importance of social media research paper

• Open access
• Published: 06 March 2024

The evolving role of social media in enhancing quality of life: a global perspective across 10 countries

• Roy Rillera Marzo 1 , 2 ,
• Hana W. Jun Chen 3 ,
• Absar Ahmad 4 ,
• Hui Zhu Thew 5 ,
• Ja Shen Choy 6 ,
• Chee Han Ng 6 ,
• Chen Loong Alyx Chew 6 ,
• Petra Heidler 7 , 8 ,
• Isabel King 9 ,
• Rajeev Shrestha 10 ,
• Farzana Rahman 11 ,
• Jehan Akhter Rana 12 ,
• Tornike Khoshtaria 13 ,
• Arian Matin 14 ,
• Nugzar Todua 15 ,
• Burcu Küçük Biçer 16 ,
• Erwin Faller 17 , 18 ,
• Randy A. Tudy 19 ,
• Aries Baldonado 20 ,
• Criselle Angeline Penamante 21 , 22 ,
• Rafidah Bahari 23 ,
• Delan Ameen Younus 24 ,
• Zjwan Mohammed Ismail 25 ,
• Masoud Lotfizadeh 26 ,
• Shehu Muhammad Hassan 27 ,
• Rahamatu Shamsiyyah Iliya 28 ,
• Asari E. Inyang 29 ,
• Theingi Maung Maung 30 ,
• Win Myint Oo 31 ,
• Ohnmar Myint 32 ,
• Anil Khadka 33 ,
• Swosti Acharya 34 ,
• Soe Soe Aye 35 ,
• Thein Win Naing 36 ,
• Myat Thida Win 37 ,
• Ye Wint Kyaw 38 ,
• Pramila Pudasaini Thapa 39 ,
• Josana Khanal 40 ,
• Sudip Bhattacharya 41 ,
• Khadijah Abid 42 ,
• Mochammad Fahlevi 43 ,
• Mohammed Aljuaid 44 ,
• Radwa Abdullah El-Abasir 45 &
• Mohamed E. G. Elsayed 46 , 47  

Archives of Public Health volume  82 , Article number:  28 ( 2024 ) Cite this article

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Excessive or inappropriate use of social media has been linked to disruptions in regular work, well-being, mental health, and overall reduction of quality of life. However, a limited number of studies documenting the impact of social media on health-related quality of life (HRQoL) are available globally.

This study aimed to explore the perceived social media needs and their impact on the quality of life among the adult population of various selected countries.

Methodology

A cross-sectional, quantitative design and analytical study utilized an online survey disseminated from November to December 2021.

A total of 6689 respondents from ten countries participated in the study. The largest number of respondents was from Malaysia (23.9%), followed by Bangladesh (15.5%), Georgia (14.8%), and Turkey (12.2%). The prevalence of social media users was over 90% in Austria, Georgia, Myanmar, Nigeria, and the Philippines. The majority of social media users were from the 18–24 age group. Multiple regression analysis showed that higher education level was positively correlated with all four domains of WHOQoL. In addition, the psychological health domain of quality of life was positively associated in all countries. Predictors among Social Media Needs, Affective Needs (β = -0.07), and Social Integrative Needs (β = 0.09) were significantly associated with psychological health.

The study illuminates the positive correlation between higher education levels and improved life quality among social media users, highlighting an opportunity for policymakers to craft education-focused initiatives that enhance well-being. The findings call for strategic interventions to safeguard the mental health of the global social media populace, particularly those at educational and health disadvantages.

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Introduction

The development of internet technology has revolutionized the way people live. As a result, social media has become an integral part of daily life. It is hard to find a person who has internet access but does not use social media. Carr and Hayes [ 1 ] defined social media as “Internet-based channels that allow users to interact and selectively self-present opportunistically, either in real-time or asynchronously, with both broad and narrow audiences who derive value from user-generated content and the perception of interaction with others”. Examples of widely used social media platforms include Facebook, LinkedIn, Instagram, WhatsApp, and other apps that enable online social interaction. Over time, the use of social media has increased significantly, primarily for obtaining information, conducting research, creating a social image, interacting with the wider community, and expressing emotions with each other [ 2 ].

Furthermore, communities rely heavily on social media as it can change their perception and behaviour according to the information they receive via social media; also, they spend much time using it [ 3 ]. On average, users spend worldwide 2.24 hrs per day on social media, 30 min more than in 2015 [ 4 ]. In January 2021, 4.2 billion people were using social media globally, which is expected to reach six billion by 2027 [ 4 ].

A new paradigm of social interaction has evolved with the arrival of social media. It brought both positive and negative effects on human life. In one aspect, it provided an opportunity to connect with distant and diverse community/family relatives and information sources, allowing close and frequent interaction and an opportunity in helping to solve each other’s emotional and other daily life challenges [ 5 , 6 ]. Some studies report an increment in quality of life, and some reported no significant improvement [ 7 , 8 , 9 ].

The global assimilation of social media into everyday life has ushered in a complex array of impacts on health-related quality of life (HRQoL), exhibiting profound diversity across various cultures and demographics. This variation necessitates a collaborative international policy approach that both recognizes and respects these differences, enabling targeted strategies to mitigate the risks and amplify the benefits of social media on a global scale. It is essential to foster research that highlights cultural nuances to optimize social media’s role in enhancing QoL universally. A study conducted among adolescents in the Netherlands reported decreased HRQoL with the longer use of social media [ 10 ]. Particularly, the excessive or inappropriate use of social media is reported to cause more anxiety-like mental health-related problems (stress, anxiety and depression) than minimizing it [ 11 , 12 ]. The literature has determined that it has affected people’s regular work routine, well-being, happiness and mental health [ 13 , 14 ]. Furthermore, Oberst et al., 2017, stated that there is a higher potential for using social media among people already suffering from depression and anxiety-like mental illnesses [ 15 ]. Additionally, increased mental health-related problems have been linked to higher social media use during the COVID-19 pandemic [ 16 ]. The concept of digital well-being was widely discussed during the pandemic, as social media was a major source of information [ 17 ].

A recent meta-analysis found insufficient evidence confirming the relationship between well-being and problematic use of social media [ 12 , 18 ]. During the COVID-19 pandemic, digital health literacy was crucial and linked to improved vaccine confidence and uptake [ 19 , 20 , 21 , 22 ]. However, beyond digital health literacy, social media usage has certainly impacted the QoL [ 20 ]. Rodriguez et al. [ 23 ] concluded that the impact of social media differs based on the social media user’s demographic, personality and cultural variances. In addressing this analytical gap, the current research aims to delineate the specific social media needs and their consequential effects on life quality within an international context. Thus, the finding of one location may not accurately reflect the situation of different places of people sufficiently. Despite several studies outlining the negative impact of COVID-19 on health and QoL [ 24 , 25 , 26 ], limited evidence is available to examine the impact of social media use on quality of life. There have been only a few global studies documenting the impact of social media on HRQoL. The social media usage has become a pervasive element of human interaction. The handling of social media or the Internet affects the physical, mental, and spiritual health of the people and as such the QoL [ 7 , 9 , 27 , 28 ]. Therefore, this study aimed to explore the perceived social media needs and their impact on the QoL among the adult population of various selected countries. Our research introduces novel insights by providing a multi-country analysis that contrasts the effect of social media on QoL in varied cultural contexts, offering a granular understanding of its role across diverse global populations. It is the first of its kind to employ a comparative cross-national approach to examine the interplay between social media needs and life quality post the COVID-19 pandemic, filling a critical gap in existing literature.

Materials and methods

A quantitative-based cross-sectional study was conducted in the countries Austria, Bangladesh, Georgia, Iran, Iraq, Malaysia, Myanmar, Nigeria, Philippines, Turkey from November 2021 to December 2021. The inclusion criteria for this study were citizens residing in the involved countries, aged 18 years and above, reachable via phone or over the internet, using a network connection, and willing to participate in this study.

The study sample size was calculated using an adjusted single population proportion formula with an additional 30% of the non-response rate, giving rise to the final sample size, n = 490. Non-probability convenience sampling will be used for sample collection.

This study used an online questionnaire available in both in their native language and English versions. In addition, three experts did the back-to-back translation. The questionnaire was adapted from validated sources: WHO Quality of Life-BREF [ 29 ] and the Social Networking Sites Uses and Needs questionnaire [ 2 ]. The online questionnaire consists of 4 sections and a total of 65 items. Section A: Sociodemographic profile (10 items), Section B: Social Networking Sites Usage and Needs (SNSUN) (27 items) and Section C: Quality of Life (WHOQOL-BREF) (26 items). The WHOQOL-BREF questionnaire consists of 26 instruments, of which 24 items are differentiated into four domains, namely physical health (seven items), psychological health (six items), social relationships (three items) and environment (eight items). The WHOQOL-BREF has shown good discriminant validity, content validity, internal consistency, and test–retest reliability [ 29 ]. The reliability of Physical health domain, psychological health, social relationship and environment were 0.71–0.79, 0.70–0.74, 0.80–0.87 and 0.81–0.89, respectively. The cut-off point for a predictor of overall good QoL of the WHOQOL-BREF questionnaire is set to be > 60 to maintain sensitivity and positive predictive value [ 30 ].

Statistical analysis

Statistical Package for Social Sciences (SPSS) version 25.0 for windows was used to analyze the data. The continuous variables were expressed as means and standard deviations, while categorical variables were expressed as proportions and frequencies. Bivariate analyses were performed to identify the possible significant factors for the four domains of the WHOQoL scale. An independent sample t-test was performed for two group comparisons. Linear regression was performed to determine the factors associated with the four domains of the WHOQoL scale. A p -value of < 0.05 was considered statistically significant in all the analyses.

A total of 6689 respondents from ten countries participated in the study. The largest number of respondents was from Malaysia (23.9%), followed by Bangladesh (15.5%), Georgia (14.8%), and Turkey (12.2%). The least respondents were from Myanmar (1.2%) and Nigeria (1.8%). Among the subjects, the majority (35.3%) were in the age group between 18 and 24, followed by 25–44 (27.5%). More than half of the respondents were female (51.5%). Around 47% were married, and 45% were single. Maximum (44.7%) respondents were tertiary level education, and most of their income sources were work (46%). Over half were employed (51.5%), and around 40% were not employed. The living arrangements for 81% of respondents were with family, and more than three quarters of the respondents were residing in an urban area. Around 19.4% were living with an illness (Table 1 ).

Table 2 demonstrates the prevalence of social media users. Age group, gender, marital status, highest qualification, Income source, employment status, living arrangements, residential area, and health condition were statistically significant with social media use. The prevalence of social media users was over 90% in Austria, Georgia, Myanmar, Nigeria, and the Philippines. The age-wise majority of uses of social media was higher in the age group 18–24. However, social media services among males were higher (91.8%) than for females (90%). Marital status as a ‘single’ was more prevalent (97%), and tertiary education (95.6%) reported a higher social media use. In addition, the prevalence was higher (97.3%) among respondents who are financially dependent on the parents. Also, employed respondents had a higher prevalence (94.5%) of social media use compared to unemployed (88.00). Respondents with living arrangements with family also reported higher use of social media. Likewise, those staying in the urban area, and those without illnesses (93%), had a higher prevalence of social media use. About 388 respondents’ did not report their income source, residential area, and health condition. Figure  1 represents the device that prefers to use social media. Most respondents used mobile devices (78.1%), followed by laptops or notebooks (9.2%) for social media use.

Device prefer to use social media

Table 3 shows the frequency of selected social networking sites. Over half (52%) of the participants used Facebook daily, while only 8.1% used Twitter. WhatsApp was used by 44.8% every day. More than one-third (37.4%) of the respondents used Instagram daily, 44.8 % used YouTube daily, and 35.3% of participants Google every day.

Table 4 presents perceived social media needs and QoL among participants. The mean score of social media needs were 8.0 (3.15), 11.31 (4.32), 7.1 (3.09), 9.4 (3.98), and 14.39 (5.22) for the diversions, cognitive needs, affective needs, personal integrative and integrative social needs respectively. Almost 39.8 and 43.2 percent of the participants self-reported poor QoL and poor health satisfaction (a score less than four is considered a poor QoL and poor health satisfaction). The mean score of the perceived QoL for domains was 61.38 (15.73), 59.36 (16.98), 57.93 (24.15), and 60.3 (18.72) for the physical health, psychological health, social relationship, and environments domain, respectively.

Table 5 presents the relationship between social media needs and QoL by country. The average physical QoL was the highest in Nigeria (68.55 ± 13.24) and lowest in Austria (55.31 ± 10.24). Similarly, psychological QoL was also higher in Nigeria (69.24 ± 13.46) and lowest in Austria (51.04 ± 10.15). Social relationship QoL was higher in Austria (73.47 ± 18.49) and lowest in Iran (53.65 ± 23.99). Furthermore, the environment QoL was highest in Nigeria (69.2 ± 15.87) and the lowest in Iran (54.2 ± 20.13).

Those who used social media for diversion were statistically significant in all three QoL domains. In addition, they were significantly associated with physical, psychological, and social QoL. Those who used social media for cognitive needs were significantly associated with the physical, psychological, and environmental domains of QoL compared with those who did not use it. Those who used social media for affective needs were statistically significant for social and environmental QoL. Social media used for personal integrative or to enhance credibility and status were statistically significant in the social relationship domain of QoL ( p  = 0.001) and environmental QoL ( p  < 0.001). However, social media needs for social integrative needs or interaction with friends and family were statistically significant in three domains physical ( p  < 0.001), psychological (< 0.001), and social relationship ( p  = 0.022).

In the multiple regression analysis (Table 6 ), all the determinants were included together, where the dependent variable was all four domains of QoL. All countries were positively associated with the physical and psychological health domain. Similarly, all countries except Malaysia and Nigeria were not significantly associated with the environmental QoL.

Secondary (β = 0.08) and tertiary educated respondents (β = 0.125), whose work was ‘business’ (β = 0.02) were not significantly associated with the physical health psychological health, social relationship, and environmental QoL. Living with family (β = 0.04), and ‘other’ living arrangements (β = 0.047) were positively associated with physical health domain of QoL. However, living in care centres (β = -0.041) and having an illness (β = -0.09) were negatively related to physical health quality. Social media needs for affective needs (β = -0.073) and social integrative needs (β = 0.07) were significantly associated with the physical health domain of QoL.

The psychological health domain of QoL was positively associated in all countries. Sociodemographic predictors for psychological health domain of QoL showed that male gender (β = 0.03), primary (β = 0.07), secondary (β = 0.16), postsecondary (β = 0.16), and tertiary level of education (β = 0.19) were positively associated. In addition, those working in ‘business’ (β = 0.03), and whose parents were working (β = 0.07) and doing ‘other’ work (β = 0.03), living with ‘others’ (β = 0.05) were positively associated with the psychological health domain of QoL.

Those who are not employed (β = -0.04) and retired (β = -0.03), or reported to live in care centres (β = -0.05), had an illness (β = -0.14), showed a negative association with the psychological health domain of QoL.

Predictors among social media needs, Affective Needs (β = -0.07), and Social Integrative Needs (β = 0.09) were significantly associated with psychological health. All participating countries were negatively associated with social relationships. The social relationship is positively associated with age (β = -0.07), secondary education level (β = -0.10), Postsecondary (β = 0.11) and tertiary level education (β = 0.149), and parents were working (β = 0.04), Living with ‘Others’ (β = 0.04), and having an illness (β = -0.11). Affective needs for social media (β = -0.07) were negatively associated with the social relationship domain of QoL. However, Social Integrative Needs (β = 0.065) were positively related to social relationships. Age (β = 0.05), male gender (β = 0.03), primary (β = 0.06), secondary (β = 0.15), postsecondary (β = 0.16), and tertiary (β = 0.207) level of education, working in business (β = 0.03), Working parents(β = 0.05), retirement status(β = -0.03), Living with ‘Others’(β = 0.05), living in care centres (β = -0.05), having illness (β = -0.128) were positively associated with environment QoL. However, among social media needs, affective Needs (β = -0.07) were negatively related to the environmental health domain of QoL, and integrative social needs (β = 0.08) were positively associated with environment.

Our world today is undeniably digital. Social media has become the go-to guide for over 61.4 percent of the global population. Despite the widespread use of social media among people of all ages, limited studies have explored the impact of social media on the overall quality of life (QoL) of populations [ 7 , 9 , 27 , 28 ]. Specifically, this study sought to fill this gap by assessing the perceived social media needs and QoL among the adult population across ten countries.

For country statistics, our study findings showed that the percentage of social media users was highest in regions of Southeast Asia (Myanmar, Philippines), Southern Europe (Austria), West Asia (Georgia) and West Africa (Nigeria), whereas the lowest number of social media users was reported in the Middle East (Iran, Iraq). These results were aligned with the Global Social Media Research Summary 2021/2022, which ranked Southeast Asia - sixth, Southern Europe - seventh, and West Asia – ninth for the highest social network penetration rate [ 31 ].

In terms of sociodemographic, among 6689 participants recruited in this study, over one-third were young adults ranged from 18–24 years. According to previous studies conducted in United States in 2015, the mean age of respondents was 28.8 years old, suggesting the usage of social media among working age group [ 32 ]. As compared to our study conducted in 2021, is seen increasing trend for young adults’ social media users. Similarly, the in Global Social Media Research Summary 2021/2022 found that Generation Z aged 10–25 showed an increasing trend in social media use [ 31 ]. Generation X and Millennials aged 26–57 showed a decreasing trend in social media usage due to increasing real-life responsibilities and an increasing trend for the Boomer generation as social media allows connection and communication with the younger generation [ 31 ]. A systematic review conducted on social media sites and older users also shows the ability for intergenerational communication is the main driving factor for the elderly to use social media sites [ 33 ]. This study also found that social media usage was slightly higher in males than females. Consistent with the Global Social Media Research Summary 2021/2022, male users predominate social media usage across all age ranges except those aged 45 years and above [ 31 ].

Interestingly, our study findings suggested that the most used social media platforms were Facebook and its associate media sites, WhatsApp, and Instagram, which are under the parent company - Meta. These findings were consistent with the Global Social Media Research Summary 2021/2022, indicating that Facebook was the most visited social media platform, predominantly visited by those aged 58 years and above [ 31 ]. Google was ranked the first most visited website worldwide, and its subsidiary company YouTube remains the top video-sharing site. YouTube and Instagram are mostly visited by those ages 18–24 at 89% and 74%, respectively. Contrary to the Global Social Media Research Summary 2021/2022, Twitter was the second most used social media platform compared to our study that showed Twitter had the least usage [ 31 ].

Country-wise QOL assessment, this study found that the mean scores for perceived QOL were lower in all domains compared to Portugal [ 34 ]; lower in psychological health and social relationship domains compared to Brazil [ 35 ] and higher for physical and environmental health domains than Brazil and Malawi [ 35 , 36 ]. Despite our study deduced that Nigerians perceived higher QOL than Malaysian and Turkish people in all domains, Skevington et al. found contradictory findings [ 37 ]. Except the social health domain was in line with our study, the mean score for the physical health domain was higher in Malaysia than in Nigeria and Turkey. Similarly, the mean score for the psychological health domain in Malaysia and Nigeria were equally higher than in Turkey. Furthermore, they also revealed that environmental health domain scores were higher in Malaysia than in Turkey and Nigeria [ 37 ]. However, it is noteworthy that these comparisons are interpreted with due caution as a previous study showed that physical and psychological domains of WHOQOL-BREF were less invariant than social relationship and environmental domains. Only 11 out of 24 facet items, excluding four facets that were fixed as reference items for which their invariance could not be assessed, were found to have invariant factor loadings and thresholds in the study mentioned above [ 38 ]. Alarming as it may sound, meaningful comparisons still can be made, provided that the proportion of non-invariant items is rather small [ 38 ].

Multiple regression analysis of sociodemographic backgrounds and four domains of WHOQOL index value showed that higher education level was positively correlated with all four domains of WHOQOL-BREF. Likewise, previous studies also reported that education level was significantly associated with physical, psychological, social relationship and environment health domain [ 34 , 35 , 39 ]. In our study, living with family and others led to better physical health scores than living alone. These findings were consistent with a previous study conducted by Patrício et al. in 2014, suggesting that living with parents, partners, or children could result in better physical health [ 34 ]. Contrary, existing literature proved unequivocally that living alone was linked deleteriously to a rise in blood pressure, poorer sleep quality, detrimental effects on immune stress response and deterioration in cognition levels over time in the elderly, which can ultimately jeopardize overall physical health [ 40 ].

In line with previous studies, gender was also determined as one of the predictors for the psychological health domain in our study, in which males were found to have better QoL than females [ 31 , 35 , 41 ]. However, controversial results were also found in some studies, ascertained that gender was not correlated with psychological health [ 39 , 42 ]. Our findings could be attributed to women’s multiple social burdens of being wives, mothers or carers, single parents or widows and the effects of their vulnerability to domestic and sexual violence [ 43 ]. Another study on older women living in low, densely populated areas in the central southern region of Portugal also shows that they are susceptible to ageing and exhibit a greater dependency on their loved ones, making them vulnerable to psychological and physical health [ 44 ].

Our study also revealed that employment status is related to psychological health, in which employed individuals had better psychological health than those who were unemployed. Similar findings were found in two studies which suggested that employment influences the QoL of the general population [ 31 , 34 ]. However, existing literature also argues that retired individuals have better psychological health than employed individuals, mainly due to workplace violence experience, poor psychosocial job quality and low job control [ 45 , 46 ]. Meanwhile, a possible explanation for our finding is that unemployment leads to the deprivation of several latent functions of employment, such as financial strain, social contacts, time structure and personal status or identity in institutions, which are also fundamental psychological needs that are important for mental health [ 47 ]. Moreover, prolonged uncertainty, self-doubt and anxiety among those unemployed also lead to a further decrement in psychological health.

In addition, our study also found that living with illness and in care centres were negatively correlated with psychological health. This finding is in accordance with a previous study conducted by Ghasemi et al. [ 48 ], suggested that older adults who prefer to live with their families could have better QoL. However, in contrast, Chung found that community-dwelling elderly had 3.14 higher odds of depression compared to nursing home elderly [ 49 ]. Nevertheless, poor psychological health among those living in residential homes could be due to the loss of freedom, social status, autonomy and self-esteem, neglect from children and approaching death [ 50 ]. As for people with illnesses, similar to our findings, numerous literatures have suggested that living with illness can affect moods, emotions, behaviour of a person, and eventually leading to poorer mental health [ 31 , 34 , 35 , 39 ].

Other than that, there was a positive association between age and environment QoL. Previous study supported the idea that personal and national ageing encourages individual pro-environmental behaviour [ 51 ], which is consistent with the theory of generativity. As people age, they may increasingly seek self-transcendence and meaning in life and pursue pro-social goals, and the practice of environmentally friendly actions may become one way for older persons to impart such wisdom. Besides, older people may become more involved in environmental issues due to their enhanced perceived effects of environmental risks on human health [ 51 ]. Furthermore, our findings on the positive association between education and environmental health was supported by another study, which suggested that decreasing the number of secondary school dropouts might increase pro-environmental behaviour [ 52 ]. The possible reason was that additional education explicitly teaches people the value of the environment [ 52 ].

As for social media needs, our study revealed that affective and social integrative needs were significantly associated with the physical health domain of QoL. According to previous research, people who actively engage in online social networks were more likely to be socially active by having online interactions and new friends. This may have favourable effects on their physical well-being [ 53 ]. Controversially, previous literature also found strong feelings of dependency on Facebook was correlated with poorer physical health [ 54 ].

Moreover, our study revealed that affective and social integrative needs were significantly associated with psychological health. In fact, it is known that humans genetically have a strong desire to connect with people, especially to share their feelings. By utilizing social media, users who enjoy virtual connections would gain many advantages, which could potentially affect their emotional well-being and psychological health [ 55 ]. In line with our study, previous research revealed a positive correlation between online social media use for interaction and psychological health [ 56 ]. Indeed, social media can provide opportunities to engage and support individuals with mental health issues [ 57 ]. Contrary, a systematic review of 16 studies found a negative association between social integrative needs and psychological health. It found that some teens had anxiety from social media due to fear of missing out, and they would regularly check all their friends’ messages [ 58 ]. In addition, a recent study revealed that taking a 1-week break from using social media can substantially improve well-being, depression, and anxiety [ 59 ].

Interestingly, for social relationship domain of QoL, our study findings suggested that it has a negative correlation with affective needs, whereas a positive association with social integrative needs. This might be due to social media use for affective needs often produces unrealistic expectations as people may compare their physical and virtual relationships [ 60 ]. Another possible reason was that certain characteristics of social media users like social isolation might influence real-life social relationship quality. However, particularly for students with introvert personality, they were more likely to communicate online as online chatting is more comfortable for them [ 61 ]. In addition, our finding could be attributable to the benefit of relational reconnection from social media, in which social media use can improve social connectedness especially during COVID-19 lockdowns [ 62 , 63 ]. Preventive measures and practices towards COVID-19 have restrained physical contacts and meetings, which highlighted the crucial need for social media platform in communication [ 64 ]. In fact, social media has been the platform for promoting health and disseminating health information globally during the pandemic [ 20 , 28 ]. Infectious diseases will continue to emerge and re-emerge, leading to unpredictable epidemics and difficult challenges to public health [ 65 , 66 ]. As going digital is indispensable, this underscores the importance of social media in daily needs fulfillment to enable better well-being and QoL.

Furthermore, the impact of social media use on physical, psychological, and social QoL was found to be statistically significant when used for diversion, aligning with earlier findings that problematic use of social networking sites correlates with attempts to alleviate boredom [ 67 ]. Studies have also linked problematic use of social media with poor psychological health outcomes [ 68 ], depression [ 69 ], and anxiety [ 70 ]. The biopsychosocial paradigm—encompassing withdrawal, conflict, tolerance, salience, mood modification, and relapse—provides a framework for understanding problematic social media use [ 71 ]. Social media, when used to alter mood or escape problems, can lead to addictive behaviors. The obsession with social media, reflected in its salience, may contribute to sedentary habits and lower levels of physical activity, which increase the risk of non-communicable diseases [ 72 ]. Additionally, excessive use can lead to irritability in the absence of social media, potentially harming social interactions [ 60 ]. It is imperative for government policies to target the resultant sedentary lifestyles and mental health issues arising from social media use. Moreover, the promulgation of such policies via social media channels is advisable to ensure broad dissemination and enhance the efficacy of government-public communication [ 73 ].

Strengths and limitations

The study leverages a large and culturally diverse sample from 10 countries, enhancing the understanding of social media’s effects on QoL on an international scale. The use of well-validated instruments, the WHOQOL-BREF and SNSUN scales, adds rigor to the research outcomes. It also thoughtfully considers the influence of education on QoL, providing nuanced insights into the social implications of social media use. The study is, however, limited by a convenience sampling method that may not be representative of the global population, potentially biasing the results. Unequal sample sizes across countries pose a challenge for valid cross-cultural comparisons and understanding the differential impact of social media. The cross-sectional design limits the ability to track changes over time or establish causality. Recommendations for future research include adopting probability sampling methods to improve representativeness and balance. Ensuring equal sample distribution across participating countries will enhance the validity of international comparisons. Longitudinal studies are suggested to better understand the causal relationships between social media use and QoL over extended periods.

Conclusions

Social media usage has become a pervasive part of individuals interaction. Intensive handling and interaction affect the physical, mental, and spiritual health of the people and as such the QoL. This study aimed to explore the perceived social media needs and their impact on the QoL among the adult population of various selected countries. A significant proportion of the survey population reported poor QoL and poor health satisfaction. Physical and psychological QoL was poor among Austrian people, whereas social relationship QoL was higher in Austria. Furthermore, social relationship QoL and environmental QoL was lower among the Iranian population, and this can be tackled by disseminating appropriate policy interventions. Those with illness reported poor physical health quality and it is important to adopt a holistic approach to tackle the problems of those already battling with illness. Finally, higher education acts as a safety net against psychological health; therefore, uneducated or low educated need intrinsic focus to tackle the menace of psychological health. As to what they can do to resolve the issue of low physical and psychological QoL. The significance of these findings lies in their ability to support additional study on social media, mental health and physical and psychological QoL. This finding may interest policymakers to address this topic to public health, in higher boards, companies, and educational sectors.

Availability of data and materials

The data presented in this study are available on request from the corresponding author.

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Marzo, R.R., Jun Chen, H.W., Ahmad, A. et al. The evolving role of social media in enhancing quality of life: a global perspective across 10 countries. Arch Public Health 82 , 28 (2024). https://doi.org/10.1186/s13690-023-01222-z

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Research Article

Social media research: We are publishing more but with weak influence

Roles Methodology

Affiliation Department of Marketing, National University of Singapore, Singapore, Singapore

Roles Resources, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Business Administration, Holy Spirit University of Kaslik, Jounieh, Lebanon

• Samer Elhajjar, 
• Laurent Yacoub

• Published: February 8, 2024
• https://doi.org/10.1371/journal.pone.0297241
• Peer Review
• Reader Comments

The purpose of this paper is to address the chasm between academic research on social media as an expanding academic discipline and at the same time a growing marketing function. A bibliometric analysis indicated the evolution of academic research on social media. The results of a survey of 280 social media practitioners shed the light on the gap between academic social media research and the practice of professionals. A qualitative study also offered novel insights and recommendations for future developments in academic research on social media. The findings of this paper showed that academic research on social media is growing in terms of the number of publications but is struggling in three areas: visibility, relevance, and influence on practitioners. This study contributes to the body of knowledge on social media. The implications of our study are derived from the importance of our findings on the directions to publish more relevant and timely academic research on social media. While extensive studies exist on social media, their influence on practitioners is still limited.

Citation: Elhajjar S, Yacoub L (2024) Social media research: We are publishing more but with weak influence. PLoS ONE 19(2): e0297241. https://doi.org/10.1371/journal.pone.0297241

Editor: Alhamzah F. Abbas, UTM Skudai: Universiti Teknologi Malaysia, MALAYSIA

Received: July 27, 2023; Accepted: January 1, 2024; Published: February 8, 2024

Copyright: © 2024 Elhajjar, Yacoub. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files. The data underlying the results presented in the study are from Scopus ( http://www.scopus.com/ ).

Funding: The author received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

In the early 1960s, academics began to advocate that marketing should gain rigor by relying on a scientific approach that respects requirements in terms of the state of knowledge, the hypotheses development, the methodology, and the analysis and interpretation of results [ 1 – 5 ]. This traditional conception of rigor has, over the years, fuelled the need to acquire tools to better evaluate, recognise and promote it. Thus, first in the United States, and now in almost all countries, various stakeholders use rankings of scientific journals, mainly Anglo-Saxon, which often consider their impact factors according to the Journal Citation Report (JCR) of the Science Citation Index or the Social Science Citation Index. Quality accreditation bodies for higher education management institutions have also followed suit by offering journal ranking lists.

However, since the early 1980s, the debate between rigor and relevance in the production and dissemination of marketing knowledge has been prominent in the literature. There is a serious concern about how academics are evaluating the impact of their research. As if the focus of marketing researchers is to improve their citation records rather than developing practical implications for practitioners. Shouldn’t marketing scholarship, when applied to practical issues, aim to harmonize rigor and relevance right from the start? How did we arrive at this risk of divorce and the need to reconcile thoroughness and applicability?

In fact, in some fields, such as pharmacy, where breakthroughs in medical procedures and the discovery of new pharmaceuticals result in societal benefits, the influence of research is simple to grasp. This effect is more difficult to detect in social media. In the discipline of marketing, for example, there have been allegations that research has strayed too far from the interests of practitioners. In turn, researchers point out the flaws in present professional methods [ 6 ]. Indeed, some in the marketing research community believe that many practical concerns that worry professional marketers are unworthy of researchers’ attention. This is mainly because of a long-standing misguidance of business schools [ 7 ] since their research is less and less influential [ 8 – 11 ]. Several studies confirm that the impact of academic research on business practices has been disappointing and that innovations have come from the consulting community, the business press, and professional associations [ 12 – 15 ].

This article aimed to identify whether there is a gap between rigor and relevance in academic research on social media. It also proposed ways for marketing researchers to foster relevance. In general, this article responded to two research questions: Is there a chasm between academic social media research and social media practitioners? How to reconcile the rigor and relevance of social media research?

The originality of this research lies in its specific focus on bridging the potential gap between rigor and relevance within the realm of academic research on social media. While social media has become an integral part of contemporary society and communication [ 16 ], there is a growing concern that academic investigations in this domain may sometimes prioritize theoretical rigor at the expense of practical applicability [ 17 ]. By addressing this issue, the research seeks to contribute significantly to the field by shedding light on the balance between rigorous methodologies and the real-world applicability of social media research findings. This unique perspective not only emphasizes the importance of ensuring academic work remains pertinent and useful in a rapidly evolving digital landscape but also offers valuable insights for researchers, educators, and policymakers striving to navigate the intricate intersection of academia and social media’s dynamic environment.

To answer our research questions, the paper was structured as follows. First, we examined the theoretical foundations of academic marketing research. Second, the research design and methodology of our three investigations were then described. Our first study involved a social media research bibliometric analysis with the goal of describing the evolution and development of academic social media research. Our second study gathered feedback and information from social media practitioners. Our third study listed suggestions for academic researchers. The three studies worked in tandem to create a comprehensive picture of academic research on social media. They offered historical context, practical insights, and actionable recommendations, collectively contributing to a holistic understanding of how researchers can bridge the gap between rigor and relevance in the dynamic realm of social media. Lastly, we listed the contributions of our study and their implications for future research.

Literature review

Academic marketing research has two purposes: first, to advance marketing theory, and second, to improve marketing practice [ 18 ]. On the one hand, theory ought to give academics fresh ideas, conceptual frameworks, and resources to aid in their understanding of marketing phenomena. On the other side, research should give marketers direction for making better decisions. As a result, marketing academics should address issues with the development of marketing theory’s rigor and its applicability to marketing practice [ 19 ]. Nevertheless, leading academic voices have expressed worry about the gap between marketing theory and practice. Reibstein et al. [ 20 ], for example, have questioned if marketing academia has lost its way, while Sheth and Sisodia [ 21 ] have urged for a reform. In a similar vein, Hunt [ 22 ] advised revising both marketing’s discipline and practice, while McCole [ 23 ] proposed strategies to refocus marketing theory on changing practice. Rust et al. [ 24 ] argue for reorienting marketing in firms to become more customer-centric, and Kotler [ 25 ] advocates for marketing theory and practice to conform to environmental imperatives. Also, because the business landscape is dynamic, Webster Jr. and Lusch [ 26 ] believe that marketing’s goal, premises, and models should be rethought. Finding answers to these problems keeps marketing from becoming obsolete [ 27 ] and marginalised [ 20 ], both as a discipline and as an organizational function [ 28 ].

According to the literature [ 29 , 30 ], marketing scholars have lost sight of both rigor and relevance. As a result, many scholarly journals have made it normal practice to provide implications and suggestions [ 31 ], their actual influence has been insignificant [ 20 ]. Many marketing academics have failed to address substantive topics [ 18 ], resulting in a loss of relevance [ 30 , 20 ] and a drop in marketing expertise [ 32 ].

The efforts of certain institutions (e.g., Marketing Science Institute), conferences (e.g., Theory + Practice in Marketing–TPM), and leading journals’ special issues on marketing theory and practice to bridge this gap are well recognised, with the goal of fostering dialogue and collaboration between marketing scholars and practitioners. Several solutions for bridging the marketing theory–practice gap have also emerged from existing literature: adopting the perspective of rigor–and–relevance in research [ 27 , 33 ]; focusing on emerging phenomena [ 34 , 35 ]; positioning research implications to the higher business level rather than the narrow level of the marketing department [ 36 ]; running role-relevant research driven by a deep understanding of the core tasks of the marketing department; translating research results into actionable recommendations [ 23 , 37 ].

In sum, marketing research has been criticised for not having an impact on practice since it is primarily focused on writing for other scholars and not for practitioners who might benefit from marketing research to address practical issues. Equivalently, publishing marketing research that is more useful for practitioners implies that there should be a well-functioning nexus between the theory and the marketing tools and techniques that practitioners need to deal with practical issues. In the context of social media, we still don’t know whether academic publications have an impact on practitioners. In other terms, one may ask whether social media practitioners read academic articles or refer to these publications in their practices.

Our paper considered the gaps between the theory and practice of social media and identifies where they exist. Some possible explanations for the gaps can be explored which may be of interest to both academics working in the field.

We conducted a bibliometric study, consisting of the collection, summarizing, assessing, and monitoring of published research, to create an up-to-date overview of the current marketing research on social media and statistically assess the associated literature [ 38 , 39 ]. Scopus, one of the most complete databases of academic articles, served as our data source. It indexes 12,850 periodicals in various categories and contains articles published since 1966. Scopus was chosen over Web of Science for two reasons. First, as researchers faced a trade‐off between data coverage and cleanliness, Scopus has been discovered to have a larger coverage (60% larger) than Web of Science [ 40 ]. Second, bibliometric studies in marketing research often employ only one database to avoid data homogeneity problems that could arise when using numerous databases [ 41 ].

To search the database, we first identified two keywords related to our study: “social media”, and “social media marketing”, we ran a query using a combination of these keywords (adopting the Boolean operator “OR”) in the fields related to “title,” “abstract,” and “keywords.” We considered works published only in business journals until October 2022. Proceedings, book chapters, and books were excluded from further consideration. To filter this data, we relied on a screening process. Documents were excluded based on whether they are not published in English and/or not available for the project team.

We placed the highest priority on maintaining the reliability of our dataset, which we accomplished by adhering to protocol. This protocol was carried out in four distinct phases: identification, screening, eligibility, and inclusion, as elaborated in Fig 1 . Using Mendeley’s robust features, we structured all identified studies in an organized format consisting of author names, titles, and publication years. Additionally, we conducted a thorough check to detect and remove any duplicate studies, ensuring the dataset’s cleanliness and integrity.

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After applying our selection criteria rigorously, our initial search of the Scopus database produced a substantial dataset comprising 5345 research works. This dataset encompassed a wide range of information, including author names, article titles, the countries of corresponding authors, publication counts, comprehensive citation statistics (total citations, average article citations, and the number of citing articles, both with and without self-citations), journal sources, keywords, geographical distribution by countries, and author-level metrics. A detailed workflow outlining our selection process is depicted in Fig 1 , providing a comprehensive overview of our systematic approach.

To further enhance the comprehensiveness of our research, we implemented a backward search strategy. In this phase, we scrutinized the reference lists of the retained studies for our final review but did not identify any additional studies relevant to our research objectives.

Once we finalized our ultimate dataset, we examined the complete text of each article. We extracted and organized all pertinent information essential for our review. To streamline this process, we developed a structured data extraction tool specifically designed to record and concisely summarize the crucial details necessary to address our research inquiries. This approach aimed to minimize potential human errors and enhance procedural transparency.

The data coding phase unfolded in two distinct steps. Initially, we subjected the data extraction form to a rigorous pilot evaluation using a select sample of the finalized articles. Two of our co-authors independently conducted data extractions from this sample, allowing for a meticulous cross-check to identify and rectify any technical issues, including completeness and the form’s usability. In the second step of data coding, each article received a unique identifier. One co-author examined the complete text of each article, coding the data into specific categories, such as article title, publication year, geographic market focus, and research theme. To ensure the utmost accuracy and reliability, a second co-author rigorously reviewed the extraction form and conducted a random sample check for cross-validation. Any discrepancies or disagreements that arose during this process were thoroughly discussed and resolved to maintain the integrity of our data coding efforts.

Then, we proceeded to conduct a comprehensive performance analysis. Within this evaluation, we scrutinized various metrics to gauge the scholarly contributions. Among the myriad measures assessed, two stood out as particularly prominent indicators of research impact. The first criterion was the number of publications produced per year or per research constituent, serving as a robust proxy for productivity and output. The second metric revolved around citations, a paramount gauge of the work’s influence and impact within the academic community. As mentioned by Donthu et al. [ 42 ], these dual facets—publication and citation—equally underscore the multifaceted nature of scholarly contributions.

Fig 2 shows the evolution of publications on social media research. Academic research was keeping up with the growth of social media platforms. In fact, since 2010, the number of social media users has significantly increased, the number of social media networks has grown, and the social media platforms evolved from direct electronic information exchange to virtual gathering place.

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These publications have collectively accumulated a total of 2,351 citations. Further dissecting this data, we found that the average citation per document stands at 0.43. Moreover, the h-index, a key indicator gauging both the productivity and influence of a researcher’s body of work, stands at 16. This signifies that a minimum of 16 citations have been garnered by these publications.

Overall, the studies have been conducted in 52 countries. The greatest share of research has been carried out in the United States, followed by the United Kingdom, Australia, and China. Business journals publishing on social media were also listed in our findings. They included a range of marketing journals (e.g., Journal of the Academy of Marketing Science; International Journal of Research in Marketing; Journal of Marketing; Marketing Intelligence and Planning; Journal of Interactive Marketing; Journal of Research in Interactive Marketing; Psychology and Marketing), business research journals (Journal of Business Research; EuroMed Journal of Business; Business Horizons; Journal of Business Media studies), and management journals (e.g., European Management Review). In general, the Marketing journals and business research journals dominated this list. The most cited paper was the classical article on the challenges and opportunities of social media published by Kaplan and Haeinlein in Business Horizons, which has received more than 27000 citations. Next, we found three papers with more than 5000 citations and 10 additional ones with over 2000 citations.

In our study, the abstracts were assessed for the keywords "theory" and "model" to identify theories and models that the social media study added to, and to explore the many theoretical lenses used to guide the research. In total, 321 papers had an abstract that included a theory or model. There were 19 different theories initiated from those works. Theory of gratification, the theory of technology acceptance, and the theory of planned behavior are the most used theories in social media research.

Next, we conducted a keyword co‐occurrence analysis aimed at identifying the main keywords i.e., academic research on social media. By investigating the relationships between keywords, keyword co-occurrence analyses helped us to represent and comprehend the literature of a scientific topic. VOSviewer package of Van Eck and Waltman [ 43 ] was used to generate bibliometric analysis which has been widely adopted in the literature [ 44 ]. VOS is superior to multidimensional scaling for constructing bibliometric analyses and maps [ 43 ], so we did not involve multidimensional scaling. The results of our keyword analysis are shown in Fig 3 . The size of the circles in the graphic representation indicates which keywords had the highest levels of co-occurrence throughout the examination of keyword co-occurrence. Social networking platforms, consume behaviour, marketing, sustainability, and economic and social effects are among the most important keywords used by social media researchers.

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Social media research has identified several prominent topics that have garnered significant attention in recent years. One of these is the impact of social media on mental health [ 45 ]. Researchers have been exploring how various aspects of social media use, such as the quantity and quality of online interactions, content consumption, and platform design, influence individuals’ mental well-being. This includes investigations into the links between social media use and consumer well-being [ 46 ].

Another critical area of focus in social media research is the spread of misinformation and fake news [ 47 ]. The mechanisms behind the dissemination of false information on social media platforms have been extensively examined, along with their effects on public opinion, trust, and political polarization. Researchers have sought to understand how the algorithms, echo chambers, and filter bubbles on these platforms contribute to the propagation of misinformation [ 47 ].

Influencer marketing is another hot topic in social media research [ 48 ]. The effectiveness of influencer partnerships, issues related to authenticity, and the ethical considerations surrounding sponsored content have all come under scrutiny. Researchers are also exploring how influencers shape consumer behavior, affecting choices and preferences [ 49 ].

Political communication on social media has attracted significant attention, particularly regarding its impact on election campaigns, policy-making, and public discourse. Scholars have examined how algorithms, the presence of filter bubbles, and the formation of echo chambers can influence political opinions and contribute to polarization [ 50 ].

Privacy and data security issues are ongoing concerns in the realm of social media research. These studies investigate user privacy, data breaches, and the effects of privacy settings on various social media platforms [ 51 ].

Research into user behavior and engagement on social media platforms is fundamental for understanding trends, virality, and the factors that drive user interactions. Numerous research studies have delved into the impact of social media on consumer behavior, offering valuable insights into this dynamic relationship [ 52 ]. The concept of social proof, where people tend to follow the actions and preferences of others, is well-established in social media research [ 53 ]. The fear of missing out (FOMO) also drives consumer behavior, as limited time offers and exclusive deals on social media can prompt quick purchasing decisions [ 54 ].

Several emerging trends in social media research are shaping the field’s future direction. One of these is the integration of artificial intelligence (AI) and machine learning into research methodologies [ 55 ]. AI is being used for sentiment analysis, content recommendation, and identifying trends within large datasets [ 56 ].

Blockchain technology is also gaining traction as a means to enhance trust and transparency in social media interactions. Researchers are exploring its potential in content authentication and combating fake news [ 57 ].

Ethical considerations surrounding AI algorithms on social media platforms are a growing concern. Research in this area focuses on issues of bias, fairness, and the ethical responsibility of tech companies in algorithm design and implementation [ 58 ].

Cross-cultural and global perspectives in social media research are becoming more prevalent, with studies investigating how social media usage varies across cultures and regions and the global impact of social media trends [ 59 – 61 ].

Looking ahead, future research in social media could consider the long-term effects of social media usage on individuals and societies, including potential generational attitudes and behaviors. Advocacy for increased algorithmic transparency on social media platforms and the study of its impact on user experiences and content distribution is another important direction for future research. Research into how humans and AI can collaborate to enhance content moderation, fact-checking, and information verification on social media platforms will become increasingly relevant. Finally, as concerns about environmental sustainability grow, future research could investigate the environmental impact of data centres and the carbon footprint associated with social media platforms.

Building upon the insights garnered from our initial study, our research journey continued with two subsequent investigations. The second study delved into the world of social media practitioners, extracting valuable feedback and information. In parallel, our third study synthesized a comprehensive list of suggestions tailored specifically for academic researchers. These two complementary endeavors, while distinct in focus, formed integral components of our overarching quest to bridge the gap between theory and practice in the realm of social media.

Numerous academics and commentators have recently claimed that marketing scholarship has stopped being sufficiently creative and has grown more disassociated from actual practice. A rush of recent special journal issues, editors’ forums, and studies on the seeming research/practice gap in marketing have been linked to such worries. While some contend that the goal of marketing research should be to enhance rather than merely describe, understand, or criticise marketing activity, a possible divide between practitioners’ and academics’ concerns appears to have formed.

Academic research, characterized by its systematic inquiry, rigor, and peer-reviewed dissemination, represents a cornerstone of knowledge production and dissemination across various fields and disciplines. Yet, the extent to which social media practitioners engage with, trust, and value academic research remains a subject of limited empirical inquiry. This gap in our understanding is particularly pertinent given the increasingly complex and intertwined relationship between social media and academia.

While a growing body of literature has explored the impact of social media on academic research dissemination and public engagement [ 62 , 63 ], relatively few studies have focused on the reverse perspective—how social media practitioners perceive and interact with academic research. In response to this gap, Study 2 aims to delve deeper into this important facet of the digital age information ecosystem.

The sample frame for this study consisted of 280 social media practitioners. Emails were sent to 441 marketers explaining the project and posing their participation. To improve response rates, a cover letter and a survey instruction letter were sent to all potential respondents [ 64 ]. The overall response rate from the participating companies was 63.5 percent. Table 1 displays the characteristics of the participants. To facilitate the process of reaching social media professionals, we collaborated with a local professional marketing body. This collaboration provided us with access to their membership database and allowed us to leverage their network to identify and contact potential participants. Our data collection initiative unfolded over the course of three months, spanning from November 2022 to January 2023.

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The selection of a sample frame comprising 280 social media practitioners for this study was well-justified on several grounds. Firstly, this choice was rooted in the research’s primary objective, which seeks to gain valuable insights into the perspectives of professionals actively engaged in the field of social media. Moreover, the sample size of 280 was both practical and feasible, considering the available resources and the capacity for efficient data collection and analysis. This size also ensured the statistical significance of the study’s findings, reducing the likelihood that results are simply due to random chance. Ultimately, this choice of sample frame aligned with the study’s research goals, methodological considerations, and ethical principles, strengthening the validity and reliability of the study’s outcomes.

Results showed that only 2% read an academic paper every quarter. Less than 1% of our respondents believed that academic research had an impact on their decisions and activities. Participants of our survey indicated that social media platforms, practical eBooks, specialised websites, and newspapers and magazines are their main sources of knowledge. Fig 4 shows the responses of the participants to the following question: What media or tools do you use to acquire knowledge in social media?

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Participants mentioned that they use the previously mentioned tools to mainly gain more information about the latest trends in the fields of social media and technology. Others read market analysis reports and practical reports, while the rest use the templates developed by marketing institutes and digital marketing agencies (See Table 2 ).

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Respondents shared their perceptions of marketing academics. Academics were regarded as being elitist because they use their own jargon, speak in convoluted scientific terms, strive to publish at all costs, and do little to advance practice. Moreover, most of our participants raised negative criticisms towards the academic research on social media. For them, academic research lacks usefulness, relevance, and visibility (see Table 3 ). Respondents were also asked what the ideal focus of an academic journal should be on. Results show that the most important areas of focus are: (1) practical cases, (2) best practice sharing and (3) dissemination of new ideas. According to the respondents, the least focus should be placed on theoretical models.

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Building upon the insights gained in our second study, we transition into our third investigation, which, like the second, continues to focus on social media practitioners. This continuity underscores the importance of deepening our understanding of their experiences, challenges, and expertise within the ever-evolving social media landscape. In this manner, our research endeavors maintain a cohesive narrative, as we gather comprehensive feedback from practitioners to inform our ongoing quest for practical solutions and academic contributions.

11 online focus groups were held with 69 social media practitioners between March and June 2023. Focus groups are a popular qualitative research method for producing cutting-edge findings. This approach was designed and justified to ensure the rigor and comprehensiveness of our research. By opting for a series of focus groups, we aimed to capture a diverse range of perspectives within the field of social media, considering its dynamic nature and the variety of roles practitioners may hold. Smaller groups can lead to more in-depth discussions and allow each participant to contribute meaningfully [ 65 ]. Furthermore, conducting these sessions during a specific time frame ensured that our data remained relevant and reflective of contemporary practices. The approach also provided opportunities for data validation and triangulation, enhancing the trustworthiness of our findings. Overall, the methodology aligned with the study’s objectives, maximizes data richness, and accounts for practical constraints, ultimately enhancing the robustness and credibility of our research.

The moderator and participants must be chosen for the online focus group to grow well. For the role of moderator, the focus group was facilitated by one of the researchers with experience in conducting online focus groups, whose main role was to encourage an open and relaxed discussion, keep the discussion relevant and probe into areas that needed clarification. A relaxed atmosphere was created to improve interaction and the free flow of ideas and opinions. ‘Starter’ questions were used at the focus group sessions to seed the discussions about the role of academic research.

We did not predetermine the number of focus groups, but we did adhere to the principles of saturation and ceased gathering data when there was no more material to add. The focus groups lasted between 62 and 91 min, with an average length of 73 min. We purposively selected information-rich participants [ 66 ] by using the authors’ networks and snowball sampling. All the participants had a strong understanding of social media, having more than three years of experience in digital marketing. An emailing list of marketing professionals was already developed by the researchers. Those professionals already participated in a previous survey or engaged in an academic activity (example: guest talk, judging a case competition, industry speech to the students). The sample frame for this study consisted of 69 marketing professionals in Singapore, France, and Lebanon. Emails were sent to 130 marketing professionals explaining the project and posing their participation. All potential respondents received a cover letter and a letter outlining the survey’s requirements to increase response rates. The overall response rate from the participating companies was 53 percent. Industries included high-tech, investment, banking, media, logistics, retailing, and healthcare. 55.07% of the sample salespeople were males with a mean age of 33 years.

Each focus group was transcribed and reviewed by an independent researcher. Using computer-based qualitative analysis software, the authors created the initial codes (QSR NVivo 12 Plus). To work methodically through the complete focus group data set and give each data item its full and equal attention, the authors scheduled frequent follow-up meetings. Then, the authors used a data-driven thematic analysis approach to look for themes that were strongly connected with the data but unrelated to the topics posed during the focus groups. To ensure that the themes formed a logical structure, the authors revised and improved the topics. To make sure that each theme appropriately reflected the meanings visible in the entire data set, the authors specifically went back to the transcripts. The final thematic categories underwent numerous rounds of editing to verify that they accurately translated the empirical data and were free of overlapping meanings. They also established connections between the detected themes and previously published works of literature. The trustworthiness of the authors’ later findings, which were demonstrated and backed by a comprehensive collection of data quotations, required such iterative analysis to be improved. Finally, the authors created a report by summarizing the results and highlighting how the new research has added to the body of knowledge. Reports were sent to all the study participants to obtain their feedback. The feedback validated the findings.

Before conducting a thematic analysis, textual data were analyzed using VOSviewer software. The software can automatically and precisely identify the keywords that frequently exist in a large text. VOSviewer analysis needs data files in.txt or.csv format for analysis. As such, all data files were converted from.docx to.txt format and uploaded to the software. The research generated many keywords, each of which was represented by a circle based on how frequently it appeared in the transcripts. The higher the frequency of occurrence of a theme in the textual data or transcripts, the larger the size of the circle (See Fig 5 ). We identified 10 topical keywords: 1) relevance; 2) automation; 3) artificial intelligence; 4) technology; 5) exposure; 6) partnership; 7) big data; 8) innovation; 9) analytics; and 10) trends. These keywords are intelligible with the importance of publishing relevant and visible academic research to practitioners. This analysis also shows that technology, automation, and artificial intelligence are among the main interests of our participants.

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In this section, we present the findings of our thematic analysis. To answer our research questions, our findings shed the light on 1) the problems of academic research on social media; and (2) the participants’ recommendations to improve the managerial and practical impact of academic research on social media.

A primary finding of this research was related to the current challenges the academic research on social media. All our participants thought that the lack of visibility of academic articles is the main problem of academic research. All of them mentioned that they are not aware of the academic journals in the field of social media and are not exposed to the academic articles. Participants believed that academic institutions and researchers don’t promote research works to practitioners, as described in the following paragraph:

I think academic research is not visible for professionals like us [ … ] I believe that academics need to invest more time with practitioners and present the results of their research . As things stand like this , we are not even aware of what researchers are doing .

(Participant 13, Digital Marketing Manager, 10 years of experience).

The participants also mentioned that the lack of relevance for research in social media—is overwhelming: the gap between social media research and its practice looks abysmal, even irreconcilable, and practitioners’ interest in the research produced by researchers is very limited. The relevance dimension relates to the originality of the results. However, according to the participants, the nature of originality differs between researchers and social media managers. The originality expected by social media practitioners is established in reference to their daily practice (there is originality when the results question the practices in use) whereas the originality for researchers has as reference the universe of theories (there is originality when the results question existing knowledge). And this has implications for the researcher concerned with relevance. If he or she evolves in the world of theories and is, therefore, able to detect what constitutes original results, as quotes of participant 24 depict:

We are looking for new and original contributions [ … ] We expect to read something that we don’t know and can help us in our job .

(Participant 24, Social Media Coordinator, 5 years of experience).

The participants felt that there is an obvious time gap between researchers and practitioners: Thus, the researcher took liberties with research time which, in the eyes of the marketers, sometimes made the results obsolete. This perspective of a two-speed world (always slow for research, very fast for marketers) brought with it the idea that researchers are disconnected from business constraints and realities, as depicted in the following quote:

We don’t work much with marketing researchers because there is too much of a time gap.

(Participant 43, Marketing Manager, 13 years of experience).

Another problem noticed by our participants concerns editorial style and the dissemination of the writings. On the one hand, practitioners knew that vocabulary is an element of a researcher’s scientific capital. It is a proof of legitimacy and a mark of identity. On the other hand, they also considered the scientific writing style complex and difficult. In fact, according to our participants, the latter do not read academic articles because they are not trained to understand their content, which is often too specific, abstract, written in specialised jargon, and peppered with references and methodological details. Social media practitioners look for easy-to-understand texts that address the real world and offer cutting-edge ideas, digital marketing trends, or advice that help prevent or solve crises, address challenges, or stay competitive in the digital world.

For our participants, the questions addressed in the research work must be in phase with the concerns of social media practitioners and the challenges facing companies. They must therefore deal with current, and even future, topics, as these are the ones that interest practitioners and can help digital marketers make a difference, stand out and progress in their practices. Therefore, many of our participants said that the topics that social media researchers tackle may neither be important nor interesting for them. In this sense, participant 3 expressed the following:

Research is not at all intriguing . It is very difficult for me to understand and covers subjects that I don’t find interesting .

(Participant 3, Social Media Specialist, 5 years of experience)

The participants listed several recommendations to improve the practical impact of academic research on social media. First, there is a need to improve the visibility and exposure of the academic articles to the practitioners. Academics can think about organizing conferences and seminars to present their results to practitioners. Joint seminars involving academics and practitioners might be planned in this order to increase the practical value of academic research. Also, academics, according to our participants, can publish the results of their results in practice websites. Researchers should also be more active on social networks and try to use less scientific and more practical language in their blogs to explain the importance of their results to social media practitioners. Participants think that researchers should share specific recommendations for practitioners through YouTube. For instance, they can practically explain how to increase social media engagement and how to improve the online reputation of a company. Moreover, professional associations and professional institutes can play an important role in transmitting academic research findings to practitioners.

In addition to presenting at practitioner conferences, writing in traditional crossover journals for practitioners as well as in shorter pieces like op-eds and blogs, and attracting the attention of those who publish columns, blogs, and articles about research for practitioners, participants discussed other ways that scholars can share pertinent research insights with practitioners. Second, participants suggested involving practitioners in research, conducting research in partnership with companies. Implementing collaborative research is not easy, however. It assumes that researchers and social media managers can navigate both worlds and comply with the rules of the game specific to each universe. Participants emphasised the importance of developing ecosystems that bring together researchers and companies to pool resources from both sides to tackle shared issues. Offering a place to share problems and solutions is relevant and improves the efficiency of efforts, whether through knowledge sharing, financial support mechanisms (sponsorship), or—the implementation of joint field studies. Social media practitioners should play an important part in the co-production of research and so shape how new social media plans and ideas are developed. Participant 19 said:

I think researchers need to bridge the gap with professionals [ … ] A key element here is : collaboration . The collaboration will help both parties . The researchers will be able to co-create knowledge with the practitioners , and the latter will get new perspectives from the researchers .

(Participant 19, Marketing Executive, 20 years of experience)

Additionally, social media practitioners can collaborate with researchers to co-produce research, as shown by examples where they have served as data sources, recipients, commissioners, endorsers, and co-researchers on collaborative projects. For two crucial reasons, it is uncommon for practitioners to write on discipline-based research. The first is that academic journals have historically been less likely to publish articles on topics that are of interest to both academics and practitioners and on which they may collaborate in research. If any such research is done, it might be published in journals geared toward practitioners, but these publications don’t seem to get the attention or credit required to improve an academic’s reputation or career. Second, because practitioners lack training in the vocabulary, tools, and processes of research analysis, co-production is uncommon. To promote the generation and dissemination of information, business schools might suggest research training for practitioners and can create networks between practitioners and academics.

Third, practitioners recommended research to tackle specific, relevant, and “real-world” topics. Practitioners look for research that can provide new insight and information, which goes beyond intuition. This relevance non-obviousness test determines whether research meets or exceeds a practitioner’s intuition. So, the research topic must evoke a real marketing problem and the focus should be directed toward helping practitioners with new insights or knowledge. Then, researchers should convert this info into practice and communicate the same in jargon-free language. Social media research should concentrate on know-how rather than know-what and need to mainly rely less on theory to the virtual exclusion of practitioner utility. It is also suggested that researchers consider the results of surveys that some academic or professional organizations periodically conduct to identify practitioner needs and challenges.

Making social media research more relevant does not mean neglecting its rigor, but rather reconciling these two qualities. This "research/teaching/transfer" synergy implies changes in thinking, acting, and managing on the part of all stakeholders: faculty, policymakers, and the management of educational institutions. Participants proposed recommendations for promoting relevance at each stage of this process. Thus, according to them, research must: 1) focus on marketing problems that face practitioners and on variables that practitioners can influence; 2) analyze the interactions between, people, organizations, and the industry and their impact on marketing performance indicators deemed important by practitioners; 3) generate results that cannot be deduced intuitively and that are quickly transferred to practitioners.

Furthermore, participants thought that there is a need to investigate the effect of media on consumers, value formation and their interplay with purchase decisions, and optimization of social media marketing tools that marketing practitioners can use in their everyday jobs. Table 4 presents examples of suggested topics by our participants.

https://doi.org/10.1371/journal.pone.0297241.t004

Fourth, social media research needs to provide recommendations that motivate practitioners to act on the results. Therefore, when possible, researchers should use examples to illustrate how their findings should affect social media practitioners’ actions while also defining the context in which those findings are most likely to be applicable. This entails including—and treating seriously—a part in papers titled "implications for practice" and, ideally, having relevant practitioners review versions of this section. In the eyes of practitioners, it appears necessary for researchers to adopt a forward-looking posture and look to the future rather than simply explaining what has happened or is happening today, as described by participant 58:

I expect recommendations from the part of researchers on how to prepare for the future of digital marketing . (Participant 58, Digital Marketing Manager, 15 years of experience)

Fifth, participants called for new thinking on research analysis methods:

We , the marketing directors , need models to help us make decisions and make judgments , and this is a strong expectation from researchers .

(Participant 40, Social Media Specialist, 7 years of experience)

As far as data mining and retargeting are concerned, social media practitioners are waiting for models to better manage data flows. Quantitative approaches are therefore not excluded, but they must be combined with interpretative approaches, backed by psychology, ethnography, or anthropology, to better understand and anticipate consumers’ choices and decisions.

Sixth, the skills needed to thrive in the field of digital marketing are numerous and diverse because it mixes traditional marketing, web design, SEO, analytics, content management, and much more. Tech-savvy digital marketers are always trying to learn more. For instance, digital marketers need to be familiar with data analytics. To make wise decisions, it is advised to regularly update the database and remove irrelevant information. Additionally, having a basic understanding of HTML and CSS can help digital marketers if they will use WordPress. So, there is an emergence in the required technical knowledge and skills. Our participants advocated for more technical academic research where marketing researchers collaborate with researchers from computer science and data analytics backgrounds. Such research would contribute to the multidisciplinary character and hybrid task structure of the digital marketing profession, which uses technology, analytics, and marketing.

Finally, participants indicated five areas where researchers can help digital marketers to be more knowledgeable and acquainted: 1) the use of big data in the social media field; 2) the AI-powered technology in digital marketing; 3) the characteristics of emerging markets; 4) the features of metaverse marketing; and 5) the use of blockchain technology in digital marketing and social media.

The study has several key implications for future social media investigations. First, a direct correlation exists between academic research and the evolution of social media in terms of users, platforms, and medium. Nevertheless, there is a gap between social media studies and their influence on the marketing function. The problem can be attributed to laxity on the part of digital marketing institutes and centers linking practitioners and researchers [ 67 ]. The onus is on digital marketing institutes to assume the intermediary role between academic researchers and social marketing professionals.

Today, much social media research is invisible to practitioners because the system is primarily self-referential. Authors are forced to decide whether to undertake socially impactful research or write publications that are only academically impactful [ 68 ]. The various participants in the focus groups provide potentially practical solutions to the issue. A close relationship between academic researchers and practitioners increases the chances of implementation. Collaborations help researchers play the role of participant-observer in practitioners’ responsibilities and decision-making. Therefore, social media investigations can consider academic and informal aspects to enhance readability and generate a significant audience.

Another reason that could explain the gap between practitioners and researchers is that the former focus on publishing instead of engaging their target audience. Thus, a disparity exists between the expectations of the marketing professionals trying to transform their work for industry consumption and the researchers’ interests. Additionally, social media marketers work in an exciting field, but academic researchers continue to ignore this vital fact [ 69 ]. Cadotte et al. [ 70 ] support the perspective and contend that practitioners feel that academics consider themselves elitists who speak their jargon and write in complex scientific language. The issue explains why 69% of our respondents stated that they do not find academic articles interesting. Although theoretical models are critical in research studies, authors should focus more on practical cases, best practice sharing, and disseminating new ideas. The fast-paced and dynamic nature of social media marketing [ 71 ] requires companies and marketers to rely on scientific studies to make informed decisions [ 69 ]. However, academic journals are characterised by the slowness of their review process. Managerial fads are often gone by the time the articles that dissect them are published.

Our research also focuses on academic research challenges regarding social media and implementing participants’ recommendations to enhance practicality. The lack of originality in academic papers means that marketing practitioners do not find the articles relevant to their practice. According to Roberts et al. [ 19 ], professionals want researchers to publish studies that value practical relevance, but academics favour journals with a high impact factor. Young and Freytag [ 72 ] indicate that the only approach to bridge the gap between research studies and their influence function is through successful collaborations between academic researchers and professional practitioners.

The findings of this paper show that academic research on social media is growing in terms of the number of publications but is struggling in three areas: visibility, relevance, and influence on practitioners. Our findings outlined some difficulties in bridging academic research and social media usage. We offered some recommendations for improving the interaction between research and practice after focusing on the viewpoints of the practitioners. Thus, we discussed why research relevance is important and how scholars might raise the relevance of their research in an effort to inspire academics to produce research that is more pertinent to social media practitioners.

Our findings should be of interest to marketing researchers and academic institutions. We presented a detailed snapshot of guidelines to publish more impactful research works. Collaboration between scholars and practitioners is an important area where the gap could be closed. Collaboration with professional organisations and businesses should already be under progress. In order to advance toward positive developments in the interaction between the academy and practice, collaboration will result in stronger links between social media research and the instruments used in professional practice. Another position consists in asserting that the lack of relevance of the knowledge produced by social media research is the direct consequence of its mode of production. By raising to the rank of dogma a paradigm inherited from the hard sciences, the scientific community has, so to speak, dried up the marketing discipline. As a result, the findings of the social media research conducted by the researchers have lost interest. To make social media research more relevant, it would be necessary to change the way research is conducted. An initiative such as the creation of the d.school at Stanford University, a program that fundamentally changes the way of thinking about teaching and research based on the design sciences paradigm, is part of this conception, but other approaches such as critical digital marketing studies, critical realism or constructivism are also proposed by the advocates of a paradigmatic renewal. Even if the solutions advocated differ, these approaches have the common characteristic of advocating a greater openness in marketing research by proposing new research methods, new forms of results, and, above all, new criteria for evaluating scientific productions.

Some limitations should be acknowledged. First, books, theses, and conference proceedings were not included in the review because it only looked at and evaluated items that were published in peer-reviewed academic journals. Future research should take this restriction into account and may decide to broaden the area of their investigations. Second, our review comprised journals identified in Scopus; upcoming studies may contemplate examining other databases. Third, the perceptions of social media practitioners may also vary by country, along with the nature of jobs and the competencies they require. To advance this research, it is advised that our data be combined with information from various geographic contexts. Finally, the results of future research can be bed on larger sample size, as the sample in our second study was comprised of only 280 practitioners.

Supporting information

https://doi.org/10.1371/journal.pone.0297241.s001

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Social Media Adoption, Usage And Impact In Business-To-Business (B2B) Context: A State-Of-The-Art Literature Review

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• Published: 02 February 2021
• Volume 25 , pages 971–993, ( 2023 )

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• Yogesh K. Dwivedi 1 ,
• Elvira Ismagilova 2 ,
• Nripendra P. Rana 2 &
• Ramakrishnan Raman 3  

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Social media plays an important part in the digital transformation of businesses. This research provides a comprehensive analysis of the use of social media by business-to-business (B2B) companies. The current study focuses on the number of aspects of social media such as the effect of social media, social media tools, social media use, adoption of social media use and its barriers, social media strategies, and measuring the effectiveness of use of social media. This research provides a valuable synthesis of the relevant literature on social media in B2B context by analysing, performing weight analysis and discussing the key findings from existing research on social media. The findings of this study can be used as an informative framework on social media for both, academic and practitioners.

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1 Introduction

The Internet has changed social communications and social behaviour, which lead to the development of new forms of communication channels and platforms (Ismagilova et al. 2017 ). Social media plays an important part in the digital transformation of businesses (Kunsman 2018 ). Digital transformation refers to the globally accelerated process of technical adaptation by companies and communities as a result of digitalisation (Sivarajah et al. 2019 ; Westerman et al. 2014 ). Web is developed from a tool used to provide passive information into the collaborative web, which allows and encourages active user engagement and contribution. If before social networks were used to provide the information about a company or brand, nowadays businesses use social media in their marketing aims and strategies to improve consumers’ involvement, relationship with customers and get useful consumers’ insights (Alalwan et al. 2017 ). Business-to-consumer (B2C) companies widely use social media as part of their digital transformation and enjoy its benefits such as an increase in sales, brand awareness, and customer engagement to name a few (Barreda et al. 2015 ; Chatterjee and Kar 2020 ; Harrigan et al. 2020 ; Kamboj et al. 2018 ; Kapoor et al. 2018 ).

From a marketing and sales research perspective, social media is defined as “the technological component of the communication, transaction and relationship building functions of a business which leverages the network of customers and prospects to promote value co-creation” (Andzulis et al. 2012 p.308). Industrial buyers use social media for their purchase as they compare products, research the market and build relationships with salesperson (Itani et al. 2017 ). Social media changed the way how buyers and sellers interact (Agnihotri et al. 2016 ) by enabling open and broad communications and cooperation between them (Rossmann and Stei 2015 ). Social media is an important facilitator of relationships between a company and customers (Agnihotri et al. 2012 ; Tedeschi 2006 ). Customers are more connected to companies, which make them more knowledgable about product selection and more powerful in buyer-seller relationships (Agnihotri et al. 2016 ). Social media also helps companies to increase business exposure, traffic and providing marketplace insight (Agnihotri et al. 2016 ; Stelzner 2011 ). As a result, the use of social media supports business decision processes and helps to improve companies’ performance (Rossmann and Stei 2015 ).

Due to digitalisation customers are becoming more informed and rely less on traditional selling initiatives (Ancillai et al. 2019 ). Buyers are relying more on digital resources and their buying process more often involves the use of social media. For example, in the research B2B buyer survey, 82% of buyers stated that social media content has a significant impact on the purchase decision (Ancillai et al. 2019 ; Minsky and Quesenberry 2016 ). As a result, these changes in consumer behaviour place high pressure on B2B salespeople and traditional sales companies (Ancillai et al. 2019 ). By using evidence from major B2B companies and consultancy report some studies claim that social media can be applied in sales to establish effective dialogues with buyers (Ancillai et al. 2019 ; Kovac 2016 ; McKinsey and Company 2015 ).

Now, business-to-business (B2B) companies started using social media as part of their digital transformation. 83% of B2B companies use social media, which makes it the most common marketing tactic (Pulizzi and Handley 2017 ; Sobal 2017 ). More than 70% of B2B companies use at least one of the “big 4” social media sites such as LinkedIn, Twitter, Facebook and YouTube. Additionally, 50% of the companies stated that social media has improved their marketing optimization and customer experience, while 25% stated that their revenue went up (Gregorio 2017 ; Sobal 2017 ). Even though B2B companies are benefitting from social media used by marketers, it is argued that research on that area is still in the embryonic stage and future research is needed (Salo 2017 ; Siamagka et al. 2015 ; Juntunen et al. 2020 ; Iannacci et al. 2020 ). There is a limited understanding of how B2B companies need to change to embrace recent technological innovations and how it can lead to business and societal transformation (Chen et al. 2012 ; Loebbecke and Picot 2015 ; Pappas et al. 2018 ).

The topic of social media in the context of B2B companies has started attracting attention from both academics and practitioners. This is evidenced by the growing number of research output within academic journals and conference proceedings. Some studies provided a comprehensive literature review on social media use by B2B companies (Pascucci et al. 2018 ; Salo 2017 ), but focused only on adoption of social media by B2B or social media influence, without providing the whole picture of the use of social media by B2B companies. Thus, this study aims to close this gap in the literature by conducting a comprehensive analysis of the use of social media by B2B companies and discuss its role in the digital transformation of B2B companies. The findings of this study can provide an informative framework for research on social media in the context of B2B companies for academics and practitioners.

The remaining sections of the study are organised as follows. Section 2 offers a brief overview of the methods used to identify relevant studies to be included in this review. Section 3 synthesises the studies identified in the previous section and provides a detailed overview. Section 4 presents weight analysis and its findings. Next section discusses the key aspects of the research, highlights any limitations within existing studies and explores the potential directions for future research. Finally, the paper is concluded in Section 6 .

2 Literature Search Method

The approach utilised in this study aligns with the recommendations in Webster and Watson ( 2002 ). This study used a keyword search-based approach for identifying relevant articles (Dwivedi et al. 2019b ; Ismagilova et al. 2020a ; Ismagilova et al. 2019 ; Jeyaraj and Dwivedi 2020 ; Williams et al. 2015 ). Keywords such as “Advertising” OR “Marketing” OR “Sales” AND TITLE (“Social Media” OR “Web 2.0” OR “Facebook” OR “LinkedIn” OR “Instagram” OR “Twitter” OR “Snapchat” OR “Pinterest” OR “WhatsApp” OR “Social Networking Sites”) AND TITLE-ABS-KEY (“B2B” OR “B to B” OR “Business to Business” OR “Business 2 Business”) were searched via the Scopus database. Scopus database was chosen to ensure the inclusion of only high quality studies. Use of online databases for conducting a systematic literature review became an emerging culture used by a number of information systems research studies (Dwivedi et al. 2019a ; Gupta et al. 2019 ; Ismagilova et al. 2020b ; Muhammad et al. 2018 ; Rana et al. 2019 ). The search resulted in 80 articles. All studies were processed by the authors in order to ensure relevance and that the research offered a contribution to the social media in the context B2B discussion. The search and review resulted in 70 articles and conference papers that formed the literature review for this study. The selected studies appeared in 33 separate journals and conference proceedings, including journals such as Industrial Marketing Management, Journal of Business and Industrial Marketing and Journal of Business Research.

3 Literature Synthesis

The studies on social media research in the context of B2B companies were divided into the following themes: effect of social media, adoption of social media, social media strategies, social media use, measuring the effectiveness of use of social media, and social media tools (see Table 1 ). The following subsections provide an overview of each theme.

3.1 Effect of Social Media

Some studies focus on the effect of social media for B2B companies, which include customer satisfaction, value creation, intention to buy and sales, building relationships with customers, brand awareness, knowledge creation, perceived corporate credibility, acquiring of new customers, salesperson performance, employee brand engagement, and sustainability (Table 2 ).

3.1.1 Customer Satisfaction

Some studies investigated how the use of social media affected customer satisfaction (Agnihotri et al. 2016 ; Ancillai et al. 2019 ; Rossmann and Stei 2015 ). For example, Agnihotri et al. ( 2016 ) investigated how the implementation of social media by B2B salesperson affects consumer satisfaction. Salesperson’s social media use is defined as a “salesperson’s utilization and integration of social media technology to perform his or her job” (Agnihotri et al. 2016 , p.2). The study used data from 111 sales professionals involved in B2B industrial selling to test the proposed hypotheses. It was found that a salesperson’s use of social media will have a positive effect on information communication, which will, in turn, lead to improved customer satisfaction with the salesperson. Also, it was investigated that information communication will be positively related to responsiveness, which impacts customer satisfaction.

Another study by Rossmann and Stei ( 2015 ) looked at the antecedents of social media use, social media use by B2B companies and their effect on customers. By using data from 362 chief information officers of B2B companies the study found the following. Social media usage of sales representative has a positive impact on customer satisfaction. Age has a negative effect on content generation. It seems that older salespeople use social media in passive ways or interacting with the customer rather than creating their own content. It was found that the quality of corporate social media strategy has a positive impact on social media usage in terms of the consumption of information, content generation, and active interaction with customers. Also, the expertise of a salesperson in the area of social media has a positive impact on social media usage.

3.1.2 Value Creation

Research in B2B found that social media can create value for customers and salesperson (Agnihotri et al. 2012 ; Agnihotri et al. 2017 ). Agnihotri et al. ( 2012 ) proposed a theoretical framework to explain the mechanisms through which salespeople’s use of social media operates to create value and propose a strategic approach to social media use to achieve competitive goals. The study draws on the existing literature on relationship marketing, task–technology fit theory, and sales service behavior to sketch a social media strategy for business-to-business sales organizations with relational selling objectives. The proposed framework describes how social media tools can help salespeople perform service behaviors (information sharing, customer service, and trust-building) leading to value creation.

Some researchers investigated the role of the salesperson in the value creation process after closing the sale. By employing salesperson-customer data within a business-to-business context, Agnihotri et al. ( 2017 ) analysed the direct effects of sales-based CRM technology on the post-sale service behaviors: diligence, information communication, inducements, empathy, and sportsmanship. Additionally, the study examines the interactive effects of sales-based CRM technology and social media on these behaviors. The results indicate that sales-based CRM technology has a positive influence on salesperson service behaviors and that salespeople using CRM technology in conjunction with social media are more likely to exhibit higher levels of SSBs than their counterparts with low social media technology use. Data were collected from 162 salespeople from India. SmartPLS was used to analyse the data.

3.1.3 Intention to Buy and Sales

Another group of studies investigated the effect of social media on the level of sales and consumer purchase intention (Ancillai et al. 2019 ; Itani et al. 2017 ; Salo 2017 ; Hsiao et al. 2020 ; Mahrous 2013 ). For example, Itani et al. ( 2017 ) used the theory of reasoned actions to develop a model that tests the factors affecting the use of social media by salesperson and its impact. By collecting data from 120 salespersons from different industries and using SmartPLS to analyse the data, it was found that attitude towards social media usefulness did not affect the use of social media. It was found that social media use positively affects competitive intelligence collection, adaptive selling behaviour, which in turn influenced sales performance. Another study by Ancillai et al. ( 2019 ) used in-depth interviews with social selling professionals. The findings suggest that the use of social media improves not only the level of sales but also affects relationship and customer performance (trust, customer satisfaction, customer referrals); and organisational performance (organisational selling performance and brand performance).

It was investigated that social media has a positive effect on the intention to purchase (Hsiao et al. 2020 ; Mahrous 2013 ). For instance, Mahrous ( 2013 ) by reviewing the literature on B2B and B2C companies concluded that social media has a significant influence on consumer buying behaviour.

3.1.4 Customer Relationships

Another group of studies focused on the effect of social media on customer relationships (Bhattacharjya and Ellison 2015 ; Gáti et al. 2018 ; Gruner and Power 2018 ; Hollebeek 2019 ; Iankova et al. 2018 ; Jussila et al. 2011 ; Kho 2008 ; Niedermeier et al. 2016 ; Ogilvie et al. 2018 ). For example, Bhattacharjya and Ellison ( 2015 ) investigated the way companies build relationships with customers by using responsive customer relationship management. The study analysed customer relationship management activities from Twitter account of a Canadian company Shopify (B2B service provider). The company uses Twitter to engage with small business customers, develops and consumers. Jussila et al. ( 2011 ), by reviewing the literature, found that social media leads to increased customer focus and understanding, increased level of customer service and decreased time-to-market.

Gáti et al. ( 2018 ) focused their research efforts on social media use in customer relationship performance, particularly in customer relations. The study investigated the adoption and impact of social media by salespeople of B2B companies. By using data of 112 salespeople from several industries the study found that the intensity of technology use positively affects attitude towards social media, which positively affects social media use. Intensive technology use in turn positively affects customer relationship performance (customer retention). PLS-SEM was applied for analysis.

Another study by Gruner and Power ( 2018 ) investigated the effectiveness of the use of multiple social media platforms in communications with customers. By using data from 208 large Australian organisations, the paper explores how companies’ investment in one form of social media impacts activity on another form of social media. A regression analysis was performed to analyse the data. It was found that widespread activities on LinkedIn, Twitter and YouTube have a negative effect on a company’s marketing activity on Facebook. Thus, having it is more effective for the company to focus on a specific social media platform in forming successful inter-organisational relationships with customers.

Hollebeek ( 2019 ) proposed an integrative S-D logic/resource-based view (RBV) model of customer engagement. The proposed model considers business customer actors and resources in driving business customer resource integration, business customer resource integration effectiveness and business customer resource integration efficiency, which are antecedents of business customer engagement. Business customer engagement, in turn, results in business customer co-creation and relationship productivity.

Niedermeier et al. ( 2016 ) investigated the use of social media among salespeople in the pharmaceutical industry in China. Also, the study investigated the impact of social media on building culturally specific Guanxi relationships-it involves the exchange of factors to build trust and connection for business purpose. By using in-depth interviews with 3 sales managers and a survey of 42 pharmaceutical sales representatives that study found that WeChat is the most common social media platform used by businesses. Also, it was found to be an important tool in building Guanxi. Future studies should focus on other industries and other types of cultural features in doing business.

Ogilvie et al. ( 2018 ) investigated the effect of social media technologies on customer relationship performance and objective sales performance by using two empirical studies conducted in the United States. The first study used 375 salespeople from 1200 B2B companies. The second study used 181 respondents from the energy solution company. It was found that social media significantly affects salesperson product information communication, diligence, product knowledge and adaptability, which in turn affect customer relationship performance. It was also found that the use of social media technologies without training on technology will not lead to good results. Thus, the results propose that companies should allocate the resources required for the proper implementation of social media strategies. Future research should examine how the personality traits of a salesperson can moderate the implementation of social media technologies.

While most of the studies focused on a single country, Iankova et al. ( 2018 ) investigated the perceived effectiveness of social media by different types of businesses in two countries. By using 449 respondents from the US and the UK businesses, it was found that social media is potentially less important, at the present time, for managing ongoing relationships in B2B organizations than for B2C, Mixed or B2B2C organizations. All types of businesses ascribe similar importance to social media for acquisition-related activities. Also it was found that B2B organizations see social media as a less effective communication channel, and to have less potential as a channel for the business.

3.1.5 Brand Awareness

Some researchers argued that social media can influence brand awareness (Ancillai et al. 2019 ; Hsiao et al. 2020 ). For instance, Hsiao et al. ( 2020 ) investigated the effect of social media in the fashion industry. By collecting 1395 posts from lookbook.nu and employing regression analysis it was found that the inclusion of national brand and private fashion brands in the post increased the level of popularity which leads to purchasing interest and brand awareness.

3.1.6 Knowledge Creation

Multiple types of collaborative web tools can help and significantly increase the collaboration and the use of the distributed knowledge inside and outside of the company (McAfee 2006 ). Kärkkäinen et al. ( 2011 ) by analysing previous literature on social media proposed that social media use has a positive effect on sharing and creation of customer information and knowledge in the case of B2B companies.

3.1.7 Corporate Credibility

Another study by Kho ( 2008 ) states the advantages of using social media by B2B companies, which include faster and more personalised communications between customer and vendor, which can improve corporate credibility and strengthen the relationships. Thanks to social media companies can provide more detailed information about their products and services. Kho ( 2008 ) also mentions that customer forums and blog comments in the B2B environment should be carefully monitored in order to make sure that inappropriate discussions are taken offline and negative eWOM communications should be addressed in a timely manner.

3.1.8 Acquiring New Customers

Meire et al. ( 2017 ) investigated the impact of social media on acquiring B2B customers. By using commercially purchased prospecting data, website data and Facebook data from beverage companies the study conducted an experiment and found that social media us an effective tool in acquiring B2B customers. Future work might assess the added value of social media pages for profitability prediction instead of prospect conversion. When a longer timeframe becomes available (e.g., after one year), the profitability of the converted prospects can be assessed.

3.1.9 Salesperson Performance

Moncrief et al. ( 2015 ) investigated the impact of social media technologies on the role of salesperson position. It was found that social media affects sales management functions (supervision, selection, training, compensation, and deployment) and salesperson performance (role, skill, and motivation). Another study by Rodriguez et al. ( 2012 ) examines the effect of social media on B2B sales performance by using social capital theory and collecting data from 1699 B2B salespeople from over 25 different industries. By employing SEM AMOS, the study found that social media usage has a positive significant relationship with selling companies’ ability to create opportunities and manage relationships. The study also found that social media usage has a positive and significant relationship with sales performance (based on relational measurers of sales that focus on behaviours that strengthen the relationship between buyers and sellers), but not with outcome-based sales performance (reflected by quota achievement, growth in average billing size, and overall revenue gain).

3.1.10 Employee Brand Management

The study by Pitt et al. ( 2018 ) focuses on employee engagement with B2B companies on social media. By using results from Glassdoor (2315 five-star and 1983 one-star reviews for the highest-ranked firms, and 1013 five star and 1025 one-star reviews for lowest ranked firms) on employee brand engagement on social media, two key drivers of employee brand engagement by using the content analysis tool DICTION were identified-optimism and commonality. Individuals working in top-ranked companies expressed a higher level of optimism and commonality in comparison with individuals working in low-ranked companies. As a result, a 2 × 2 matrix was constructed which can help managers to choose strategies in order to increase and improve employee brand engagement. Another study by Pitt et al. ( 2017 ) focused on employee engagement of B2B companies on social media. By using a conceptual framework based on a theory of word choice and verbal tone and 6300 reviews collected from Glassdoor and analysed using DICTION. The study found that employees of highly ranked B2B companies are more positive about their employer brand and talk more optimistically about these brands. For low ranked B2B companies it was found that employees express a greater level of activity, certainty, and realism. Also, it was found that they used more aggressive language.

3.1.11 Sustainability

Sustainability refers to the strategy that helps a business “to meet its current requirements without compromising its ability to meet future needs” (World Commission Report on Environment and Development 1987 , p 41). Two studies out of 70 focused on the role of social media for B2B sustainability (Sivarajah et al. 2019 ; Kasper et al. 2015 ). For example, Sivarajah et al. ( 2019 ) argued that big data and social media within a participatory web environment to enable B2B organisations to become profitable and remain sustainable through strategic operations and marketing related business activities.

Another study by Kasper et al. ( 2015 ) proposed the Social Media Matrix which helps companies to decide which social media activities to execute based on their corporate and communication goals. The matrix includes three parts. The first part is focusing on social media goals and task areas, which were identified and matched. The second part consists of five types of social media activities (content, interaction/dialog, listening and analysing, application and networking). The third part provides a structure to assess the suitability of each activity type on each social media platform for each goal. The matrix was successfully tested by assessing the German B2B sector by using expert interviews with practitioners.

Based on the reviewed studies, it can be seen that if used appropriately social media have positive effect on B2B companies before and after sales, such as customer satisfaction, value creation, intention to buy and sales, customer relationships, brand awareness, knowledge creation, corporate credibility, acquiring new customers, salesperson performance, employee brand management, and sustainability. However, limited research is done on the negative effect of social media on b2b companies.

3.2 Adoption of Social Media

Some scholars investigated factors affecting the adoption of social media by B2B companies (Buratti et al. 2018 ; Gáti et al. 2018 ; Gazal et al. 2016 ; Itani et al. 2017 ; Kumar and Möller 2018 ; Lacka and Chong 2016 ). For instance, Lacka and Chong ( 2016 ) investigated factors affecting the adoption of social media by B2B companies from different industries in China. The study collected the data from 181 respondents and used the technology acceptance model with Nielsen’s model of attributes of system acceptability as a theoretical framework. By using SEM AMOS for analysis the study found that perceived usability, perceived usefulness, and perceived utility positively affect adoption and use of social media by B2B marketing professionals. The usefulness is subject to the assessment of whether social media sites are suitable means through which marketing activities can be conducted. The ability to use social media sites for B2B marketing purposes, in turn, is due to those sites learnability and memorability attributes.

Another study by Müller et al. ( 2018 ) investigated factors affecting the usage of social media. By using survey data from 100 Polish and 39 German sensor suppliers, it was found that buying frequency, the function of a buyer, the industry sector and the country does not affect the usage of social media in the context of sensor technology from Poland and Germany. The study used correlation analysis and ANOVA.

Lashgari et al. ( 2018 ) studied the adoption and use of social media by using face-to-face interviews with key managers of four multinational corporations and observations from companies’ websites and social media platforms. It was found that that the elements essential in forming the B2B firm’s social media adoption strategies are content (depth and diversity), corresponding social media platform, the structure of social media channels, the role of moderators, information accessibility approaches (public vs. gated-content), and online communities. These elements are customized to the goals and target group the firm sets to pursue. Similarly, integration of social media into other promotional channels can fall under an ad-hoc or continuous approach depending on the scope and the breadth of the communication plan, derived from the goal.

Similar to Lashgari et al. ( 2018 ), Shaltoni ( 2017 ) used data from managers. The study applied technology organisational environmental framework and diffusion of innovations to investigate factors affecting the adoption of social media by B2B companies. By using data from marketing managers or business owners of 480 SMEs, the study found that perceived relative advance, perceive compatibility, organizational innovativeness, competitor pressure, and customer pressure influence the adoption of social media by B2B companies. The findings also suggest that many decision-makers in B2B companies think that Internet marketing is not beneficial, as it is not compatible with the nature of B2B markets.

Buratti et al. ( 2018 ) investigated the adoption of social media by tanker shipping companies and ocean carriers. By using data from 60 companies the following was found. LinkedIn is the most used tool, with a 93.3% adoption rate. Firm size emerges as a predictor of Twitter’s adoption: big companies unveil a higher attitude to use it. Finally, the country of origin is not a strong influential factor in the adoption rate. Nonetheless, Asian firms clearly show a lower attitude to join SM tools such as Facebook (70%) and LinkedIn (86.7%), probably also due to governmental web restrictions imposed in China. External dimensions such as the core business, the firm size, the geographic area of origin, etc., seem to affect network wideness. Firm size, also, discriminates the capacity of firms to build relational networks. Bigger firms create networks larger than small firms do. Looking at geographical dimensions, Asian firms confirm to be far less active on SM respect to European and North American firms. Finally, the study analyzed the format of the contents disclosed by sample firms, observing quite limited use of photos and videos: in the sample industries, informational contents seem more appropriate for activating a dialogue with stakeholders and communication still appears formulated in a very traditional manner. Preliminary findings suggest that companies operating in conservative B2B services pursue different strategic approaches toward SMM and develop ad hoc communication tactics. Nonetheless, to be successful in managing SM tools, a high degree of commitment and a clear vision concerning the role of SM within communication and marketing strategy is necessary.

Gazal et al. ( 2016 ) investigated the adoption and measuring of the effectiveness of social media in the context of the US forest industry by using organisational-level adoption framework and TAM. By using data from 166 companies and performing regression analysis, the following results were received. Years in business, new sales revenue, product type, amount of available information on a company website, perceived importance of e-commerce and perceived ease of use of social media significantly affected social media use. Also, it was found that companies’ strategies and internal resources and capabilities and influence a company’s decision to adopt social media. Also, it was found that 94 of respondents do not measure the ROI from social media use. The reason is that the use of social media in marketing is relatively new and companies do not possess the knowledge of measuring ROI from the use of social media. Companies mostly use quantitative metrics (number of site visits, number of social network friends, number of comments and profile views) and qualitative metrics (growth of relationships with the key audience, audience participation, moving from monologue to dialogue with consumers. Facebook was found to be the most effective social media platform reported by the US forest industry.

The study by Kumar and Möller ( 2018 ) investigated the role of social media for B2B companies in their recruitment practices. By using data from international B2B company with headquarter in Helsinki, Finland comprised of 139 respondents it was found that brand familiarity encourages them to adopt social media platforms for a job search; however, the effect of the persuasiveness of recruitment messages on users’ adoption of social media platforms for their job search behavior is negative. The study used correlation analysis and descriptive analysis to analyse the data.

Nunan et al. ( 2018 ) identified areas for future research such as patterns of social media adoption, the role of social media platforms within the sales process, B2B consumer engagement and social media, modeling the ROI of social media, and the risks of social media within B2B sales relationships.

The study by Pascucci et al. ( 2018 ) conducted a systematic literature review on antecedents affecting the adoption and use of social media by B2B companies. By reviewing 29 studies published in academic journal and conferences from 2001 to 2017, the study identified external (pressure from customers, competitors, availability of external information about social media) and internal factors (personal characteristics -managers age, individual commitment, perceptions of social media-perceived ease of use, perceived usefulness, perceived utility), which can affect adoption of social media.

The study by Siamagka et al. ( 2015 ) aims to investigate factors affecting the adoption of social media by B2B organisations. The conceptual model was based on the technology acceptance model and the resource-based theory. AMOS software and Structural equation modelling were employed to test the proposed hypotheses. By using a sample of 105 UK companies, the study found that perceived usefulness of social media is influenced by image, perceived ease of use and perceived barriers. Also, it was found that social media adoption is significantly determined by organisational innovativeness and perceived usefulness. Additionally, the study tested the moderating role of organisational innovativeness and found that it does not affect the adoption of social media by B2B organisations. The study also identified that perceived barriers to SNS (uncertainty about how to use SNS to achieve objectives, employee’s lack of knowledge about SNS, high cost of investment needed to adopt the technology) have a negative impact on perceived usefulness of social media by B2B organisations. The study also used nine in-depth interviews with B2B senior managers and social media specialists about adoption of social media by B2B. It was found that perceived pressure from stakeholders influences B2B organisations’ adoption intention of social media. Future research should test it by using quantitative methods.

While most of the studies focused on the antecedents of social media adoption by B2B companies, Michaelidou et al. ( 2011 ) investigated the usage, perceived barriers and measuring the effectiveness of social media. By using data from 92 SMEs the study found that over a quarter of B2B SMEs in the UK are currently using SNS to achieve brand objectives, the most popular of which is to attract new customers. The barriers that prevent SMEs from using social media to support their brands were lack of staff familiarity and technical skills. Innovativeness of a company determined the adoption of social media. It was found that most of the companies do not evaluate the effectiveness of their SNS in supporting their brand. The most popular measures were the number of users joining the groups/discussion and the number of comments made. The findings showed that the size of the company does not influence the usage of social media for small and medium-sized companies. Future research should investigate the usage of social media in large companies and determine if the size can have and influence on the use. The benefits of using social media include increasing awareness and communicating the brand online. B2B companies can employ social media to create customer value in the form of interacting with customers, as well as building and fostering customer relationships. Future research should investigate the reasons why most of the users do not assess the effectiveness of their SNS. Future research should also investigate how the attitude towards technology can influence the adoption of social media.

Based on the reviewed studies it can be seen that the main factors affecting the adoption of social media by B2B companies are perceived usability, technical skills of employees, pressure from stakeholders, perceived usefulness and innovativeness.

3.3 Social Media Strategies

Another group of studies investigated types of strategies B2B companies apply (Cawsey and Rowley 2016 ; Huotari et al. 2015 ; Kasper et al. 2015 ; McShane et al. 2019 ; Mudambi et al. 2019 ; Swani et al. 2013 ; Swani et al. 2014 ; Swani et al. 2017 ; Watt 2010 ). For example, Cawsey and Rowley ( 2016 ) focused on the social media strategies of B2B companies. By conducting semi-structured interviews with marketing professionals from France, Ireland, the UK and the USA it was found that enhancing brand image, extending brand awareness and facilitating customer engagement were considered the most common social media objective. The study proposed the B2B social media strategy framework, which includes six components of a social media strategy: 1) monitoring and listening 2) empowering and engaging employees 3) creating compelling content 4) stimulating eWOM 5) evaluating and selecting channels 6) enhancing brand presence through integrating social media.

Chirumalla et al. ( 2018 ) focused on the social media engagement strategies of manufacturing companies. By using semi-structured interviews (36), observations (4), focus group meetings (6), and documentation, the study developed the process of social media adoption through a three-phase engagement strategy which includes coordination, cooperation, and co-production.

McShane et al. ( 2019 ) proposed social media strategies to influence online users’ engagement with B2B companies. Taking into consideration fluency lens the study analysed Twitter feeds of top 50 social B2B brands to examine the influence of hashtags, text difficulty embedded media and message timing on user engagement, which was evaluated in terms of likes and retweets. It was found that hashtags and text difficulty are connected to lower levels of engagement while embedded media such as images and videos improve the level of engagement.

Swani et al. ( 2014 ) investigate the use of Twitter by B2B and B2C companies and predict factors that influence message strategies. The study conducted a longitudinal content analysis by collecting 7000 tweets from Fortune 500 companies. It was found that B2B and B2C companies used different message appeals, cues, links and hashtags. B2B companies tend to use more emotional than functional appeals. It was found that B2B and B2C companies do not use hard-sell message strategies.

Another study by Swani et al. ( 2013 ) aimed to investigate message strategies that can help in promoting eWOM activity for B2B companies. By applying content analysis and hierarchical linear modeling the study analysed 1143 wall post messages from 193 fortune 500 Facebook accounts. The study found that B2B account posts will be more effective if they include corporate brand names and avoid hard sell or explicitly commercial statement. Also, companies should use emotional sentiment in Facebook posts.

Huotari et al. ( 2015 ) aimed to investigate how B2B marketers can influence content creation in social media. By conducting four face-to-face interviews with B2B marketers, it was found that a B2B company can influence content creation in social media directly by adding new content, participating in a discussion and removing content through corporate user accounts and controlling employees social media behaviour. Also, it can influence it indirectly by training employees to create desired content and perfuming marketing activities that influence other users to create content that is favorable for the company.

Most of the studies investigated the strategies and content of social media communications of B2B companies. However, the limited number of studies investigated the importance of CEO engagement on social media in the company’s strategies. Mudambi et al. ( 2019 ) emphasise the importance of the CEO of B2B companies to be present and active on social media. The study discusses the advantages of social media presence for the CEO and how it will benefit the company. For example, one of the benefits for the CEO can be perceived as being more trustworthy and effective than non-social CEOs, which will benefit the company in increased customer trust. Mudambi et al. ( 2019 ) also discussed the platforms the CEO should use and posting frequencies depending on the content of the post.

From the above review of the studies, it can be seen that B2B companies social media strategies include enhancing brand image, extending brand awareness and facilitating customer engagement. Companies use various message strategies, such as using emotional appeal, use of brand names, and use of hashtags. Majority of the companies avoid hard sell or explicitly commercial statement.

3.4 Social Media Use

Studies investigated the way how companies used social media and factors affecting the use of social media by B2B (Andersson et al. 2013 ; Bernard 2016 ; Bolat et al. 2016 ; Denktaş-Şakar and Sürücü 2018 ; Dyck 2010 ; Guesalaga 2016 ; Habibi et al. 2015 ). For example, Vasudevan and Kumar ( 2018 ) investigated how B2B companies use social media by analysing 325 brand posts of Canon India, Epson India, and HP India on Linkedin, Facebook, and Twitter. By employing content analysis the study found that most of the posts had a combination of text and message. More than 50% of the posts were about product or brand-centric. The study argued that likes proved to be an unreliable measure of engagement, while shares were considered a more reliable metric. The reason was that likes had high spikes when brand posts were boosted during promotional activities.

Andersson and Wikström ( 2017 ) used case studies of three B2B companies to investigate reasons for using social media. It was found that companies use social media to enhance customer relationships, support sales and build their brands. Also, social media is used as a recruiting tool, a seeking tool, and a product information and service tool.

Bell and Shirzad ( 2013 ) aimed to conduct social media use analysis in the context of pharmaceutical companies. The study analysed 54,365 tweets from the top five pharmaceutical companies. The study analysed the popular time slots, the average number of positive and negative tweets and its content by using Nvivo9.

Bernard ( 2016 ) aims to examine how chief marketing officers use social media. By using case studies from IBM experience with social media it was found that B2B CMO’s are not ready to make use of social media. It was proposed that social media can be used for after-sales service, getting sales leads, engaging with key influencers, building the company’s reputation and enhancing the industry status of key individuals. B2B firms need to exploit the capabilities of processing massive amounts of data to get the most from social media.

Bolat et al. ( 2016 ) explore how companies apply mobile social media. By employing a grounded theory approach to analyse interviews from 26 B2B company representatives from UK advertising and marketing sector companies. It was found that companies use social media for branding, sensing market, managing relationships, and developing content.

Denktaş-Şakar and Sürücü ( 2018 ) investigated how social media usage influence stakeholder engagement focusing on the corporate Facebook page of 30 3PLs companies. In total 1532 Facebook posts were analysed. It was found that the number of followers, post sharing frequency, negatively affect stakeholder engagement. It was found that content including photos facilitates more stakeholder engagement (likes, comment, share) in comparison with other forms. Vivid posts and special day celebration posts strengthen relationships with stakeholders.

Dyck ( 2010 ) discussed the advantages of using social media for the device industry. Social media can be used for product innovation and development, to build a team and collaborate globally. Also, there is an opportunity to connect with all of the stakeholders needed in order to deliver the device to the market. Additionally, it provides to receive feedback from customers (doctors, hospitals) in real-time.

The study by Guesalaga ( 2016 ) draws on interactional psychology theory to propose and test a model of usage of social media in sales, analysing individual, organizational, and customer-related factors. It was found that organizational competence and commitment to social media are key determinants of social media usage in sales, as well as individual commitment. Customer engagement with social media also predicts social media usage in sales, both directly and (mostly) through the individual and organizational factors analysed, especially organizational competence and commitment. Finally, the study found evidence of synergistic effects between individual competence and commitment, which is not found at the organizational level. The data obtained by surveying 220 sales executives in the United States were analysed using regression analysis.

Habibi et al. ( 2015 ) proposed a conceptual model for the implementation of social media by B2B companies. Based on existing B2B marketing, social media and organisational orientational literature the study proposed that four components of electronic market orientation (philosophical, initiation, implementation and adoption) address different implementation issues faced in implementing social media.

Katona and Sarvary ( 2014 ) presented a case of using social media by Maersk-the largest container shipping company in the world. The case provided details on the program launch and the integration strategy which focused on integrating the largest independent social media operation into the company’s broader marketing efforts.

Moore et al. ( 2013 ) provided insights into the understanding of the use of social media by salespersons. 395 salespeople in B2B and B2C markets, utilization of relationship-oriented social media applications are presented and examined. Overall, findings show that B2B practitioners tend to use media targeted at professionals whereas their B2C counterparts tend to utilize more sites targeted to the general public for engaging in one-on-one dialogue with their customers. Moreover, B2B professionals tend to use relationship-oriented social media technologies more than B2C professionals for the purpose of prospecting, handling objections, and after-sale follow-up.

Moore et al. ( 2015 ) investigated the use of social media between B2B and B2C salespeople. By using survey data from 395 sales professionals from different industries they found that B2B sales managers use social selling tools significantly more frequently than B2C managers and B2C sales representatives while conducting sales presentations. Also, it was found that B2B managers used social selling tools significantly more frequently than all sales representatives while closing sales.

Müller et al. ( 2013 ) investigated social media use in the German automotive market. By using online analysis of 10 most popular car manufacturers online social networks and surveys of six manufacturers, 42 car dealers, 199 buyers the study found that social media communication relations are widely established between manufacturers and (prospective) buyers and only partially established between car dealers and prospective buyers. In contrast to that, on the B2B side, social media communication is rarely used. Social Online Networks (SONs) are the most popular social media channels employed by businesses. Manufacturers and car dealers focus their social media engagement, especially on Facebook. From the perspective of prospective buyers, however, forums are the most important source of information.

Sułkowski and Kaczorowska-Spychalska ( 2016 ) investigated the adoption of social media by companies in the Polish textile-clothing industry. By interviewing seven companies representatives of small and medium-sized enterprises the study found that companies started implementing social media activities in their marketing activities.

Vukanovic ( 2013 ) by reviewing previous literature on social media outlined advantages of using social media for B2B companies, which include: increase customer loyalty and trust, building and improving corporate reputation, facilitating open communications, improvement in customer engagement to name a few.

Keinänen and Kuivalainen ( 2015 ) investigated factors affecting the use of social media by B2B customers by conducting an online survey among 82 key customer accounts of an information technology service company. Partial least squares path modelling was used to analysed the proposed hypotheses. It was found that social media private use, colleague support for using SM, age, job position affected the use of social media by B2B customers. The study also found that corporate culture, gender, easiness to use, and perception of usability did not affect the use of social media by B2B customers.

By using interviews and survey social media research found that mostly B2B companies use social media to enhance customer relationships, support sales, build their brands, sense market, manage relationships, and develop content. Additionally, some companies use it social media as a recruitment tool. The main difference between B2B and B2C was that B2B sales managers use social selling tools significantly more frequently than B2C managers.

3.5 Measuring the Effectiveness of Social Media

It is important for a business to be able to measure the effectiveness of social media by calculating return on investment (ROI). ROI is the relationship between profit and the investment that generate that profit. Some studies focused on the ways B2B companies can measure ROI and the challenges they face (Gazal et al. 2016 ; Michaelidou et al. 2011 ; Vasudevan and Kumar 2018 ). For example, Gazal et al. ( 2016 ) investigated the adoption and measuring of the effectiveness of social media in the context of the US forest industry by using organisational-level adoption framework and TAM. By using data from 166 companies it was found that 94% of respondents do not measure the ROI from social media use. The reason is that the use of social media in marketing is relatively new and companies do not possess the knowledge of measuring ROI from the use of social media. Companies mostly use quantitative metrics (number of site visits, number of social network friends, number of comments and profile views) and qualitative metrics (growth of relationships with the key audience, audience participation, moving from monologue to dialogue with consumers).

Another study by Michaelidou et al. ( 2011 ) found that most of the companies do not evaluate the effectiveness of their SNS in supporting their brand. The most popular measures were the number of users joining the groups/discussion and the number of comments made.

Vasudevan and Kumar ( 2018 ) investigated how B2B companies use social media and measure ROI from social media by analysing 325 brand posts of Canon India, Epson India, and HP India on Linkedin, Facebook, and Twitter. By employing content analysis the study found that most of the post has a combination of text and message. More than 50% of the posts were about product or brand-centric. The study argued that likes proved to be an unreliable measure of engagement, while shares were considered a more reliable metric. The reason was that likes had high spikes when brand posts were boosted during promotional activities. Future research should conduct longitudinal studies.

By reviewing the above studies, it can be concluded that companies still struggle to find ways of measuring ROI and applying correct metrics. By gaining knowledge in how to measure ROI from social media activities, B2B companies will be able to produce valuable insights leading to better marketing strategies (Lal et al. 2020 ).

3.6 Social Media Tools

Some studies proposed tools that could be employed by companies to advance their use of social media. For example, Mehmet and Clarke ( 2016 ) proposed a social semiotic multimodal (SSMM) framework that improved the analysis of social media communications. This framework employs multimodal extensions to systemic functional linguistics enabling it to be applying to analysing non-language as well as language constituents of social media messages. Furthermore, the framework also utilises expansion theory to identify, categorise and analyse various marketing communication resources associated with marketing messages and also to reveal how conversations are chained together to form extended online marketing conversations. This semantic approach is exemplified using a Fairtrade Australia B2B case study demonstrating how marketing conversations can be mapped and analysed. The framework emphasises the importance of acknowledging the impact of all stakeholders, particularly messages that may distract or confuse the original purpose of the conversation.

Yang et al. ( 2012 ) proposed the temporal analysis technique to identify user relationships on social media platforms. The experiment was conducted by using data from Digg.com . The results showed that the proposed techniques achieved substantially higher recall but not very good at precision. This technique will help companies to identify their future consumers based on their user relationships.

Based on the literature review, it can be seen that B2B companies can benefit by using the discussed tools. However, it is important to consider that employee should have some technical skills and knowledge to use these tools successfully. As a result, companies will need to invest some resources in staff training.

4 Weight Analysis

Weight analysis enables scrutiny of the predictive power of independent variables in studied relationships and the degree of effectiveness of the relationships (Jeyaraj et al. 2006 ; Rana et al. 2015 ; Ismagilova et al. 2020a ). The results of weight analysis are depicted in Table 3 providing information about an independent variable, dependent variable, number of significant relationships, number of non-significant relationships, the total number of relationships and weight. To perform weight analysis, the number of significant relationships was divided by the total number of analysed relationships between the independent variable and the dependent variable (Jeyaraj et al. 2006 ; Rana et al. 2015 ). For example, the weight for the relationship between attitude towards social media and social media is calculated by dividing ‘1’ (the number of significant relationships) by ‘2’ (the total number of relationships) which equals 0.5.

A predictor is defined as well-utilised if it was examined five or more times, otherwise, it is defined as experimental. It can be seen from Table 3 that all relationships were examined less than five times. Thus all studied predictors are experimental. The predictor is defined as promising when it has been examined less than five times by existing studies but has a weight equal to ‘1’ (Jeyaraj et al. 2006 ). From the predictors affecting the adoption of social media, it can be seen that two are promising, technical skills of employees and pressure from stakeholders. Social media usage is a promising predictor for acquiring new customers, sales, stakeholder engagement and customer satisfaction. Perceived ease of use and age of salesperson are promising predictors of social media usage. Even though this relationship was found to be significant every time it was examined, it is suggested that this variable, which can also be referred to as experimental, will need to be further tested in order to qualify as the best predictor. Another predictor, average rating of product/service, was examined less than five times with a weight equal to 0.75, thus it is considered as an experimental predictor.

Figure 1 shows the diagrammatic representation of the factors affecting different relationships in B2B social media with their corresponding weights, based on the results of weight analysis. The findings suggest that promising predictors should be included in further empirical studies to determine their overall performance.

Diagrammatic representation of results of weight analysis. Note: experimental predictors

It can be seen from Fig. 1 that social media usage is affected by internal (e.g. attitude towards social media, technical skills of employees) and external factors (e.g. pressure from stakeholders) of the company. Also, the figure depicts the effect of social media on the business (e.g. sales) and society (e.g. customer satisfaction).

5 Discussion

In reviewing the publications gathered for this paper, the following themes were identified. Some studies investigated the effect of social media use by B2B companies. By using mostly survey to collect the data from salespeople and managers, the studies found that social media has a positive effect on number of outcomes important for the business such as customer satisfaction, value creation, intention to buy and sales, customer relationships, brand awareness, knowledge creation, corporate credibility, acquiring new customers, salespersons performance, employee brand management, and sustainability. Most of the outcomes are similar to the research on social media in the context of B2C companies. However, some of the outcomes are unique for B2B context (e.g. employee brand management, company credibility). Just recently, studies started investigating the impact of the use of social media on sustainability.

Another group of studies looked at the adoption of social media by B2B companies (Buratti et al. 2018 ; Gáti et al. 2018 ; Gazal et al. 2016 ; Itani et al. 2017 ; Kumar and Möller 2018 ). The studies investigated it mostly from the perspectives of salespersons and identify some of the key factors which affect the adoption, such as innovativeness, technical skills of employees, pressure from stakeholders, perceived usefulness, and perceived usability. As these factors are derived mostly from surveys conducted with salespersons findings can be different for other individuals working in the organisation. This it is important to conduct studies that will examine factors affecting the adoption of social media across the entire organisation, in different departments. Using social media as part of the digital transformation is much bigger than sales and marketing, it encompasses the entire company. Additionally, most of the studies were cross-sectional, which limits the understanding of the adoption of social media by B2B over time depending on the outcomes and environment (e.g. competitors using social media).

Some studies looked at social media strategies of B2B companies (Cawsey and Rowley 2016 ; Huotari et al. 2015 ; Kasper et al. 2015 ; McShane et al. 2019 ; Mudambi et al. 2019 ). By employing interviews with companies’ managers and analysing its social media platforms (e.g. Twitter) it was found that most of the companies follow the following strategies: 1) monitoring and listening 2) empowering and engaging employees 3) creating compelling content 4) stimulating eWOM 5) evaluating and selecting channels 6) enhancing brand presence through integrating social media (Cawsey and Rowley 2016 ). Some studies investigated the difference between social media strategies of B2B and B2C companies. For example, a study by Swani et al. ( 2017 ) focused on effective social media strategies. By applying psychological motivation theory the study examined the key differences in B2B and B2C social media message strategies in terms of branding, message appeals, selling, and information search. The study used Facebook posts on brand pages of 280 Fortune companies. In total, 1467 posts were analysed. By using Bayesian models, the results showed that the inclusion of corporate brand names, functional and emotional appeals and information search cues increases the popularity of B2B messages in comparison with B2C messages. Also, it was found that readers of B2B content show a higher message liking rate and lower message commenting rate in comparison with readers of B2C messages.

The next group of studies looked at social media use by B2B companies (Andersson et al. 2013 ; Bernard 2016 ; Bolat et al. 2016 ; Denktaş-Şakar and Sürücü 2018 ; Dyck 2010 ; Guesalaga 2016 ; Habibi et al. 2015 ). B2B companies use social media for enhancing and managing customer relationships (Andersson and Wikström 2017 ; Bolat et al. ( 2016 ); branding (Andersson and Wikström 2017 ; Bolat et al. 2016 ), sensing market (Bolat et al. 2016 ) and co-production (Chirumalla et al. 2018 ). Additionally, it was mentioned that some of the B2B companies use social media as a recruiting tool, and tool which helps to collaborate globally (Andersson and Wikström 2017 ; Dyck 2010 ).

It is important for companies to not only use social media to achieve positive business outcomes but also it is important to measure their achievements. As a result, some of the studies focused on the measuring effectiveness of social media (Gazal et al. 2016 ; Michaelidou et al. 2011 ; Vasudevan and Kumar 2018 ). Surprisingly, it was found that not so many companies measure ROI from social media (Gazal et al. 2016 ; Michaelidou et al. 2011 ). The ones who do it mostly use quantitative metrics (number of site visits, number of social network friends, number of comments and profile views) and qualitative metrics (growth of relationships with key audience, audience participation, moving from monologue to dialogue with consumers) (Gazal et al. 2016 ). Some future studies should investigate how ROI influences the strategy of B2B companies over period of time.

The last group of studies focused on social media tools used by B2B companies (Keinänen and Kuivalainen 2015 ; Mehmet and Clarke 2016 ; Yang et al. 2012 ). By using number of social media tools (Social Semiotic Multimodal) companies are able to improve their analysis of social media communications and identify their future consumers based on their user relationships. Studies investigating barriers and factors adoption of various social media tools by B2B companies are needed.

After reviewing studies on b2B social media, weight analysis was performed. Based on the results of weight analysis the conceptual model for future studies was proposed (Fig.  2 ). It is important to note that a limited number of studies focused and empirically tested factors affecting the adoption, use, and effect of social media. As a result, identified factors were considered as experimental (examined less than five times). It is too early to label these experimental predictors as worst or best, thus their further investigation is encouraged.

Social media impact on digital transformation and sustainable societies

Additionally, our review of the literature on B2B social media identified dominant research methods used by scholars. Qualitative and quantitative techniques were used by most of these studies. Closer analysis of 70 publications reviewed in this study revealed the multiple techniques applied for gathering data. Quantitative methods used in the studies mostly used surveys (see Table 4 ).

The data was mostly gathered from salespersons, managers and data from social media platforms (e.g. Twitter, Facebook). Just a limited number of studies employed consumer reported data (see Table 5 ).

On the other hand, publications using qualitative methods mainly used interviews and web scraping for the collection of the required data. To analyse the data studies used a variety of techniques including SEM, regression analysis and content analysis being one of the most used (see Table 6 ).

5.1 Digital Transformation and Sustainability Model

Based on the conducted literature review and adapting the model by Pappas et al. ( 2018 ) Fig. 2 presents the digital transformation and sustainability model in the context of B2B companies, which conceptualise the social media ecosystems, and the factors that need to collaborate to enable the use of social media towards the achievement of digital transformation and the creation of sustainable societies. The model comprises of social media stakeholders, the use of social media by B2B companies, and effect of social media on business and society.

5.1.1 Social Media Stakeholders

Building on the discussion and model provided by Pappas et al. ( 2018 ), this paper posits that the social media ecosystem comprises of the data stakeholders (company, society), who engage on social media (posting, reading, using information from social media). The use of social media by different stakeholders will lead to different effects affecting companies, customers and society. This is an iterative process based on which the stakeholders use their experience to constantly improve and evolve their use of social media, which has impacts on both, business and society. The successful implementation of this process is key to digital transformation and the creation of sustainable societies. Most of the current studies (Andersson et al. 2013 ; Bernard 2016 ; Bolat et al. 2016 ; Denktaş-Şakar and Sürücü 2018 ; Dyck 2010 ; Guesalaga 2016 ) focus mostly on the company as a stakeholder. However, more research is needed on other types of stakeholders (e.g. society).

5.1.2 Use of Social Media by B2B Companies

Social media affects not only ways how companies connect with their clients, but it is also changing their business models, the way how the value is delivered and profit is made. To successfully implement and use social media, B2B companies need to consider various social media tools, antecedents/barriers of its adoption, identify suitable social media strategies which are in line with the company’s overall strategy, and measure effectiveness of the use of social media. There are various factors that affect the use of social media by B2B companies. The study found that social media usage is influenced by perceived ease of use, adoption of social media, attitude towards social media and age of salesperson.

The majority of the studies focus on the management of the marketing department. However, digital transformation is much bigger than just marketing as it encompasses the entire organisation. As a result, future studies should look like the entire organisation and investigate barriers and factors affecting the use of social media.

It is crucial for companies to design content which will be noticed on social media by their potential, actual and former customers. Social media content should be interesting and offer some beneficial information, rather than just focus on services the company provides. Companies could use fresh views on relevant industry news, provide information how they are contributing to society and environment, include humour in their posts, share information about the team, make it more personal. It is also useful to use images, infographics, and video content.

It is also important for companies to measure digital marketing actions. More studies are needed on how to isolate the impact of specific media marketing actions to demonstrate their impact on the desired business outcomes (Salo 2017 ). Thus, future studies can consider how particular social media channels (e.g. Facebook, LinkedIn) in a campaign of a new product/ service influence brand awareness and sales level. Also, a limited number of studies discussed the way B2B companies can measure ROI. Future research should investigate how companies can measure intangible ROI, such as eWOM, brand awareness, and customer engagement (Kumar and Mirchandani 2012 ). Also, future research should investigate the reasons why most of the users do not assess the effectiveness of their SNS. Furthermore, most of the studies focused on likes, shares, and comments to evaluate social media engagement. Future research should focus on other types of measures. More research needs considering the impact of legislation on the use of social media by companies. Recent B2B studies did not consider recent legislation (General Data Protection Regulation 2018 ) in the context B2B (Sivarajah et al. 2019 ).

5.1.3 Effect of Social Media on Business and Society

Social media plays an important part in the company’s decision-making process. Social media can bring positive changes into company, which will result in improving customer satisfaction, value creation, increase in sales, building relationships with customers, knowledge creation, improve the perception of corporate credibility, acquisition of new customers, and improve employment brand engagement. Using information collected from social media can help companies to have a set of reliable attributes that comprise social, economic and environmental aspects in their decision-making process (Tseng 2017 ). Additionally, by using social media B2B companies can provide information to other stakeholders on their sustainability activities. By using data from social media companies will be able to provide products and services which are demanded by society. It will improve the quality of life and result in less waste. Additionally, social media can be considered as a tool that helps managers to integrate business practices with sustainability (Sivarajah et al. 2019 ). As a result, social media use by B2B companies can lead to business and societal changes.

A limited number of studies investigated the effect of social media on word of mouth communications in the B2B context. Future research should investigate the differences and similarities between B2C and B2B eWOM communications. Also, studies should investigate how these types of communications can be improved and ways to deal with negative eWOM. It is important for companies to respond to comments on social media. Additionally, future research should investigate its perceived helpfulness by customers.

Majority of studies (Agnihotri et al. 2016 ; Ancillai et al. 2019 ; Rossmann and Stei 2015 ; Agnihotri et al. 2012 ; Agnihotri et al. 2017 ; Itani et al. 2017 ; Salo 2017 ; Bhattacharjya and Ellison 2015 ; Gáti et al. 2018 ; Gruner and Power 2018 ; Hollebeek 2019 ) investigated positive effect of social media such consumer satisfaction, consumer engagement, and brand awareness. However, it will be interesting to consider the dark side of social media use such as an excessive number of requests on social media to salespeople (Agnihotri et al. 2016 ), which can result in the reduction of the responsiveness; spread of misinformation which can damage the reputation of the company.

Studies were performed in China (Lacka and Chong 2016 ; Niedermeier et al. 2016 ), the USA (Guesalaga 2016 ; Iankova et al. 2018 ; Ogilvie et al. 2018 ), India (Agnihotri et al. 2017 ; Vasudevan and Kumar 2018 ), the UK (Bolat et al. 2016 ; Iankova et al. 2018 ; Michaelidou et al. 2011 ). It is strongly advised that future studies conduct research in other countries as findings can be different due to the culture and social media adoption rates. Future studies should pay particular attention to other emerging markets (such as Russia, Brazil, and South Africa) as they suffer from the slow adoption rate of social media marketing. Some companies in these countries still rely more on traditional media for advertising of their products and services, as they are more trusted in comparison with social media channels (Olotewo 2016 ). The majority of studies investigate the effect of social media in B2B or B2C context. Future studies should pay attention to other contexts (e.g. B2B2B, B2B2C). Another limitation of the current research on B2B companies is that most of the studies on social media in the context of B2B focus on the effect of social media use only on business outcomes. It is important for future research to focus on societal outcomes.

Lastly, most of the studies on social media in the context of B2B companies use a cross-sectional approach to collect the data. Future research can use the longitudinal approach in order to advance understanding of social media use and its impact over time.

5.2 Research Propositions

Based on the social media research in the context of B2B companies and the discussion above the following is proposed, which could serve as a foundation for future empirical work.

Social media is a powerful tool to deliver information to customers. However, social media can be used to get consumer and market insights (Kazienko et al. 2013 ). A number of studies highlighted how information obtained from a number of social media platforms could be used for various marketing purposes, such as understanding the needs and preferences of consumers, marketing potential for new products/services, and current market trends (Agnihotri et al. 2016 ; Constantinides et al. 2008 ). It is advised that future research employs a longitudinal approach to study the impact of social media use on understanding customers. Therefore, the following proposition can be formulated:

Proposition 1

Social media usage of B2B companies has a positive influence on understanding its customers.

By using social media companies can examiner valuable information on competitors. It can help to understand competitors’ habits and strategies, which can lead to the competitive advantage and help strategic planning (Dey et al. 2011 ; Eid et al. 2019 ; Teo and Choo 2001 ). It is advised that future research employs a longitudinal approach to study the impact of social media use on understanding its competitors. As a result, using social media to understand customers and competitors can create business value (Mikalef et al. 2020a ) for key stakeholders and lead to positive changes in the business and societies. The above discussion leads to the following proposition:

Proposition 2

Social media usage of B2B companies has a positive influence on understanding its competitors.

Proposition 3

Culture influences the adoption and use of social media by B2B companies.

Usage of social media can result in some positive marketing outcomes such as building new customer relationships, increasing brand awareness, and level of sales to name a few (Agnihotri et al. 2016 ; Ancillai et al. 2019 ; Dwivedi et al. 2020 ; Rossmann and Stei 2015 ). However, when social media is not used appropriately it can lead to negative consequences. If a company does not have enough resources to implement social media tools the burden usually comes on a salesperson. A high number of customer inquiries, the pressure to engage with customers on social media, and monitor communications happening on various social media platforms can result in the increased workload of a salesperson putting extra pressure (Agnihotri et al. 2016 ). As a result, a salesperson might not have enough time to engage with all the customers online promptly or engage in reactive and proactive web care. As a result, customer satisfaction can be affected as well as company reputation. To investigate the negative impact of social media research could apply novel methods for data collection and analysis such as fsQCA (Pappas et al. 2020 ), or implying eye-tracking (Mikalef et al. 2020b ). This leads to the following proposition:

Proposition 4

Inappropriate use of social media by B2B companies has a negative effect on a) customer satisfaction and b) company reputation.

According to Technology-Organisation-Environment (TOE) framework environmental context significantly affects a company’s use of innovations (Abed 2020 ; Oliveira and Martins 2011 ). Environment refers to the factors which affect companies from outside, including competitors and customers. Adopting innovation can help companies to change the rules of the competition and reach a competitive advantage (Porter and Millar 1985 ). In a competitive environment, companies have a tendency to adopt an innovation. AlSharji et al. ( 2018 ) argued that the adoption of innovation can be extended to social media use by companies. A study by AlSharji et al. ( 2018 ) by using data from 1700 SMEs operating in the United Arab Emirates found that competitive pressure significantly affects the use of social media by SMEs. It can be explained by the fact that companies could feel pressure when other companies in the industry start adopting a particular technology and as a result adopt it to remain competitive (Kuan and Chau 2001 ). Based on the above discussion, the following proposition can be formulated:

Proposition 5

Competitive pressure positively affects the adoption of social media by B2B companies.

Companies might feel that they are forced to adopt and use IT innovations because their customers would expect them to do so. Meeting customers’ expectations could result in adoption of new technologies by B2B companies. Some research studies investigated the impact of customer pressure on companies (AlSharji et al. 2018 ; Maduku et al. 2016 ). For example, a study by Maduku et al. ( 2016 ) found that customer pressure has a positive effect on SMEs adoption of mobile marketing in the context of South Africa. Future research could implement longitudinal approach to investigate how environment affects adoption of social media by B2B companies. This leads to the formulation of the following proposition:

Proposition 6

Customer pressure positively affects the adoption of social media by B2B companies.

6 Conclusion

The aim of this research was to provide a comprehensive systematic review of the literature on social media in the context of B2B companies and propose the framework outlining the role of social media in the digital transformation of B2B companies. It was found that B2B companies use social media, but not all companies consider it as part of their marketing strategies. The studies on social media in the B2B context focused on the effect of social media, antecedents, and barriers of adoption of social media, social media strategies, social media use, and measuring the effectiveness of social media. Academics and practitioners can employ the current study as an informative framework for research on the use of social media by B2B companies. The summary of the key observations provided from this literature review is the following: [i] Facebook, Twitter, and LinkedIn are the most famous social media platforms used by B2B companies, [ii] Social media has a positive effect on customer satisfaction, acquisition of new customers, sales, stakeholder engagement, and customer relationships, [iii] In systematically reviewing 70 publications on social media in the context of B2B companies it was observed that most of the studies use online surveys and online content analysis, [iv] Companies still look for ways to evaluate the effectiveness of social media, [v] Innovativeness, pressure from stakeholders, perceived usefulness, and perceived usability have a significant positive effect on companies’ adoption to use social media, [vi] Lack of staff familiarity and technical skills are the main barriers that affect the adoption of social media by B2B, [vii] Social media has an impact not only on business but also on society, [viii] There is a dark side of social media: fake online reviews, an excessive number of requests on social media to salespeople, distribution of misinformation, negative eWOM, [ix] Use of social media by companies has a positive effect on sustainability, and [x] For successful digital transformation social media should change not only the way how companies integrate it into their marketing strategies but the way how companies deliver values to their customers and conduct their business. This research has a number of limitations. First, only publications from the Scopus database were included in literature analysis and synthesis. Second, this research did not use meta-analysis. To provide a broader picture of the research on social media in the B2B context and reconcile conflicting findings of the existing studies future research should conduct a meta-analysis (Ismagilova et al. 2020c ). It will advance knowledge of the social media domain.

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Published on 3.4.2024 in Vol 26 (2024)

Public Discourse, User Reactions, and Conspiracy Theories on the X Platform About HIV Vaccines: Data Mining and Content Analysis

Authors of this article:

Original Paper

• Jueman M Zhang 1 , PhD   ; 
• Yi Wang 2 , PhD   ; 
• Magali Mouton 3   ; 
• Jixuan Zhang 4   ; 
• Molu Shi 5 , PhD  

1 Harrington School of Communication and Media, University of Rhode Island, Kingston, RI, United States

2 Department of Communication, University of Louisville, Louisville, KY, United States

3 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada

4 Polk School of Communications, Long Island University, Brooklyn, NY, United States

5 College of Business, University of Louisville, Louisville, KY, United States

Corresponding Author:

Jueman M Zhang, PhD

Harrington School of Communication and Media

University of Rhode Island

10 Ranger Road

Kingston, RI, 02881

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Phone: 1 401 874 2110

Email: [email protected]

Background: The initiation of clinical trials for messenger RNA (mRNA) HIV vaccines in early 2022 revived public discussion on HIV vaccines after 3 decades of unsuccessful research. These trials followed the success of mRNA technology in COVID-19 vaccines but unfolded amid intense vaccine debates during the COVID-19 pandemic. It is crucial to gain insights into public discourse and reactions about potential new vaccines, and social media platforms such as X (formerly known as Twitter) provide important channels.

Objective: Drawing from infodemiology and infoveillance research, this study investigated the patterns of public discourse and message-level drivers of user reactions on X regarding HIV vaccines by analyzing posts using machine learning algorithms. We examined how users used different post types to contribute to topics and valence and how these topics and valence influenced like and repost counts. In addition, the study identified salient aspects of HIV vaccines related to COVID-19 and prominent anti–HIV vaccine conspiracy theories through manual coding.

Methods: We collected 36,424 English-language original posts about HIV vaccines on the X platform from January 1, 2022, to December 31, 2022. We used topic modeling and sentiment analysis to uncover latent topics and valence, which were subsequently analyzed across post types in cross-tabulation analyses and integrated into linear regression models to predict user reactions, specifically likes and reposts. Furthermore, we manually coded the 1000 most engaged posts about HIV and COVID-19 to uncover salient aspects of HIV vaccines related to COVID-19 and the 1000 most engaged negative posts to identify prominent anti–HIV vaccine conspiracy theories.

Results: Topic modeling revealed 3 topics: HIV and COVID-19, mRNA HIV vaccine trials, and HIV vaccine and immunity. HIV and COVID-19 underscored the connections between HIV vaccines and COVID-19 vaccines, as evidenced by subtopics about their reciprocal impact on development and various comparisons. The overall valence of the posts was marginally positive. Compared to self-composed posts initiating new conversations, there was a higher proportion of HIV and COVID-19–related and negative posts among quote posts and replies, which contribute to existing conversations. The topic of mRNA HIV vaccine trials, most evident in self-composed posts, increased repost counts. Positive valence increased like and repost counts. Prominent anti–HIV vaccine conspiracy theories often falsely linked HIV vaccines to concurrent COVID-19 and other HIV-related events.

Conclusions: The results highlight COVID-19 as a significant context for public discourse and reactions regarding HIV vaccines from both positive and negative perspectives. The success of mRNA COVID-19 vaccines shed a positive light on HIV vaccines. However, COVID-19 also situated HIV vaccines in a negative context, as observed in some anti–HIV vaccine conspiracy theories misleadingly connecting HIV vaccines with COVID-19. These findings have implications for public health communication strategies concerning HIV vaccines.

Introduction

Vaccination has long been recognized as a crucial preventive measure against diseases and infections, but opposition to vaccines has endured [ 1 ]. HIV vaccination has been regarded as a potential preventive measure to help combat the HIV epidemic in the United States, with research and progress dating back to the mid-1980s but without success thus far [ 2 ]. An estimated 1.2 million people were living with HIV in the United States by the end of 2021, with 36,136 new HIV diagnoses reported in 2021 [ 3 ].

On January 27, 2022, the biotechnology company Moderna announced the initiation of clinical trials for an HIV vaccine using messenger RNA (mRNA) technology [ 4 ]. In March 2022, the National Institutes of Health announced the start of clinical trials for 3 mRNA HIV vaccines [ 5 ]. The mRNA technology had previously been used in the Pfizer-BioNTech and Moderna COVID-19 vaccines, which protected individuals against severe symptoms and fatalities during the pandemic [ 6 ]. Following the successes of mRNA COVID-19 vaccines, which led to the Nobel Prize in Physiology or Medicine being awarded to 2 scientists in October 2023 [ 7 ], researchers have been investigating the potential of mRNA vaccines for various other diseases, including HIV [ 8 , 9 ]. The announcements of clinical trials for mRNA HIV vaccines revived public discussion on the prospect of vaccines to combat HIV [ 9 ] despite >3 decades of unsuccessful research [ 2 ]. Meanwhile, these announcements were made against the backdrop of intense vaccine debates during the COVID-19 pandemic, with misinformation and conspiracy theories fueling vaccine hesitancy [ 10 - 12 ].

The X platform, formerly known as Twitter, has been a significant social media platform and a vital source for text-based public discourse. Posts on X have been studied to understand public discourse about vaccines in general [ 13 - 15 ] and about specific vaccines, such as COVID-19 vaccines in recent years [ 12 , 16 , 17 ]. However, there is a dearth of research about public discourse on HIV vaccines on social media. Given the advancement in mRNA technology in COVID-19 vaccines and heated vaccine debates, it has become especially important to gain insights into public discourse and reactions regarding potential new vaccines.

This study is grounded in the growing field of infodemiology and infoveillance, which investigates the “distribution and determinants of information in an electronic medium,” specifically on the web, by analyzing unstructured text with the aim of informing public health practices or serving surveillance objectives [ 18 ]. In recent infodemiology and infoveillance studies, machine learning algorithms have been increasingly used to examine substantial amounts of social media content, such as posts on X related to COVID-19 vaccines [ 12 , 16 , 17 ] and HIV prevention [ 19 ], to extract insights into public discourse and reactions. These algorithms automatically analyze extensive volumes of posts and capture latent textual information such as topics and sentiments. This study aimed to investigate how users used different post types to contribute original content to topics and valence identified through machine learning algorithms and how these topics and valence affected user reactions on X regarding HIV vaccines. In addition, by manually coding the most engaged posts, similar to an approach used in previous infodemiology and infoveillance research [ 20 ], the study intended to identify salient aspects of HIV vaccines related to COVID-19 as well as prominent anti–HIV vaccine conspiracy theories. Analyzing posts on X about HIV vaccines can shed light on public discourse and information diffusion. These findings have implications for shaping public health communication strategies about HIV vaccines [ 18 ]. Furthermore, the findings may help in understanding the acceptability of the HIV vaccine upon its successful development in comparison with adherence to existing HIV prevention measures. Previous infodemiology and infoveillance research effectively increased the forecast accuracy of COVID-19 vaccine uptake by leveraging insights derived from posts on X [ 21 ].

Literature Review

Public discourse about hiv prevention on x.

Social media platforms have become important channels for HIV communication, enabling the dissemination of and engagement with content encompassing a wide array of issues related to HIV prevention, treatment, coping, and available resources [ 22 , 23 ]. An earlier infodemiology study examined 69,197 posts on the X platform containing the hashtag #HIVPrevention between 2014 and 2019 and categorized these posts into 10 identified topics concerning HIV prevention [ 19 ]. Among them, pre-exposure prophylaxis had the highest representation with 13,895 posts, followed by HIV testing; condoms; harm reduction; gender equity and violence against women; voluntary medical male circumcision; sex work; postexposure prophylaxis; elimination of mother-to-child transmission of HIV; and abstinence, which had the lowest representation with 180 posts. Furthermore, that study suggested a consistency between the volume of posts related to specific HIV prevention measures on X over time and the temporal trends in the uptake of those measures [ 19 ]. It is noteworthy that the topic of HIV vaccines was absent, which suggested minimal public discourse on the topic during these years. This may be associated with the extensive history of unsuccessful research in this area [ 2 ].

Despite the availability of current HIV prevention measures, efforts have been made to develop HIV vaccines, which are considered necessary to bridge the gap between the challenges in adhering to existing HIV prevention measures and the ambitious goal set by United Nations member states to end the HIV epidemic by 2030 [ 24 , 25 ]. The surge in public discussion about HIV vaccines, possibly elicited by the clinical trials for mRNA HIV vaccines [ 9 ], presented an optimal opportunity to investigate public discourse and reactions regarding HIV vaccines. To the best of our knowledge, this is the first study to analyze posts on X about HIV vaccines.

Public Discourse and Post Types on X

On the X platform, public discourse featuring original content can be observed through 3 post types: self-composed posts, quote posts, and replies [ 26 ]. X users can compose a post. They can also create a quote post, which entails reposting a post while adding their comments. In addition, they can reply to a post to share their comments [ 26 ]. While self-composed posts initiate new conversations, quote posts and replies enable users to join existing conversations by contributing their own comments [ 27 ]. The Pew Research Center’s analysis of survey respondents’ posts on X from October 2022 to April 2023 revealed the composition of different types of posts. Regarding the 3 types of posts containing original content, replies accounted for the highest proportion at 40%, followed by self-composed posts at 15% and quote posts at 9%. The remaining 35% were reposts [ 28 ].

Machine learning algorithms have been increasingly used in recent years to identify latent message features, including textual topics and sentiment valence, among vast numbers of social media posts, as exemplified by previous research analyzing posts on X about COVID-19 vaccines [ 12 , 16 , 17 ] and HIV prevention [ 19 ]. However, the patterns of public discourse in social media conversations are unclear. Specifically, there is a scarcity of research on how people contribute their original content to topics and valence related to a public health issue. This study aimed to address this gap by examining the relationship between post types and message features, specifically topics and valence uncovered using machine learning algorithms, with a focus on HIV vaccines as the subject matter. The findings will advance our knowledge of user contributions to social media conversations about HIV vaccines.

Message Features Influencing User Reactions on X

Examining message diffusion on social media has been a multifaceted challenge, especially with vaccines being a contentious issue debated fervently during the COVID-19 pandemic [ 16 ]. Another contribution of this study is to advance this research area by using machine learning to investigate the synergistic impact of content and account features on user reactions regarding a potential new vaccine amid the context of intense vaccine debates.

The extent to which a message results in optimal diffusion on social media can be gauged by user reactions [ 16 , 29 - 31 ]. On X, a user can engage with posts—be it a self-composed post, quote post, or reply—in 2 primary 1-click reactions: liking and reposting [ 26 ]. An X user can like a post to show appreciation for it or repost it to share it publicly. Compared to liking, reposting is a more social behavior [ 16 , 32 ]. Unlike X’s old timeline, which mostly displayed posts from accounts that a user followed, its current “For you” timeline also shows posts that those accounts have engaged with along with other posts recommended based on user reactions [ 33 ]. The nature of promoting posts based on user reactions makes it more important to investigate the factors that influence user reactions.

This study investigated 2 categories of message-level features that, according to previous research, can drive user interactions: content features in terms of topics and valence and account features in terms of user verification and follower count. Post topics affect likes and reposts on X [ 16 , 30 , 34 ]. Previous research on COVID-19 vaccine posts on X has indicated that posts containing useful information garner more likes and reposts [ 16 ]. This is likely because information utility fills people’s knowledge gaps and serves their utilitarian needs in the face of health risks [ 16 , 32 , 34 - 36 ]. In addition, previous studies have suggested that the novelty of useful information further facilitates sharing of digital health information [ 32 , 36 ], such as updates about COVID-19 vaccine development [ 12 ]. Given the initial success of mRNA technology in COVID-19 vaccines, mRNA HIV vaccine candidates may possess the inherent features of prospective usefulness and ongoing novelty. As a result, posts presenting pertinent information have the potential to generate more likes and reposts. Meanwhile, the announcements of clinical trials for mRNA HIV vaccines were made amidst intense vaccine debates during the COVID-19 pandemic [ 12 ]. Previous research has shown that perceived controversiality in health information increases viewership but not sharing on social media [ 32 ]. In the context of the heated controversy surrounding vaccines, it is crucial to understand user reactions to new potential vaccines.

In addition to post topics, post valence can play a role in user reactions [ 34 ]. Past research has generally revealed that there are more positive than negative posts on X about vaccines in general [ 13 - 15 ] and, more recently, about COVID-19 vaccines in particular [ 12 , 16 , 17 ]. However, the influence of post valence on user reactions remains unclear. One study on COVID-19 vaccines showed that positive posts on X received more likes but not more reposts [ 16 ]. Another study on vaccines regardless of their type revealed that antivaccine posts garnered more reposts than provaccine posts on X [ 13 ]. A psychological rationale supporting the social transmission of positive content is the motivation of individuals to present themselves positively and shape their self-identity [ 35 , 37 ]. In comparison, social transmission of negative content can be attributed to the idea that certain negative content triggers activation, which drives user reactions [ 35 ].

Furthermore, previous research has shown that account features such as verification status and follower count affect user reactions on social media [ 13 , 16 , 34 ]. Given the vast amounts of information available in the digital age, the authenticity of user accounts becomes crucial in the diffusion of health information. One study revealed that account verification enhanced the number of likes and reposts for posts about COVID-19 vaccines on X [ 16 ]. Another study indicated that follower counts increased the number of reposts for posts about vaccines on X regardless of vaccine type [ 13 ].

Conspiracy Theories

A conspiracy theory refers to the belief that a coalition of powerholders forms secret agreements with malevolent intentions [ 38 , 39 ]. It differs from other types of misinformation by hypothesizing a pattern in which people, objects, or events are interconnected in a causal manner [ 39 ]. Previous research has revealed conspiracy theories as a salient theme in antivaccine discourse on social media, along with other themes such as side effects and inefficacy [ 40 , 41 ]. For HIV vaccines, conspiracy theories are crucial in understanding public discourse against them given the limited information about side effects and inefficacy until future success. An additional contribution of this study is the identification of prominent anti–HIV vaccine conspiracy theories through manual coding of the most engaged with negative posts.

Antivaccine conspiracy theories contribute to vaccine hesitancy [ 42 - 44 ], as observed recently with COVID-19 vaccines [ 10 , 11 ]. Understanding the themes and reasoning behind antivaccine conspiracy theories will provide vital implications for deploying evidence-based and logic-driven strategies to counter them [ 45 - 47 ]. A systematic review of antivaccine discourse on social media from 2015 to 2019 revealed pre–COVID-19 conspiracy theories [ 41 ]. These theories claimed that powerholders promoted vaccines for self-serving interests, including hiding vaccine side effects for financial gain and controlling society and the population [ 40 , 41 ]. During the COVID-19 pandemic, antivaccine conspiracy theories thrived on social media. Some theories claimed that the pandemic was invented for pharmaceutical companies’ profit from vaccines [ 44 ], whereas others linked mRNA COVID-19 vaccines to infertility and population control [ 10 , 11 , 44 , 48 , 49 ]. Another conspiracy theory claimed that Bill Gates and the US government aimed to implant trackable microchips into people through mass vaccination [ 11 , 27 , 49 ]. This aligns with conspiracy theories from earlier years. In particular, the Big Pharma conspiracy theory claims that pharmaceutical companies, together with politicians and other powerholders, conspire against the public interest [ 50 ]. The New World Order conspiracy theory alleges that a power elite with a globalization agenda colludes to rule the world [ 51 ]. Conspiracy theories have also linked other vaccines, such as poliovirus vaccines in the past [ 52 , 53 ] and COVID-19 vaccines in recent years, to HIV infection [ 54 , 55 ]. These conspiracy theories were based on the claims that alleged vaccines contained HIV.

Research Questions

To understand public discourse and reactions surrounding HIV vaccines on the X platform, we put forward the following research questions (RQs):

• What are the topics of the posts about HIV vaccines? (RQ 1)
• What is the valence of the posts about HIV vaccines? (RQ 2)
• How do topics and valence vary across different types of posts? (RQ 3)
• How do content features (topics and valence) and account features (verification status and follower count) affect 1-click reactions in terms of likes and reposts, respectively? (RQ 4)
• What are the prominent anti–HIV vaccine conspiracy theories that receive the most reactions? (RQ 5)

Data Source

We collected English-language original posts about HIV vaccines on the X platform from January 1, 2022, to December 31, 2022, using Netlytic [ 56 ]. The selected time frame began in January 2022 with the initiation of mRNA HIV vaccine clinical trials fueling public discussion and concluded in December 2022, a significant month for HIV and AIDS awareness marked by World AIDS Day on the first day of the month. Posts, excluding reposts, that contained both keywords (case insensitive)—“HIV” and “vaccine”—were extracted, resulting in a total of 36,424 posts across 365 days. Posts were collected weekly. Posts published from the last ending time point to at least 24 hours before each collection time point were included in the data set, allowing for a substantial reaction time.

The unit of analysis was a post. For each post, automated extraction produced data for user reactions (the number of likes and reposts) as well as account features (account verification status and follower count). All 36,424 posts underwent topic modeling using latent Dirichlet allocation (LDA) to identify latent topics, as well as sentiment analysis using Valence Aware Dictionary and Sentiment Reasoner (VADER) to access valence. LDA generated topic-specific loadings and identified the dominant topic for each post. VADER generated a valence compound score for each post, which was also categorized as positive, neutral, or negative based on standard VADER classification values.

LDA revealed 3 topics. As the topic of HIV and COVID-19 dominated in a large proportion of posts, we manually coded the 1000 most engaged posts containing the words “HIV” and “COVID” to uncover the salient aspects of HIV vaccines related to COVID-19. To develop coding for subtopics, 2 researchers initially reviewed and coded the top 200 posts with the most reactions. Subtopics were categorized by adapting existing categories from the literature [ 16 , 34 ] and integrating newly identified subtopics from the posts. The Scott π was 0.80 for categorizing subtopics. Subsequently, each researcher independently coded half of the remaining 800 posts.

We then conducted cross-tabulation analyses among all posts to examine the distribution of topics and valence among different types of posts. Furthermore, we conducted linear regression analyses among all posts to assess the influence of content and account features on these 1-click reactions. Of all 36,424 posts, 19,284 (52.94%) received ≥1 like, and 9155 (25.13%) received ≥1 repost. We added a constant value of 1 to all data points for likes and reposts before applying the natural logarithm. This was done to include posts with 0 likes or reposts and to mitigate the skewness of the data distribution.

Of the 28,439 posts that received likes or reposts, 6176 (21.72%) were negative. We manually coded the top 1000 negative posts with the most reactions to uncover prominent anti–HIV vaccine conspiracy theories. To develop coding for conspiracy theories, 2 researchers initially reviewed and coded the top 200 negative posts that received the most reactions. Posts containing conspiracy theories were identified based on expressions of postulated causal connections between people, objects, or events with malevolent intent [ 38 , 39 ]. Conspiracy theories were then classified based on the existing ones from the literature [ 50 , 51 ] and the emerging ones observed in the posts. Coding discrepancies were resolved through a further review of questionable posts and refinement of the conspiracy theories following the approach used in previous social media content analyses [ 40 , 57 ]. The procedure identified conspiracy theories and established intercoder reliability. The Scott π was 0.83 for identifying conspiracy theories and 0.81 for categorizing them. Each researcher then independently coded half of the remaining 800 negative posts.

User Reactions

One-click reactions were measured by the number of likes and reposts, which were automatically extracted. Because a small number of posts garnered significant 1-click reactions, the distribution of likes and reposts was right skewed. To reduce right skewness, we used the natural logarithm of the number of likes and reposts in linear regression analyses, as done in previous research [ 16 , 30 , 34 ].

Post Topics

All posts underwent topic modeling using LDA [ 58 ]. Topic modeling is a commonly used unsupervised learning method that generates a probabilistic model for a corpus of text data [ 59 ]. As a widely used topic model [ 59 ], LDA has been applied to discover topics within rich sources of digital health information, such as electronic health records [ 60 ], reviews on the web [ 61 ], and posts on X [ 16 , 34 ].

LDA relies on 2 matrices to define the underlying topical structure: the word-topic matrix and the document-topic matrix [ 62 ]. In this study, a post was considered a document. The general idea is that a post is represented by a Dirichlet distribution of latent topics, with each latent topic being represented by a Dirichlet distribution of words [ 59 ]. In the word-topic matrix, where the rows represent words and the columns represent topics, each element reveals the conditional probability of a word appearing within a topic [ 62 ]. A topic can be interpreted by examining a list of the most probable words ranked by their frequencies within a given topic using 3 to 30 words [ 63 ]. In the document-topic matrix, where rows represent posts and columns represent topics, each element reveals the conditional probability of a topic underlying a post [ 62 ]. In other words, it reveals the topic-specific loadings for each post.

When interpreting each topic, we reviewed the word-topic matrix as well as sample posts with high topic-specific loadings and significant reactions. LDA generated topic-specific loadings for each post ranging from 0 to 1, with values closer to 1 indicating a higher probability of a topic being associated with a post. Furthermore, LDA determined the dominant topic for each post by selecting the topic with the highest topic-specific loading among all topics. In the cross-tabulation analysis examining the distribution of topics across post types, the dominant topic for each post was entered for analysis. In the linear regression models assessing message-level drivers of user reactions, topic-specific loadings for each post were entered as topic values following previous research [ 16 , 34 ].

Post Valence

We used VADER to analyze the sentiment valence of each post. VADER is a rule-based model specifically attuned for assessing sentiments expressed in social media text [ 64 ]. VADER generated a compound valence score for each post ranging from –1 to 1, with a value of –1 indicating the most negative sentiment and a value of 1 indicating the most positive sentiment [ 65 ]. The standard VADER compound value thresholds for classifying valence categories are as follows: 0.05 to 1 for positive, −0.05 to 0.05 for neutral, and −0.05 to −1 for negative [ 65 ]. In the cross-tabulation analysis examining the distribution of valence among post types, the valence category for each post was entered for analysis. In the linear regression models assessing message-level drivers of user reactions, the VADER compound valence score for each post was used.

This study collected original posts excluding reposts. For each original post, it was automatically extracted whether it was a self-composed post, a quote post with comments, or a reply.

In total, 2 researchers manually coded the top 1000 out of 6176 negative posts with the highest total number of likes and reposts to uncover highly engaged conspiracy theories. They distinguished conspiracy theories from other types of negative information, particularly other types of misinformation, by recognizing the presence of a hypothesized pattern of causal connections between people, objects, or events for malicious intent [ 38 , 39 ]. Conspiracy theories were then categorized based on the existing ones from the literature and the emerging ones observed in the posts.

As an example, consider a post paraphrased as follows:

Image using condoms consistently, only to contract HIV from a COVID vaccine.

It was posted on February 9, 2022, and received 783 likes and 296 reposts. This post was not coded as displaying a conspiracy theory as it only presented misinformation suggesting that COVID-19 vaccines caused HIV. In comparison, another post was paraphrased as follows:

The COVID vaccine contained a spike protein derived from HIV. I was banned from saying this and ridiculed for months. Also, pharmacies stock up HIV self-tests.

It was posted on February 8, 2022, with 147 likes and 48 reposts. This post was coded as displaying a conspiracy theory. It was further classified within the category of conspiracy theories linked to COVID-19 vaccines containing, causing, or increasing HIV. This post suggested a hypothesized pattern of maliciously intended causal connections between the claim that the COVID-19 vaccine contained HIV and the stocking of HIV self-tests in pharmacies. As another example, a post was paraphrased as follows:

Scientists uncover a “highly virulent” strain of HIV in the Netherlands.

It was posted on February 12, 2022, and received 11 likes and 11 reposts. This post conveyed negative information but did not present a conspiracy theory. In comparison, another post was paraphrased as follows:

By coincidence again, the development of a new mRNA HIV vaccine began just before the emergence of the new HIV strain.

It was posted on February 8, 2022, and received 102 likes and 4 reposts. This post was coded as presenting a conspiracy theory and further classified into the category of conspiracy theories linked to the identification of a new highly virulent HIV strain. This post emphasized the speculative timing of the discovery of the new highly virulent HIV strain occurring shortly after the announcement of the development of a new mRNA HIV vaccine.

Account Features

For each post, the posting account’s verification status and follower count were automatically extracted.

Data Analysis

We used cross-tabulation analyses to investigate the distribution of topics and valence across different post types, in which the dominant topic and valence category for each post were entered, respectively, alongside the post type. We used linear regression models to examine the message-level drivers of user reactions among posts that received likes or reposts. In the linear regression models, a constant value of 1 was added to all data points of like and repost counts. The natural log-transformed values for each post were then regressed on 3 topic-specific loadings generated from LDA, the valence compound score generated from VADER, and 2 autoextracted account features—account verification status and follower count. The “plus one” technique was used to include posts that received 0 likes or reposts and to address the skewness of the data distribution.

Ethical Considerations

Following Long Island University’s institutional review board determination process, an institutional review board review was deemed unnecessary for this study, which collected and analyzed publicly available social media data. All referenced posts were paraphrased to avoid association with any particular user on the X platform.

RQ 1 asked about the topics present in all the posts. We trained a topic model using LDA exploring topic numbers ranging from 2 to 20. The optimal number of topics ( k ) was selected considering both the coherence score ( C v ) and the topic model visualization in a Python library called pyLDAvis , as done in previous research [ 16 , 66 ]. C v is a metric that reflects the semantic coherence of topics by evaluating the word co-occurrence likelihood within topics [ 67 ]. A higher C v indicates a better classification achieved by the topic model. In this study, the model with 2 topics ( k =2) yielded the highest C v (0.42), whereas the model with 3 topics ( k =3) yielded the second highest C v (0.35). The pyLDAvis chart depicts each topic as a circle. Overlapping areas between circles suggest similarities in topics. Thus, a chart without overlapping circles is preferable for k . The pyLDAvis chart for this study showed that, when the value of k was 2 or 3, the circles did not overlap. However, when k reached 4, the circles began to overlap, and overlapping circles persisted for values of k ranging from 4 to 20. Between the k values of 2 and 3, we opted for a model comprising 3 topics ( k =3) considering that a smaller number of topics tends to result in overly broad meanings for each topic [ 68 ].

Table 1 summarizes the 3 topics and lists their representative posts. Each topic was interpreted by examining the top 10 probable words ranked by frequency, along with sample posts exhibiting high topic-specific loadings and 1-click reactions. Topic 1 was HIV and COVID-19, covering 78% of the tokens [ 69 ] and dominating in 92.46% (33,678/36,424) of the posts. Topic 2 was mRNA HIV vaccine trials, covering 14% of the tokens and dominating in 5.91% (2151/36,424) of the posts. Topic 3 was HIV vaccine and immunity, covering 8% of the tokens and dominating in 1.63% (595/36,424) of the posts.

Figure 1 illustrates the daily numbers of original posts about HIV vaccines throughout 2022, in total and categorized into 3 topics. Moderna’s announcement of clinical trials for its first mRNA HIV vaccine on January 27, 2022, likely triggered the initial surge, culminating in a daily peak when the number of posts reached 805 on January 29, 2022. The daily number of posts about mRNA HIV vaccine trials (topic 2) in the week following Moderna’s announcement was higher than on other days throughout the year. Nevertheless, even during that week, there were higher daily numbers of posts about HIV and COVID-19 (topic 1), which remained dominant among the 3 topics during the entire year. The year’s second and highest daily peak occurred on February 8, 2022, recording a total of 1603 posts, most of which focused on HIV and COVID-19 (topic 1). This could be attributed to the emergence of new HIV-related events in early February 2022, including the promotion of HIV tests by public figures [ 64 ] and the discovery of a new highly virulent HIV strain [ 65 ]. The third highest daily peak, comprising 1085 posts, occurred on May 18, 2022, which has marked HIV Vaccine Awareness Day since 1998. Most of the posts centered on HIV and COVID-19 (topic 1). The remainder of the year did not reach such high peaks, with the largest daily volume of 205 posts occurring on December 2, 2022, the day following World AIDS Day, observed since 1988. Similar to previous daily peaks, most of the posts revolved around HIV and COVID-19 (topic 1).

The results revealed the dominance of HIV and COVID-19 (topic 1) in 92.46% (33,678/36,424) of the posts, with HIV as the most frequent word and COVID as the fourth most frequent word. To gain a deeper understanding of salient aspects of HIV vaccines related to COVID-19, we manually coded the top 1000 posts with the highest total number of likes and reposts that contained both HIV and COVID . Table 2 summarizes the subtopics and their representative posts with like and repost counts.

The first major subtopic, comprising 24% (240/1000) of the posts, focused on the reciprocal influence of HIV vaccines and COVID-19 vaccines on each other’s development. Years of HIV vaccine research facilitated the rapid development of mRNA COVID-19 vaccines, and the success of COVID-19 vaccines might accelerate the development of mRNA HIV vaccines. The second major subtopic, comprising 17.6% (176/1000) of the posts, involved comparisons between HIV and COVID-19 in various aspects. Specifically, the development speed of HIV vaccines compared to COVID-19 vaccines was a major point of comparison. In addition, some posts questioned whether potential HIV vaccines could be comparable to COVID-19 vaccines in terms of cost and accessibility during rollout. Others raised concerns about efficacy, safety, and inequality for both vaccines. The third major subtopic, comprising 26.5% (265/1000) of the posts, connected COVID-19 vaccines with HIV. One issue discussed was whether COVID-19 vaccines contained, caused, or increased HIV. Another issue raised was distinguishing between HIV symptoms and COVID-19 vaccine side effects, such as a fabricated condition called VAIDS , short for vaccine-acquired immunodeficiency syndrome. The fourth major subtopic, comprising 13.6% (136/1000) of the posts, featured conspiracy theories that presented hypothesized patterns linking COVID-19, HIV, and their vaccines with malicious intent. Prominent conspiracy theories in this subtopic included connecting misinformation that COVID-19 vaccines contain, cause, or increase HIV with the ongoing development of HIV vaccines; associating HIV and AIDS symptoms with side effects of COVID-19 vaccines; and claiming that COVID-19 originated from unsuccessful HIV vaccine research. As this study also manually coded the 1000 most engaged negative posts to identify prominent conspiracy theories, additional results pertaining to conspiracy theories will be discussed further in another subsection. The remaining posts related to HIV and COVID-19 included those that generally mentioned research on them or made connections without specifying details.

a mRNA: messenger RNA.

a The reaction count is the total number of likes and reposts.

b PrEP: pre-exposure prophylaxis.

c VAIDS: vaccine-acquired immunodeficiency syndrome.

d The categories labeled as “other” contain various topics. Thus, no representative post is displayed.

RQ 2 asked about the sentiment valence present in all the posts. According to the standard VADER classification values, valence is categorized by compound scores as follows: positive (0.05 to 1), neutral (−0.05 to 0.05), and negative (−0.05 to −1) [ 65 ]. On average, all posts had a marginally positive score of 0.053. HIV and COVID-19 (topic 1) had a slightly positive average score of 0.055. The mRNA HIV vaccine trials (topic 2) had a neutral average score of 0.040, leaning toward the positive side. HIV vaccine and immunity (topic 3) had a more neutral average score of −0.0008. Moreover, 42.78% (15,584/36,424) of the posts were positive, 25.64% (9338/36,424) of the posts were neutral, and 31.58% (11,502/36,424) of the posts were negative.

Topics and Valence Across Post Types

Of the 36,424 posts, 18,580 (51.01%) were replies, making up over half of the overall count. Self-composed posts totaled 41.6% (15,151/36,424), whereas the remaining 7.39% (2693/36,424) were quote posts. RQ 3 asked about the distribution of topics and valence among the 3 post types. As Table 3 shows, the distribution of topics varied by post type (N=36,424, χ 2 4 =2511.4, P <.001). Of the self-composed posts, 85.36% (12,933/15,151) focused on HIV and COVID-19 (topic 1) and 13.21% (2001/15,151) focused on mRNA HIV vaccine trials (topic 2). In comparison, quote posts and replies exhibited a different pattern, in each case >97% of posts centering on HIV and COVID-19 (topic 1; 2616/2693, 97.14% and 18,129/18,580, 97.57%, respectively).

As Table 4 shows, the distribution of valence also varied by post type (N=36,424, χ 2 4 =911.7, P <.001). The proportion of positive posts was slightly higher among self-composed posts at 44.95% (6810/15,151) compared to replies at 41.09% (7634/18,580) and quote posts at 42.33% (1140/2693). Self-composed posts had a smaller proportion of negative posts at 23.56% (3570/15,151) compared to replies at 37.64% (6994/18,580) and quote posts at 34.83% (938/2693). The proportion of neutral posts was larger for self-composed posts at 31.49% (4771/15,151) compared to quote posts at 22.84% (615/2693) and replies at 21.27% (3952/18,580).

Regarding the distribution of topics and valence among the 3 types of posts, quote posts and replies displayed similarities, whereas self-composed posts diverged. Compared to self-composed posts, which initiate new conversations, there was a higher proportion of HIV and COVID-19-related posts (topic 1) and a greater proportion of negative posts among quote posts and replies, which contribute to existing conversations.

a N=36,424, χ 2 4 =2511.4, P <.001.

b mRNA: messenger RNA.

a N=36,424, X 2 4 =911.7, P <.001.

Content and Account Features Influencing User Reactions

RQ 4 asked about the influence of content and account features on likes and reposts.

Liking is more common than reposting. While 52.94% (19,284/36,424) of posts received an average of 24.83 likes, ranging from 1 to 102,843, a total of 25.13% (9155/36,424) posts received an average of 11.38 reposts, ranging from 1 to 10,572. Table 5 reveals the influence of content features (topics and valence) and account features (verification status and follower count) on the natural log-transformed number of likes and reposts. Both linear regression models were significant at P <.001. The adjusted  R 2 was 0.072 for the like model and 0.090 for the repost model.

Among the 3 topics identified using LDA, HIV and COVID-19 (topic 1) did not affect like counts but decreased repost counts. In comparison, mRNA HIV vaccine trials (topic 2) decreased like counts while increasing repost counts. Positive valence increased like and repost counts. Account verification status and follower count increased like and repost counts.

a The natural logarithm, ln (Y i +1), was calculated on like and repost counts. This transformation was conducted to include posts receiving 0 likes and reposts, as well as to account for the skewness of the data distribution.

b F (model significance): P <.001; adjusted R 2 =0.072.

c F (model significance): P <.001; adjusted R 2 =0.090.

d mRNA: messenger RNA.

e The models excluded topic 3 on HIV vaccine and immunity to address multicollinearity issues arising from its correlations with topics 1 and 2. The reported standard β for topic 3 represents a possible β value if it had been included in the models.

Posts With Most Reactions

Table 6 summarizes posts ranked within the top 5 for the number of likes and reposts presented in chronological order. It is worth noting that all posts in the top 5 for likes and reposts were self-composed. One particular post, which garnered the most likes (n=102,843) and reposts (n=10,572), expressed the incredible feeling of witnessing the development of an HIV vaccine within our lifetimes. It was posted by an unverified account on January 28, 2022, the day after Moderna’s announcement of clinical trials for its first mRNA HIV vaccine.

a Ranks beyond the fifth were not indicated.

Anti–HIV Vaccine Conspiracy Theories

RQ 5 asked about prominent anti–HIV vaccine conspiracy theories. Of the 1000 negative posts that received the most reactions, 227 (22.7%) contained conspiracy theories. As Table 7 shows, we classified these prominent anti–HIV vaccine conspiracy theories into 4 categories and presented their representative posts and the number of reactions.

The first category, comprising 44.9% (102/227) of the posts, formulated conspiracy theories by connecting COVID-19, COVID-19 vaccines, HIV, and HIV vaccines. For instance, 52.9% (54/102) of these posts connected the misinformation regarding COVID-19 vaccines containing, causing, or increasing HIV with the ongoing efforts to develop HIV vaccines. This misinformation may have arisen from past occurrences resurfacing following Moderna’s initiation of its mRNA HIV vaccine trials. One incident occurred at the end of 2020, when an Australian COVID-19 vaccine, which used a small fragment of protein from HIV to clamp SARS-CoV-2’s spike proteins, was abandoned due to false HIV-positive results [ 70 ]. Another incident occurred in October 2020, when 4 researchers sent a letter to a medical journal expressing concerns about the potential increased risk of HIV acquisition among men receiving COVID-19 vaccines using adenovirus type-5 vectors without supporting data from COVID-19 vaccines [ 71 ]. The misinformation typically interpreted the incidents out of context and generally suggested that COVID-19 vaccines contained, caused, or increased HIV without specifying details. In addition, there were conspiracy theories linking HIV and AIDS to COVID-19 vaccine side effects, including a fabricated condition known as VAIDS. VAIDS falsely suggests that COVID-19 vaccines caused immune deficiency [ 72 ]. Furthermore, there were claims that COVID-19 originated from unsuccessful HIV vaccine research.

The second category, comprising 38.3% (87/227) of the posts, suggested that the alignment of concurrent events with Moderna’s start of mRNA HIV vaccine trials in late January 2022 was intentional to manipulate the market for HIV vaccines. These events included the rising HIV discussion and fear; promotion of HIV tests by public figures [ 73 ]; the discovery of a new highly virulent HIV strain [ 74 ]; and the passing away of HIV researchers, including Luc Montagnier, codiscoverer of HIV with an antivaccine stance during the COVID-19 pandemic [ 75 ], all occurring in early February 2022.

The third category, with 11.5% (26/227) of the posts, revealed conspiracy theories based on the distrust of powerholders [ 76 ]. Some posts extended existing conspiracy theories, such as the Big Pharma conspiracy theory [ 50 ] and the New World Order conspiracy theory [ 51 ], into the context of HIV vaccines, emphasizing the intent of powerholders, including major pharmaceutical companies and governments, behind vaccine promotion for financial profits and society control. Other posts created conspiracy theories about the government’s research on HIV vaccines. The remaining posts generally stated that HIV vaccines were a scam. The final category comprised the remaining 5.3% (12/227) of the posts with other conspiracy theories.

It is worth noting that, of the 227 posts containing conspiracy theories, 39 (17.2%) were posted by accounts that had already been suspended at the time of manual coding. For these posts, the X platform displays the following message—“This post is from a suspended account”—and the content of the post is not visible. The X platform suspends accounts that violate its rules [ 77 ]. However, specific details of the violations are not accessible on the platform. The invisibility of these posts halted their spread when the suspension was enacted. For our manual coding of these posts, we used the text obtained during the data collection process.

b The posts were from suspended accounts.

d The categories labeled as “other” contain various conspiracy theories. Thus, no representative post is displayed.

Principal Findings

This study investigated the patterns of public discourse and the message-level drivers of user reactions on the X platform regarding HIV vaccines through the analysis of posts using machine learning algorithms. We examined the distribution of topics and valence across different post types and assessed the influence of content features (topics and valence) and account features (account verification status and follower count) on like and repost counts. In addition, we manually coded the 1000 most engaged posts about HIV and COVID-19 to understand the salient aspects of HIV vaccines related to COVID-19 and the 1000 most engaged negative posts to identify prominent anti–HIV vaccine conspiracy theories.

The results revealed that COVID-19 plays a substantial role as a context for public discourse and reactions regarding HIV vaccines. Of the 3 topics identified using LDA, the leading topic was HIV and COVID-19, covering 78% of tokens and dominating in 92.46% (33,678/36,424) of the posts. Furthermore, on each of the top 4 days with the highest post counts, most of the posts were about HIV and COVID-19. This comprehensive topic included important subtopics that linked HIV vaccines with COVID-19 vaccines, as demonstrated through the manual coding of the 1000 most engaged posts about HIV and COVID-19. These subtopics encompassed the reciprocal influence of HIV vaccines and COVID-19 vaccines in advancing each other’s development; comparisons in their development speed; inquiries about the possible alignment of HIV vaccines with COVID-19 vaccines in terms of cost and accessibility during distribution; and concerns about efficacy, safety, and equality for both vaccines.

COVID-19 positioned HIV vaccines in both a positive and negative context. On the one hand, the success of mRNA technology in COVID-19 vaccines [ 6 ] potentially cast mRNA HIV vaccines in a positive light. The topic of HIV and COVID-19 had a marginally positive valence score of 0.055. Moreover, 3 (60%) out of the 5 most liked posts and 2 (40%) out of the 5 most reposted posts expressed excitement about advancements in HIV vaccines that were based on the experience with COVID-19 vaccines. On the other hand, antivaccine discourse, including conspiracy theories, heated up during the COVID-19 pandemic [ 10 , 11 , 27 , 44 , 48 , 49 ], which posed challenges to HIV vaccines. Of the 1000 most engaged posts about HIV and COVID-19, a total of 136 (13.6%) featured conspiracy theories. Of the 1000 most engaged negative posts, 227 (22.7%) contained conspiracy theories, with 102 (44.9%) of them revolving around HIV and COVID-19. For instance, a prominent conspiracy theory connected the misinformation about COVID-19 vaccines containing, causing, or increasing HIV infection [ 55 ] with the initiation of clinical trials for mRNA HIV vaccines [ 4 , 5 ], implying a malevolent intent behind the deliberate connection. The results indicate that conspiracy theories tend to elicit an approach-oriented response, as evidenced by people engaging in liking and reposting, as opposed to an avoidance-oriented approach [ 39 ]. This underscores the need to intensify efforts to counter conspiracy theories in public health communication about HIV vaccines.

According to a study conducted by the Pew Research Center, irrespective of the subject matter, replies constituted the largest portion of original posts on X, followed by self-composed and quote posts [ 28 ]. Specifically, the number of replies was 3 times greater than that of self-composed posts. In this study, although replies constituted slightly more than half (18,580/36,424, 51.01%) of the posts, it is worth noting that the subject of HIV vaccines elicited a higher proportion of self-composed posts at 41.6% (15,151/36,424). Specifically, the number of replies was 23% higher than that of self-composed posts. Moreover, the topic of mRNA vaccine trials was most evident in self-composed posts compared to replies and quote posts. In comparison, there was a higher proportion of focus on the topic of HIV and COVID-19 and a greater proportion of negative posts among quote posts and replies, which contribute to existing conversations. This suggests that users were more likely to initiate new conversations rather than joining existing conversations about mRNA HIV vaccines. In contrast, they were more likely to join existing conversations rather than starting new conversations about HIV and COVID-19. In addition, users were less likely to initiate new conversations negatively but more likely to contribute negatively to existing ones.

As the primary topic, HIV and COVID-19 had no impact on like counts but had a negative impact on repost counts. In comparison, the topic of mRNA HIV vaccine trials had a negative impact on like counts and a positive impact on repost counts. The results should be interpreted while considering that, as revealed in previous research [ 16 , 34 ] and this study, most posts on the X platform are unlikely to receive likes and even less likely to receive reposts. In this study, among the total of 36,424 posts, approximately half (n=19,284, 52.94%) received likes, and approximately one-quarter (n=9155, 25.13%) received reposts. To include all posts and mitigate the data distribution skewness in the linear regression analysis, we applied the “plus one” technique. This involved adding a constant value of 1 to all like and repost data points before taking the natural logarithm. Although most posts were not liked or reposted, it is noteworthy that the topic of mRNA HIV vaccines led to an increase in repost counts, highlighting its positive influence on social sharing. In addition, 2 (40%) out of the 5 most reposted posts were about mRNA HIV vaccine trials. These results correspond to the findings of previous research that suggested the diffusion of novel useful information [ 12 , 16 , 32 , 36 ].

The overall valence of the posts about HIV vaccines was marginally positive. The positivity aligns with the positive sentiment found in posts on X about vaccines in general [ 13 - 15 ] and COVID-19 vaccines in particular [ 12 , 16 , 17 ]. However, the positivity about HIV vaccines was not apparent as the average score of 0.053 placed it on the edge of the neutral range, which goes from −0.05 to 0.05 according to the standard VADER classification values. Positive sentiment had a favorable impact on like and repost counts, partially consistent with findings of previous research on COVID-19 vaccines [ 16 ]. The post that achieved the most likes conveyed the incredible feeling of witnessing the development of an HIV vaccine in our lifetimes. This could be attributed to the psychological rationale that social transmission of positive content fulfills people’s motivation to present a positive image [ 35 , 37 ]. In alignment with the findings of previous research [ 13 , 16 , 34 ], account verification status and follower count increased like and repost counts.

This study has implications for public health communication related to HIV vaccines and potentially other vaccines. Given the massive scale of the COVID-19 vaccination campaign, it is understandable that people will draw comparisons with other vaccines. Topic modeling identified HIV and COVID-19 as the primary topic, and manual coding revealed various intertwined aspects. Leveraging the advantages observed in the COVID-19 vaccine campaign, such as its widespread accessibility, could be valuable. Furthermore, addressing common concerns such as efficacy, safety, and inequality could also prove beneficial.

In the case of HIV vaccines, it is essential to tackle concerns associated with COVID-19 vaccines, especially those related to HIV vaccines. A major subtopic of HIV and COVID-19 involved suspicions about COVID-19 vaccines containing, causing, or increasing HIV. Another major subtopic was the confusion between HIV symptoms and the alleged side effects of COVID-19 vaccines, such as VAIDS. Misinformation concerning both subtopics has been woven into conspiracy theories, further complicating this situation. To combat misinformation and conspiracies that have these elements, efforts could focus on promoting evidence-based factual information [ 45 - 47 ].

Another notable technique in the conspiracy theories was linking concurrent COVID-19 and other HIV-related events in unsubstantiated relationships to create false perceptions, suggesting that these events were intentional to manipulate the market for HIV vaccines. These HIV-related events included rising HIV discussion and fear, promotion of HIV tests by public figures [ 73 ], the discovery of a new highly virulent HIV strain [ 74 ], and the passing away of HIV researchers, all occurring in early February 2022. These findings suggest that refuting false connections among such concurrent events can be an effective strategy to counter these conspiracy theories [ 45 - 47 ]. These occurrences, frequently entwined within conspiracy theories, could be specifically addressed in public health communication efforts.

Limitations

This study has several limitations. Because we used autoidentified content features (topics and valence) and autoextracted account features (verification status and follower count) in the regression models to predict the autoextracted number of user reactions (likes and reposts), the results were mostly limited to the examined autoidentified and autoextracted factors. For instance, political polarization, which manifested in a wide range of issues, including response to vaccines [ 78 ], could be a factor worth investigating in future studies. Furthermore, manual coding of conspiracy theories revealed a prevalent technique of twisting concurrent events into false relationships. This underscores the significance of refuting unfounded associations among these incidents to counter such conspiracy theories. It will be interesting for future research to assess the impact of this technique on user reactions to conspiracy theories. These findings could provide further insights into public health communication strategies to combat conspiracy theories.

Conclusions

The results highlight COVID-19 as a significant backdrop for public discourse and reactions on the X platform regarding HIV vaccines. COVID-19 situated HIV vaccines in both a positive and negative context. The success of mRNA COVID-19 vaccines shed a positive light on HIV vaccines. However, COVID-19 also situated HIV vaccines in a negative context, as evident in anti–HIV vaccine conspiracy theories falsely linking HIV vaccines to COVID-19. The findings provide implications for public health communication strategies concerning HIV vaccines.

Acknowledgments

This study was supported in part by the College of Arts and Sciences and the Harrington School of Communication and Media at the University of Rhode Island. The authors express their appreciation for the support. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Data Availability

The data sets collected and analyzed during this study are available from the corresponding author upon request.

Conflicts of Interest

None declared.

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Abbreviations

Edited by G Eysenbach; submitted 04.10.23; peer-reviewed by X Ma, J Zhang; comments to author 18.10.23; revised version received 08.11.23; accepted 28.02.24; published 03.04.24.

©Jueman M Zhang, Yi Wang, Magali Mouton, Jixuan Zhang, Molu Shi. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers

Deema farsi.

1 Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people’s lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world.

This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs.

A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients’ perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use.

The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues.

Conclusions

Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important.

Introduction

A key characteristic of being human is the ability and desire for social networking. Over the ages, humanity has thrived in social communities in which members shared knowledge, opinions, and experiences, empowered by a sense of belonging. As the world continues to advance in terms of technology, social media (SM)—defined as “a group of Internet-based applications (apps) that allow the creation and exchange of user-generated content”—is becoming an essential part of billions of people’s lives worldwide and is affecting almost every industry imaginable [ 1 ]. The definition of SM (the “read, write web,” “Web 2.0,” or “social networking”) is constantly evolving [ 2 ]. The Merriam-Webster Dictionary defines it as “any form of electronic communication through which users create web-based communities to share information, personal messages, ideas, and other content such as photos and videos” [ 3 ]. SM is considered one of the most powerful communication tools of the 21st century. There has been a proliferation of SM tools in recent years, creating new opportunities to communicate, connect, create, and share information, without requiring exceptional coding skills to create or retrieve content [ 4 ].

Specifically, SM is increasingly becoming an augmenting tool in health care by enabling its users to acquire and share information; connect with others in the field; and communicate with colleagues, patients, or the public regarding health topics. Furthermore, SM supports patient empowerment by expanding the knowledge of the patients and placing them in a position where they can take control of their own health care needs [ 5 ]. This review is based on numerous studies and reviews that have investigated the different uses of SM in health care and its limitations and shortcomings. Consequently, this narrative is comprehensive and up to date, including the recent use of SM during the COVID-19 pandemic. The topic is relevant in today’s scenario because the use of SM and social networking sites (SNSs) is increasing worldwide, especially in the health care industry. The findings presented in this review have strong implications for health care professionals, educators, and researchers.

This review aims to shed light on SM use worldwide and discuss how SM has been an essential tool in the health care industry from the perspective of health care providers (HCPs). The review will be continued in Part II, where the use of SM from the perspective of patients will be discussed.

Search Strategy and Information Sources

Between March and April 2020, a comprehensive search on 4 databases (MEDLINE, PubMed, Google Scholar, and Web of Science) was conducted for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. A combination of the following keywords was used to search for titles and abstracts: “social media” (MeSH term) OR “social networking” OR “internet” (MeSH term) OR “WhatsApp” OR “Instagram” OR “Facebook” OR “YouTube” OR “Twitter” OR “LinkedIn” AND “healthcare” OR “health” (MeSH term) OR “medicine” (MeSH term) OR “physician” (MeSH term) OR “nursing” (subheading) OR “dentistry” (MeSH term) OR “telemedicine” (MeSH term), “recruitment” OR “education” (subheading) OR “career” OR “behavior” (MeSH term) OR “research” (MeSH term). Each of the 9 words in the first set was separately searched with each of the 12 words in the second set using “AND.”

Screening Process

The articles were entered into an EndNote library, and duplicate publications were removed. Articles published before 2007 were excluded, as the words social and media at that time did not represent the current definition of SM. Titles and abstracts were assessed for eligibility. Studies that were not in English were excluded, along with those with inaccessible full text after unsuccessful attempts to access them. Irrelevant studies, such as studies that were not related to health care, studies whose primary outcome was not the use of SM in health care, or studies that discussed the negative impact of SM on health, were also excluded. Dissertations were also excluded from the study. The full texts of the studies were then appraised. Several relevant studies investigating SM use from patients’ perspectives were found. Reviews on legal and ethical issues pertaining to the use of SM in health care were also obtained, following which, the publications were divided into 4 groups: HCP , patient or the public , ethics and legal considerations , and shortcomings . A decision was made to defer reviewing the last 3 groups and focus on this review on SM use by HCPs.

Categorization

After accessing the complete texts of the articles of interest, their reference lists were searched for additional studies, and the cited studies were also located. Thereafter, the articles were comprehensively reviewed. On the basis of the key findings, articles were initially grouped as follows: sharing information , recruitment , education , and marketing . As the review proceeded and more information was obtained, the groups were modified. Sharing information was divided into 2 groups: health promotion , focusing on HCPs sharing scientific information with the public, and critical public health care issues , which focuses on health announcements in crisis, especially COVID-19–related publications that warrant special attention. Recruitment was also divided into 2 groups: recruitment , which included job employment and residency program enrollment, and scientific research , in which studies discussed recruiting research participants and analyzing SM data. Education was renamed professional medical education , as this name specifies medical education. Studies related to continuous education were added to marketing , and the group was renamed career development and practice promotion . Another group was created— professional networking and destressing —which included findings from sharing information that discussed peer-to-peer communication and those from education that did not reflect professional education or career development. Finally, an additional group was created, telemedicine , as studies on this subject were abundant.

Summary and Characteristics of Included Studies

The search yielded 5683 titles that were scanned with their abstracts. After exclusion of duplicates and noneligible studies, the initial sample comprised 73 publications. The full-text papers were retrieved. Additional studies from the article references or those emerged from the review but were not identified earlier were also added. This was because of variation in the keywords with respect to spellings (eg, behavior and behaviour), terminology (social networking and social network), and synonyms (eg, recruitment and employment) that were not accounted for in the initial search. A total of 142 articles (63 original studies) and 3 textbook chapters were reviewed ( Figure 1 ).

Flowchart of the selection procedure.

The studies were conducted in the United States (61), Canada (12), Brazil (2), the United Kingdom (12), Europe (22), the Middle East (9), India (9), Asia (8), and Australia (7). The earliest study was published in 2008, and the latest studies were published in 2020, with most of them being published after 2014 ( Figure 2 ).

Number of included publications per year.

SM Platforms

Most reviews discussed SM in general and did not specify a particular platform; however, some original studies investigated specific platforms. The platforms investigated were WhatsApp/WeChat (15), Facebook (8), Twitter/Weibo (9), YouTube (4), Instagram (1), LinkedIn (1), Podcast (1), and Wikipedia (1).

Medical Specialties

Some reviews discussed SM use in a particular medical specialty, whereas others reviewed studies from diverse or unspecified specialties. Researchers from a variety of medical specialties investigated SM use in their original studies. These specialties were surgery (1), plastic surgery (4), neurosurgery (1), maxillofacial surgery (2), medicine (2), emergency medicine (2), psychiatry (3), orthopedics (3), otolaryngology (1), immunology (2), dermatology (1), radiology (1), urology (2), anesthesia (1), cardiology (1), pediatrics (1), oncology (3), nursing (5), dentistry (11), and pharmacy (1).

Principal Findings

This literature review aimed to examine SM use in the modern world and how it has been recently incorporated into health care. Most of the reviewed articles were published in the past decade, suggesting that this review is both relevant and contemporary. It is evident from the published studies that SM has broad applications in modern health care. As discussed in the subsequent sections, HCPs (the term is used in this review as including physicians, dentists, nurses, medical and dental allied personnel, and health care organizations) not only use SM to provide care to their patients but also for personal development and destressing.

SM use is one of the most common web-based activities, with an estimated 2.9 billion users worldwide as of 2019, a number that is projected to increase to 3.4 billion by 2023 [ 6 ]. With this, digital networking has witnessed a massive growth, and social communities have become boundless. Facebook, Twitter, Instagram, WhatsApp, and Google are relatively new platforms, but they are being used every day by millions of people worldwide. SM platforms are among the most commonly used sources for acquiring and disseminating information [ 7 , 8 ]. They are not only used for socialization, knowledge acquisition, and entertainment, but they have also been linked to significant political events led by young users [ 2 ].

Many SM tools have been introduced, and they continue to evolve. They may be categorized as tools for social networking (eg, Facebook and Instagram), professional networking (eg, Doximity and Sermo), media sharing (eg, YouTube and WhatsApp), content production (eg, Twitter), and blogs [ 9 ].

In terms of technological knowledge, SM users belong to 1 of the following 2 groups, as classified by Prensky [ 10 ]: digital natives and digital immigrants. Digital natives are those born after 1980, who are skilled in using technology, and who rely heavily on technology and social networking. Most digital natives were introduced to technology at an early age. Conversely, digital immigrants are those who acquired technological skills and adopted technology later in their careers [ 9 ]. SM use is generally high among digital natives, who explicitly prefer it over traditional media [ 11 ]. Some researchers believe that there is no dichotomous divide between internet users and nonusers. Although the terms are commonly used, Prensky’s model and its usefulness have been challenged [ 12 ]. First, basic digital skills are not difficult to acquire, especially with repetitive use. With practice, a person born in the 1960s can become as digitally fluent as a millennial. Second, the distinction between both generations implies that digital immigrants can never completely acquire digital abilities and that digital natives are automatically technologically skilled. This approach is neither scientific nor based on any empirical evidence. Third, the model overlooks the fact that age is not the only factor in determining digital skills. Socioeconomic and cultural factors of digital capability must not be ignored. For instance, a millennial who lacks access to technology is not a digital native.

Regarding SM demographics, its use is prevalent across all ages and professions [ 13 ]. However, different SM platforms differ in their demographics. The demographics of some of the most commonly used SM platforms worldwide can be further explored. Facebook has 2.7 billion monthly active users. According to a 2020 report, the highest number of Facebook users were aged between 18 to 29 years and 30 to 49 years, with more female than male users and more urban than suburban or rural users [ 13 ]. India had the largest number of users, followed by the United States, Indonesia, and Brazil. Regarding Instagram, there are 1 billion users globally. As of August 2020, there were more female than male users, and the United States had the highest number of users [ 13 ]. Users aged between 25 and 34 years represented the largest group of users [ 14 ]. Twitter had over 330 million users, who were predominantly male [ 13 ]. The top 3 countries for Twitter use were the United States, Japan, and India [ 13 ]. Approximately 30% of all users were aged between 25 and 34 years [ 15 ]. The Chinese Twitter-like SM platform is Weibo, and it had an estimated 480 million users [ 16 ]. WhatsApp is a mobile messaging app that is used by 2 billion users in 180 countries and in 60 different languages [ 17 ]. WhatsApp is more commonly used by younger people [ 17 ]. WhatsApp’s direct Chinese competitor is WeChat, and it has about 1.17 billion users [ 18 ]. YouTube is commonly used worldwide, particularly in the United States. It is estimated that it has approximately 2 billion users. The users are more commonly male than female, and its use is prevalent in urban, suburban, and rural locations [ 13 ]. Finally, there were about 46 million students and recent college graduates on LinkedIn out of 675 million users [ 19 ]. Male users constituted 67% of the total users, and the United States had the highest number of users, followed by India, China, and Brazil.

Although most SM platforms share common features such as free registration, public and private communication, and fast content upload and retrieval, each platform is unique and has distinctive uses. It is common for users to have different accounts across multiple platforms, using each platform for different purposes. Facebook is an SNS that can be accessed from any internet-enabled device, such as personal computers and smartphones. Registration on Facebook is free, and users can create a profile that reveals selective information about themselves [ 20 ]. Users can post text, photos, and multimedia that become available to any user in their friend list . Users generally begin by adding family members and friends to their friend list, which can be expanded to include colleagues, acquaintances, and strangers with or without common interests. Apart from being able to share public comments and likes , a few years after Facebook was founded, a messaging feature was added that allows users to send private messages to individuals and groups. Users can use a variety of embedded apps; join and create groups and pages ; play games; and receive updates regarding the activities of their friends, pages, and groups. Although the platform was initially limited to students in certain American universities, Facebook now has users worldwide. Instagram is a newer SM platform owned by Facebook and is designed primarily for free photo and video sharing [ 21 ]. By modifying their privacy preferences, Instagram users can opt to have either public accounts or limit their content to users that they accepted as followers . The platform also allows viewing, commenting on, and liking posts shared by users that they follow as well as private messaging between users. WhatsApp, which was acquired by Facebook in 2014, is a text and voice messaging app that has become incredibly popular owing to its features, flexibility, and compatibility with various phone and computer operating systems [ 22 ]. Although a free service, WhatsApp allows exchange of messages and calls on both desktop and mobile devices, in addition to media sharing and group features. WhatsApp’s objective was to provide an alternative to SMS. Using WhatsApp, billions of users across the globe can simultaneously and instantly connect with others.

“Twitter is what’s happening in the world and what people are talking about right now”—this is how Twitter describes itself [ 23 ]. It is a microblogging platform that allows users to post and access short text, image, or video posts called tweets. Although tweets were originally limited to 140 characters, the limit was increased to 280 characters in 2018, along with permitting the sharing of website links and multimedia. Twitter’s mission is to provide users with the ability to create and share ideas and information instantly and without barriers. Users follow other personal, official, or organizational accounts. They can either create their own tweets or retweet those by others to their followers. YouTube is a web-based video-sharing platform that allows users to upload, view, share, rate, report, comment on videos, and subscribe to other users [ 24 ]. Its mission is to provide users with a voice through video sharing, stemming from the belief that the world would be a better place when people listen, share, and build a community through their stories. The name of this platform is straightforward: You represents content that is user-generated and not created by the site itself, and Tube is an older term for television. Most YouTube content is uploaded by individuals, but some media corporations have established partnerships with YouTube to offer some of their materials on this platform. LinkedIn, acquired by Microsoft in 2016, is a business and employment-oriented SM service that operates as both a website and mobile app. LinkedIn is mainly used for professional networking, allowing employers to post about job openings and seekers to share their curricula vitae [ 25 ]. Using the platform, users can build strategic professional relationships rather than expand their friend circle. LinkedIn’s vision is to provide professional opportunities to its users, and its mission is to connect professionals worldwide. It originated in the living room of one of its cofounders a year before its launch in 2003. LinkedIn today has a diversified business model that has generated successful recruitments.

SM users have claimed that they have more digital friends and connections than real-world ones, which highlights the transformation of the ways in which people connect with each other and the importance of web-based relationships in today’s world [ 26 ]. Over time, social networking platforms have targeted different age cohorts, making SM use widespread among the general population. For example, as of April 2020, men aged between 25 and 34 years constituted the largest demographic group of Facebook users, and those aged 65 years and older were the fastest-growing group [ 27 , 28 ]. Similarly, the largest group of Twitter users were people aged 25 to 34 years, whereas 15% of users were older than 50 years [ 15 ].

The public attitude toward SM use has drastically changed over the years as it became more accessible and diverse in its offerings. Consequently, SM has become a universal communication channel, and responses in reality and on the web have increasingly become intertwined and concurrent [ 29 , 30 ]. Furthermore, SM offers lucrative opportunities to disseminate information and thoughts directly to the public, share experiences, build communities, and connect people with common interests, something unthinkable 20 years ago [ 31 ].

SM Use in Health Care

The more digitally oriented the world becomes, the more the health care industry visualizes SM as an important channel for health care promotion, employment, recruitment of new clients or patients, marketing for HCPs, and building a captivating brand name. HCPs have realized that SM is not just a platform to post vacation photos and interact with followers. Perhaps the 4 most common areas where SM plays a major role in the health care industry are health promotion, research, marketing and branding for individuals and practices, and recruitment. It has been evident that web-based content can be spread to offline environments, such as classrooms and meeting rooms. Furthermore, SM has undeniably changed patient-practitioner relationships because of patients’ better understanding of health information and their more active role in health maintenance [ 32 ].

The effect of behavioral and social factors on health outcomes has evolved significantly in recent decades [ 33 ]. HCPs continually search for new and more efficient methods to reach larger populations, especially those who were inaccessible via traditional methods. It is incumbent upon them to use every available tool to reach their intended audience. Thus, HCPs and health organizations should capitalize on the opportunities provided by SM and update strategies to reach communities and age cohorts at a relatively low cost [ 7 , 34 ]. In other words, SM brings a new dimension to health care and is changing the nature and speed of health-related interactions between individuals and health organizations. For example, communicating through photos and videos along with text is part of the mobile revolution, and messaging apps are now regarded as a viable medium for sharing knowledge and discussing clinical cases [ 35 ]. In summary, using SM could be a key strategy in addressing some of the challenges and limitations often faced by HCPs in traditional health communication through faster and cheaper dissemination, more accessibility, better interaction, and increased patient empowerment [ 7 ]. Moreover, information can now be easily brought to audiences with special needs or low literacy [ 36 ].

In the fast-paced modern world, time constraints are common in medical practice, and when combined with the demands of individuals with chronic conditions or unplanned emergency situations, it is challenging for HCPs to dedicate extra time to patients. SM can provide efficient and easy-to-use platforms that encourage patient-practitioner interaction and facilitate necessary actions from both ends [ 37 ]. In fact, as of April 2018, there were more than 200,000 health apps, including social networks for people living with a specific medical condition; approximately 19% of smartphone users have at least one health app on their phones [ 38 ]. Furthermore, in a 2013 survey of more than 4000 physicians, 65% stated that they used SM for professional reasons [ 39 ]. SM use has not been limited to HCPs. Patients have also incorporated SM in their daily lives, which encourages HCPs to explore different ways of making their mark in this growing market [ 31 ].

Technology is evolving very rapidly [ 40 ]. Competition produces better services, and the diversity of options enables users to choose a tool that best matches their individual needs. Although different platforms often have different target demographics, audience overlapping may occur and should be considered by health organizations when devising their SM health promotion strategies. In health care, SM tools can be used for different purposes (health promotion; dissemination of health information; education; professional development; recruitment; communication with the public, colleagues, and patients; and research) and in diverse medical specialties (cardiology, nursing, radiology, dentistry, surgery, pathology, pediatrics, pharmacy, emergency, and critical and palliative care) [ 41 ]. As of August 4, 2020, 27,546 results appeared when searching for social media on PubMed, demonstrating the growing interest in SM within the health care industry.

Health care systems, especially in times of crisis and outbreaks, require the dissemination of information to practitioners, patients, and the general public rapidly and effectively [ 34 ]. Health organizations and officials, by taking upon a more active SM presence, gain access to vast global networks capable of quickly spreading information and promptly mobilizing large numbers of people toward public health goals [ 2 , 42 ]. Never before has the entire world united as it has in recent months in its fight against the disease caused by SARS-CoV-2, more commonly known as COVID-19. Searching COVID-19 on PubMed on August 4, 2020, yielded 37,576 results, which exposes the abundance of information and data that has become available in 7 months since the beginning on the pandemic [ 8 ]. However, the World Health Organization (WHO) has expressed concerns about fighting 2 battles at once: the pandemic and the infodemic —the latter refers to a rapid and far-reaching spread of both accurate and inaccurate information about the disease [ 43 ].

It is important to mention that the popularity of SM is directly linked to its many advantages. Advantages of using SM in health care include its expressive nature, accessibility from a smartphone, prompt content sharing and response generation, improved and two-sided communication, reduction of consultation time, smoothing of hierarchy, more efficient teamwork, ability to forge connections between people, and ability to reach large masses [ 44 , 45 ]. Furthermore, SM facilitates the access to health information for extended population groups, regardless of geographic location, age, or education, compared with traditional communication methods [ 41 ]. However, the most influential advantage of SM remains its cost-benefit feature: it can reach an increasing number of people without the high cost of traditional means and the information remains available 24 hours a day, 7 days a week.

Similar to most technologies, SM has its disadvantages. In the health care industry, these include increased workload, risk of unprofessional behavior, disparity in the sense of urgency, a demanding sense of needing to stay connected 24 hours a day, difficulty in obtaining discussion records, worries about leading to or identifying patients, privacy breech, change of patient-practitioner relationship from a professional to a personal one, and the risk of reducing the autonomy of junior doctors [ 45 ]. Those who choose to use SM should be aware of the potential risks and problems that they could encounter but should not shy away from using SM because it can greatly increase the reach and impact of HCPs’ work and improve patients’ health [ 34 ]. In the following section, the specific uses of SM in health care are discussed in more depth.

SM Use From the Perspective of HCPs

The literature review yielded an abundance of information. The studies were categorized as follows to best present the findings: health promotion, career development or practice promotion, recruitment, professional networking and destressing, professional medical education, telemedicine, scientific research, and critical public health care issues.

Health Promotion

Producing and disseminating information has played a pivotal role in the history of humanity. Over the years, an increasing number of public health organizations, medical institutes, and HCPs are using SM tools to disseminate visually rich public health messages to the general public. The primary goal is to share solid, evidence-based, and up-to-date health information that educates and affects millions of SM users and to dispel common misconceptions and counterbalance inaccurate material rapidly spreading through SM [ 2 , 32 ]. Examples of how SM can increase the accessibility of a massive number of recipients to health care information around the world include concise educational tweets on Twitter, a pediatric dentistry group on Facebook where fellow specialists discuss anonymized cases and share ideas, photos of a salvation mission to an underprivileged community on Instagram, and the results of a clinical study broadcasted via WhatsApp. These are all examples of how SM can not only increase accessibility, but it can do so at a faster rate than any other means, and perhaps in the cheapest way possible.

Access to oral health care services is limited by a lack of universal coverage. SM, which is a method of mass communication, offers an alternative to traditional communication, which extends to reach underprivileged and underserved communities. The WHO and the United States Centers for Disease Control and Prevention (CDC) are among many other public health institutions that use SM to communicate with the public during public health crises and natural disasters [ 8 , 29 , 35 ]. Physicians also use SM to promote patient health care education on a smaller scale within their networks. Research has shed light on the many tools that have been used for this purpose. For example, HCPs can tweet, record videos, and participate in health-related discussion forums, which provides an opportunity for physicians to share scientific information and broaden their knowledge [ 46 , 47 ]. Furthermore, information from international conferences and findings from the latest research and clinical trials can be presented in mainstream media to be shared with millions of people [ 48 ].

Sharing such information not only helps improve knowledge but can also improve attitudes and practices related to health. For example, in dentistry, SM has played a role in helping patients cope with challenges such as dental anxiety and in presenting dental management options in a convenient and nonthreatening manner [ 42 , 49 ]. Evidence now shows that SM-based interventions are linked to healthy practices such as tobacco cessation, increased physical activity, and diversion from risky sexual behaviors [ 39 , 50 ].

In conclusion, there is evidence that SM helps to improve access to health information. When designing SM campaigns and interventions to disseminate health information, it is important to develop messages that may be more likely to resonate with and elicit reactions from individuals [ 2 ]. Messages tailored to certain population segments are more effective than generic messages, as tailored messages address the specific needs of their recipients [ 51 ]. Furthermore, interactive (two-way) communication is more effective than linear (one way) communication [ 7 ]. Importantly, SM must complement rather than replace traditional health promotion. More research is needed to investigate strategies that can increase access to health information for minorities and marginalized communities and for populations deprived of internet access.

Career Development or Practice Promotion

One of the measures of the success of HCPs is their ability to attract and retain patients. This will not only maximize income but will also boost reputation. SM has played an important role in enhancing practice or practitioner ranking on search engines, even more than academic pedigree and experience [ 52 ]. As search engines generally direct patients’ traffic, a strong presence on the web can be crucial to attract patients to a practice.

HCPs at all stages of their careers can use SM to brand their name. SM aids in developing their name, expanding their network, and learning about career-enhancing opportunities [ 53 ]. It can also be used as a marketing strategy to attract patients of various demographics and has been proven to be effective in engaging and obtaining new patients [ 54 ]. In a survey conducted in 2013, 12.5% of health care organizations reported attracting new patients through SM [ 39 ]. Moreover, a 2012 study of dental practices in the United States revealed that 51% of the practices used SM, of which 91% used it for marketing purposes and 73% used it to increase their presence on the web [ 55 ].

With the extended use of SM among patients and HCPs, practitioners must now compete for patients’ attention and need to be strategic regarding the content they share and platforms they use [ 7 ]. HCPs should advertise their professional trajectories, areas of experience, and treatment outcomes by focusing on information tailored to the target audience in an educational manner that does not typify commodification or unfair competition. The eagerness to achieve popularity and to attract new customers or compete with colleagues results in some HCPs thinking only with a short-term approach and prioritizing greater financial gains. For example, some orthodontists and plastic surgeons post before-and-after photographs with drastic improvements without explaining that biological variations among patients, differences in response to treatment, and other external factors may affect the course and outcome of the intervention. Without such information, patients tend to have unrealistic expectations and end up being disappointed [ 56 ]. Unfortunately, some practitioners tend to digitally modify images to accentuate treatment-led improvements. This misuse of technology could lead to serious reputational damage for the practitioner and the profession in general in addition to unfavorable court decisions [ 56 ].

HCPs build their status using SM in diverse ways. They begin by creating a profile page on one or multiple platforms, which allows them to create and upload content. By connecting with colleagues, they can begin to establish a digital social network. Moreover, groups based on common interests further expand their social network and raise the practitioner’s name in bigger circles. These processes can create a haven for viral marketing, which can be leveraged to create a name, develop a digital voice, and disseminate health information in a timely and cost-efficient way [ 7 , 30 , 42 ]. Moreover, for newly qualified practitioners, contributing to discussions on forums and virtual meetings raises their profile among more experienced practitioners who may be geographically distant. This can leverage word-of-mouth referrals and attract fellow researchers to collaborate.

In terms of cost-effectiveness, a 2017 study on the SM return on investment (ROI) showed an upward trend that represented stable growth for Facebook, whereas Instagram demonstrated substantial ROI. It was concluded that SM resources were superior to standard internet-based resources. When all SM platforms were combined into one graph, there was a consistent finding of growth associated with all SM sources over time [ 57 ]. As the following quote summarizes, “physicians have to realize that our patients are doing it (SM), so this is where we need to be” [ 58 ].

In summary, there is no one-size-fits-all SM platform, and there is no single way to share content that is superior to all others. It is essential for an HCP to emphasize the importance of their specialty; present the strengths in their particular practice; understand the features and user demographics for SM platforms; and, most importantly, know their target audience. For example, a plastic surgeon or orthodontist may find it beneficial to share pre- and posttreatment or procedure photos of anonymized patients, for which Instagram may be the ideal platform. A practice that is community friendly may invest in a Facebook page to keep the audience updated on offers and services. A family medicine office may share announcements regarding the arrival of a flu-vaccine and post photos of staff members vaccinating themselves to motivate people. Twitter may be useful for posting specialty-related educational messages or sharing information on health-related matters to make HCPs more visible. A pediatric dentist may use YouTube to share videos of tricks used in the office to make the experience less threatening for children. More training courses and talks on how to leverage SM to establish a presence and build a name may be beneficial for HCPs who are not SM savvy.

Recruitment

SM is making great strides not only in the modern world of technology but also in the workplace: it is transforming the way people find and engage in work. It seems that the conventional channels for recruiting employees are not as effective as they once were. Instead, we are shifting toward SM not only as a platform for social interaction, photograph exhibition, and creative expression but also as a space for far-reaching, low-cost job searches. Regarding employment, the interest in SM is bidirectional. On the one hand, employers are often keen to know more about a candidate applying for a position than what is stated in their resumé. On the other hand, employees, especially millennials, will first want to know more about the dynamics of a firm and the personalities of their future boss and coworkers before they commit to the job. Recruitment in the medical field requires more than an application. In this section, the recruitment of HCPs for employment or students for residency programs is discussed.

Human capital is of major importance to any organization because humans produce income and are a source of competitive advantage [ 59 ]. Recruitment of qualified employees who are fit for the job is not a simple, one-way decision as it used to be. Performing due diligence in hiring a new employee is more essential than ever and is a multidimensional process, including at least one interview, drug screenings, and background checks. More recently, employers have turned to nontraditional methods and to SM to further analyze potential candidates [ 60 ]. SM prescreening may have the potential to offer information about the applicant above and beyond what is stated in the resumé and can be assessed in a more traditional screening [ 61 ]. For job seekers, because of the large number of SM users and the relatively low cost of setting up, SM platforms are ideal for finding employment. Furthermore, many organizations are now investing in SM to display their employer brand and, in return, attract qualified applicants [ 59 , 62 ]. Organizations aiming to attract applicants, especially in fields where competition and demand are high, such as in nursing, must make every effort to promote a unique brand image and attract potential candidates [ 59 , 63 ].

There is evidence that recruiters can accurately determine productivity-related traits solely on the basis of personal information about a candidate available on SNSs [ 64 ]. Baert [ 65 ] found that personal photographs have become more effective as objects of communication than of memory. This research described interesting theoretical mechanisms that underlie better labor market outcomes for more attractive people. For example, it proposed that self-confidence from good looks could drive productivity, leading to emotional stability, and, consequently, labor market success [ 66 ]. The study also found a higher impact of face pictures seen on Facebook’s profile photo compared with those attached to a resumé [ 65 ].

From a job seeker’s point of view, SM makes it possible to apply to hundreds of jobs, even globally, at once. Through SM, job applicants can increase their presence on the web to grab the attention of employers [ 60 ]. In the health care industry, it is advisable for job seekers to be active in various medical societies to expand their connections and to make a positive impression on future employers. Similar to the real world, it is advisable for applicants to attend virtual conferences and discussion boards and to introduce themselves to others at every reasonable opportunity [ 67 ]. It is important to note that employers do not use only professional platforms such as LinkedIn for hiring. In fact, they check many SM platforms when screening for prospective employees [ 60 ]. It is not a bad idea that employers and applicants conduct periodic searches for their own names to ensure that their SM persona projects a professional image [ 2 ].

Several studies have investigated the effects of SM on recruitment in health care. It was found that a hospital’s profile on SM can shape employer brand perceptions and attract nurses. In addition, nurses who visited the hospital’s Facebook page were more attracted to work there [ 59 ]. In another study, over 92% of employers stated that they were planning to use SM for recruiting [ 68 ]. Moreover, a study conducted in 2012 found that the recruitment and screening costs were reduced by 50% by using SM and that 65% of employers were evaluating the integrity and character of potential employees based on their SM profiles [ 60 ]. As shown in a review by Davison et al [ 61 ], a study found that 20% of the organizations surveyed were planning to use SM for applicant screening. Furthermore, LinkedIn was the most commonly used SM platform for screening applicants, whereas the use of Twitter for screening purposes increased from 11% to 31% between 2011 and 2013 [ 61 ]. Interestingly, a study found that there were 38% more job interview invitations to candidates with the most beneficial Facebook pictures [ 65 ]. In addition, a Microsoft survey revealed that 79% of employers searched for web-based information regarding prospective employees, but only 7% of the candidates were aware of this possibility [ 69 , 70 ].

Regarding residency programs, SM is a mechanism to accentuate the programs’ visibility on the web and to screen residency applicants [ 71 ]. It is important to note that it is not only credentials and high scores that secure a spot in a specialty program; personality traits and characters are becoming more significant than ever. Program directors (PDs) now want to know applicants on a personal level. As much of this information would be illegal to obtain in a traditional interview, they may search for it on SM [ 72 ]. Admission officers and PDs are now capitalizing on the abundance of information and the popularity of SM [ 72 ]. They may encounter content that seems unprofessional or exposes negative character traits that are useful in making decisions about applicants. Many residency programs now search Facebook and other personal SM platforms to screen applicants [ 73 ]. Even residents are now using SM platforms to obtain information on possible postgraduate opportunities [ 71 ].

There is an abundance of research on the use of SM for applicant selection in residency programs. In one study, 17% of PDs screened applicants on SM, 33% gave lower rankings to applicants based on SM findings, and 69% stated that they will continue to use SM for applicant screening [ 74 ]. In another survey, most school children who were interested in studying medicine felt that behaviors on SM should be considered for admission to medical schools [ 75 ]. Furthermore, a study conducted in 2016 found that 18% of PDs visited the SM profiles of residency applicants, 10% gave a lower rank or completely disqualified an applicant because of negative web-based behavior, and 10% took formal disciplinary action against a resident because of negative web-based behavior, with Facebook being the platform used by most PDs [ 76 , 77 ]. Another survey found that 97% and 90% of PDs agreed that candidates should be held accountable for illegal acts and unprofessional behavior on the web, respectively, whereas 89% of them agreed that information voluntarily published on the web is fair to use in judging character and professionalism. Furthermore, 82.4% of PDs indicated that they would favor the candidate with a sterile Facebook profile if they were choosing between 2 mock candidates [ 78 ]. Moreover, student pharmacists demonstrated a general attitude that web-based personas on SM should not be used to judge professional attitudes and abilities [ 79 ]. Although most medical school PDs believed that screening applicants on SM does not constitute a violation of the applicants’ privacy, the topic remains controversial and views regarding the appropriateness of using SM profiles to judge character and professionalism vary [ 78 , 80 ]. There is general agreement that SM information is open for judgment by others, especially among older PDs [ 78 ].

Professionalism is advocated by the American College of Surgeons as a quality that extends beyond the clinic, operating room, and hospital and into the community in the real world and on the web [ 81 ]. There are some issues associated with using SM to judge a possible employee’s or resident’s professionalism and character. First, screening is usually done by a single person without a standardized scoring rubric. Second, content is unstandardized among the different SM platforms, and the information displayed differs across platforms; for instance, it would not be fair to compare someone’s Facebook photo album of a Spring Break trip with someone’s contribution to a medical discussion on Twitter. Moreover, screening SM content showed poor test-retest reliability, especially as the content could change rapidly. Interrater reliability is potentially affected by the content being rated and the characteristics of the rater. Construct validity also seems to be weak as no specific construct is usually in mind; instead, a rater casually scans profiles to make a judgment on an applicant or screen potential new hires. Finally, there is a problem with generalizability across platforms. It is suggested that personality traits should be judged from platforms with flexible formats (eg, Facebook), whereas professional traits and experiences should be judged from more structured platforms (eg, LinkedIn) [ 61 ].

In summary, although e-professionalism is a new topic, it is receiving considerable attention from recruiters and is being taught as a part of medical curricula [ 76 , 79 , 82 , 83 ]. It is necessary in this age to educate job or residency candidates about their digital voice and persona management [ 65 ]. Job or residency candidates should consider their publicly available web-based information as an extension of their resumé and should be aware that many employees use SM to investigate applicants. Therefore, candidates should ensure that their public SM profiles include nothing unprofessional about themselves [ 65 , 67 ]. Finally, the establishment of clear and equitable guidelines for searching candidates on SM is essential to prevent potential bias.

Professional Networking and Destressing

Professional connections represent important channels through which HCPs exchange knowledge, share expertise, refer patients, seek a second opinion, collaborate on research, hire and employ, provide social support, and improve health care outcomes. In the last few years, work-related communication has changed considerably with the advent of electronic communication tools, especially with the aid of instant messaging on smartphones [ 30 , 84 ]. Virtual professional communities can enable members to quickly access evidence-based information and disseminate work, which can lead to increased immediate impact [ 85 , 86 ]. Most SM platforms are found to be easy to implement, effective, quick, and low cost [ 87 ]. In a recent systematic review, positive predictors for using SM among HCPs were identified to be younger age, lower rank, and fewer years of experience, and the most commonly used platforms for communicating with colleagues were Facebook, Twitter, LinkedIn, and WhatsApp [ 88 ].

Owing to the exceedingly large number of HCPs on SM, platforms that are designed only for medical personnel have been introduced. Digital communication and social interactions occur between people who may or may not be known to each other [ 44 ]. In addition to medical issues, discussions usually address diverse subjects such as politics, practice management, career enhancement opportunities, and even dating in a medical environment [ 2 , 89 ]. Sermo, the world’s largest virtual doctors’ lounge, is a leading social network for physicians that is now available in 30 countries [ 90 ]. Doximity is a newer physician-only social networking platform with more than 500,000 members as of 2020 [ 91 ]. In addition, there is the Medical Directors Forum, which is an SNS exclusively for medical directors that provides a secure environment for peer-to-peer interaction [ 92 ]. Studies on HCPs’ preferred SM platform showed that Facebook was used most frequently (86%). Other commonly used platforms were Medscape Physician Connect (52%), Sermo (44%), LinkedIn (42%), YouTube (40%), Blogging (25%), and Twitter (20%) [ 26 ]. These statistics have been confirmed in subsequent studies [ 32 ]. For health-related reasons, physicians primarily used LinkedIn (70.7%) and Twitter (51.2%) [ 32 ]. Another study reported that HCPs spent an average of 11 to 13 hours per week on medical professional networking sites [ 26 ].

WhatsApp has been used as an intradepartmental, patient-related communication method because of its instant and more efficient handovers [ 93 ]. When physical proximity was a barrier, physicians preferred to use WhatsApp to exchange work-related knowledge over traditional text messages [ 84 ]. The American Academy of Pediatric Dentistry has a private group on Facebook with fewer than 3800 members who share clinical cases, clinical experiences, research results, new products, and relevant events [ 9 ]. Facebook has many other groups for dentists that are open to the public to view and join [ 30 ]. Microblogs such as Twitter allow a dynamic and concise exchange of information that is instantly accessible by an increasingly large number of readers [ 89 ]. Furthermore, the dissemination of scientific literature on SM (eg, Twitter) has increased the number of citations and downloads of published articles [ 94 - 96 ]. LinkedIn serves as a professional space for HCPs to demonstrate their expertise and capabilities; 54% of physicians have used it to communicate with colleagues [ 32 , 42 ].

SM also has a positive impact on students. The sense of belonging is crucial for undergraduate training. By being part of a well-respected learning environment, students benefit educationally and socially [ 97 ]. Moreover, having guidance and support on a 24/7 basis can ease their transition from university to more independent training centers [ 30 ].

In recent months, SM platforms have become helpful in maintaining communication with friends and family and reducing isolation and sense of loneliness, which could have a negative psychological impact [ 98 ]. Amid the COVID-19 pandemic, many practices have been affected and many jobs have been lost worldwide [ 99 ]. The sense of unity and comradery introduced by SM among users has helped countless individuals overcome hardships, including HCPs. In the first half of 2020, HCPs were deployed into unfamiliar environments because of the COVID-19 pandemic, worked beyond their areas of expertise and over long hours, and had to involuntarily isolate themselves from their families. This crisis has been anxiety inducing and stressful for HCPs, who often resorted to SM to voice their frustrations, experiences, and opinions not only with family and friends but also with the global network of frontline staff enduring similar challenges. The unique virtual siblinghood united the global health care community like never before. A Facebook page was created to facilitate the renting of recreational vehicles for HCPs to self-isolate outside their homes [ 100 ]. The public played an important role in paying due respect to HCPs, who were often referred to as heroes, both literally and figuratively. Illustrations portraying their pivotal role were shared on every known SM platform. Videos showing countless people applauding for HCPs at certain hours of the day went viral. Many HCPs engaged in what was labeled as COVID-19–free zones to escape, even if momentarily, from the pandemic stress. Clinicians from all specialties in diverse locations joined forces against a single enemy. Their voices echoed louder when they addressed lawmakers demanding improved access to personal protective equipment (PPE), increased testing for COVID-19, reduced reimbursement barriers to telemedicine, and improved mental health care.

To conclude, SM plays an important role in the lives of HCPs at a personal level. Whether SM is used for amusement, zoning out , or commiserating, it provides a safe haven for HCPs to put off their metaphoric heroes’ capes and find comfort in their humanhood again. Future research should investigate the role of SM in helping HCPs individually and collectively tackle the challenges resulting from the COVID-19 pandemic.

Professional Medical Education

Millennial students of health professions are increasing in numbers each year. They possess qualities consistent with being lifelong learners [ 71 ]. As Prensky [ 10 ] discussed, traditional education systems are no longer suitable for contemporary students. Millennials and younger generations process information in a fundamentally different manner from their predecessors. SM offers formal and informal educational opportunities and has the ability to remove physical barriers that could otherwise impede access to educational resources [ 51 ]. Not only is SM rich in educational resources but coupling the information with the interactive exchange of ideas and the live discussions has also made it a valuable educational tool. When SM was integrated into teaching, students were motivated by content obtained from SM, and positive behavioral changes were promoted [ 101 ]. Moreover, when SM was incorporated into clinical education, students perceived better collaboration with their peers, improved professional and career development, and larger supportive learning communities [ 102 ].

Social networks are an underutilized educational resource, not only for trainees but also for experienced clinicians. A large array of educational material is abundant on SM from seniors with advanced experience and from fellow trainees as well, usually at no cost to the user [ 30 ]. The differences between experts and novices are slowly diminishing because of novel forms of peer learning and knowledge production facilitated by SM [ 35 ]. Most platforms are frequently used to engage learners. YouTube in particular is more commonly used to teach technical skills and has been acknowledged by dentists as a convenient educational platform [ 30 , 71 , 103 , 104 ]. YouTube can also be used in classrooms to forge discussion, illustrate a procedure, or reinforce information, which promotes critical thinking and problem-solving skills [ 70 ]. A study conducted in Saudi Arabia found that YouTube was the most commonly used SM platform in medical education [ 105 ].

Evidence suggests that SM has a place in health care education. Universities use SM to create virtual classrooms and increase access to academic libraries [ 70 ]. In the United States, 95% of medical schools have some Facebook presence, and 71% of them have student groups [ 106 ]. In a study on nursing students, Twitter was used to view videos of clinical scenarios, and students tweeted their observations for instructor feedback [ 70 ]. Internet and SM content have been successfully used to train older caregivers to improve the caregivers’ and patients’ quality of life [ 5 ]. In a unique experience, the University of Rhode Island managed to connect students to geriatric patients on Facebook. It promoted students’ empathy and communication skills while helping patients advance their SM skills to battle loneliness [ 2 ]. In addition, students in an oral and maxillofacial radiology course perceived using Twitter as a helpful learning tool that enhanced access to faculty [ 107 ]. Moreover, medical students and professionals in cardiology reported the use of social networks for education and professional training [ 103 ].

Learning may be considered a social activity [ 106 ]. The more senses the students stimulate in their learning process, the more likely the information acquired is to be retained. Thus, the greater the engagement and contribution of the students, the better the learning outcomes. SM provides a medium for active collaboration rather than passive learning. In nursing, 92.4% of students perceived a positive learning impact from the podcasting of lecture materials [ 108 ]. In another study, students who were more heavily engaged in blog-based discussion of relevant learning material had higher grades than peers who had contributed less to the discussion [ 109 ]. Passing an examination was significantly associated with combining discussion on a WhatsApp group with the web-based question bank, and so were their higher grades [ 110 ]. Medical students who used Wikipedia had superior short-term knowledge acquisition compared with those who used a digital textbook, which suggested a potential role for Wikipedia in medical education [ 111 ]. In addition, medical students who integrated the use of SM in 2 elective courses were satisfied with the new approach [ 112 ]. Twitter and Instagram have also been described as helpful tools in radiology education [ 113 ]. Participants in a study reported that SM was perceived as helpful and very helpful for improving knowledge, creativity, decision making, critical skills, and problem-solving abilities [ 114 ].

In a study by Alsuraihi et al [ 105 ], YouTube, Facebook, and Twitter were among the most commonly used resources for learning. Although 95.8% of the students believed that SM was beneficial for learning, 40% thought it might be distracting [ 105 ]. In a review by Chan et al [ 85 ], it was found that multiple residencies used SM to broaden the horizons of trainees and facilitate engagement in journal clubs using virtual classrooms; a wide range of SM platforms were featured, including Facebook, blogs, Wikipedia, and podcasts. Specifically, dermatologists in a study agreed that WhatsApp discussions enriched their scientific knowledge of clinical cases and promoted learning about relevant references and upcoming meetings [ 115 ]. Participants of a 2015 study on surgical teams expressed that WhatsApp helped to flatten the hierarchy among students, residents, and experienced consultants, enabling them all to actively contribute to discussions without inhibition. This comfortable environment is especially helpful for shy and marginalized students [ 116 ].

Once students move beyond structured, supervised learning environments, they must recognize their own gaps in knowledge and skills over time and make every effort to fill them, adopting skills for lifelong learning [ 106 ]. The increasing mutability of knowledge in the digital age and its exchangeability and accessibility on mobile phones make learning thorough SM platforms a common practice for many medical students [ 35 , 117 ]. However, learning cannot be done through SM alone but is used to augment learning from textbooks, peer-reviewed research publications, and mentors, and just like with other sources of information, critical appraisal to information retrieved from SM must be applied; this is what lays the foundation for a future competent web-based learner [ 85 , 106 , 118 ]. It is important that students understand that educational material shared through SM cannot be accepted as is without a great degree of skepticism and objective evaluation.

To summarize, today’s students are unique in how they learn and acquire skills. Current educational systems must adapt to the needs and qualities of modern students and augment, if not replace, the traditional teaching methods with more digital means. It is essential for educators to put every effort in determining the best means of presenting information to their students and guiding them in their information search and appraisal. Retrospective research can be planned to compare the performances, learning outcomes, and teaching strategies between 2 student cohorts: those that were taught in a traditional manner and those that relied on SM.

Telemedicine

As people are becoming increasingly fluent in using novel technologies, health care has recently changed when, where, and how patients and HCPs communicate [ 119 ]. Telemedicine is the use of communication technologies and electronic information to provide health care support to patients or health care workers who are physically distant from HCPs [ 120 ]. Many branches of medicine are now adopting electronically mediated care; terms such as teledentistry and telepsychiatry are not uncommon, and publications related to telemedicine have been increasing [ 121 - 123 ]. Among the specialties that use telemedicine are pediatrics, psychiatry, diabetes, dentistry, nursing, palliative care, and allergies [ 124 - 130 ]. HCPs can now overcome their limited clinical time by communicating with their patients remotely. With the aid of novice technology, they provide a more convenient type of care for patients, especially for following up patients with chronic health care needs [ 131 ].

As young and highly qualified HCPs prefer staying in urban communities, telemedicine significantly augments clinical care, especially in underprivileged and underserved communities in rural areas [ 2 , 82 , 132 , 133 ]. Furthermore, as health care costs continue to increase, organizations are aiming to reduce costs without jeopardizing the quality of care being provided [ 134 ]. Recruitment and workforce sustainability are often an issue, and some countries with large, sparsely populated rural areas have grappled with how to overcome medical and dental provider shortages in these rural areas. Telemedicine and teledentistry can be of great use to ensure that new practitioners appointed in rural locations are not secluded and have the advice and support they need to promote their clinical work and psychological well-being [ 135 ]. It may also be used to connect HCPs in third-world countries with specialists in more medically advanced regions; for example, surgical procedures may be streamed live, and questions can be asked in real time [ 69 ].

Smartphones are fast, portable, and simple to use; mobile apps now seem to be ideal for quick learning or communication between colleagues or HCPs and the public or patients. Mobile apps are among the most commonly used tools for telemedicine [ 82 ]. Globally, but particularly in low- and middle-income countries, communication among HCPs is facilitated via WhatsApp, providing faster diagnosis and immediate management of acute findings [ 136 - 138 ]. A systematic review on telehealth concluded that 74% of the studies reported economic benefits of eHealth interventions for different medical conditions [ 134 ].

Programs for electronically monitoring intensive care units allowed HCPs to remotely monitor the conditions of up to 100 patients in multiple hospitals [ 139 ]. Pandemics and natural disasters pose challenges to effective and prompt health care delivery. Although telemedicine and eHealth might not solve them all, they can aid HCPs in providing the necessary management in scenarios in which the infrastructure is intact. In recent weeks, the distant triage that allowed patients to be efficiently screened for COVID-19 was patient centered and in compliance with self-quarantine; thus, it protected patients, clinicians, and the community from exposure to the virus [ 139 ]. For instance, replacing scheduled office visits with telemedicine visits in case HCPs were quarantined, absent, or sick was a productive initiative at Jefferson Health, Philadelphia, Pennsylvania [ 139 ]. An interesting model of telemedicine was explained by Baker and Stanley [ 40 ], in which patients use an app to navigate to a specific medical site, answer a few triage questions about their medical condition, wait in a virtual queue to be connected by video to an HCP, and discuss their condition or concern.

Sending clinical photographs privately between colleagues for a second opinion or to enrich discussion is not uncommon. A comprehensive review by Boulos et al [ 35 ] shares findings from multiple studies on the use of WhatsApp and Instagram in those contexts. One study found excellent inter- and intraobserver agreement in the assessment images of tibial fractures using WhatsApp [ 140 ]. There was a report of a life-saving use of WhatsApp in a resource-limited situation in which the life of a critically ill patient was saved by sending clinical monitor images with electrocardiogram changes and receiving feedback from an expert consultant who was 40 km away from the center where the patient was admitted [ 141 ]. Moreover, evaluating maxillofacial computed tomography scans using WhatsApp has been reported to be easy and rapid [ 142 ]. WhatsApp was also useful for communication between emergency department consultants when they were not onsite [ 143 ]. In dentistry, a study showed that 67.32% of dentists used WhatsApp to send clinical images to colleagues seeking second opinions, and 35.29% of them did so on a weekly basis. About 60.29% of the dentists received a prompt response, whereas 38.23% received delayed responses. In addition, about 98.52% of dentists sent radiographs on WhatsApp for a second opinion [ 144 ].

In conclusion, it is noteworthy that telemedicine is not a practice in and of itself [ 145 ]. It is not the most suitable model of care for every patient and is not the preferred approach when physicians cannot meet clinical standards of care. Patients using telemedicine must also have access to traditional emergency care, if needed. Although these innovations have significant potential benefits, the electronic exchange of health information and care may pose risks to patients’ privacy, confidentiality, and safety and to quality and continuity of care. Furthermore, the limitations of electronically mediated physical examination may weaken the relationship between patients and HCPs, thereby jeopardizing care [ 119 ]. High-quality research is needed to improve the utilization of telemedicine, and more well-designed studies comparing telemedicine with traditional patient care are essential.

Scientific Research

The perceived benefits of using SM in health care include the ability to connect with geographically distant researchers and to build and foster research communities [ 4 ]. SM is a potential tool to revolutionize health research, as it has fewer temporal and spatial limitations and can overcome boundaries between research communities and the public [ 146 , 147 ]. SM can aid research in several ways: by recruiting participants, disseminating surveys, connecting with fellow researchers, identifying research opportunities, sharing study findings, and gaining access to published work.

There are conveniences in taking scientific research to the digital world. Publishing study findings on SM provides enhanced dissemination of research and increases the access to valid evidence-based information for patients. Furthermore, because not all studies end in a publication in a traditional journal, their findings can thus be shared via SM to a wider audience and be of substantial value to a broader research community [ 4 ]. Another advantage of SM for scientific research became evident during the COVID-19 pandemic, which made it possible to break geographical barriers and arrange collaborative research projects, surveys, and multicenter studies [ 8 ]. Sites such as Google Scholar and ResearchGate create communities for researchers to network, collaborate with each other, and promote publications [ 53 , 148 ]. The anonymity of posts, not having to answer questions in the presence of others and acquiring large samples that attenuate the effect of false information or extreme views were viewed as advantages unique to SM surveys and possible factors that improve research accuracy [ 146 ]. Content posted on the web may be used as data for research without interacting with the authors of the content, and perhaps without even considering them to be human subjects [ 146 ]. Moreover, compared with traditional recruitment methods, web-based surveys have the ability to store large numbers of responses, which can be easily accessed for analysis [ 5 ].

Recruiting research participants on SM has gained popularity in recent years. In a review by Lafferty and Manca [ 4 ], it was found that the most common tools used for recruiting participants were Facebook, Twitter, and a combination of both. Snowballing sampling method involves participants themselves recruiting more participants by contacting people in their networks [ 149 ]. A study on 8252 participants found that web-based recruitment was more efficient and had lower costs per recruited participant compared with traditional methods [ 150 ].

Disseminating surveys on the web is now a common practice. One study chose SM platforms to send its survey because it was cost effective, time saving, and easily accessible [ 151 ]. In another dentist or patient study, the survey for dentists was distributed via a dentist-only Facebook group that had more than 4500 members; for patients, the survey distribution was mainly through Facebook, LinkedIn, and Twitter, and the recipients were asked to share it with their connections [ 42 ]. Furthermore, in a study involving health care quality personnel, the survey was distributed through WhatsApp [ 114 ]. In a study in Saudi Arabia, the link to the web-based questionnaire was made available through Twitter and Facebook, the 2 most popular SNSs in the country [ 152 ]. Over half of university students strongly or somewhat liked using Facebook for research conducted by university researchers [ 153 ]. Zaballos et al [ 154 ] developed a web-based multiplatform that integrated WhatsApp and emails to assess the quality of life of individuals with hearing loss issues; the tool facilitated data collection in an easy-to-use platform.

A review by Topolovec-Vranic and Natarajan [ 155 ] showed that 40% of the studies found SM to be the most effective recruitment method, whereas 50% of them stated that their target population was hard to reach . Approximately 43% of the studies reported cost-effectiveness [ 155 ]. In addition, SM helped in recruiting a large number of individuals and reached challenging populations such as adolescents and young adults. Another review found that traditional recruitment methods tend to underrepresent users of marijuana, ecstasy, cocaine, or alcohol or people with at-risk sexual behavior; in comparison, Facebook recruitment yielded more representative results [ 156 ].

Researchers who plan to recruit participants on SM must consider their target populations’ SM use patterns and preferences. For example, a study on sexual health might consider dating sites for recruitment, whereas Facebook may be more suitable for a nonsexual health study [ 157 ]. To best tailor recruitment campaigns, the selection of hashtags or keywords that reflect the interests of the target population might be useful [ 45 ].

Regarding shortcomings, it is important to note that research participants recruited from web-based environments may not truly represent the population of interest as a whole, suggesting that SM should only augment traditional recruitment methods [ 4 ]. A study suggested that people with disabilities may disproportionately be living in conditions with lower standards of living and may not have access to the internet [ 158 ]. In another study, subjects recruited from SM were largely middle class, whereas those recruited at a local hospital were more disadvantaged [ 159 ]. A review by Whitaker et al [ 156 ] showed an overrepresentation of young White women resulting from web-based recruitment.

Other limitations of using SM for research include that researchers have little control over distractions, the research idea may be copied, or participants may share research information with other participants, which puts the scientific integrity of the study at risk [ 4 ]. In a review by Denecke et al [ 5 ], the most reported ethical concerns for using SM for research recruitment were self-selection—that is, users with an interest in the study area will be recruited preferentially, which will affect the representativeness of the sample—and a skew toward well-educated and higher socioeconomic status cohorts on the web [ 5 ].

Ethical and privacy concerns regarding SM for research recruitment must be addressed because tracking, profiling, and targeting of users are common in the digital world [ 45 ]. Bender et al [ 160 ] proposed privacy-enhanced SM recruitment guidelines, including proactive measures to protect privacy and declaration of potential risks. Vulnerable groups such as children and teenagers, homosexuals in regions where homosexuality is illegal, and individuals with mental illnesses require extra emphasis on respect, confidentiality, and caution in obtaining consent [ 146 ].

To summarize, there is growing evidence to suggest that SM is a useful research tool that enables researchers to connect with each other, recruit participants, and share their findings with the public. Moreover, the data obtained from SM can be investigated. Nevertheless, researchers must not overlook the shortcomings of SM that may ultimately debilitate the integrity of the study. Privacy concerns and ethical considerations must also be considered. The development of guidelines for ethical conduct in web-based research should be based on the best available practices and should be comprehensive and standardized to minimize a study’s error margin. Future studies that compare different recruitment methods and varying participant demographics recruited using various methods should be encouraged. Research investigating the cost-effectiveness of SM research and those with large sample sizes that enable the generalizability of findings is also recommended.

Critical Public Health Care Issues

SM can be used by emergency notification systems to mass communicate information to large groups in a fast and low-cost manner. Studies have shown that SM can be a source of data to detect outbreaks, infection distribution, and areas of acute health care needs [ 29 ]. It can also help understand the public’s knowledge, fears, attitudes, and behaviors during a crisis [ 161 - 163 ]. For example, the Red Cross tracks Twitter posts during natural disasters, such as hurricanes and earthquakes, to assess where the greatest needs lie [ 50 , 164 ]. Perhaps one of the first publications investigating SM use during a pandemic is a study that analyzed tweets posted during the 2009 H1N1 outbreak; this study found that SM can be a useful tool for disseminating information and for the public to share their opinions and experiences [ 165 ]. Twitter posts were also helpful in monitoring disease activity during the cholera and influenza outbreaks [ 166 , 167 ]. When interaction and collaboration were essential, as with the influenza A-H1N1 pandemic, SM provided an unmatched opportunity to engage the public and was used by prominent health organizations such as the WHO [ 7 , 41 ]. However, coordination between web-based and real-world response activities is also important [ 29 ].

Perhaps there is no more powerful example of SM use during a health crisis than what has happened during the COVID-19 pandemic. The dissemination of information during a pandemic has never been this quick and effective in the past. Information on the virus spread as quickly as the virus itself and dominated conversations on SM. On March 11, 2020, there were more than 20 million mentions of coronavirus-related terms on SM [ 168 ]. Since the beginning of the outbreak, SM has been one of the most commonly used communication channels by international health organizations such as the WHO and the CDC to possibly disseminate information to every person on earth with access to SM. Thousands of smaller health authorities may have also used SM to communicate with local communities. Although traditional access to medical guidelines and policies often requires some form of affiliation or membership, it is available to internet users today with a tap on a keyboard or a finger slide on a smartphone. The distribution of PPE, sharing treatment protocols, clinical trial results, and allocation of medical resources have been efficient with the aid of SM [ 8 ]. A recent study evaluated the 100 most viewed coronavirus videos on YouTube; as of March 5, 2020 (very early in the pandemic), these videos had 165 million views [ 169 ]. Another study in China collected data from 250 million Weibo users, a Twitter-like SM platform. Posts mentioning symptoms or diagnoses significantly predicted daily case counts ahead of the statistics announced by officials in Hubei Province, the epicenter of the initial outbreak, and the rest of China [ 170 ].

Perhaps the founders of Twitter did not expect it to become a helpful tool in the fight against COVID-19. For example, using Twitter, a cardiologist was able to expedite the delivery of a drug to a COVID-19 patient within just 6 hours of his tweet [ 171 ]. The American Heart Association launched a registry on Twitter to aggregate COVID-19 cases to better understand risk factor profiles and treatment algorithms [ 171 ]. Hashtags such as #GetUsPPE highlighted the scarcity of PPE, resulting in technology pioneers ramping up their production of PPE [ 171 ]. After calls were raised on Twitter and other SM platforms, HCPs flew to other parts of their countries that were in crisis, retired clinicians volunteered to rejoin the work force in several countries, and those who were unable to be present helped colleagues through telemedicine. Another example of SM use during the pandemic is the COVIDBRONCH Initiative—an international network of airway specialists who foster rapid acquisition and dissemination of knowledge regarding airway procedures during the pandemic [ 172 ].

Despite its catastrophic impact and the substantial loss of lives, humans will overcome the existential threat brought by COVID-19 and will also likely overcome future pandemics. Over time, humans have survived environmental, biological, and man-made calamities because of their innate adaptability, resilience, innovativeness, and persistence. Today, humans use SM to disseminate information quickly and to a large number of people, thus eliciting an almost immediate response. More research is already taking place and will continue to investigate the key role of SM in the fight against pandemics, not only from a medical perspective but also from social and economic viewpoints.

This review provided an overview of the different uses of SM in health care. It is evident that SM use indicates not a trend but a fundamental shift in how people communicate today. Multidimensional health care, which includes SM and other forms of communication, has been shown to be highly successful. Not only can SM be used to improve direct patient care but it can also be used to increase the public’s knowledge, facilitate research, connect HCPs, improve medical education, and combat public health crises. However, striking the right balance between digital and traditional health care is imperative. As SM is a relatively recent phenomenon, further research is needed to determine its long-term effectiveness and to identify the best strategies for maximizing its advantages and limiting risks. This review will be continued in the second part, in which the use of SM from patients’ perspectives will be discussed. This discussion will be supplemented with specific barriers, ethical considerations, and disadvantages reported in the extant literature.

Acknowledgments

The author acknowledges the steadfast support and telementoring of Professor Paul Casamassimo.

Abbreviations

Conflicts of Interest: None declared.