JMIR Publications

ABSTRACT

Background:

Twitter is acknowledged by US health agencies, including the CDC, as an important public health communication tool. However, there is a lack of data describing its use by state health agencies over time. This knowledge is important amid a changing social media landscape in the wake of the COVID-19 pandemic.

Objective:

Our objective was to describe US state health agencies’ use of Twitter from 2012 through 2022. Further, we organized our data collection and analysis around the theoretical framework of the networked public, to contribute to broader literature around health communication online beyond a single platform.

Methods:

We used Twitter API data as indicators of state health agencies’ engagement with the 4 key qualities of communication in a networked public: scalability, persistence, replicability, and searchability. To assess scalability, we calculated Tweet volume and audience engagement metrics per Tweet. To assess persistence, we calculated the portion of Tweets that were manual Retweets or included an account Mention. To assess replicability, we calculated the portion of Tweets that were Retweets or Quote Tweets. To assess searchability, we calculated the portion of Tweets using at least 1 hashtag.

Results:

We observed a pandemic-era shift in state health agency engagement with scalability and searchability, toward high-volume output and a more fragmented approach to searchability amid decreased engagement with searchability overall. We did not observe such a pandemic-era shift in engagement with persistence and replicability, but instead a longer-term decrease in their prominence among state health agencies.

Conclusions:

Overall, we observed a more fragmented approach to state health agency communication on Twitter during the pandemic, prioritizing volume over searchability, formally replicating existing messages, and leaving traces of interactions with other accounts.