JMIR Publications

ABSTRACT

Background:

During the COVID-19 pandemic, tribal and public health organizations used social media to rapidly disseminate public health guidance highlighting protective behaviors such as masking and vaccination to mitigate the pandemic’s disproportionate burden on Native American communities.

Objective:

Seeking to provide guidance for future communication campaigns, this study aimed to identify Twitter post characteristics associated with higher performance, measured by audience reach (impressions) and online behavior (engagement rate).

Methods:

We analyzed Twitter posts sent in a campaign by the Johns Hopkins Center for American Indian Health from July 2020 to June 2021. Qualitative analysis was informed by in-depth interviews with members of a Tribal Advisory Board and thematically organized according to the Health Belief Model. Logistic regression was used to analyze associations between Twitter post theme, impressions, and engagement rate.

Results:

The campaign published 162 Twitter messages which organically generated 427,888 impressions and 6,045 engagements. Iterative analysis of these Twitter posts identified 10 unique themes under theory- and culture-related categories of framing knowledge, cultural messaging, normalizing mitigation strategies, and interactive opportunities, corroborated by interviews with Tribal Advisory Board members. Statistical analysis of Twitter impressions and engagement rate by theme demonstrated that posts featuring culturally-resonate community role models (p=.02), promoting online events (p=.002), and messaging as part of Twitter Chats (p=<.001) were likely to generate higher impressions. In the adjusted analysis controlling for date of posting, only the promotion of online events (p=.003) and Twitter Chat messaging (p=.01) remained significant. In terms of engaging users, highly visual and explanatory posts promoting self-efficacy (p=.01; p=.01) and humorous posts (p=.02; p=.01) were most likely to generate high engagement rates in both the adjusted and unadjusted analysis.

Conclusions:

Results from the one-year Twitter campaign provide lessons to inform organizations designing social media messages to reach and engage Native social media audiences. The use of interactive messaging, instructional graphics and Native humor are promising practices to engage community members, potentially opening audiences to receiving important and time-sensitive guidance, particularly during a pandemic.