 2017).
Despite seemingly positive support for the use of Twitter in the sphere of health
professional education there are no randomised controlled studies and few objective
evaluations assessing the knowledge uptake and retention from education delivered
or facilitated using Twitter. There is also very little comparison between the flow of
education material via Twitter, that is, does reciprocal interaction improve the impact
and effect of learner engagement and knowledge acquisition. An increasing number
of papers reflect the uptake of Twitter by health professionals internationally
(Alsobayel, 2016; Hart et al., 2017; McKendrick et al., 2012). There is, however, a
paucity of knowledge in existence with regard to integration of Twitter specifically
9 | P a g e
within the Australian context and allied health use of Twitter within the continuing
education sphere.
Twitter has been integrated in health professional education utilising a variety of
initiatives, with different target groups and aims. This narrative review highlights
opportunities for Twitter to be used within allied health continuing education to foster
a community of learning (Blayden, 2018). Moving forward, attention needs to focus
on more rigorous evaluation and studies including under-represented health
professional groups.
Hence, this research aims to address these gaps regarding the benefits of Twitter
within the context of allied health professions by examining its use in relation to Allied
Health Telehealth Virtual Education (AHTVE). AHTVE is an initiative of the New
South Wales (NSW) Children's Healthcare Network Allied Health Educators program
(A2K). AHTVE aims to promote the use of videoconferencing as a means of
supporting and developing allied health professionals' knowledge and confidence in
the treatment of children presenting with more serious or complex clinical conditions.
AHTVE provides NSW Health allied health professionals who work with children, with
fortnightly access to education activities and workshops conducted at various sites
across NSW. The sessions are 60 minutes in duration and presented by allied health
professionals who have identified expertise in various clinical areas. A yearly
calendar of proposed educational topics and presenters is developed and available
on the A2K website as well as promoted in monthly newsletter and email alerts.
When developing educational initiatives it is important to embed active learning in all
sessions as it is well accepted that adults learn more effectively through experiential
techniques including questioning and discussion (Brookfield, 1998; Brundage &
10 | P a g e
Mackeracher, 1980). Due to the limitations of the technology used and number of
sites linked into AHTVE there is limited time for discussion and the sessions are often
presented in didactic lecture style format. It is essential to explore further modalities
to facilitate active learning by participants accessing AHTVE.
The research explored how Twitter may be integrated into AHTVE to facilitate
communication, sharing of resources and support, specifically for those in regional
and rural areas. For the duration of the research, the AHTVE sessions were run in
the current fortnightly format for content. Participants however were also invited to
take part in Twitter. Based on the outcomes from the study, recommendations will be
made regarding the effectiveness and potential utilisation of Twitter as an ongoing
component of the existing AHTVE initiative.
Methods and Technologies
Research Question
What is the effectiveness of Twitter in facilitating active participation in Allied Health
Telehealth Virtual Education (AHTVE)?
Primary Objectives Twitter may facilitate active participation in AHTVE. This will be verified through:
Analysis of the integration of Twitter with the existing education modality of
AHTVE.
Demonstration of the potential use of Twitter in bringing together allied health
professionals across a broad geographical area to discuss and share resources,
best practice and experiences around nominated session topics.
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Ethics
The NSW Children’s Healthcare Network Allied Health Educator in conjunction with
the Sydney Children’s Hospitals Network (SCHN) initiated this research. The project
received ethical approval by the SCHN Human Research Ethics Committee’s
Executive Committee with HREC reference LNRSSA/18/SCHN/272. SCHN
Research Governance approved a Site Specific Assessment (SSA) with SSA
reference number LNR/18/SCHN/306. The research component was approved by
James Cook University external HREC approval number H7501.
Participants
The target audience was the allied health professionals employed by NSW Health
facilities that work with children including child life therapists, dietitians, occupational
therapists, physiotherapists, social workers, and speech pathologists.
Participation in this research project was voluntary and if allied health professionals
chose not to participate in the research it did not impact on their ability to engage in
the AHTVE initiative. Content from Twitter that was analysed was in the public
domain and open for public access.
The allied health population participants were drawn from those who participate in
AHTVE. Each AHTVE session has an average of 20 – 35 different sites with a total
of approximately 20 – 80 registered participants. These participants varied from
session to session depending on clinical topic presented, professional background,
work commitments or access to appropriate information technology infrastructure.
Twitter discussions were evaluated from August 2018 to April 2019.
Recruitment for this research was opportunistic utilising the allied health
professionals currently accessing A2K initiatives. The use of Twitter as part of
12 | P a g e
AHTVE was advertised and promoted on the A2K website, in the A2K newsletter and
via email with information regarding each of the education sessions. Interest in
taking part in this research snowballed as allied health professionals shared benefits
with their peers.
Materials/resources
Pre- and post-surveys utilised the SurveyMonkey platform to collect data concerning
basic demographics, history of twitter use, perceived advantages and disadvantages
and ways to facilitate its use for professional purposes. They were adapted from
surveys by Alsobayel (2016) and Barry and Pearson (2015) with the addition of some
further open-ended questions to further qualify how Twitter is used for professional
purposes. Open ended questions were those used to identify what professional
groups or individuals allied health professionals connected with and how they would
recommend allied health professional use Twitter for professional purposes (see
Appendix One: Twitter pre-survey).
The post-survey is based on the pre-survey used with the addition of questions
relating to Twitter use and AHTVE (see Appendix Two: Twitter post-survey).
Procedure
A mixed methods study design comprising pre- and post -surveys with analysis of
Twitter activity were used to explore the engagement of allied health professionals in
Twitter discussions regarding AHTVE. A scoping literature review exploring Twitter’s
use in supporting allied health education was used to inform the process of
introducing Twitter into AHTVE.
The research comprised three phases over a 12-month period from July 2018 to July
2019. This process is represented in Figure 1. During the research period the
13 | P a g e
AHTVE sessions continued to be conducted regularly. They maintained their
previous format with the addition of Twitter to provide the opportunity for enhanced
professional discussion and sharing of resources. These sessions were advertised
via the A2K newsletter, website and email. Individualised hash tags distinguished
each session.
Figure 1: Diagrammatic Representation of Methodology
Statistical Analysis
In conjunction with basic descriptive data for all outcomes, results were compared
between pre- and post-surveys. Summary statistics are reported as frequency and
percentages. The items in Likert-type questions were coded numerically to support
14 | P a g e
analysis. A total score or mean score for the Likert scale items has been presented.
Despite controversy, educators and researchers, when measuring less concrete
concepts, such as perceptions concerning social media utilise this analysis (Diug,
Kendal, & Ilic, 2016; Pisano et al., 2016; Sullivan & Artino, 2013).
Categorical data was analysed by the Fisher’s Exact Test due to small numbers in
subcategories. Thematic analysis was used to identify themes within the open-
ended questions. This analysis was completed using the six-phase guide described
by Braun and Clarke (2006).
Twitter Analytics was used to explore the uptake and use of Twitter across 10
different AHTVE Twitter sessions. The data reviewed included the number of
followers, impressions, engagement and engagement rates.
Privacy
Privacy considerations are a risk for all social media usage. The privacy
considerations that need to be considered for Twitter include that all posts are within
the public sphere and no personal information, or patient identifiers should ever be
posted. This was reinforced in all promotion regarding Twitter use, with participants
referred to the Social Media Policy within their own Local Health Districts. Education
regarding the use of Twitter provided specific training related to the privacy settings
that can be utilised. There were no foreseeable areas where participant safety may
be compromised.
15 | P a g e
Results Results from data collection included a comparison between pre- and post-survey
results in relation to 1. Participants, 2. Twitter use, 3. Thematic analysis of
advantages, disadvantages, and 4. Ways of facilitating Twitter use. In addition,
Twitter Analytics were used to explore Twitter engagement in relation to AHTVE.
1. Participants
The Twitter pre-survey (N= 141) and the post-survey (N=130) were drawn from the
same sample of allied health professionals who work with children in NSW. Variation
between respondents in the two surveys is not accounted for and there was no
control to identify if the same participants completed the pre- and post-surveys. The
respondents in both surveys were located across a wide geographical area as
reflected by the Local Health Districts in which they are employed. This included the
eight Local Health Districts that cover the Sydney metropolitan region, and seven that
encompass rural and regional NSW.
Respondents represented a variety of allied health professional backgrounds that
work with children and their families in NSW. Respondents identifying as other
specified a range of professional backgrounds including medical, nursing, dental and
audiology. The highest qualification held by the majority of respondents was a
Bachelor Degree and the majority of respondents were between 31 – 50 years of age
and over 90% of all respondents identified as female. The demographics of the
respondents are illustrated in Table 1. No further statistical analyses of the groups
was performed due to the low number in some categories.
16 | P a g e
Table 1: Demographic data for the pre-and post- surveys.
Characteristic Pre-survey
Number (%)
Post-survey
Number (%)
Mean
Local Health District
Rural and Regional 79 (56%) 79 (61%) 79.0
Metropolitan 60 (43%) 51 (39%) 55.5
Profession
Child life therapist 2 (1%) 1 (1%) 1.5
Dietitian 16 (11%) 17 (13%) 16.5
Occupational therapist 26 (18%) 30 (23%) 28.0
Pharmacist 0 (0%) 1 (1%) 0.5
Physiotherapist 27 (19%) 18 (14%) 22.5
Psychologist 9 (6%) 9 (7%) 9.0
Social worker 7 (5%) 11 (8%) 9.0
Speech pathologist 37 (26%) 32 (25%) 34.5
Other 17 (12%) 11 (8%) 14.0
Highest Qualification
Diploma 3 (2%) 1 (1%) 2.0
Bachelor Degree 97 (69%) 87 (67%) 92.0
Master Degree or higher 41 (29%) 42 (32%) 41.5
Age
21 - 30 19 (13%) 18 (14%) 18.5
31 - 40 38 (27%) 32 (25%) 35.0
41 - 50 48 (34%) 47 (36%) 47.5
51 - 60 25 (18%) 28 (22%) 26.5
61 or above 5 (4%) 3 (2%) 4.0
Prefer not to say 6 (4%) 2 (2%) 4.0
Gender
Female 131 (93%) 119 (92%) 125.0
Male 9 (6%) 10 (8%) 9.0
Other 0 (0%) 0 (0%) 0
Prefer not to say 1 (1%) 1 (1%) 1
17 | P a g e
2. Use of Twitter
Overall an average of 20% (n=55) of respondents reported using Twitter. There were
no significant differences in professions between Twitter users and non-users in pre-
and post-surveys (p> 0.05). The number of respondents and corresponding Twitter
use by professional background is reflected in Table 2.
Table 2: Use of Twitter of Different Professions
Pre-Survey n (%) Post-Survey n (%)
Profession Respondents Twitter Users Respondents Twitter Users
Child life therapist
2 (1.4) 0 (0) 1 (0.8) 0 (0)
Dietitian 16 (11.4) 4 (13) 17 (13.3) 2 (8.3)
Occupational therapist
26 (18.4) 2 (6.5) 29 (22.7) 7 (29.2)
Pharmacist 0 (0) 0 (0) 1 (0.8) 1 (4.2)
Physiotherapist 27 (19.2) 7 (22.6) 18 (14) 3 (12.5)
Psychologist 9 (6.4) 3 (9.7) 9 (7) 2 (8.3)
Social worker 7 (5) 2 (6.5) 11 (8.6) 2 (8.3)
Speech pathologist
37 (26.2) 9 (29) 31 (24.22) 6 (25)
Other 17 (12) 4 (13) 11 (8.6) 1 (4.2)
TOTAL 141 31 130 24
Allied health professionals use of Twitter did not increase as a result of facilitating its
use as part of AHTVE. The total number of Twitter users in the pre-survey 22%
(n=31) compared to 18% (n=24) in the post-survey is not a significant difference (p<.
05).
The respondents utilising Twitter, categorised their usage on a continuum from
exclusively personal to exclusively professional use. Twitter use for professional
reasons (excluding those using it as exclusively or predominantly for personal use)
18 | P a g e
was reported to be 15 – 16 % of respondents. Comparison of pre- and post-
surveys did not indicate any significant differences although the numbers were very
small. The reasons for Twitter use pre- and post-survey are illustrated in Table 3.
Table 3: Reasons for Twitter use
Reasons for Twitter Use
Pre-Survey n (%) Post-Survey n (%) P
Personal
Exclusively personal
9 (7) 3 (3) 0.33
Predominantly personal
3 (2.3) 5 (4.9) 0.45
Professional
Equal personal and professional
7 (5.4) 3 (3) 0.50
Predominantly professional
7 (5.4) 8 (7.8) 0.57
Exclusively professional
5 (3.9) 5 (4.9) 0.74
Further analysis of those allied health professionals utilising Twitter illustrated the
engagement varied with only 3 – 4% of Twitter users tweeting weekly and 8 – 10%
tweeting monthly. The analysis of AHTVE Twitter use further supported low numbers
of tweet activity as demonstrated by the small number of allied health professionals
who tweeted in relation to AHTVE (see Table 5). These Twitter users generally
viewed and explored the resources rather than tweeting. These results are illustrated
in Figure 1. One respondent summarised their view:
You don’t have to tweet yourself, you can just follow.
The frequency with which allied health professionals posted on Twitter did not
increase as a result of facilitating its use as part of AHTVE (p<.05). No significant
19 | P a g e
difference was noted in the total number of Twitter users generating tweets in the
pre-survey 61% (n=19) compared to 71% (n=12) in the post-survey.
Figure 1: Frequency of Twitter use
Respondents utilising Twitter for professional purposes were able to identify multiple
reasons for using this modality although there were no significant differences
between the pre- and post-surveys. The most popular responses included the
following of professional organisations, keeping up to date with evidence based
practice, and knowledge exchange. Figure 2 displays these results. Respondents
also included a number of other motivations including:
To stay up to date with health news, events and happenings. To
connect with rural health advocates/organisations.
0
2
4
6
8
10
12
14
Never Less than oncea month
At least once amonth
At least once aweek
Num
ber
of
Responses
Frequency of Twitter Posts
Pre Survey Twitter Users Post SurveyTwitter Users
20 | P a g e
Figure 2: Reasons for Twitter use
Respondents were asked to rate the effectiveness of using Twitter on their
professional development. Respondents were able to choose from a Likert scale
rating Twitter ‘s usefulness in improving a number of areas including: knowledge,
clinical, critical problem solving, creativity, clinical/professional, or patient care.
These results are illustrated in Figure 3.
0
2
4
6
8
10
12
14
16
Num
ber
of
respondents
Reasons for using Twitter
Pre Survey Twitter Users Post SurveyTwitter Users
21 | P a g e
Figure 3: Impact of Twitter on Improvement in areas of Professional Development
The pre-survey identified a range of groups as major contact points including Speech
Pathology Australia, public health, rural networks and areas of clinical interest. The
most prevalent groups Twitter users connected with included general professional
organisations and colleagues (see Table 4).
Table 4: Groups Allied Health Professionals Connect with on Twitter
0
1
2
3
4
Mean L
ikert
Score
(1=
not
at
all,
4 =
exte
mely
help
ful)
Areas impacted by Twitter
Pre-survey Post-survey
Groups Number
Professional organisations and colleagues 11
Allied health, same profession 7
Clinical area 4
Universities or research 4
Public Health or Local Health Districts 2
Conference participation and speakers 2
22 | P a g e
3. Advantages and disadvantages of Twitter use
An open-ended question was used to explore the advantages of Twitter for
professional purposes. These responses were thematically grouped with ten
common topics reflecting the advantages of engaging with Twitter around
professional education. These themes related to Twitter facilitating contact with other
professionals (networking, diverse audience, seeking support); facilitating knowledge
(keeping up to date, information sharing) and the type of communication (fast and
efficient, easily accessible). These themes were common across both surveys with
the only notable difference being that more respondents commented on networking
in the pre-survey and on the advantages of ongoing dialogue in the post-survey. The
themes and the times they appear are shown in Figure 4. The most cited reason for
Twitter use on both the pre- and post-survey was for the opportunity to network with
other professionals.
Figure 4: Advantages of using Twitter
0
5
10
15
20
25
30
Nu
mb
er
of
resp
on
den
ts
Advantages of Using Twitter
Pre Survey
Post Survey
23 | P a g e
An open-ended question was used to explore the disadvantages of Twitter for
professional purposes. Inductive analysis allowed thematic grouping of responses
into 17 common topics reflecting the identified disadvantages of engaging with
Twitter around professional education and these are reflected in Figure 5. Of the
respondents to the pre- and post-survey, 40% (n=51) or 47% (n=48) respectively
identified no known disadvantages although continued unfamiliarity or reluctance to
engage with the modality was flagged as an ongoing challenge. The most cited
reasons in the pre-survey that were less of a concern in the post-survey included lack
of time and continued anxiety around quality of information. Issues around
confidentiality/privacy as well as that of access and support were concerns
expressed in both surveys.
Figure 5: Disadvantages of using Twitter
0
2
4
6
8
10
12
14
16
Nu
mb
er
of
resp
on
den
ts
Disadvantages of Twitter
Pre Survey Post Survey
24 | P a g e
4. Strategies for facilitating Twitter
Insights from respondents providing recommendations for facilitating Twitter were
consistent in both pre- and post-survey. These included a. Strategies of continuing
need for education, b. Clear guidelines for Twitter use, and c. Need for support by
employing organisations. These comments are further explained below.
a. Strategies of continuing need for education
A number of respondents are still seeking further information and support around
utilising Twitter. This includes explanation and reassurance of how this information
would only reach the appropriate audience. A number of respondents are still
reporting that Twitter is an unfamiliar modality and they are seeking more education
and support to maximise any benefits. Part of the education could include further
developing the role of local champions to help clinicians learn and promotion during
professional meetings.
One respondent identified that the education provided to date was useful and
maybe this needs to be further developed.
Keep doing what you’re doing. I’m going to sign up for a professional twitter
account following your email and easy to use guide.
The following comments represent common responses to the question seeking
information on future education strategies to facilitate Twitter use.
Education on how to explore great and appropriate threads as well as
suggestions of professional organisation to follow.
Conduct an AHTVE session on Use of Social Media to Support Health
Professionals.
25 | P a g e
Promotion at conferences – that is where one has time to be reflective
and is interested in the value of such tools.
b. Clear guidelines for Twitter use
Allied health professionals are still looking for general guidelines for using Twitter
within the professional workplace. They are looking for specific information regarding
assistance with the setup of filters and feeds as shown by the comment below:
Make the social media policies of the public health system clear to
alleviate fears of the potential negative professional consequences of
identifying as a public servant on social media.
c. Need for support by employing organisations
An obstacle for many health clinicians is the challenge of Twitter access in the
workplace due to information technology restrictions on this platform. Despite all
Local Health Districts having their own Twitter profile many health professionals are
restricted on accessing this modality on work devices such as computers or mobile
phones. These reflections are highlighted below:
If clinicians could access Twitter in the work time on work computers it
would certainly make it more attractive.
Hopefully this research may help convince executive that there are clear
professional benefits in using Twitter.
5. Twitter Analytics
A2K in its role as providing education and clinical support to Allied health professionals
working with children across NSW established a Twitter profile in June 2018. The
following information highlights the uptake and use of Twitter across 10 different AHTVE
26 | P a g e
sessions utilising Twitter Analytics as illustrated in Table 5. The information presented in
the following section includes the number of followers, impressions and engagement.
Since the creation of the A2K Twitter profile, the number of followers has steadily
increased to 69 in July 2019. These followers are people or organisations that have
chosen to follow A2K tweets and will see these tweets in their Home Timeline
whenever they log in to Twitter. The followers included a mix of individual allied
health professionals as well as organisations.
Impressions were also collected over the period of the study. Impressions are the
number of times users saw a specific tweet on Twitter, they are not necessarily
followers. The impressions varied from 558 in March 2019 to 15 838 in September
2018. The outlying data for March 2019 is likely to be from the period in March when
due to direction from SCHN management Twitter was not to be used in the period
leading up to the NSW State Election.
Engagement statistics are the total number of times a user has interacted with a tweet.
This includes all clicks anywhere on the tweet, retweets, replies, likes and uniform
resource locator (URL) clicks. A retweet is a re-posting of someone else’s tweet, Twitter
likes are illustrated by a small heart and are used to show appreciation for a tweet. URL
clicks reflect the times Twitter users utilise the URLs included in the links to gather
information from the nominated website content. The variability of the engagement may
be due to a number of factors including the clinical areas of interest or resource content
posted at this time. These analytics are useful for gauging these very specific Twitter
metrics but does not supply insight into how allied health professionals use this
information.
27 | P a g e
The original plan of thematically analysing the conversations was not completed, as overall
activity did not provide any active dialogue. Rather the activity included retweets, likes or
exploration of links and resources provided. Link or URL clicks and likes were the most
common interactions. This data reflects a slowly expanding audience that predominantly
engaged in Twitter more passively than originally anticipated.
28 | P a g e
Table 5: A2K Twitter Analytics
Number of followers
Impressions Engagements Retweets Likes
URL clicks
August
2018
19 9529 64 2 21 21
September 2018
25 15838 46 4 14 12
October 2018
34 1636 48 1 13 7
November 2018
43 5503 47 2 10 8
December 2018
45 3908 49 0 18 10
January 2019
54 3509 76 7 15 0
February 2019
57 871 22 1 4 8
March 2019
*Blackout period
59 558 16 0 2 3
April 2019
69 2837 32 2 6 9
44189 400 19 103 78
The main findings from the results indicate that allied health professionals working with
children in NSW Health facilities have demonstrated a slow uptake of Twitter. Pre- and
post-survey results highlight some reluctance around engaging with Twitter due to
unfamiliarity and concerns regarding confidentiality. There were no significant differences
between pre- and post-survey results. Despite this, the A2K Twitter account opened in
conjunction with AHTVE demonstrated an increasing number of followers. Twitter activity
measured related to likes and exploration of links without active conversations.
29 | P a g e
Discussion
Principle Findings
This study explored the benefits of Twitter in AHTVE by allied health professionals
in NSW for the purpose of professional development. Despite the reported uptake
of Twitter by general health professionals to facilitate professional networking,
knowledge sharing and evidence informed practice (Rolls et al., 2016) this was not
supported in this study. In both the pre- and post-survey the majority of allied
health professionals were still wary of using Twitter despite the opportunities
presented within A2K. This is consistent with a study of pharmacists’’ use of
Twitter for professional purposes.
The number of followers of the A2K handle steadily increased over the period of
the study although there was no significant reported increase in the use of Twitter
by respondents. Review of available literature did not identify a baseline for
tweeting activity among allied health professionals, reports however indicate that
22% of medical health professionals tweet regularly (Panahi et al., 2016). Despite
the engagement with the A2K handle, only 3 – 4% of respondents identified
tweeting weekly. The analysis of A2K Twitter activity demonstrated predominantly
likes and retweets as the major tweeting activity rather than any dialogue. There
were no reasons evident for this discrepancy except the population studied and
the integration with AHTVE.
This study reflected the Twitter behaviour of allied health population across
sixteen Local Health Districts of NSW. There were no significant differences found
in the age groups, professional backgrounds or qualification levels of allied health
professionals utilising Twitter. Among this sample the age groups most likely to
30 | P a g e
use Twitter were those in the 41 – 50 year age group, this however, did not reach
statistical significance. This is in contrast to a study of pharmacists illustrating that
participants between 20 and 39 years of age were more likely to be users of social
media for professional purposes (Barry & Pearson, 2015).
The integration of Twitter and AHTVE was designed to promote online social
interactions with the aim of enhancing learning and promoting change through
these interactions. No previous analysis of Twitter conversations was identified in
the context of allied health literature. General study results, however, indicate that
the percentage of passive users in social networks is increasing (Abel, Hauff,
Houben, & Tao, 2012). Passive users are not inactive accounts, but rather users
that only consume information on social networks without generating any content.
This passive behaviour may have also been increased by the large number of
allied health professionals identifying that they were first time users, thereby
creating a steep learning curve on their part. It is possible that these newcomers
observed Twitter conversations (liking and retweeting) rather than participating in
active conversations.
Hash tags for individual AHTVE topics were promoted to facilitate discussion.
Unfortunately there were no questions posed by the participants either during or
after the sessions. There was also no feedback or posting through tweets during
AHTVE sessions. This is similar to the findings in previous studies into Twitter use
at professional conferences whereby the majority of postings were prior to or after
the presentations (McKendrick et al., 2012).
31 | P a g e
Advantages and Disadvantages of Twitter Use
Allied health professionals identified a number of reasons for using Twitter for
professional education including the ability to follow professional organisations,
stay up to date with evidence based practice, knowledge exchange and
professional development. The advantages of using Twitter for professional
development were perceived by the participants as helpful in a number of domains
including, networking and information sharing. These findings are consistent with
other studies identifying the benefits of staying connected with other health
professionals, sharing knowledge and engaging in continued education
(Alsobayel, 2016; Hart et al., 2017; Panahi et al., 2016; Rolls et al., 2016). In this
study, the engagement of allied health professionals with searching profiles and
exploring links contained in tweets support that Twitter may be particularly useful
in sharing research updates and clinical resources.
Allied health professionals have concerns about the use of Twitter that need to be
addressed, including patient, personal and other health care professionals’
privacy. Such concerns are increasingly being recognised and discussed (Barry &
Pearson, 2015; Panahi et al., 2016). Guidance for the use of social media is
produced by each of the Local Health Districts although allied health professionals
are unaware of their existence or are still searching for more guidance. Allied
health professionals are still seeking recommendations on strategies for non-users
who are not confident in professional Twitter media use. This is consistent with
suggestions by a number of authors (D'Souza et al., 2017).
The technology acceptance model is a useful tool in examining human
behavioural responses to the adoption of new computer use (McGowan, Wasko,
Vartabedian, Miller, Freiherr, & Abdolrasulnia, 2012). This model, applied to the
32 | P a g e
integration of Twitter with AHTVE identifies the importance of usability, trialability,
relative advantage and workplace fit. This model suggests that for allied health
professionals to be able to integrate Twitter and AHTVE they will require a positive
attitude towards Twitter. They need to be able to practice its use, the modality has
to work better than current solutions, and the technology needs to be accessible in
the workplace and compatible with current practice. Allied health professionals
describe their concerns regarding the use of Twitter and the identified technical
challenges with accessing Twitter within work environs. Shortcomings in these
areas were identified within the survey findings and therefore, the poor uptake of
Twitter as an active learning strategy is not surprising.
Limitations
There are a number of limitations to the current study. The first is that the allied
health professionals who participated in this study are those that work with
children and their families within NSW and therefore reflect a small proportion of
allied health professionals overall. This is a significant limitation in both the
characteristics of this population and the generalisability of the results.
The second major limitation was the length of the data collection. Changing health
professional behaviour is a complex undertaking, that can potentially be time
intensive dependent on a number of variables (Dombrowski, 2016; Ramani, 2019).
Changing health professionals’ behaviour when adopting a new behaviour or
clinical guideline can take up to three years (National Institute for Health and
Clinical Excellence, 2007). Therefore, expecting allied health professionals that
have a low uptake of Twitter (less than 31 allied health professionals in the pre-
survey) to embrace this modality in a short period of time may be unrealistic. The
33 | P a g e
overall length of this research did not allow for change in behaviour when Twitter
was very new and daunting to many allied health professionals.
The magnitude of technical challenges created another major limitation. This
included the restriction within certain Local Health Districts to access Twitter on
work devices, which further impacted on its uptake.
Future research
Future research should include a broader clinical sample than those that work with
children. In addition to a wider population, research carried out over a longer time
frame may allow analysis of Twitter conversations and networking patterns.
Conclusion The goal of this research was to analyse the integration of Twitter with the existing
education modality AHTVE. Demonstration of the potential use of Twitter in
bringing together allied health professionals across a broad geographical area to
discuss and share resources, best practice and experiences around nominated
session topics was the aim.
The majority of allied health professionals in NSW participating in this study
remain unsure of the benefits of the integration of Twitter into AHTVE. In terms of
professional development benefits, Twitter was perceived as being most helpful
for improving knowledge and problem solving. These findings suggest that Twitter
has potential to engage health care professionals in their professional
development. Twitter has potential to be a useful tool at future AHTVE sessions,
but there are pitfalls that should be recognised including many technological
challenges.
34 | P a g e
Despite this, the results obtained provide new data concerning social media usage
for professional development amongst allied health professionals in NSW who
work with children. Twitter is a free and easy to use modality for sharing
information and resources across distances that required minimal administrative
support. Allied health professionals are still seeking recommendations on
principles for using Twitter and strategies for non-users who are not confident in
professional Twitter media use. Further research directions may include
investigating Twitter interaction and the subsequent impact on learning and
behaviour change.
Moving forward there is opportunity to continue to facilitate the use of Twitter and
AHTVE and measure changes over a significantly longer period. Three years may
be appropriate to accurately measure behaviour change and evaluate the
usefulness of Twitter in supporting allied health education.
35 | P a g e
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Appendix One: Twitter Pre-Survey
Twitter and Allied Health Telehealth Virtual Education Pre-Survey
Introduction: This survey forms part of a research study of Twitter. The aim of the research is to explore how Twitter can be integrated into Allied Health Telehealth Virtual Education (AHTVE) to facilitate communication, sharing of resources and support. Your participation in completing this survey is greatly appreciated. Completion of this survey is voluntary and will not impact on your ability to participate in AHTVE. The completion of this survey implies consent for this information to be used within the research. All responses will be de-identified and used for purposes for this research project only. This is to meet requirements of Master of Health Professional Education. It is anticipated that it will take 5 – 10 minutes to complete. If you have any questions, please do not hesitate to contact the Allied Health Educators at [email protected].
44 | P a g e
Participant Details 1. What is local health district do you work within?
Central Coast
Far West
Hunter New England
Illawarra-Shoalhaven
Mid North Coast
Murrumbidgee
Nepean Blue Mountains
Northern NSW
Northern Sydney
South Eastern Sydney
Southern NSW
South Western Sydney
Sydney
Sydney Children’s Hospital Network
Western NSW
Western Sydney
Other (please specify):
2. What is your profession?
Child Life Therapist
Dietitian
Occupational Therapist
Pharmacist
Physiotherapist
Psychologist
Social Worker
Speech Pathologist
Other (please specify):
3. What is your highest level of qualification?
Diploma
Bachelor Degree
Master Degree or higher
4. What is your age?
21 - 30
31 - 40
41 - 50
51 - 60
60 or above
Prefer not to say
5. What is your gender?
Female
Male
Other
Prefer not to say
45 | P a g e
Twitter Use 6. How would you describe your use of Twitter?
I do not use Twitter
Exclusively personal
Predominantly personal
Equal personal and professional
Predominantly professional
Exclusively professional
7. How often do you post on Twitter?
Never, I don’t post on Twitter
Less than once a month
At least once a month
At least once a week
At least once a day
Several times a day
8. What are your reasons for using Twitter for professional purposes? (select ALL that apply)
I do not use Twitter
To connect with health colleagues from the same profession
To connect with other allied health professionals
To stay up to date with evidence based practice
To follow professional organisations
To follow healthcare conferences
Health promotion
Knowledge exchange
Employment/research opportunities
Professional development
All of the above
Other (please specify):
9. Rate the impact of using Twitter on your professional development and practice. Not at all
helpful Somewhat helpful
Very helpful Extremely helpful
Improving knowledge about the profession
Improving clinical reasoning skills
Improving critical thinking skills
Improving problems solving skills
Improving creativity Improving clinical/professional decision making
46 | P a g e
Improving patient outcomes
10. If you use your Twitter account for professional purposes, list who you regularly connect with, for example professional organisation, colleagues. 11. Please identify any advantages of using Twitter for professional purposes. 12. Please identify any perceived disadvantages of using Twitter for professional purposes. 13. Do you have any suggestions for ways of encouraging allied health professionals to use Twitter for professional purposes?
Thank you for your time spent completing this survey
47 | P a g e
Appendix Two: Twitter Post-Survey
Twitter and Allied Health Telehealth Virtual Education Post -Survey
Introduction: This survey forms part of a research study of Twitter. The aim of the research is to explore how Twitter can be integrated into Allied Health Telehealth Virtual Education (AHTVE) to facilitate communication, sharing of resources and support. Completion of this survey is voluntary and will not impact on your ability to participate in AHTVE. The completion of this survey implies consent for this information to be used within the research. All responses will be de-identified and used for purposes for this research project only. This is to meet requirements of Master of Health Professional Education. It is anticipated that it will take 5 – 10 minutes to complete. If you have any questions, please do not hesitate to contact the Allied Health Educators at [email protected].
48 | P a g e
Participant Details 1. What is local health district do you work within?
Central Coast
Far West
Hunter New England
Illawarra-Shoalhaven
Mid North Coast
Murrumbidgee
Nepean Blue Mountains
Northern NSW
Northern Sydney
South Eastern Sydney
Southern NSW
South Western Sydney
Sydney
Sydney Children’s Hospital Network
Western NSW
Western Sydney
Other (please specify):
2. What is your profession?
Child Life Therapist
Dietitian
Occupational Therapist
Pharmacist
Physiotherapist
Psychologist
Social Worker
Speech Pathologist
Other (please specify):
3. What is your highest level of qualification?
Diploma
Bachelor Degree
Master Degree or higher
4. What is your age?
21 - 30
31 - 40
41 - 50
51 - 60
60 or above
Prefer not to say
5. What is your gender?
Female
Male
Other
49 | P a g e
Prefer not to say
Twitter Use 6.How would you describe your use of Twitter?
I do not use Twitter
Exclusively personal
Predominantly personal
Equal personal and professional
Predominantly professional
Exclusively professional
7. What are your reasons for using Twitter for professional purposes? (select ALL that apply)
I do not use Twitter for professional purposes
To connect with health colleagues from the same profession
To connect with other allied health professionals
To stay up to date with evidence based practice
To follow professional organisations
To follow healthcare conferences
Health promotion
Knowledge exchange
Employment/research opportunities
Professional development
All of the above
Other (please specify):
8. How often do you post on Twitter?
Never, I don’t post on Twitter
Less than once a month
At least once a month
At least once a week
At least once a day
Several times a day
9. How often do you view or post Twitter conversations related to AHTVE?
Never, I haven’t followed any AHTVE conversations on Twitter
Less than once a month
At least once a month
At least once a week
At least once a day
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10. Rate the impact of integrating Twitter and AHTVE on your professional development and practice.
Not at all
helpful Somewhat helpful
Very helpful Extremely helpful
Improving knowledge about the profession
Improving clinical reasoning skills
Improving critical thinking skills
Improving problems solving skills
Improving creativity Improving clinical/professional decision making
Improving patient outcomes
11. Please identify any advantages of integrating Twitter and AHTVE. 12. Please identify any perceived disadvantages of integrating Twitter and AHTVE. 13. Do you have any suggestions for ways of encouraging allied health professionals to use Twitter for professional purposes?
Thank you for your time spent completing this survey.
Appendix Three: AHTVE Sessions from July 2018 to April 2019
Likes Retweets Detailed
expands
Replies Profile clicks Link clicks Media
engagemen
ts
Hashtag
clicks
Telepractice: Delivering quality allied
health services to children in rural and
remote Australia
(33 site registrations)
12 1 13 2 1 5 3 3
Eating Disorders, Everyone has a Role -
Q&A Session
(15 site registrations)
4 2 0 0 0 11 0 0
Rehabilitation in paediatric palliative care
(17 site registrations)
5 2 2 1 1 1 1 0
Genetic Metabolic Diets
(16 site registrations)
5 0 0 0 0 2 1 0
Paediatric Oral Nutrition Initiative (PONi)
(19 site registrations)
4 0 0 0 0 0 0 1
Executive Functions Disorders
(33 registrations)
2 0 3 0 2 5 4 3
Neonatal Abstinence Syndrome
(29 registrations)
3 0 1 0 3 4 0 3
Supporting Children with Complex
Feeding Difficulties (SuCCEED) Study
(30 registrations)
5 3 4 0 5 3 0 3
NDIS Early Childhood Early Education
(ECEI) NSW Update
(47 registrations)
0 1 1 0 0 0 3 2
New Beginnings: Transition to the NDIS
for children and young people with a
newly acquired disability
(16 registrations)
0 0 0 0 0 3 0 4
TOTALS 69 9 24 3 12 34 0 19