Statistical analysis

Responses were analyzed to compare how different healthcare professionals are using social media and to identify the potential for educational use. Bivariate analyses were performed to examine unadjusted variation between professional affiliation and each of the various covariates (e.g. age, access) in the survey. We conducted multivariable logistic regression to evaluate the likelihood of professionals to agree or disagree with each of the survey questions: (1) social media is an effective educational tool and (2) social media should be accessed at the workplace for educational purposes only in separate models. We chose the Likert-style question stating social media is an effective tool for educational purposes to fulfill the analysis of what factors contribute to those who use social media for educational purposes. The confounders controlled for in this analysis were age, social media access at work, and profession type. These were Likert-style questions transformed to agree (yes), for all responses that were strongly agree and agree, or disagree (no), for all the responses that were strongly disagree and disagree. The answers for neither disagree or agree were not used.

To account for potential selection bias due to unbalanced nurse professional response, we conducted a propensity-weighted logistic regression using age and geographical location to define the weighting class which stabilized the unbalanced nurse professional’s response. Higher propensity weights were assigned to subjects with low responses and vice versa. It is assumed that one weighting adjustment is enough to address non-response bias in all estimates [25, 26]. A p-value of < 0.05 was deemed statistically significant. All analyses were conducted in SAS version 9.4.

Educational uses of social media

Sharing/exchanging ideas with other professionals, chat discussions, following conference highlights, and healthcare agency alerts were some of the ways respondents in this present study expressed their use of social media for educational purposes. This is similar to the findings of authors from the University of Scranton who highlighted 5 ways social media is used by healthcare professionals: sharing information, comparing and improving quality, training medical personnel, live updates during procedures, and communication through times of crisis [27]. Ventola and colleagues also described social media in healthcare use to include professional networking, professional education, organizational promotion, patient care, patient education, and public health programs [8]. There are many resources in the literature on this topic [28, 29]. Not surprisingly, those under 40 years of age strongly agreed that social media was an effective tool for educational purposes. Although, it is unclear why pharmacists, attending physicians and nurses in our present study disagreed that social media was an effective educational tool. Interestingly, Twitter® (61.9%) and Pinterest® (59.5%) had more low frequency users but were in the top group for social media accounts used for educational purposes. The effectiveness of social media has not been fully evaluated in the literature and may not correlate directly with social media use depending on certain platforms.

An increase in journal awareness is another way to utilize social media. O’Kelly and colleagues found that the presence of a Twitter® feed contributed to an increased impact factor (P = 0.017) in urological and pediatric journals from 2012–2016 [30]. Additionally, a new non-traditional metric of professional impact called Altmetric (https://www.altmetric.com) analyzes the penetration of a published article through social media and non-publisher or journal affiliated outlets. It provides an alternative way to view and measure the article’s activity outside of the journal’s impact factor [31–34]. Professional conferences increasingly utilize social media and designated hashtags to link and disseminate conference and other pertinent healthcare information. These topical hashtags have prompted numerous interactions on social media [35]. Our survey results were similar to several previous studies, demonstrating the multifunctional use of social media in healthcare for education. Although, in our study, research collaboration was not a common reason for social media use, interactions and relationships built over time may allow for future collaboration through more traditional means (e.g. meeting at conferences, email contact).

Social media access at work

In general, our data show access to social media at work affected ideas regarding using social media for educational purposes. Those with unlimited access to social media were less likely to agree with the benefit of social media for education (OR = 0.30, P < 0.0001). We hypothesize this is due to the wording of the survey item. Since the item stated using social media for educational purposes only in the workplace, then those with unlimited access could have viewed this as a restriction to their current access. In contrast, those with limited access could have agreed with the statement because of more desired access at work. In today’s age of smart phones and data plans, it is safe to say this also could have affected these results.

Nursing response impact

This study was impacted by a large percentage of nurse respondents (75%). Prior studies have shown an interest in electronic resources for educational purposes by nursing beginning as early as 1990 [36]. With the advancement of technology, nursing use of social media for healthcare education has become present with protocols, activities, and resources [37–39]. Rutledge et al designed a tool on social media for Doctor of Nursing Practice program students in rural health care [40]. Another survey-based study among first year nursing students demonstrated that 81% of students felt Twitter® was beneficial in increasing awareness of nursing issues [41]. With nurses being the largest group healthcare members who responded to this survey, this could also explain why Pinterest® was in the top group of social media platforms used for healthcare education since nursing responded to using Pinterest® the most (60%) out of the practitioners. One study analyzing the accuracy of information on Pinterest® for psychogenic non-epileptic seizures (PNES) found 87.7% of the 57 pins analyzed reporting at least one factor indicative of PNES [42] Pinterest® has also aided nursing faculty in preparation and educational activities [43]. Targeting social media platforms like Twitter® and Pinterest® in future studies may be beneficial to analyze potential correlation between frequency of social media use and use for educational purposes. Our results having a high response-rate by nurses could be attributed to the amount of nursing education and connectivity with social media in this field. Results were adjusted by a propensity score in order to reduce bias in the data.

Healthcare administrator perspective

Healthcare administrators (n = 98, 5.96%) in this study were more than 4 times as likely to agree that social media could be an effective educational tool (Table 5). They were also 59% more likely to agree with allowing social media use for educational purposes in the workplace (Table 2). This was interesting since a higher percentage of respondents answered that they had limited or no access at work. The Sentinel Watch, a blog by American Sentinel University that offers degrees in nursing and healthcare management, encourages hospital administrators to have a presence on social media [44]. In addition, some healthcare organizations, including the American College of Clinical Pharmacy and American Association of Colleges of Pharmacy, have published reports or conducted webinars to provide advice on the importance of and how to build a digital brand through social media [45–47]. Social media is a platform that could be utilized to market services of the healthcare system or to provide access for complaints or appraisals in a quick manner [48]. There are many further options to utilize social media as a resource to reach patients and deliver patient care, and while not educational per se, it does encourage social media activity among healthcare administrators [49–51]. Because of this open interaction, it is imperative to note the potential dangers of social media which include poor quality of information, damage to professional image, breaches of patient privacy (e.g. HIPAA), violation of the patient-healthcare practitioner boundary, licensing issues, and legal issues. The necessity of professional guidelines for the use of social media by institutions needs to be stressed [8]. Interestingly, a large percentage of respondents (40%) did not know their workplace social media policy (Table 1). However, this mirrors previously published data where a similar percentage of healthcare workers were unaware of their workplace policy [52]. These are also important to recognize if trying to implement social media for educational purposes into clinical practice, as there may be significant institutional or operational barriers. Only 31% of healthcare organizations have specific social media guidelines for writing or posting social media content. However, 26% of U.S. hospitals are already utilizing social media in some form for education [53]. On the other hand, 70% of respondents in this study, stated that access to social media at work would be or currently is a distraction. As mentioned above, distraction is another consideration that is noted as a risk in previous literature explaining how to use social media in the workplace [8].

Strengths and limitations

The strengths of this study include the different sites represented which allowed for both a large sample size and responses from different regions in the US and professions. All the survey questions collected views on multiple social media platforms for educational use. The limitations of this study include the issues regarding none of the survey questions were required to answer in order to submit the survey. This limited some responses such as the primary profession indication and social media account use. The primary responses of “administrative roles” and “other” could have been confusing for the respondent and should have been defined. This confusion could have included unintended and/or excluded eligible participants. Throughout the distribution of the survey, not all sites received the survey on the exact same day, leading to the survey being available from January 22 through May 1, 2018. Additionally, an exact record of how many individuals received the survey emails was not able to be recorded. Email listservs were utilized which made it difficult to track the total number of potential participants. Responder bias also played a factor in this study. Those who are more engaged in social media may have been more likely to complete the study. This was accounted for by the propensity score weighted multivariable analyses. As mentioned previously, the large percentage of nurse respondents may have biased the results towards nursing profession, however, this was accounted for with propensity scoring. Based on these results and others, one future area of study will be to further evaluate the effectiveness of social media as an educational tool among healthcare practitioners.