This paper presents the novel finding that Twitter misinformation regarding a SMT/immunity link increased dramatically during the onset of the COVID crisis. Further, activity levels and engagement were roughly equal between tweets promoting a SMT/immunity link and tweets refuting this claim. Interestingly, the potential audience (reach) of tweets refuting these claims was 3 times higher than those promoting these claims.
Mentions over time
The majority of search results (i.e. mentions) from Search #1 were coded as not relevant on the TTI and did not mention a specific profession (778 (70%)). Combined with tweets having a neutral tone (12 (2%)), the vast majority of mentions from Search #1 were not relevant to our analysis. While our search terms could have been made more restrictive to reduce this number of irrelevant mentions (e.g. using “spinal manip*”), we preferred to err on the side of having too many search results that were then coded by our team rather than construct too narrow a search that potentially missed relevant tweets.
Clearly, Twitter mentions about a SMT/immunity link increased during the onset of the COVID-19 crisis with peak activity being almost 5 x higher on March 9, 2020 (19.7 k mentions) compared to any other peak activity in the prior 12 months (e.g. September 9, 2019, 4.2 k mentions). This suggests that mentions during the COVID-19 crisis were intentional and not an aberration of baseline activity. To further assess baseline Twitter activity, we evaluated the second largest peak of mentions in the preceding 12 months (September 9, 2019, 4.2 k mentions). This activity consisted almost entirely of twitter content unrelated to the aims of the paper. However, our analysis did reveal a smaller activity peak on October 21, 2019 that appeared to be related to an automated message delivered from a web content subscription service.
“Chiropractic care can improve your immune system, mobility, strength, and so much more. If you want to see a positive change in your health, schedule an appointment with us”.
This specific tweet appeared in 17/21 unique tweets on October 21, 2019 within hours of each other. These 17 tweets generated a total potential reach of 54 users and an engagement score of 1 (retweets + likes). In contrast, a single tweet in the same time period that refuted this message generated a potential reach of 2657 users with an engagement score of 25.
Tweet coding and sentiment
When a tweet is made, it automatically goes out to all persons who follow (i.e. subscribe) the author’s Twitter account. While sometimes the potential reach of that author is in the thousands or even millions, there is no guarantee that their followers open their device and see the tweet let alone read it. Therefore, the number of followers, or the potential reach of an author is a measure of the potential impact of a tweet. In contrast, if someone acknowledges a tweet by giving it a like or retweeting it (i.e. rebroadcasting it to their own followers), this confirms that the original tweet was both read and acknowledged indicating a true interaction between users. Considering this, tweets that refute a SMT/immunity link had almost 3 times the potential reach compared to those that promoted this link although the engagement between these two groups was similar. This is an important finding as it suggests that promoting tweets create as much engagement as refuting tweets but with the important note that refuting tweets have the potential of reaching many more persons with their message. Still, it is highly likely that the engagement and potential reach of promoting and refuting tweets have differing audiences who are unaligned in their belief systems about SMT and immunity [33].
Regarding professions mentioned in tweets, our coding revealed that our initial wildcard search terms for physiotherapy and osteopathy were too broad resulting in tweets having topics related to physiology and osteology for example. Following coding to eliminate these tweets, chiropractic was the profession most often referenced with 4 times more mentions than the next profession (naturopathy). These data suggest that the majority of twitter activity regarding a SMT/immunity link is associated with the chiropractic profession with the total number of posts being roughly equal between those promoting and those refuting this link.
Tweets themes
Tweet themes do not appear to be a good indicator of the impact of specific content as the frequency of the theme is not related to the potential reach or engagement associated with the message; an infrequent theme may be posted in a tweet with far greater reach and engagement than higher ranked themes with lower reach and engagement.
Influencers
The top influencers for tweets promoting and refuting a SMT/immunity link each had engagement scores that were ~ 1000 points higher than the next influencer. This shows influence distribution is not equal within each group. Even more so, top influencers appear to be individuals and not academic institutions, regulatory bodies or professional organizations. Thus, few institutions (e.g. universities, associations) were identified as influencers although some individuals with a specific institutional affiliation could be identified. Although Twitter data is publicly available, and Twitter users agree to make their information available publicly, we have chosen not to identify user names of influencers so as not to inadvertently legitimize those who promote misinformation.
Demographics and global distribution
The majority of those promoting or refuting a SMT/immunity link were male and English speakers. Interestingly, tweets promoting a SMT/immunity link most commonly originated in the United States. Although tweets rarely were affiliated with specific institutions, we note that the majority of chiropractic, naturopathic and osteopathic schools in the world are in the United States. In contrast, the majority of tweets refuting a SMT/immunity link were from Canada which suggests that geographic proximity between countries is not a factor in establishing a position on this topic. These data likely reflect the distribution of Twitter use around the world. The United States is the number one user of Twitter with Japan in second place and Canada in 12th place [34].
Strengths and limitations
Results from this work have the potential to help policy makers and others understand the impact of SMT misinformation and devise strategies to mitigate its impact. Specifically, our results suggest that while the potential reach of messaging that refutes misinformation about SMT was substantial, very few institutions added to this total. Assuming that most institutions related to SMT stand to gain from combating misinformation about SMT (educational programs, associations, regulators, health care administrators etc), these same institutions should re-evaluate their social media strategies lest their silence be taken to be complicit of misinformation or lead to their own demise from an erosion of public trust.
The results reported here are different from those presented previously by investigators who explored chiropractic messaging on Twitter in December of 2015 [35]. In this prior work, Tweets refuting claims about questionable benefits from SMT, including changes in immunity, appeared to be less in proportion compared to those promoting such claims. Possible explanations for these incongruent results include the methodologies used, the year/month of data collection and an increasing awareness of social media misinformation especially during the covid crisis.
While Talkwalker can assess other electronic data sources, only Twitter provides full access to its “firehose”, the entirety of its activity except for direct messaging between users (a private channel of communication between users). As a result, the data from this paper are presumed to be robust in that they represent all activity taking place on a single social media platform although search results from Talkwalker have not been compared against other services/techniques for accessing Twitter data.
Although Twitter provides a window into conversations within a social media community, it is limited in that it does not represent all persons in the world. Presently, Twitter ranks 13th in total monthly users; Facebook has 2.45 billion active monthly users compared to Twitter’s 340 million [36].
Some of the data used in this study were obtained from proprietary algorithms available from TalkerWalker Quick Search but whose methods of calculation were not available to us (e.g. sentiment scores). Similarly, Talkwalker Quick Search uses artificial intelligence to derive some demographic information not directly included in Twitter user profiles (age, occupation and interests). These proprietary metrics of defining user profiles were not used in our analysis.