JMIR Publications

ABSTRACT

Background:

During the early pandemic, there was substantial variation in public and government response to COVID-19 in Europe and the United States. Mass media are a vital source of health information and news, frequently disseminate this information through social media, and may influence public and policy response to the pandemic.

Objective:

The aims of this study were to describe the extent to which major media outlets in the USA and Spain tweeted about health-related behaviors relevant to COVID-19, compare the tweeting pattern between both countries’ media outlets, and determine user engagement in response to these tweets.

Methods:

We investigated tweets posted by 30 major media outlets (17 from Spain and 13 from the United States) between December 1st 2019 and May 31st 2020 that included keywords related to health-related behaviors (HRB) relevant to COVID-19. We classified tweets into six categories: 1) mask-wearing, 2) physical distancing, 3) handwashing, 4) quarantine/confinement, 5) disinfecting objects, or 6) multiple HRB (any combination of the prior HRB categories). In addition, we assessed likes and retweets generated by each tweet. Poisson regression analyses were performed to compare average predicted number of likes and retweets between the different HRB categories and to compare between both countries.

Results:

Of 2,351 COVID-19-related tweets included in the content analysis, 1,479 (62.91%) mentioned at least one HRB. The proportion of COVID-19 tweets mentioning at least one health-related behavior was significantly different between countries (p=0.006). Quarantine/confinement-was mentioned in nearly half of all HRB tweets in both countries. On the other hand, the least frequently mentioned HRB was disinfecting objects in Spain (6.9%) and hand washing in the USA (9.1%). For tweets from the USA mentioning at least one HRB, disinfecting objects had the highest median likes and retweets, whereas mask-wearing and hand-washing related tweets achieved the highest median number of likes from Spanish tweets. Tweets from Spain that mentioned social distancing or disinfecting objects had a significantly lower predicted count of likes compared to tweets mentioning a different HRB (p=0.02 and p=0.01, respectively). Tweets from the USA that mentioned quarantine/confinement or disinfecting objects had a significantly lower predicted number of likes compared to tweets mentioning a different HRB (p<0.001), whereas masks and hand washing-related tweets had a significantly greater predicted number of likes (p=0.04 and p=0.02, respectively).

Conclusions:

The type of health-related behavior content and engagement with media outlet tweets containing this content varied between Spain and the USA early in the pandemic. However, content related to quarantine/confinement and engagement related to hand-washing was relatively high in both countries.