“Health policy Twitter”, as it is affectionately known to users, is a virtual home for many AcademyHealth members, used for sharing information and forging relationships beyond the Annual Research Meeting or other in-person meetings and events. Twitter has become a particularly crucial destination for reacting to the news in 2017, when the pace of health policy-making seems faster, and more tumultuous, than ever before. What is the impact of Twitter – and health policy Twitter in particular – on health policymaking? Does Twitter help create more evidence-informed health policy?
Answering these big questions is hard. We need to better understand whether relationships forged through Twitter are trusted and credible to those we hope will use our research. We need to better understand the ecology of the information shared, whether research shared on Twitter is the best available, or is vulnerable to the biases and ideological filtering that characterize information-sharing in so many other contexts, including traditional media sources. We also need to better understand the types of networks that exist. If health policy decision-makers (and their staff and aides) are not connected to “health policy Twitter” – or at least, to the information sources that regularly provide data-enriched information about health policy, then it is unlikely that Twitter can be the translation vehicle many hope it might be.
To address this latter question, we (along with co-authors Raina Merchant and Jane Seymour) conducted an investigation of the Twitter networks from Congressional health staffers. Our paper was published in the American Journal of Managed Care. We obtained a proprietary list of 558 Congressional staffers working on health from Legistorm. Then we searched for each of the individuals to locate them on Twitter, and categorized their accounts as public vs. private. Within the public accounts (n=115), we then downloaded their list of accounts that they followed. This yielded 30,843 accounts. Since Twitter is always changing, it’s important to note that we did this original download on July 26, 2014.
To focus our analysis only on those accounts that might be influential, we examined accounts followed by at least three staffers (thus excluding staffers’ own personal friends and loved ones), which yielded 2203 accounts, or what we call plausible “information sources” for the health staffers. We conducted a content analysis of the byline information for each of these sources to assess what type of entity they were – such as a news media organization, a think tank, a government agency, or an individual affiliated with these types of organizations. We also analyzed all sources for whether they were broadly health-related or not, and whether they had an academic affiliation.
We found that Congressional health staffers in 2014 were following surprisingly few health-focused accounts. Of all 2203 accounts followed by 3 or more Congressional staff, only 71 (5.6%) were health-related. In contrast, news media organizations and reporters were dominant, comprising 51% of the accounts followed. Of those, national (e.g, New York Times) and political news (e.g, Politico) were the most common types of news accounts followed. Accounts by elected officials and government agencies were the next most common type of account followed. There were only 30 academic institutions or individuals followed in the entire sample.
Among the health-related accounts followed, the top was Sarah Kliff at Vox, followed by 26 of the staffers. Also popular was the Department of Health and Human Services, HealthCareGov and nytimeshealth, the dedicated health news account of the New York Times. Health Affairs was the only academic journal on the list, followed by 7 staffers; 7 staffers also followed Kaiser Health News.
While these findings may sound discouraging for knowledge translation – after all, Congressional health staffers in 2014 were rarely following academic accounts or journals publishing health policy and health services research -- we don’t take these results to mean that Twitter doesn’t have value. On the contrary, our study points to the very important role of journalist intermediaries. Congressional staffers are attentive to mass media outlets like Politico, the Washington Post, and Vox -- and these information sources likely remain important in 2017. Researchers should be considering these important intermediaries as audiences for our work, cultivating trusting relationships with journalists, and helping them interpret the implications of our fast moving policy environment. Twitter represents another way to reach the big media outlets that have always been an important venue for publicizing health services research.
It’s important to re-emphasize the date of our study. While Twitter was well established in health policy in 2014, its use has almost certainly grown since then. (While active users of Twitter have remained fairly constant since 2014, anecdotally we observe that the number of health services and policy researchers who have adopted the technology has likely grown from the 15% we noted in a 2013 survey of ARM attendees). More research is needed to document the changes in use of Twitter and its impact in today’s policy environment. Such research should examine the characteristics of networks on the researcher side (e.g, whether researchers effectively connect with intermediaries of their work); whether networks at the state and local policy level are different from those in Congress; and whether Twitter really serves to democratize information by making evidence more accessible, and available more quickly, than traditional publication. Finally, studies are needed to assess whether the growth of “Health policy Twitter” has actually corresponded with any growth in use of evidence in policy. The health services research community—with our arsenal of quantitative, qualitative, and Big Data skills – is ideally suited to tackle these questions. The impact of our efforts in policy and practice may well depend on it.