Social media tools studied
See Table 2 for a summary of the social media tools studied. Discussion forums were the most commonly studied tools (43/96; 44.8%). In 31 (32.3%) studies, the social media tool was included as a component of a complex intervention. Often, investigators created their own tool to evaluate. In those studies, however, that made use of a preexisting tool and in those examining usage patterns and preferences, the most common tools were Facebook (8/96; 8.3%), YouTube (8/96; 8.3%), Twitter (7/96; 7.3%), Wikipedia (4/96; 4.2%), and Second Life (4/96; 4.2%).
Social media user group setting
We divided social media users’ settings into three categories: education, practice, and general purpose (see Table 3). The largest group, education, included 66 (68.8%) studies. The most studies (22/96; 22.9%) fell into the discipline of medical education, followed by nursing education (17/96; 17.7%). Social media tools were studied to a limited extent in continuing education and in professional development; however, nearly all these interventions were aimed at students or residents. In all disciplines, a range of social media tools was studied. In allied health, interdisciplinary education, medicine, and nursing, discussion forums were studied most often; however, in dentistry/dental hygiene and public health, blogs or microblogs were, and, in pharmacy, collaborative projects were.
Social media use in professional practice was examined in 18 (18.8%) studies (see Table 3). The most studies again fell into the discipline of medicine (7/96; 7.3%). As with education, a range of tools was studied, with the exception of virtual worlds. Blogs or microblogs were studied most frequently, often in the context of general posts targeted for other professionals.
The general purpose category included studies in which health care professionals were asked about their perceptions and attitudes towards social media tools and studies that analyzed health-related content posted online either descriptively or for accuracy. Ten studies (10.4%) fell into this category (see Table 3). Of these 10 studies, 4 were cross-sectional examinations of how social media is being used, and 6 were content analyses of user-generated general health or medical posts online.
We included medical specialties that appeared in more than one study in Table 3. Together, administration, critical appraisal, and research were studied most frequently (11/96; 11.5%), followed by public health (9/96; 9.4%). In 33 (34.4%) studies, the investigation ranged across multiple specialties. The tool studied did not seem to vary by specialty.
Purpose of social media use
We divided the objectives of the social media tools into three categories: knowledge, skills, and communication (see Table 2). In 59 (61.5%) studies, the purpose of the tool was to facilitate communication. This ranged from peer-to-peer or instructor-to-student communication within classes, to communication between clinicians and their patients, to clinicians communicating with the public via tools such as blogs. Nearly all studies of blogs or microblogs (25/27; 92.6%) and social networking sites (15/16; 93.8%) included communication as a main focus. Studies of social media tools as part of a complex intervention were least likely to evaluate communication (14/31; 45.2%). In 41 (42.7%) studies, researchers evaluated increases in knowledge, and in 19 (20.8%) studies, improvement in skills. Collaborative projects (11/20; 55.0%) and discussion forums (22/43; 51.2%) were often used to increase knowledge, and virtual worlds to improve or learn clinical skills (4/9; 44.4%).
We classified the outcomes measured in each of the included studies in one of three categories: clinicians’ knowledge, clinicians’ experience, and professional behavior (see Table 4). Most studies measured outcomes related to clinicians’ experience, which included satisfaction levels and the degree or type of communication. Few studies measured outcomes related to professional behavior; when researchers did measure such outcomes, most were related to skills. We also included professional boundaries in this category, which encompassed topics such as how personal and professional lines could be blurred with easily accessible information online and the use of social media by professionals to access information on their patients. When we excluded discussion forums from this analysis, we found less of an emphasis on measures that were prominent in educational settings—namely, peer-to-peer and instructor–student communication. All of the studies that examined boundaries and privacy used tools other than discussion forums.
For most studies, the most commonly measured outcome was related to peer-to-peer communication (see Table 4). For those that evaluated collaborative projects, however, satisfaction was most commonly studied.
Evaluation of social media use
Quantitative studies represented 56.3% (54/96) of the sample, 41 (42.7%) of which were cross-sectional studies, whereas qualitative studies represented 21.9% (21/96) (see Table 1).
Thirteen quantitative studies evaluated the effectiveness of a social media tool—5 randomized controlled trials, 1 nonrandomized controlled trial, 1 controlled before–after study, and 6 before–after studies. Of the 5 randomized trials, 4 were in medical or dental education, and all evaluated discussion boards and targeted knowledge. Three of these 5 studies found statistically significant improvements in knowledge and exam performance, 1 found a positive trend, and the other described the intervention as “promising.” Similarly, 6 of the 8 comparative studies using other designs were conducted in educational settings (medicine, pharmacy, and dental hygiene). They demonstrated greater diversity than the randomized trials in the tools studied, evaluating blogs, wikis, and virtual worlds. These studies aimed to improve both knowledge and skills. In 12 of the 13 studies that evaluated the effectiveness of a social media tool, the authors concluded that the intervention had positive value. However, only 6 reported statistically significant findings for their primary outcome.
Most of the qualitative studies were conducted in nursing education settings (9/21; 42.9%) and evaluated discussion forums (13/21; 61.9%). Researchers in 76.2% (16/21) of the qualitative studies evaluated social media tools that facilitated communication. Mixed-methods studies made up 11.5% (11/96) of the sample and were used across disciplines. Nine of these 11 studies (81.8%) included a survey as one component of the mixed-methods design.
The use of social media in health care education and practice is growing, and a significant body of literature examines its uses. Most of these studies, however, have been descriptive, either analyzing the content that exists online or investigating users’ preferences. Given the rapid evolution of social media technology, early studies likely will be exploratory; however, the use of social media platforms and tools has become sufficiently widespread that studies of effectiveness are beneficial and could inform the development and adoption of tools in the realm of education.
Because of the changing nature and continual progression of social media, establishing an operational definition to determine eligibility in our study proved challenging. Social media is defined inconsistently in the literature28,29; therefore, we selected Kaplan and Haenlein’s5 classification scheme because they used discrete groups to categorize social media platforms, providing a framework but also allowing flexibility in the tools that we could include. However, we still encountered gray areas, most significantly in deciding whether or not to include discussion forums in our review. Although they did not fall into one of Kaplan and Haenlein’s5 prespecified categories, we agreed that, because discussion forums and online bulletin boards included user-generated online content, we should consider them to be early versions of social media and thus include them in our study.
Despite the popularity of specific tools like Facebook and YouTube, most of the studies we found evaluated tools that were developed specifically for the study team’s purposes, most commonly blogs and wikis. We were not surprised by this finding given that the populations evaluated in many of the studies included trainees, and these particular platforms lend themselves to educational settings because of the high level of detail they can incorporate. Of those studies for which the researchers evaluated existing tools, about one-third asked participants about their current online presence. Studies specific to Facebook tended to be related to issues of professional boundaries and privacy. Those studying YouTube and Second Life were skills based, evaluating whether participants could demonstrate techniques or allowing them to practice a learned skill.
Issues related to professionalism, privacy, and confidentiality were addressed only in a small number of included studies; however, these issues remain a major concern and potential barrier in the adoption of social media in health care. In conjunction with future research on the benefits of social media use, researchers also should explore the potential dangers.
Although education was the predominant setting in the included studies, social media use was evaluated in a variety of disciplines, indicating widespread interest in its potential. With the aim of facilitating instruction and an overarching focus on health care, findings from different professional groups likely are applicable across disciplines and can be used to inform future applications and research in the area. Similarly, social media use was spread across a diverse range of specialties, with multidisciplinary coverage in approximately one-third of studies. This finding suggests that although the content may be tailored to a particular group, the tools and platforms are relevant to many different user groups.
Not surprisingly, facilitating communication was the most common purpose for using social media. Social media tools were created to enable interaction and have expanded from primarily acting as channels of personal contact to providing opportunities for professional conduct. We found that researchers explored unique applications specific to their professional context, particularly with regard to those tools that have been used to target improvements in knowledge and skills. With their intrinsic focus on personalization and interactivity, social media platforms are ideal to become highly versatile tools that can be used to enable knowledge translation, a key goal in health care education today.
The findings from this review provide a map of the current literature on the use of social media in health care and, as such, can be used to identify gaps in that literature and to provide direction for future research. We identified three key areas that could drive the future research agenda: (1) choice of social media tool, (2) effectiveness studies, and (3) outcomes-based research.
First, the largest proportion of studies included in our review evaluated the use of discussion forums; however, exploring the unique applications in the education setting of newer tools, such as collaborative projects, content communities, and virtual worlds, has great potential. Studies of the impact of wikis on collaborative, in-class learning and the hands-on, practical training opportunities provided by tools such as YouTube and virtual worlds could advance instructional methods, if shown to be effective. Second, conducting effectiveness studies will be critical to understanding whether social media tools truly benefit education and practice in health care or whether their use is driven primarily by the novelty of the medium. As most included studies were descriptive, an opportunity exists to advance the methodological rigor of this body of literature through controlled, comparative study designs. Although we identified 13 effectiveness studies, the intervention in each included the social media tool as one component of a complex intervention; therefore, studies that evaluate the effectiveness of social media tools independently would be informative. Additionally, of the included studies that measured the effectiveness of these tools, nearly all reported that the use of social media was beneficial, but only half provided statistically significant findings to substantiate this claim, lending uncertainty to the strength of these results. Finally, the primary focus of most of the included studies was outcomes related to clinicians’ and trainees’ experience—namely, measures of communication between peers and participants’ satisfaction with the use of the social media tool. However, evidence of these tools’ broader utility and application to professional behavior change would propel the evidence base beyond these short-term outcomes to the more relevant impact of social media use on the education and training of clinicians, potentially improving the health care they provided and, ultimately, patient outcomes.
Social media is a relatively new concept and is continually undergoing transformations. As such, no universal definition exists, adding complexity to the process of determining study eligibility in our review. The constantly changing nature of social media also proved challenging in defining our literature search, and the novelty of the topic made it difficult to keep the search up to date with the steady influx of new reports. However, as we conducted a scoping review, the broad categorization of the uses of social media was our focus and likely would not change with the addition of studies published since we conducted our literature search. Finally, one-third of the included studies examined social media as one component of a complex intervention, making it difficult to determine the specific impact of the tool. This concern applied mostly to studies that included discussion forums; other tools tended to be evaluated on their own.
This scoping review provides a map of the literature on the uses of social media by health care professionals and trainees. The existing body of evidence is extensive, focusing primarily on the use of social media in education and providing descriptive findings related to how such tools are being used. Considering the popularity and prevalence of these tools, research must keep pace, delving further into whether or not social media is effective for professional and educational purposes through qualitative and quantitative research, and must focus on innovation to capitalize on the potential held by this technology.
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