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Novel survey disseminated through twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals.

Introduction

Social media has increasing significance in the world of medicine and particularly in urology. According to surveys conducted by the American Urological Association (AUA), over two-thirds of members have a social media account, (1,2) and Twitter use at urology conferences continues to expand. (3-5) Twitter is a microblogging service involving short messages (or "tweets") of <140 characters. Keywords (or "hashtags") are used to index tweets together that are related to a particular topic, and are designated using the # symbol. At the European Association of Urology (EAU) congress, the number of conference-related tweets increased from 347 in 2012 to 5904 in 2014, (3) and recently to 7110 in 2015. (6)

In addition to its growing use at conferences, (3,4) Twitter is being used for a monthly international urology journal club, as reported by Thangasamy and colleagues, using the hashtag #urojc. (7) During its first year, the club had 189 individuals from 19 countries discussing urological articles, demonstrating the capacity and feasibility of such an online club as an international platform for exchange of professional information. Additionally, an increasing number of urology journals are represented on Twitter, and there is a significant positive association between Twitter presence and impact factor. (8)

Despite the increasing use of social media in urology, its impact on users' clinical practice, research activity, and career development remains unknown. (9) A recent survey by the AUA demonstrated that a significant proportion of urologists remain unconvinced about the usefulness of social media, with a perceived lack of added value as a top reason for non-participation. (2) The aim of our study was to assess the perceived utility of Twitter for professional goals and the perceived impact of Twitter on clinical practice of active Twitter physician users.

Methods

We designed an 11-item online survey using the platform www.surveymonkey.com on the perceived utility of Twitter for users' clinical and academic practice (Appendix 1). The survey was designed and carried out in accordance with the Checklist for Reporting Results of Internet-E-Surveys (CHERRIES). (10) It was not mandatory for participants to answer all survey questions.

The survey assessed the perceived utility of Twitter for the following professional activities: advocacy, networking, disseminating information, clinical decision-making, research, career advancement, and physician-patient communication. Participants were also asked about whether they had followed a congress remotely using Twitter, about their preferred social platforms and how they are accessed, and about their familiarity with professional social media guidelines.

Before administering the survey, we tested it for usability and technical functionality. During the pilot phase, the survey was disseminated in a non-targeted fashion on Twitter at the EAU Congress (April 11-15, 2014) using the conference hashtag #EAU14. It was tweeted out 8 times during various different days and hours of the congress from the individual Twitter account of one author (HB). To follow-up on the results, we used the Symplur website (www.symplur. com) to obtain a complete list of all 1199 participants in the 2014 AUA meeting Twitter feed (hashtag #aua14). We then initiated a larger phase of the survey by using Twitter to individually tweet the survey link to all 1199 #AUA14 Twitter contributors. This was accomplished by creating a new Twitter account (@urosurvey), through which we tweeted a description of the survey with its website address one time to each respective @username from the list of conference Twitter contributors. Since it is not possible to determine the specific job description of all Twitter profiles in the #EAU14 and #aua14 discussions, we asked participants their profession in the survey. We then performed a subset analysis of physicians to determine the impact of Twitter on the clinical practice in those who self-identified as physicians. This was addressed by three survey questions: (1) agreement with the statement "Twitter has an impact on my clinical practice" (responses on a 4-point Likert scale); (2) whether Twitter is useful for clinical decision-making (yes/no); and (3) whether the respondent has ever made a clinical decision based on an online case discussion (yes/no). Analytics were tallied using the tools within www.surveymonkey.com.

Results

A total of 312 unique individuals responded to the survey, including 57 during the pilot phase at the 2014 EAU meeting (representing 7.2% of all #eua14 Twitter users), and 255 of 1199 participants from the 2014 AUA Twitter feed (21.3% response rate) (Table 1).

The greatest perceived benefits of Twitter were for networking (97%) and disseminating information (96%) (Fig. 1). Most users also found Twitter beneficial for research (75%), advocacy (74%), and career development (62%). In addition to Twitter, the most commonly used social media platforms were Facebook (73%), Linkedln (64%), and YouTube (50%); whereas Google+ (28%) and Pinterest (15%) were less common. (Fig. 2). Of the Twitter users, 76% of users indicated that they have followed a congress remotely and 65% indicated that they were familiar with guidelines for online professionalism.

The subset analysis included 234 physician participants. Among these, 14% strongly agreed and 57% agreed that Twitter has an impact on their clinical practice, while 23% disagreed and 5% strongly disagreed (Fig. 3).

Discussion

Our results demonstrate for the first time that among this selected group of urology Twitter participants, virtually all find it useful for networking and disseminating information. Most respondents also found it useful for research, advocacy, and career advancement. In the subgroup of physician Twitter users, most perceived that Twitter also has an impact on their clinical practice. This phenomenon has not yet been reported and shows the great potential of Twitter, which has thus far only been shown as widely used for scientific communication at congresses. (3)

Among our selected group of Twitter users in 2014, the use of other social media platforms was higher than among randomly selected urologists in the United States in 2012 and in Canada in 2014. (1,11) The higher social media uptake among our population can be explained by the bias of the survey population that already uses a social media platform and by the growing popularity of social media in recent years. In our analysis, Twitter was perceived useful for multiple professional goals, such as networking, disseminating research and advocacy. Of note, Twitter was rated as useful for networking by 97% of active Twitter users in our study, while in a previous study only 41% of Canadian urologists found social media useful for fostering new networking contacts for potential collaborations. (11) Furthermore, social media (perhaps even all media) use is shifting from a classical desktop computer over laptop computers towards mobile devices. Almost all survey participants used Twitter on a mobile phone, while less than the half used it on laptop or desktop computers.

The scientific information flow through Twitter opens up the opportunity to follow a congress remotely. By either following the meeting stream in general, a particular topic hashtag, key opinion leaders in the field or all at once, the remote conference experience offers chances to filter the information needed from congress discussions. In our survey, 76% of Twitter users stated that they have already followed a congress remotely showing the great potential for remote conference participation.

Despite the many benefits of social media in urology, there are also potential dangers with regard to confidentiality and professionalism. Numerous organizations, including the EAU and AUA, and journals like BJU International, have created guidelines for physicians' online behaviour. (12-14) It is encouraging that most active users in our survey were familiar with these guidelines, which should be further disseminated as social media continues to expand in our field.

Although our survey included a limited number of queries and only a selection of engaged Twitter users in the #EAU14 and #AUA14 Twitter feeds, this study provides several important new insights. While surveys provide a low level of evidence and the study population may not represent the urological community at-large, nevertheless it is useful to understand the perceived benefits (or lack thereof) among active users. Yet it should be mentioned that these questions on utility were primarily captured in a binary fashion rather than on a Likert scale that gauges the level of enthusiasm.

Recently, social media platforms have successfully been used to improve clinical trial recruitment. (15,16) Another contribution of our study is the use of Twitter as a novel social media tool to disseminate a survey by individually directed tweets at our target population. Each participant was sent a single tweet and we received only positive feedback, suggesting the feasibility of this approach. Indeed, the non-targeted survey distribution during the pilot phase led to fewer responses than the targeted survey distribution. This might be due to varying levels of engagement during conference hours (17) and consequently a varying visibility of the tweet. We achieved a higher level of participation by directly tweeting the survey to target accounts with a description and the website address. Furthermore, our response rate of 21% using targeted tweets as a method of dissemination compares favourably with the 6.8% response rate in a previous AUA survey on social media sent via email. (2) Thus, this study also demonstrates the feasibility of Twitter messages as a rapid and novel method to disseminate targeted surveys within the urological community.

Conclusion

Our survey suggests that most Twitter users at urology meetings do perceive numerous important benefits of social media use for networking, disseminating research, advocacy, clinical practice, and other professional goals. In addition, our study provides a proof of principle demonstration on the feasibility of using directed tweets to perform targeted survey research within the urological community.

http://dx.doi.org/10.5489/cuaj.3014 Published online October 13, 2015.

Acknowledgments: We thank all Twitter users that participated in this survey.

Competing interests: The authors all declare no competing financial or personal interests.

This paper has been peer reviewed.

References

(1.) Loeb S, Bayne CE, Frey C, et al. Use of social media in urology: Data from the American Urological Association. BJU Int 2014;1 13:993-8.

(2.) Loeb S, Bayne CE, Frey C, et al. On behalf of the American Urological Association Social Media Work Group. Updated Suivey of Social Media Use in the American Urological Association. Urology Practice 2015 (In press). http://dx.doi.org/10.1016/j.urpr.2014.09.009

(3.) Wilkinson SE, Basto MY, Perovic G, et al. The social media revolution is changing the conference experience: Analytics and trends from eight international meetings. BJU Int 2015;1 15:839-46.

(4.) Canvasser NE, Ramo C, Morgan TM, et al. The use of social media in endourology: An analysis of the 2013 world congress of endourology meeting. J Endourol 2015;29;615-20.

(5.) Loeb S. Social media makes global urology meetings truly global. BJU Int 2015;115:175. http:// dx.doi.org/10.1111/bju.13027

(6.) Symplur.com Symplur: The Healthcare Hashtag project. http://www.symplur.com. Accessed May 20, 2015.

(7.) Thangasamy IA, Leveridge M, Davies BJ, et al. International urology journal club via Twitter: 12-month experience. Eur Urol 2014;66:112-7. http://dx.doi.org/10.1016/j.eururo.2014.01.034

(8.) Nason GJ, O'Kelly F, Kelly ME, et al. The emerging use of Twitter by urological journals. BJU Int 2015;1 15:486-90. http://dx.doi.org/10.1111/bju.12840

(9.) Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of professional ideas across continents. Eur Urol 2014;66:118-9. http://dx.doi.org/10.1016/j.eururo.2014.02.048

(10.) Eysenbach G. Improving the quality of web surveys: The checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res 2004;6:e34. http://dx.doi.org/10.2196/jmir.6.3.e34

(11.) Fuoco M, Leveridge MJ. Early adopters or laggards? Attitudes toward and use of social media among urologists. BJU Int 2015;115:491-7. http://dx.doi.org/10.1111/bju.12855

(12.) Roupret M, Morgan TM, Bostrom PJ, et al. European Association of Urology (@Uroweb) recommendations on the appropriate use of social media. Eur Urol 2014;66:628-32. http://dx.doi.org/10.1016/j. eururo.2014.06.046

(13.) American Urological Association: Social Media Best Practices. http://www.auanet.org/press-media/ social-media-bp.cfm. Accessed May 20, 2015.

(14.) Murphy DG, Loeb S, Basto MY, et al. Engaging responsibly with social media: The BJUI guidelines. BJU Int 2014;114:9-11. http://dx.doi.org/10.1111/bju.12788

(15.) Shere M, Zhao XY, Koren G. The role of social media in recruiting for clinical trials in pregnancy. PIoS one 2014;9:e92744. http://dx.doi.org/10.1371/journal.pone.0092744

(16.) Lane TS, Armin J, Gordon JS. Online recruitment methods for web-based and mobile health studies: A review of the literature. J Med Internet Res 2015;17:e183. http://dx.doi.org/10.2196/jmir.4359

(17.) Matta R, Doiron C, Leveridge MJ. The dramatic increase in social media in urology. J Urol2014;192:494-8. http://dx.doi.org/10.1016/jquro.2014.02.043

Correspondence: Dr. Hendrik Borgmann, University Hospital Frankfurt, Germany; borgmann.hendrik@gmail.com
Appendix
1. Survey-Twitter use of urologists

1. Twitter has an impact on my clinical practice

strongly agree

agree

disagree

strongly disagree

2. Have you followed a congress remotely using Twitter?

Yes

No

3. Which profession do you have?

Doctor

Nurse

Researcher

Business person

Other

4. Which status do you have?

Trainee

Consultant

No answer

5. Have you ever made a clinical decision based on an online case
discussion?

Yes

No

6. From which continent are you?

Africa

Asia

Australia

Europe

North America

South America

7. Have you dealt with guidelines/recommendations on online medical
professionalism?

Yes

No

8. Twitter is useful for ...

Yes

No

... advocacy

... networking

... disseminating information

... clinical decision-making

... research

... career advancement

... doctor-patient communication

9. How old are you?

Below 20

20-29

30-39

40-49

50-59

60 or older

10. Which social media do you use?

Twitter

Facebook

LinkedIn

Youtube

Pinterest

Google+

11. On which device do you use Twitter?

Smartphone

Tablet-PC

Laptop

Desktop-PC


Hendrik Borgmann, MD; ([yen]) Sasha DeWitt, MD; ([section]) Igor Tsaur, MD; ([yen]) Axel Haferkamp, MD; ([yen]) Stacy Loeb, MD *

([yen]) Department of Urology, University Hospital Frankfurt, Frankfurt, Germany; ([section]) Department of Urology and Population Health, New York University and Manhattan Veterans Affairs Medical Center, New York, NY; * University Hospital Frankfurt, Germany
Table 1. Demographics of the survey participants

Category                           No. (%)

Profession
  Physician                       234 (75%)
  Nurse                            10 (3%)
  Researcher                       16 (5%)
  Business person                  20 (6%)
  Others                          32 (10%)
Status
  Trainee                         62 (20%)
  Consultant                      188 (61%)
  No answer                       60 (19%)
Age, years
  [less than or equal to] 20       1 (0%)
  20-29                           40 (13%)
  30-39                           127 (41%)
  40-49                           94 (30%)
  50-59                           40 (13%)
  [greater than or equal to] 60    10 (3%)
Continent of origin
  North America                   134 (43%)
  Europe                          110 (35%)
  Australia                        25 (8%)
  South America                    20 (6%)
  Asia                             13 (4%)
  Africa                           9 (3%)

Fig. 1. Positive ("yes," %) responses of 312 Twitter
users from the European Association of Urology and
American Urological Association 2014 meetings on
the utility of Twitter for various professional activities.

Twitter is useful for

networking                        98%
disseminating information         96%
research                          71%
career development                71%
advocacy                          66%
physician-patient communication   52%

Note: Table made from bar graph.

Fig. 2. Responses of 312 Twitter users from the
European Association of Urology and American
Urological Association 2014 meetings on the question on
which device they use Twitter. Multiple answers were allowed.

On which device do you use Twitter?

Smartphone   95%
Tablet-PC    40%
Laptop       49%
Desktop-PC   27%

Note: Table made from bar graph.

Fig. 3. Subset analysis containing 234 responses of
physician Twitter users on their use and perceived
usefulness of Twitter for clinical practice and other
professional goals.

Physicians only: Use and perceived usefulness of Twitter

useful for networking                          97%
useful for disseminating information           97%
useful for research                            72%
useful for career development                  61%
useful for advocacy                            73%
useful for physician-patient communication     39%
useful for clinical decision-making            44%
used for remote conference participation       79%
familiar with social media guidelines          70%
made clin. decision after Twitter discussion   33%

Note: Table made from bar graph.
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Article Details
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Title Annotation:ORIGINAL RESEARCH
Author:Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy
Publication:Canadian Urological Association Journal (CUAJ)
Article Type:Report
Geographic Code:4EUGE
Date:Oct 1, 2015
Words:2658
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