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The rise of social media in medical publishing
Social media is now one of the primary cultural mediums of our generation and it has become inextricably linked with medical publishing. Data from the 2018 Pew Internet Survey show that 69% of adults use social networking sites or systems.1 The majority use Facebook (68%), followed by Instagram (26%) and Twitter (23%). Over half of US adults get their news regarding health and medicine from Twitter or Facebook. Many medical journals are now using social media campaigns to help disseminate medical information beyond the pages of their journals to a potentially broader audience.2 All top-tier medical journals have social media presence and campaigns and recognise that the key to their future is to disseminate information and encourage discourse through this medium.1
When research published in a journal provokes opinion from readers, the traditional approach has been for the reader to write a letter to the editor.1 Letters were assessed by the editorial staff and in general published in the next edition. With the delay from acceptance to publication in print, however, this process used to take months. Now that articles are published ahead of print, readers are able to comment immediately through e-letters. Even this produces delays and barriers to submission, as publishing a comment usually requires that the user goes through an online registration process in which he or she must provide demographic information, credentials and conflict of interest information. With social media, journal readers can share opinions and comments about journal articles immediately after reading the article, with no prepublication review by the journal’s editorial staff.
How does social media affect a military health journal?
As a traditional health journal, we have primarily relied on electronic views of our articles from sites such as PubMed or directly from Google (figure 1). These result in a higher proportion of views from institutions and have resulted in an annual growth rate of 13.4% for the journal in Europe. These methods can, however, limit the growth in some regions, such as in developing areas of the globe (figure 2). As the UK’s military health journal, the Journal of the Royal Army Medical Corps (JRAMC) will always have to run the gauntlet when it comes to social media. We are currently owned by the Charity of the Royal Army Medical Corps, and all of the journal editorial board members are currently serving military officers, be that regular or reservist. As such, we both represent the Defence Medical Services publicly and are subject to Defence rules and regulations regarding social media. The UK military as a whole has been a slow and careful adopter of social media, reflecting understandable concerns with both security and image. The Armed Forces have multiple types of social media accounts, with Twitter being the most common and Facebook to a far lesser degree.3 The Defence Medical Services now has official Twitter accounts for many of its more senior officer appointments and the platform is increasingly being seen as a way of disseminating pertinent information to more junior military clinicians and associated health partners and the general public.
At the start of our partnership with BMJ in 2013, the journal had its’ own Facebook and Twitter accounts. These were slow to grow and initially there were concerns expressed over how the journal could balance the trend towards greater social media delivery with the requirements of organisations and individuals within the UK Armed Forces. We chose not to link ourselves to the Facebook accounts of individuals and we did not connect with LinkedIn, another commonly used site for clinicians. This led to a slower growth in the journal’s social media presence when compared with some of our competitors, which was at times understandably difficult for our new colleagues at BMJ to relate to. One of the decisions I made when starting as Editor in Chief was to stop our Facebook account and concentrate efforts solely on Twitter. This has been successfully led by our Deputy Editor and our followership continues to rise (figure 3).
Will the effort provide a return on our investment?
A critical factor regarding social media campaigns in the context of medical journal publishing is how to quantify impact, value and return on investment.1 Impact metrics can be based on the overall size of the feed’s following or can be post-specific. For example, on Twitter, the ultimate number of people who view a post is referred to as impressions. A recent study on randomly selected medical tweets demonstrated that only 50 tweets collectively reached an average of 1 200 865 individuals,4 demonstrating the true power of social media networks to rapidly transmit information. This level of engagement is reassuring when discussing whether social media activity provides a return on investment. Alternative ‘Altmetrics’ are newer measures of journal impact that go beyond traditional metrics of impact factor and citation rate and are now embedded in each article published in JRAMC.5 The Altmetrics score includes the number of times a journal article is viewed, downloaded, mentioned or discussed on social media or saved by various citation manager programmes. They have been shown to correlate with the number of times an article is ultimately cited. There is no strong evidence, however, that social media exposure per se increases citations, although this is an area of future enquiry.1 A study undertaken in the journal, Circulation, randomised all eligible original article manuscripts to receive social media exposure or to the control group, which was not exposed to social media through the official Circulation accounts.6 They found no difference in 30-day page views among the articles randomised to exposure by comparison with articles in the control group. It is clear there is room for further dialogue in this arena but the vast number of medical journals running social media campaigns would indicate its importance.1
What will be our future challenges?
Although we can control the contents of our publications and how we disseminate our message on Twitter and press releases, we have only a limited ability to control how messages are shared after that. The character limit on Twitter, although now increased, means that messages must be condensed into brief soundbites. Such truncated posts may lead to misinterpretation of a more nuanced message.1 In addition, the use of social media is lower among clinicians, and particularly those in or associated with the military, than among the general population.7 Most interestingly, the medical journals with the largest followings on social media also tend to be the journals with a more general focus rather than a specialty focus.1 Although the current title may not obviously demonstrate it, the JRAMC is a multidisciplinary journal reflective of military health in its most general sense. We therefore have the opportunity to reach out to a far broader readership than the majority of our competitors. This does, though, depend on the potential readership knowing what we do.
Most medical journals currently use Facebook and Twitter. Over time, other platforms will likely gain in popularity and be used for medical social media. Launching a new feed takes time; journals may be hesitant to add more social media channels to present campaigns without a clear sense of the ultimate value. At JRAMC, we have decided to focus on a single medium in Twitter. We will be supplementing that with podcasts on subjects that we feel will be of relevance to our readership. But beyond that, do we need to actively engage in social media to increase our presence? Many medical authors now envisage a time when social media becomes the major delivery vehicle for all medical communication.1 Is this really the way in which our military health journal will evolve? We are, in the end, all still serving members of the UK armed forces and personal security must always be a factor when considering this degree of exposure. The ultimate goal must be to promote the messaging of complex topics more widely to improve health and wellness. To investigate this, we have appointed a member of the editorial board primarily dedicated to social media. One of the challenges will be to start curating podcasts, which are regularly used in medical publishing to target particular health messages and generate discussion. Just as all of our journal articles are now available to everyone wherever they are in the world, be that in a first world hospital or a medical tent during a humanitarian mission, we envisage these podcasts opening up a new group of readers to our journal and ensure its future in the years to come. The DUN Project in 2015 identified Recruitment, Afghanistan and Training as three of the most discussed topics on social media in relation to UK Armed Forces.3 The JRAMC is clearly producing papers of national interest (figure 4), particularly those relating to medical decency policy and multidisciplinary consensus statements.8 In turn, we must use social media to identify future topics pertinent to our readership and tailor our content accordingly.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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