An exploration of the reach of the #MakeSpace4Research hashtag

Embedding a positive research culture within the nursing, midwifery and allied health professionals (NMAHP) workforce is regularly referred to in journal articles, white papers, organisational strategies and progress reports across the health and social care landscape (Carrick-Sen et al, 2016; Baltruks and Callaghan, 2018; Department of Health and Social Care, 2021; NHS England and NHS Improvement, 2021; Peckham et al, 2021; Health Education England, 2022). Dialogue in this area usually addresses how best to approach the delivery of clinical trials and how to engage the wider workforce in valuing, using and leading research within their clinical roles.

It has been reported that the success of engaging staff in research activity is often limited by the perceived accessibility of research terminology, assumed complexity of projects and authorisation, and the extent to which employees see research as being relevant or integral to their role, the departments in which they work and the patients they provide services for (Tinkler et al, 2018; Tinkler and Robinson, 2020).

Twitter

The integration of social media into modern society is a contemporary worldwide phenomenon, which has the potential to allow for rapid and global connectivity (Gibbs et al, 2015; Brady et al, 2017). Today, social media user numbers globally sit at around 4.8 billion (Datareportal, 2023), with Twitter alone hosting 368 million active users (Statista, 2022).

Twitter is a free social networking and microblogging service, established in 2006, on which an estimated 4340 tweets are posted per second (Pfeffer et al, 2023). It has been widely said to have increasing utility in medical communications and education (Killackey and Morley 2019; Scott and Goode, 2020). This includes live tweeting at events and conferences (Mackenzie et al, 2020); tweet chats with specific themes (Nevins, 2020); online journal clubs (Moorley and Chinn, 2019); coordination of research collaborative groups (Haase and Thorne, 2018); recruitment to research (Haase and Thorne, 2018); dissemination of new research from peer-reviewed journals (Klar et al, 2020); and, increasingly, as a route to learning required for continuing professional development (Scott and Goode, 2020).

Hashtags (#) are added to keywords or phrases, and enable users to track a specific subject area or discussion thread through the collation of associated tweets. The curation of content to relevant audiences is enabled via these hashtags.

Research within practice

Fewer than 0.1% of the NMAHP workforce are classed as a clinical academics, in comparison with 4.6% of the medical workforce (Baltrucks and Callaghan, 2018). The term clinical academic, however, is potentially narrow in scope and refers only to practitioners with a dual role across higher education institutes and clinical practice (Baltruks and Callaghan, 2018). This does not account for the range of potential ways in which NMAHPs engage with and contribute to the research culture across the NHS.

Regardless of the nuances of such definitions, various national bodies advocate the adoption of innovative approaches to develop the critical mass required to realise the full potential of research engagement and activity in health care (Baltrucks and Callaghan, 2018; Henshall et al, 2021; Peckham et al, 2021).

The #MakeSpace4Research campaign was just one element of a strategy to engage with and support NMAHPs to realise their potential through research at Newcastle upon Tyne Hospitals NHS Foundation Trust. The campaign is to be viewed within the wider context of operational, workforce and financial challenges, each of which has potential to limit the extent to which staff can engage or be supported to get involved.

The principles of the campaign focused on changing perceptions of staff ‘being released from practice’ to develop and undertake research towards a mindset of ‘making space within clinical practice’, while raising awareness of the work of NMAHPs in the delivery of research within broader teams across the NHS.

#MakeSpace4Research

Conceptualised in late 2018, the campaign began with a single tweet on 28 November 2018. The early success of the local campaign quickly sparked interest from other NHS sites across the UK. As well as the MakeSpace4Research hashtag (written as #MakeSpace4Research), merchandise was available to trusts on request. This included a Twitter banner, bespoke logos (Figure 1) including organisational Twitter handles and a short video animation. This animation, which has been viewed more than 2650 times, was launched at Newcastle upon Tyne Hospitals' NMAHP research conference on 20 May 2019 and designed to encourage NMAHPs to change the narrative around being released from practice into making space for research.

To date, 12 NHS organisations are official collaborators, with many more using the campaign hashtag for their own research agendas. Early anecdotal feedback from the campaign suggests it has led to vocabulary changes in meetings and in documentation, promoting the terminology ‘make space’ rather than ‘release from practice’.

Aim

Initially, the hashtag was developed to improve connectivity, encourage debate and discussion, and influence a change in terminology from ‘being released from practice’ to ‘making space for research within clinical practice’ among NMAHPs who were active in research. There was initially no intention to evaluate. However, as use of the hashtag appeared to increase and was adopted beyond the organisation, it became important to evaluate engagement generated by the campaign.

The aim of this evaluation was therefore to explore the reach of the #MakeSpace4Research campaign during its first 12-month period.

Methods

This cross-sectional evaluation measured online engagement with the #MakeSpace4Research campaign: a novel intervention to build an online community of research aware and active NMAHPs using the Twitter platform. Ethical approval was not required.

Brandwatch analytics

The #MakeSpace4Research hashtag was registered on the online analytical tool Brandwatch (www.brandwatch.com). This online tool assimilates data on specific hashtags analysing user interactions, social media users, trends, demographics and digital behaviour. Data on the number of tweets containing the hashtag #MakeSpace4Research were extracted from 28 November 2018 to 28 November 2019 (12 months).

The #MakeSpace4Research hashtag was retrospectively characterised for the first 3 months following its launch, and the final 3 months of the observational period, using Brandwatch. The studied variables were: total reach; total impressions; unique authors; total retweets; total mentions; and top tweeters. All these variables were collated using two separate variables: matching tweets and impact.

Impressions refer to the potential of a tweet being viewed on an individual's social media; not all tweets are viewed for a number of reasons, such as an individual not checking their Twitter page. Reach is measured when a tweet has actually been seen.

Results

During the 12-month period, there were 16 293 507 impressions using the hashtag. This involved 1085 unique user accounts and 6884 tweets. Three-quarters of authors were female and 25% were male. Most (89%) user accounts were in the UK, although there was activity elsewhere, particularly in the USA, Canada, Australia and the Netherlands.

During the first 3 months following the launch, the hashtag was used in 915 tweets (including retweets) by 252 unique authors (Figure 2). Use during this period remained consistent, at around 10-30 mentions per day. During the 3 months at the end of the 12 months of the #MakeSpace4Research campaign, the number of mentions (including retweets) had risen to 2722 tweets from 565 unique authors (Figure 2). The daily mentions similarly increased to around 30-50 per day.

#MakeSpace4Research tweets received more than 2 million impressions over the initial 3-month period following the launch, which rose to over 6 million impressions over the final 3 months of the observational period. Likewise, the total reach grew from 274 000 to 3 million between the two observed periods.

Although a discernible impact on uptake was not initially observed, the NMAHP research conference and educating delegates using the animation proved highly popular and the hashtag was mentioned over 500 times (Figure 3). Compared with baseline use, the NMAHP research conference had a demonstrable positive effect on the tweet activity levels and impressions of the #MakeSpace4Research hashtag.

The top 10 Twitter users on the hashtag are shown in Table 1. They accounted for 2883 (42%) of the overall tweets throughout the observed time period, with a reach of 16 526. While these accounts had varying numbers of followers, they had a strong network with frequent interactions, influencing a much wider network of users by interacting with the hashtag and each other.

Associated hashtags significantly influenced the reach and impact of the campaign (Table 2). Of particular significance was the hashtag #WhyWeDoResearch, set up in 2014 as part of a Christmas campaign (Gibbs et al, 2015; Yhnell et al, 2019) by the lead nurse for NMAHP research at James Paget University Hospitals NHS Foundation Trust. This hashtag was also used in 3109 of the total 6884 #MakeSpace4Research tweets (45.2%).

Discussion

Twitter has emerged as a transformational and important resource for health professionals in a variety of settings. Described as ‘probably one of the most disruptive – and net beneficial – things that has happened in academic medicine’ by Professor Vinay Prasad, an active Twitter user (Wetsman, 2020), the advantages include enhancement of communication and teamwork (Scott and Goode, 2020), making contacts (Riddell et al, 2019), providing high-quality educational content (Schnitzler, 2016), instant global reach (Killackey and Morley, 2019) and having minimal or no cost.

Because of this media's immediacy and intimacy, and its significant international reach, Twitter campaigns have been used by a variety of users to promote an agenda. Recently, healthcare-related Twitter campaigns have demonstrated high levels of engagement (Payne, 2015; Yhnell et al, 2019; Ansari and Pitt, 2021).

This targeted online campaign using the hashtag #MakeSpace4Research in tweets that were relevant to NMAHP research proved highly successful in enhancing interaction and encouraging communication between Twitter-active professionals. The results demonstrate clear growth in the use and awareness of the hashtag, showing a rise within the first year following its inception. Over the 12-month observational period, #MakeSpace4Research grew to involve over 1000 unique authors and nearly 7000 individual tweets; tweets using this hashtag have gained more than 16 million impressions.

The success of the hashtag has increased the visibility of the issue at the core of the campaign and also provided the NMAHP research community with an easy means of communication and to share ideas with one another effectively and rapidly on a global scale. Overall, the hashtag has been used by both individuals and institutions invested in changing the narrative from being released from practice to making space for research.

Although there are alternative social media outlets such as Facebook, LinkedIn and YouTube as well as blogging, Twitter has been identified as an emerging platform for professionals. Unlike Facebook, which has a larger reach in terms of numbers, Twitter is not restricted by the need to accept someone as a friend, which allows the individual or institution behind a handle to garner followers and follow others not only globally but also indiscriminately. This has led to a reduction in the confines of professional hierarchy and ‘lowers the boundaries of the institutional silos’ (Wetsman, 2020).

Professional use of Twitter also appears to bridge the gender divide, encouraging more women to participate in online discussions. Gender statistics were pulled from Twitter via analytics platform Brandwatch. Twitter users self-identify gender as one of the two options of male and female. Despite Twitter having more male users overall, within the realms of professional Twitter use, women are as likely to use Twitter as their male counterparts (Klar et al, 2020). These findings have been replicated within this study, with 75% of the campaign participants women compared with 25% men across the entire observational period. This is encouraging and helpful, given that most of the NMAHP workforce at Newcastle upon Tyne Hospitals is female (90%).

Much of the research into professional and academic Twitter use has focused primarily on the role it plays in research impact. Increasing evidence suggests that articles with more tweets receive more citations (Klar et al, 2020). Research disseminated through Twitter benefits from being able to push research through active dissemination, rather than using the pull model, whereby the researcher waits for their work to be found by interested people in academic databases.

However, although Twitter is an effective way of sharing knowledge that does not require university-affiliated access or an expensive subscription (Killackey and Morley, 2019), its merits with respect to research impact should be treated with caution. The number of research papers being tweeted is low (21.5%), compared with the number receiving at least one citation (66.8%) (Sharp et al, 2018). Additionally, a lack of engagement from tweet authors can limit the effectiveness of Twitter dissemination, making activity appear mechanical with little evidence of conversation (Robinson-Garcia et al, 2017).

Within the #MakeSpace4Research campaign, the focus has been on raising awareness and visibility of NMAHP research through engagement with and dissemination of the hashtag. Although caution related to research impact is advised, within the objectives of the campaign, growth of reach, impressions and unique authors clearly demonstrate successful engagement. Whether this will translate into long-term changes in the narrative surrounding #MakeSpace4Research will need to be evaluated at a later stage.

Although visibility and awareness of NMAHP research has been demonstrated in terms of mentions, impressions and reach, engagement has proved more difficult to measure. Positions and evidence around social media-based metrics or altmetrics (Haustein et al 2015) vary, which makes measuring impact and engagement difficult. Engagement in terms of retweets and replies shows active participation and reveals impact beyond the potential audience as measured by impressions. Not everybody will read a tweet that shows up on their feed, so impressions can reveal only so much about the impact the tweet truly has.

However, even though there are limitations in measuring the extent of a hashtag's global reach, Twitter users, in an active process of engagement, could share new knowledge, challenges and successes and the platform is a unique way of communicating and developing with other professionals (Killacky and Morley, 2019; Moorley and Chinn, 2019; Reinbeck, 2019; Riddell et al, 2019; Mackenzie et al, 2020). Although impressions may positively influence research impact (Sharp et al, 2018), other metrics, such as retweets and comments, are important to give validity to findings about engagement with tweets (Pinho-Costa et al, 2016; Sharp et al, 2018).

The spike in use identified during the NMAHP research conference in May 2019 demonstrates the potential for Twitter to enr ich engagement at such events. That the #MakeSpace4Research hashtag flourished indicates that connectivity beyond the confines of the conference location made a positive impact. Use of the hashtag at future conferences has the potential to raise awareness and visibility of the campaign beyond the event itself. Although unlikely to usurp the benefits of attendance, Twitter provides a proxy medium that can go some way in extending reach. Against the backdrop of COVID-19, this could prove to be a vital extension of content and connectivity that encouraged more participation from professionals unable to attend because of social distancing measures. As this study observed growth within a specific period in which there was only one conference, more evaluation needs to be done to measure the impact of conferences on the use of the campaign hashtag in the future.

A positive association of use was also observed when the #Makespace4Research hashtag was used in conjunction another hashtag #WhyWeDoResearch. The latter was created as part of a separate movement, which had the similar aims of raising awareness of health research (Gibbs et al, 2015; Yhnell et al, 2019). As with the #MakeSpace4Research campaign, the intention had been to communicate locally (Yhnell et al, 2019), but those involved quickly found that it had inspired uptake worldwide. Though both movements had similar aims – to increase awareness of health research – they deviated in terms of audience: whereas #WhyWeDoResearch does not have a targeted approach, the #MakeSpace4Research campaign was specifically aimed at NMAHP research. Despite this difference, together the two campaigns have the potential to attract more interest nationally. In terms of reach and impressions, when used together, the hashtags will likely have an impact on the campaigns' combined aims and open the conversation to a wider audience.

A potential pitfall in the use of the #MakeSpace4Research hashtag is the slow uptake of Twitter, particularly among NMAHPs, reportedly because of early institutional mistrust of social media (Scott and Goode, 2020) and concerns around online professionalism (Cain and Romanelli, 2009; Wang et al, 2019; O'Connor et al, 2021). However, when used correctly, Twitter has the potential to support collaboration, knowledge translation, resource sharing and global interaction (Jackson et al, 2018; Killackey, 2019). NMAHPs who do use social media find it to be of great benefit for interacting with health research and informing practice (Chinn, 2017) and view Twitter as a key learning tool (Deaves et al, 2019; Nevins and Smith, 2020). Despite these benefits, however, reticence to engage on Twitter has been noticeable among nurses (Moorley and Chinn, 2019).

Disinformation or fake news is another bone of contention. Social media use is a standard part of life for many in 2023 and has been for some time. Disinformation can be dangerous for patients, public and staff alike. When considering professional codes of practice across the NMAHP professions, ‘do no harm’ is consistent, as is the importance of evidence-based information, which underpins social media guidance (Nursing and Midwifery Council, 2022). With 4.8 billion social media users worldwide (Datareportal, 2023), it could be argued that health professionals should be active on it and promote the sharing of evidence-based research; this must be combined with the need for transparency as to the source of the evidence.

Of note, while the aim of the #MakeSpace4Research campaign was to increase the awareness and visibility of NMAHP research in UK health organisations, and thereby changing and influencing the culture of NMAHP research, the hashtag was picked up in several other, mostly developed countries. The UK was a clear leader at 89% of the total mentions but there was a small uptake in the USA, Canada, the Netherlands and Australia. It is unclear whether the use within these countries was in line with the campaign's original objectives or had been co-opted for a different use. There was very little uptake outside the UK on the day of the conference, which suggests the hashtag had been assimilated into separate agendas.

Limitations

The analytics are descriptive data so there are limitations in terms of the conclusions that can be drawn from as the findings are not powered sufficiently for statistical significance. Although the data look positive, it is unclear as to how much this is the above or below normal growth for a health-related hashtag.

Access to social media is limited in certain areas. Anecdotal evidence suggests that some trusts still block or limit access to Twitter and other social media sites on work computers, which affects user engagement during work hours for NMAHPs.

Conclusion

Social media, in particular Twitter, has the potential to transform modern-day engagement in NMAHP research. The significant growth in uptake of the #MakeSpace4Research campaign within the 12-month observational period is encouraging. At this stage, it is unclear whether its use indicates a shared objective to change the narrative around making space for research within clinical practice or a means to connect with other NMAHP researchers.

Whatever the intention, the #MakeSpace4Research hashtag serves to raise awareness and visibility of the campaign. Embedding the message of making space for research is about culture change, which will take time and likely a sustained approach to changing attitudes, both systemic and individual; however, with the conception of #MakeSpace4Research, awareness of culture change is growing.

Similarly, the reach of the hashtag cautiously suggests a need for connectivity and engagement around NMAHP research, which has the potential to be capitalised on for use within conferences. Although further evaluation around the use of the campaign at individual trusts is needed, the Twitter hashtag has certainly proved popular, driving engagement and providing a platform for national connectivity and influence.

KEY POINTS

• Twitter has the potential to transform engagement and provides a connection platform for nurse, midwife and allied health professional researchers nationally
• Twitter can be used as a proxy medium to engage and connect people during conferences, including those who cannot attend in person
• Engagement with the #MakeSpace4Research hashtag, derived to improve the visibility of nursing, midwifery and allied health professionals research, has been observed across a range of indicators
• When #MakeSpace4Research is used in conjunction with a the #WhyWeDoResearch hashtag, reach and engagement with the #Makespace4Research hashtag is greater

CPD reflective questions

• How can you use social media to increase engagement with research?
• What can you do to change culture around making space for research at your work?
• Who can you connect with using social media that can inspire engagement in nursing, midwife and allied health professional research?