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AcademyHealth Webinar Underscores Effectiveness of Tweets as Evidence Dissemination Tool

In an era when demand for health care-related academic research insights is higher than ever, most academics have yet to embrace the Twitter communication channels that have become crucial information sources for health policy and media professionals. That's according to a panel of health services researchers speaking at the AcademyHealth "Using Twitter to Translate and Disseminate Evidence" webinar.
The event was moderated by Kristin Rosengren @RosenKris, co-director of the AcademyHealth Translation and Dissemination Institute; panelists were Zachary Meisel @zacharymeisel, an MD, emergency physician at the Hospital of the University of Pennsylvania and Senior Fellow at the Leonard Davis Institute of Health Economics (LDI); William Gardner @Bill_Gardner, PhD,
edm headerKristin Rosengren
Kristin Rosengren, co-directs an AcademyHealth research translation and dissemination institute.
Zachary Meisel
Zachary Meisel is co-author of a recent study of researchers' social media habits -- or lack of them.
William Gardner
William Gardner is a professor and aggressive social media user.
Whitney Bowman-Zatzkin
Whitney Bowman-Zatzkin emphasizes the tools that make Twitter easier to use.
Professor of Medicine at The Children's Hospital of Eastern Ontario in Ottawa and a regular contributor to the Incidental Economist blog; and Whitney Bowman-Zatzkin @MsWZ, MPA, MSR, Project Director at the Robert Wood Johnson Foundation-funded Flip the Clinic experiment in managing the patient-clinician relationship.

Reaching policymakers
All four participants emphasized the potential of Twitter for tracking the latest events and developments in any given area of research, and as a potentially potent tool for getting research results in front of policymakers and media players.

This latter issue of dissemination is an increasingly important one in this era of health reform because both government and corporate managers in health care-related organizations report they are routinely unable to access or otherwise benefit from the latest scientific findings in their area. Meanwhile, AcademyHealth estimates that only 1 in 1,000 health services research studies ever receive mention in mainstream media.

The webinar was organized by the Electronic Data Methods (EDM) Forum, an organization established by AcademyHealth and the Agency for Healthcare Research and Quality (AHRQ) in 2010 to foster broader use of digital communications systems by health care researchers.

Avoiding social media
Meisel opened the discussion with a synopsis of the low number of academics who are involved with Twitter. In the 2013 AcademyHealth annual meeting, he and Penn colleague David Grande, MD, interviewed attendees to determine how academic researchers were or were not using Twitter and other social media to communicate their findings to the broader world. That study, published in Health Affairs in 2014, found that only 14% of health services researchers they interviewed had Twitter accounts and that most of the others felt Twitter was incompatible with their research discipline and/or potentially risky to their professional reputations and career advancement.

"Academics were worried," Meisel told the webinar audience, "that if they spent time on social media it would be viewed by their peers as not rigorous or a distraction or maybe even fluffy or unscientific."

"When we started this project," Meisel said, "there were a few of us who were actively engaged in exploring new ways to communicate evidence to the outside world. We had all come to understand that much of the policy debates that were a significant force in defining health care were occurring outside the narrow world of academic journals."

Information locked away
Panelist Gardner agreed: "We're all aware that unless we've done something really path-breaking, most of the articles that appear in journals are read a few times by our peers and actually accessed by almost no one else. And so information which may have important implications for some specific real world problem is locked away in journals. Why?"

"It's the exact information that policymakers frequently need but don't know how to get," Gardner continued, "because searching scientific literature is a highly refined skill that requires a high
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level of understanding about the question itself in order to get meaningful results. Few individuals outside the scientific world have the ability to do this and even when they find a particularly study, they're not in a position to appreciate its strengths and weaknesses or how it fits into a larger framework of study."

"The people best equipped to do this," Gardner continued, "are us because we ARE able to translate the findings for others and one of the effective new ways to communicate that information is Twitter. It's really a good place to get involved with the sort of discussions and conversations that will facilitate the best translation. It also really fits because journalism itself is rapidly becoming a social media technology -- and several major U.S. social and health care-related scientists have taken full advantage of that to make themselves engaged policy intellectuals with large national audiences of journalists and policymakers."

As examples, Gardner pointed to Princeton Professor of Economics and New York Times Op-Ed columnist Paul Krugman (@nytimeskrugman), who has 1.32 million Twitter followers; and Brigham and Women's Hospital surgeon and health services researcher Atul Gawande (@atul_gawande) who has 119,000 followers.

Breaking down barriers
"Gawande is engaged in a lot of conversations," said Gardner whose own @bill_gardner Twitter account has 1,514 followers. "I interact with him, but you can interact with him too. He takes questions seriously, and he's got a really great Twitter style. And conversations like these break down some of the barriers to accessing scientific information. For instance if you are a journalist or a policymaker, you're using this channel to ask questions in a motivated state -- you're actively looking for scientifically-based answers."

"I tweet four or five tweets on any given day," said Gardner, "and a few hundred people see them, which is probably more than will be reading most of the eight or nine articles I published last year. Occasionally I send out a tweet that really hits some sort of button and within a couple of hours, 20,000 people have seen it. That gives you a sense of the power that you have to communicate information albeit in a quite compact form."

Panelist Bowman-Zatzkin emphasized that available tools make it easier than may initially be apparent to use Twitter for research dissemination. "Targeting your tweets at various Twitter communities of professionals, for instance," she said. "One way to do this is with hashtags."

Hashtag power
When included in a tweet (like this: #subjectname) hash tags place a copy of your tweet on a centralized public list accessible to anyone and followed by people who often monitor a given subject daily. There are tens of thousands of established hashtags and anyone can create and promote new ones.

To find specific hashtags for various research fields, go to the online Healthcare Hashtags database maintained by Symplur, a health care data company. Access is free and the Symplur utility also provides the latest daily traffic reports for each hashtag, indicating which are the most heavily trafficked.

"Hashtags facilitate creating a loose community around a research subject," said Bowman-Zatzkin. "These are totally about connections between people of shared interests."

But for all its benefits, Twitter's unrestrained mode of communication can be a bit off-putting for the newcomer, the three panelists acknowledged.

"Twitter, like blogs," said Meisel, "enables both experts and non-experts to push out opinions which can make it slightly messy when you have both experts and non-expert voices competing with each other. One of the challenges related to these social media streams is how best to curate them so that the most solid voices rise to the top."

He also pointed out that newcomers can elect to be "lurkers" who monitor the tweet traffic but don't directly inject themselves into the conversational fray.

'Like a news service'
"A lot of my Penn colleagues who use Twitter do so from the 'sidelines,'" Meisel explained. "They have Twitter accounts and follow people or hashtags that are directly relevant to their research interests. And you can do that relatively quickly and without any risk. In this way, Twitter performs like a daily news service bringing you the latest information from your field that you might not otherwise have encountered. Likewise, it remotely introduces you to researchers and others in your field whose work you may not have previously known about."

And all three panelists cite examples of Twitter's effectiveness as a dissemination tool.

"Part of what I am trying to do on Twitter," said Gardner, "is get information about our science to policymakers. There may be Congressional staff who are in my Twitter feed and there are certainly a lot of Washington, D.C. policy-kind of think-tank people, and there are a lot of journalists. At the Incidental Economist blog, we often see the breaking research news we post picked up by health care journalists who write about these things. Similarly if you are engaged in the right way, Twitter gets you one or two degrees of connection away from these same key media people."

"Twitter is also useful for the same reasons that attending professional meetings can be useful -- not the formal sessions, but those evenings in the bar when you get to discuss new insights and issues with people you would never see in your daily work," Gardner said. "On Twitter, I've discovered all sorts of diverse scientific colleagues and non-academics involved in the communications business. Some of these have led me to new collaborations. Others have generated publicity for my own publications. But the main thing is, I get a feeling of promoting knowledge in my field, which is what we should all be doing as effectively as we can, right?"

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Hoag Levins is a journalist and editor of digital publications at the Leonard Davis Institute of Health Economics.

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