Twitter as a Information Translation Software to Enhance Consciousness of the OpenHEARTSMAP Psychosocial Evaluation and Administration Software within the Subject of Pediatric Emergency Psychological Well being


The growing prevalence of pediatric psychological well being displays in pediatric emergency departments (PED) requires improved integration of evidence-based administration methods. Social media, particularly Twitter, has proven potential to help in closing the data translation (KT) hole between these evidence-based administration methods and pediatric emergency medication (PEM) suppliers.

Goals and goals

The first end result of this examine is to judge the effectiveness of Twitter as a KT dissemination software in PEM. The exploratory outcomes have been to evaluate the best way to successfully implement Twitter in KT, discover methods by which Twitter can maximize the worldwide attain of OpenHEARTSMAP and whether or not Twitter can result in elevated adoption of OpenHEARTSMAP.


A one-week potential promotion on Twitter was carried out to disseminate the OpenHEARTSMAP software utilizing 15 topic-related hashtags (arm 1, 15 Tweets) versus one submit whereby 15 completely different Twitter customers have been talked about in 15 completely different feedback (arm 2, 1 Tweet). A one-week management interval instantly previous to posting was employed for comparisons.


Throughout the Twitter week, visits per day to OpenHEARTSMAP elevated by 175%; imply time spent on the web site elevated by 212%; and imply web page actions per go to elevated by 130%. The best improve in visits occurred on the primary day of Tweeting. Arm 2 acquired the best engagements. Inside arm 1, the class of pediatrics acquired essentially the most engagements (hashtag #Peds was hottest). Arm 1 acquired 455 impressions in comparison with 2071 in arm 2. No new customers registered an account on the OpenHEARTSMAP web site, which is required to bodily use the software.


Twitter could be an efficient KT software to extend consciousness of analysis, step one of KT, within the area of PEM psychological well being care. Methods for fulfillment embrace constructing a strong Twitter following; posting throughout peak healthcare-related Twitter site visitors occasions; using hashtags coinciding with present occasions; and concentrating on posts by tagging customers who needn’t essentially be usually well-known opinion leaders.


Information translation (KT) and the KT hole

Whereas scientific proof has expanded over the previous few many years, the hole between data and motion in all areas of medication has widened. Studies have described a lag of roughly 17 years between analysis publication and implementation, with solely 14% of recent discoveries reaching bedside observe [1,2]. This hole has been coined because the KT ‘chasm.’ For that reason, as much as 40% of kids fail to obtain applicable evidence-based remedies in pediatric emergency departments (PEDs) [3].

The immense quantity of revealed analysis coupled with restricted useful resource entry and time constraints have been cited as obstacles to proof uptake. This contributes to poor consciousness, or data, of revealed literature – the vital first step in KT [4]. Attitudes and behavioural adjustments as soon as the data is acquired kind the following steps in KT [4].

The function of social media in KT

Social media is a group of on-line web sites and purposes the place “customers contribute, retrieve, and discover content material generated by fellow customers…for customers, thus permitting data and help to move extra successfully” [5]. In distinction to the static move of knowledge via medical journals, Tunnecliff et al. amongst others have validated the notion of social media in well being care as a strong, globally accessible, handy, and cost-effective communication software that ‘pushes’ data to end-users, offering a potential avenue to fill in parts of the KT hole [6,7].

Twitter in KT

Twitter is taken into account the most well-liked social media platform for healthcare communication [8]. Choo et al. commented on Twitter’s benefits as a technique for KT: broad-reaching data alternate; elevated entry to info to enhance high quality of care; and a platform to foster frequent collaboration and a way of group via two-way communication [8].

Emergency medication has been a pioneer free of charge open-access medical training (FOAMed) [9]. Twitter has been central to FOAMed’s improvement. In a survey of Canadian emergency medication practitioners, 99.5% of residents described utilizing FOAMed sources for common emergency medication training. Moreover, pediatric-specific FOAMed sources have been developed – an necessary step in the direction of the interpretation of PEM analysis [10,11].

Pediatric emergency medication (PEM) psychological well being and HEARTSMAP

At present, as many as one in 5 kids and adolescents suffers from a neuropsychiatric situation [12]. Pediatric psychological well being emergencies characterize a considerably growing part of PEM, as EDs grow to be a security internet for psychiatric displays in kids [13-15]. Nonetheless, ED suppliers have been proven to exhibit restricted data of efficient ED psychiatric look after youth, over-reliance on consultants within the context of already lowered inpatient companies, uncertainty round out there psychological well being referral sources, and a scarcity of routinely used psychological and behavioural well being screening instruments, leading to variable and unreliable assessments [13, 15-17].

Accordingly, researchers have advisable the necessity for a standardized psychological health-screening questionnaire with corresponding follow-up or discharge directions [13,17,18]. To handle this advice, our staff at BC Kids’s Hospital created the HEARTSMAP evaluation and disposition software (Appendix). This software incorporates 10 sections (similar to the acronym ‘HEARTSMAP’) to assist facilitate a full however environment friendly emergency psychosocial evaluation: Dwelling, Training and actions, Alcohol and medicines, Relationships and bullying, Ideas and anxiousness, Security, sexual well being, Temper and behavior, Abuse, and Professionals and sources. Every part is scored from 0 to three with zero that means no considerations and 1 to three that means gentle, reasonable or extreme considerations, respectively. Primarily based on the entire rating, suggestions are generated to allow ED clinicians to reliably handle emergency pediatric psychosocial displays. Potential administration options vary from acute psychiatric session to outpatient referral to a disaster response staff, social companies, or adolescent well being [19]. HEARTSMAP has proven to be a legitimate and dependable psychological health-screening software, with robust inter-rater settlement [20]. Though native translational efforts of this software have been partially efficient, formal analysis revealed a necessity for broader dissemination.

Analysis hole informing this examine

KT in PEM is an rising area and there’s a paucity of literature as to particular efficient strategies to disseminate PEM data, which is step one of KT [21]. To our understanding, no earlier examine has evaluated the function of social media in pediatric emergency care of psychological well being displays. We sought to find out whether or not Twitter may successfully disseminate and improve consciousness of the HEARTSMAP software, which is particularly related to PEM.

Research goals

A one-week potential social media promotion was carried out with a main purpose of figuring out the effectiveness of Twitter as a KT dissemination technique in PEM in growing consciousness of the HEARTSMAP software.

Exploratory goals have been to find out which Twitter implementation technique results in maximal end-user interplay; to find out which Twitter implementation technique results in maximal international attain of HEARTSMAP; and to find out whether or not Twitter results in elevated use of HEARTSMAP.

Consciousness, the first purpose of this examine, varieties the primary part of the KT pathway, whereas adoption varieties the final step of KT [4]. Implementation and attain have been metrics used to match the efficacy of the 2 examine arms as described under.

Supplies & Strategies


To broaden the worldwide attain and utility of HEARTSMAP, a publicly accessible model referred to as OpenHEARTSMAP was created. The software is obtainable at Clinicians can register on-line for gratis to grow to be an OpenHEARTSMAP person after submitting primary skilled demographic info. Full entry to the software requires profitable completion of three coaching circumstances embedded inside the registration course of.

Research intervention

Utilizing our established @HEARTSMAP_ Twitter account with 52 followers, 15 hashtag-specific Tweets (arm 1) and one generic Tweet with out hashtags by which 15 completely different feedback have been made tagging 15 completely different customers (arm 2) have been posted as two KT dissemination methods. All Tweets have been written in lower than 280 characters and contained: a traceable hyperlink to OpenHEARTSMAP, a visible part to extend dissemination and a name to motion for viewers to retweet our submit [22, 23]. Feedback (Twitter posts tagging particular customers) contained a message requesting the tagged person to retweet the generic Tweet. One Tweet was posted each half-hour in random order to forestall a flood of Tweets to customers’ information feeds. No different randomization was used on this examine. All Tweets have been posted on Could sixth, 2020. Information for the Twitter week ended on Could thirteenth, 2020. The management week spanned from April twenty eighth to Could fifth, 2020.

Research arms

In arm 1, the 15 hashtag-specific Tweets referenced 5 completely different matter classes associated to OpenHEARTSMAP in addition to present occasions (COVID-19, associated psychological well being occasions) to find out whether or not hashtag use particular to a selected time frame is influential: FOAMed, pediatrics, emergency medication, psychological well being and COVID-19, with three Tweets per class (Fashionable FOAMed teams have been recognized utilizing the most recent Social Media index rankings [24]). COVID-19 was included as a class given the start of the pandemic was March 2020. Throughout this time, social media was an necessary platform to convey info relating to high school closures, isolation practices and potential results on little one and adolescent psychological well being [25]. The opposite hashtags have been recognized utilizing beforehand revealed weblog surveys of common corresponding hashtags. The chosen hashtags have been (so as of lowering reputation inside every class): #FOAMed, #FOAMped and #MedEd (FOAMed); #Pediatrics, #Peds and #Children (pediatrics); #emergencymedicine, #emergencydepartment and #ems (emergency medication); #mentalhealth, #mentalhealthawareness and #mentalhealthawarenessmonth (psychological well being); and #COVID19, #coronavirus, #pandemic (COVID-19).

In arm 2, one generic Tweet containing our message with out hashtags was tagged to fifteen completely different customers who fall into 5 completely different matter classes of accounts associated to OpenHEARTSMAP: FOAMed accounts, pediatric opinion leaders, emergency medication opinion leaders, psychological well being opinion leaders or organizations, and COVID-19-related opinion leaders, with three tags per class. FOAMed accounts have been recognized as described above. Opinion chief accounts or organizations have been recognized upon session with skilled physicians at our hospital. These accounts have been recognized primarily based upon their reputation (variety of followers) and/or the opinion leaders’ private data of influential people and organizations within the area of emergency medication. The chosen accounts have been: @LITFLblog; @emcrit and @ALiEMteam (FOAMed); @dzungxvo-Dr. Dzung X Vo., @offcall99-Dr. Badrinath Narayan, @QdQwerty-Dr. Quynh Doan (pediatric opinion leaders); @Tingdan-Dr. Danial Ting; @Brent_Thoma-Dr. Brent Thoma, @TChanMD-Dr. Theresa Chan (emergency opinion chief); @Tylerblack23-Dr. Tyler Black, @Skye_Barbic-Skye Barbic and @CMHA_NTL (psychological well being opinion leaders); and @picardonhealth-Andre Picard, @adriandix-Adrian Dix and @drsanjaygupta-Dr. Sanjay Gupta (COVID-19-related opinion leaders).

Pattern tweet

OpenHEARTSMAP makes it simpler for any supplier, wherever, to evaluate psychosocial displays amongst kids and youth within the emergency division, particularly throughout this pandemic. Please retweet to unfold the phrase! (#____)

Pattern tagged submit

(@____) We thought of the OpenHEARTSMAP software, created by physicians at British Columbia’s Kids’s Hospital in Vancouver, is perhaps of curiosity to you throughout these occasions. Please do retweet this submit to assist unfold the phrase, thanks!

Final result measures

Throughout the one-week promotion, each day metrics have been collected from Twitter’s analytic software and from the OpenHEARTSMAP internet analytics web page.

Main Final result – Consciousness

The effectiveness of Twitter as a data dissemination software to extend consciousness was measured by the entire variety of ‘web page visits’, ‘common go to period’ and ‘web page actions’ on the OpenHEARTSMAP webpage. The strategy of entry to the OpenHEARTSMAP web site was additionally examined via web sites (clicking the web site hyperlink via a special web site), direct entry, search engines like google and yahoo or Twitter.

Exploratory Outcomes – Implementation, Attain and Adoption

We assessed implementation, exploring the best method to make use of Twitter as a KT software (hashtag versus tagging), by measuring Twitter interplay metrics of ‘engagements’ (whole variety of occasions when a person interacts with a Tweet together with: clicks wherever on the Tweet, together with retweets, replies, follows, likes, hyperlinks, playing cards, hashtags, embedded media, username, profile photograph or Tweet growth) for every Tweet.

Attain was measured for every Tweet utilizing the metric ‘impressions’ (whole views from showing in information feeds or search outcomes).

Adoption of OpenHEARTSMAP was quantified by the variety of on-line registrations and varieties accomplished of the OpenHEARTSMAP software.

Information evaluation

Main Final result

For measuring consciousness, the imply baseline variety of ‘web page visits’, ‘go to period,’ and ‘web page actions per go to’ to OpenHEARTSMAP have been collected for one week previous to the promotion and on the completion of the one-week promotion. P.c adjustments have been calculated. The change in technique of entry to OpenHEARTSMAP was additionally in contrast between the management week and Twitter week. Adjustments to the first end result metrics have been analyzed utilizing a paired pattern t-test. Usually distributed steady explanatory variables have been described utilizing parametric exams. Outcomes have been thought of statistically vital with p values < 0.05. All statistical analyses have been carried out utilizing RStudio (RStudio, Boston, MA, USA).

Exploratory Outcomes

For implementation, every Tweet was ranked based on the sum variety of ‘engagements’ inside every class after the one-week promotion to determine the most well-liked KT Twitter technique (hashtags or generic Tweet with tagged customers) and matter class that enabled maximal person interplay.

For attain, the ‘impressions’ have been summed per arm to grossly determine which Twitter KT technique (hashtags or tagging) led to the biggest attain.

For adoption, the imply baseline variety of on-line registrations and varieties accomplished for one week previous to the promotion and on the completion of the one-week promotion. P.c adjustments have been calculated. The change in technique of entry to OpenHEARTSMAP was additionally in contrast between the management and Twitter weeks and brought into consideration.

Moral concerns

Approval was obtained by the College of British Columbia Kids and Ladies’s Analysis Ethics Board (H17-00748).


Main end result

Throughout the management week, a mean of 1.6 visits per day was recorded on the OpenHEARTSMAP web site, for a complete of 13 visits (Determine 1). Visits elevated by 175% throughout the Twitter week to a mean of two.8 visits per day, for a complete of twenty-two visits (imply improve: 1.2; 95% CI: -0.9-3.1). There was a 212% improve for the time being spent on the web site per go to (imply time per go to for management week: 0.48 min; imply time per go to for the Twitter week: 1.00 min; imply improve: 0.52 min; 95% CI: -0.45-1.5), and a 130% improve in imply web page actions per go to (imply web page actions for management week: 1.9; imply web page actions for the Twitter week: 2.5; imply improve: 0.6; 95% CI: -1.4-2.6).

Determine 2 reveals the distinction in visits per day to OpenHEARTSMAP in contrast between the Twitter week and to the typical variety of visits per day throughout the management week. The best improve in visits occurred on the primary day of Twitter posting, with fluctuating adjustments on subsequent days.

When it comes to technique of entry, we noticed a lower in 10% or extra in entry via web sites or search engines like google and yahoo in favour of Twitter throughout the Twitter week in comparison with the management week (Determine 3).

Exploratory outcomes

With reference to impressions, Research arm 2 acquired better engagements. Inside arm 1, the subject class of pediatrics acquired essentially the most engagements, with the hashtag #Peds as the most well-liked (Figures 4, 5). The subject classes of emergency medication and FOAMed acquired no engagements. The sources of retweets per examine arm are depicted in Desk 1. Not one of the 15 tagged customers in examine arm 2 retweeted our generic submit.

Arm1: Hashtag-specific Tweets Complete retweets 1
      Consumer is our follower 100%
      Consumer isn’t our follower 0%
Arm2: Generic Tweet with tagged accounts Complete retweets 8
      Consumer is our follower 38%
      Consumer isn’t our follower 62%

With reference to achieve, a complete of 455 impressions have been obtained in arm 1 in comparison with 2071 in arm 2 as depicted in Determine 6.

With reference to adoption, one new registration was obtained throughout the management week whereas no new registrations on the OpenHEARTSMAP web site have been obtained throughout the Twitter week. No new varieties have been began or accomplished throughout the management week nor the Twitter posting week.


No earlier analysis has examined the function of social media particularly for data translation in psychological well being because it pertains to PEM. Twitter has been proven to enhance data of analysis proof in different domains as outlined under. That is the primary examine, to our data, to recommend that Twitter as a KT software could be efficient in growing consciousness of analysis within the area of PEM, step one in KT, however not essentially adoption, the final step in KT.

Twitter and Fb have been evaluated by Tunnecliff et al. for his or her efficacy as an academic platform [6]. On this examine, clinicians realized about tendinopathy administration through both Twitter or Fb. Between the 2 teams, nearly three-quarters of respondents indicated the social media intervention modified their observe and promoted elevated use of analysis proof in medical observe through social media [6]. Nonetheless, they famous that Twitter was simpler when constructing a community and disseminating info. Twitter has additionally been proven to extend views of medical articles and journal web sites [6,7]. These research reveal the final effectiveness of Twitter to disseminate data to practitioners. Our examine extends these findings to pediatric emergency care and pediatric psychological well being displays within the ED.

Research implications

Throughout the Twitter dissemination week, substantial will increase have been proven in all metrics used to measure the change in consciousness – ‘web page visits’, ‘common go to period’, and ‘web page actions’ on the OpenHEARTSMAP webpage. Our outcomes affirm, with these of earlier research, that Twitter seems to be an efficient technique for medical KT to extend consciousness of PEM-related analysis. We additionally discovered that throughout the Twitter dissemination week, the variety of folks accessing the OpenHEARTSMAP web site through the Twitter hyperlink usually elevated. This lends additional perception into the potential of Twitter as an efficient avenue to seize end-users for KT.

We measured implementation utilizing the Twitter interplay metrics of engagements for every Tweet. Engagement is thought to be a extra credible and dependable measure than impressions to judge social media methods. Twitter is a platform that works finest with focused content material and that is supported by our findings [26]. We noticed better engagements in arm 2 the place customers have been tagged in a message that was addressed to them immediately and would have been notified by Twitter. The arm 2 Tweet was additionally the primary Tweet posted at 09:00 PST, which can have contributed to its excessive engagement.

From the 15 tagged opinion leaders we recognized, none (even these identified personally to the analysis staff) headed the decision to motion to retweeted our submit. Of the eight retweets, greater than half have been from non-followers of the @HEARTSMAP_ account, but nonetheless got here throughout our Tweet from those that do observe us and retweeted. These findings help the notion of Twitter as an efficient dissemination software via a snowball impact, the place one could not must be personally related to customers as a way to disseminate a medical concept. This presents the notion that constructing a strong and engaged Twitter following is perhaps useful in medical KT, extra so than actively looking for out customers to retweet a submit.

Inside examine arm 1, the subject class of pediatrics acquired essentially the most engagement (#Peds as the most well-liked) adopted by matter classes COVID-19 and psychological well being. The subject classes of emergency medication and FOAMed acquired no engagements. These findings recommend that utilizing related hashtags coinciding with native or present occasions could also be an efficient engagement technique (e.g., COVID-19 in Could of 2020 or Could being psychological well being consciousness month). Moreover, utilizing the best trending hashtag inside a subject was much less efficient than using hashtags which are trending inside a subject, but not essentially the most used. This might probably be defined by the truth that the final reputation of extremely used hashtags ends in speedy dilution of any single Tweet.

Attain was measured for every Tweet utilizing impressions. Arm 2 of our examine had greater than 4 and a half occasions as many impressions. Regardless of these outcomes, it can’t be concluded that tagging customers in a Tweet is a extra profitable technique for KT. For one, this Tweet for arm 2 occurred to be the primary Tweet that was posted at 09:00 PST, which, primarily based on parallel information from the OpenHEARTSMAP web site go to occasions, usually marks a better site visitors time which additionally coincides with the best healthcare-related site visitors occasions [27]. This may very well be an element within the bigger variety of impressions for the Tweet in arm 2. Alternatively, this Tweet additionally acquired extra engagements (together with the 15 feedback we made to tag customers), which may have made it extra more likely to seem increased in a followers’ information feeds as a consequence of algorithms that preferentially depict extra related content material reasonably than content material in chronological order. Whereas extra impressions could seem higher, the metric is perhaps deceptive [27]. Impressions can not assure that customers have actually seen or interacted with the Tweet. For that reason, engagements are a extra correct reflection of interplay [26].

Adoption, or use, of OpenHEARTSMAP was quantified by the variety of on-line registrations and varieties accomplished of the OpenHEARTSMAP software. There was no change within the variety of accomplished varieties between the management week and the Twitter dissemination week and one new registration on the OpenHEARTSMAP web site throughout the management week. Whereas adoptability, or behavioural change, is the last word measure of profitable KT, this examine targeted on consciousness as the first measure of KT, due to this fact these outcomes don’t take away from our findings of Twitter as an efficient KT software to extend consciousness of PEM analysis. Our findings are similar to Hawkins et al. who explored whether or not social media may improve journal subscriptions and readership [28]. They found that social media was a fruitful software for growing consciousness, although had little to no affect on adoptability of readership. Our findings, although comparable, are novel within the area of PEM psychological well being. Like readership of their examine, using our OpenHEARTSMAP software is a subjective choice. This displays the perspective and behaviour-related domains because the second and third steps respectively within the pipeline of efficient KT past the scope of this examine.


Whereas our main goal was to drive site visitors to our web site utilizing Twitter, the small numbers on this examine preclude us from drawing definitive associations between Twitter and web site metrics which have beforehand been instructed to correlate poorly [29]. Moreover, as a consequence of a scarcity of accessible strategies, we have been unable to determine which Tweets or which examine arm, particularly, led to the rise in web site visits to additional elucidate the social media technique on Twitter that was best. Lastly, it’s potential that our findings have been confounded by parallel coaching of OpenHEARTSMAP outdoors of social media in March to early Could 2020, in step with native medical efforts throughout the COVID-19 pandemic. Nonetheless, this confounder was current throughout each the management and Twitter weeks. Future Twitter-based research in PEM psychological well being may take into account the above limitations, incorporate superior metrics corresponding to the speed of retweets, management for the impact of time of day of posts in addition to elucidate methods for altering attitudes and growing adoption of analysis, being the second and third steps of KT.


Twitter could be an efficient KT software to extend consciousness of analysis, step one of KT, within the area of PEM psychological well being care. Throughout our Twitter promotion, there have been will increase in visits, imply time spent and imply web page motion per go to to the OpenHEARTSMAP webpage. Methods for profitable dissemination through Twitter derived from this examine embrace constructing a strong following; posting throughout peak healthcare-related Twitter site visitors occasions; using hashtags coinciding with present occasions reasonably than using essentially the most trending hashtags; and concentrating on posts by tagging customers, who needn’t essentially be usually identified opinion leaders.

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