Enhancing engagement beyond the conference walls: analysis of Twitter use at #ICPIC2019 infection prevention and control conference

Most international conferences, including those on infection prevention and control (IPC) and infectious diseases remain scarcely accessible to an extensive set of attendees for multiple reasons (time, budget, country entry requirements, etc.). Involvement of all stakeholders, including patient and public involvement is considered critical indeed to bend the curve on the rising global and economic tide posed by antimicrobial resistance (AMR), as one example related to infections [1]. Improving communication from scientific content delivered during the conference to the scientific community but also the general public might be essential to reach the aforementioned objective.

Twitter provides a unique opportunity to bridge the divide for researchers, patient communities and the public to engage with scientific information remotely in a more accessible, inclusive, and diverse platform keeping up with cutting-edge research, sharing knowledge, and having the opportunity to learn [2]. Interactions with published messages include tweets, retweets which share original messages and quote tweets which include personal comments, and replies related to the original tweet. These interactions are unilateral, meaning that followers are not always followed. More recently, Twitter has reshaped the impact of scientific conferences by engaging virtual followers as documented across medical specialities [3‐6] including infectious diseases and IPC [7‐9].

Studies have identified the importance of including patients as partners in scientific conferences, helping to direct research and current discussion in a patient-centric approach, driving the future of healthcare [10, 11].

The 5^th international consortium for prevention and infection control (ICPIC) [12], is an established 4-day congress in the prevention of healthcare-associated infections and control of antimicrobial resistance that is held biannually. ICPIC2019 was the first in IPC conferences to integrate patient participation and conferred a patient-included™ charter status [13] (Additional file 1: Table 1). A conference successfully meeting all five of the charter’s pillars namely: (1) codesign (patients participate in the selection of topics and speakers), (2) engagement (including patients as presenters and in the audience), (3) accommodation (support in travel and accommodation and provide scholarship), (4) disability requirements (accommodating the physical needs of patients) and 5) virtual participation (free online video streaming) may be accredited as a Patients Included™ event [13]. Patient integration in IPC conferences is an important step to bring patients closer to the conversations driving patient safety and to ultimately improve the lives of patients and their families [12]. Inclusion and active engagement of patients as stakeholders can help drive knowledge dissemination and identify issues that matter most to patients, caregivers and their families (Table 1).

Twitter may enhance the experience of scientific congresses to a wider audience and generate international engagement and global reach [14, 15]. However, this is not a guarantee for various reasons, such as the number of followers [15], and the content of published messages that need to be informative and of interest to non-attending individuals in order to sustain engagement [16]. Furthermore, an echoing effect has been observed with scientists mainly reaching other scientists, impacting the spread of the message to other stakeholders [15]. Assessing this echoing effect might estimate the spread of content from scientific conferences among the general public. Through non-supervised clustering approach based on biographies of the Twitter participants and their followers, we might describe more in detail the categories of stakeholders involved in the spread of online content [17‐21]. As patients’ status might be hardly ascertained based on biographies, such analysis would focus on the diversity of categories of Twitter users observed, hypothesizing that they represent past, present and future patients.

This study was performed: (i) to assess how ICPIC2019 allowed conference participants to reach out to other peers (in-reach) and to non-scientific audiences (general public) (outreach) through Twitter discussion; (ii) to compare the professional background of followers of participants (“reach”), and followers that interacted with original tweets; (iii) to explore connectedness between followers of each participant and estimate the potential spread of scientific information.

In September 2019 (ICPIC2019), a total of 1264 participants attended the conference of which 28 were patients.

Our study used unsupervised learning in the tweets mentioning #ICPIC2019 for profiling of both authors and their respective followers according to their biographies, in the context of a patient-included™ conference. Including only English Tweets (based on their last tweet), the volume of followers and authors categorized was significant, with 235′620 followers linked to 474 authors. Unsurprisingly, we observe that the majority of Twitter users interacting during #ICPIC2019 were healthcare workers (34%), followed by industry (11%), and academic researchers (8%). These results highlight that Twitter activity during ICPIC2019 scientific congress reached a broader audience than expected. This observation supports the use of Twitter as a communication tool to increase the overall reach of disseminating scientific information [2, 8]. In parallel to other existing commercialized methods to characterize Twitter users and followers (e.g. Symplur healthcare hashtags, Twitonomy), we were able to use this approach to measure the number of distinct followers per user, but at the same time, to keep all followers per user in order to evaluate specific relationships.

The methods used do not only rely on specific words to categorize authors and followers, but rather on their specific frequencies and distributions present in the biographies. These parameters are influenced by multiple factors indicative of gender, culture, personalities and specific interests [22, 23]. Specific interests sometimes converged to provide a clue about professional backgrounds. We observed some clusters to be more specific than others because of the use of a specific lexicon, including healthcare workers and academic researchers. Patient-oriented biographies might include less specific vocabulary and overlap with multiple other categories.

The categories of authors largely influenced categories of followers. This finding has already been observed in a previous study [15]. Furthermore, we observed more diversity in the reach of non-healthcare workers compared to healthcare workers. This observation was also supported by further network analysis between all followers of specific categories. Influencers with a large number of followers might also influence the diversity of reach, impact the reach of Twitter connectedness, and steer conversations [15]. Unfortunately, this information was not accounted for in the analysis.

To note, the population of active followers only represents 0.05 to 0.3% of the total reach. Thus, it should be considered that followers might not always estimate the actual spread of a message. Interestingly, when observing the network of Twitter interactions, different categories of biographies often interacted together. We did not observe particular clusters or over-representation of specific categories, such as healthcare workers in online interactions. In the network analysis, we observed that industries or patients also participated in this online interactions and contributed to the diffusion of conference messages.

Given the homogeneity of Twitter networks from healthcare workers and academics, but the heterogeneity of professions involved in Twitter interactions, the designation of a patient-included™ status and the process of systematically addressing methods to strengthen the inclusion of patients through social media may foster the spread of core messages to non-attending individuals reaching a more diverse population. While this study cannot make this conclusion, Utingen and colleagues performed a social network analysis to analyse Twitter activity from 1672 healthcare conferences and showed that when engaged patients are included in congresses, they increase the spread of conference information flow across social networks [11]. There is little doubt that patient inclusion can have benefits, but identifying the specific advantages requires further attention.

The SARS-CoV-2 pandemic has shifted in-person scientific conferences to virtual and digital events. The shift has provided unprecidented opportunities to use social media platforms including Twitter, to reach a wide audience across the world allowing advanced integration among users and real-time interaction of key findings [25]. Now more than ever it is important to maximize the reach of evidence-based information on infection prevention and control from scientific conferences via social media platforms to debunk misinformation.

First, being unable to confirm participants from the conference from an official list, we only hypothesized that Tweet authors mainly participated in the conference. Second, professions represented in biographies originally represented a mixture of probabilities between different categories. For the sake of simplicity, biographies were categorized only using the most probable category. Therefore, overlapping categories were lost in this analysis (e.g. healthcare worker and academic research). Furthermore, due to the small number of characters allowed for biographies (n = 160), the unsupervised technique is less performant and generalizable. However, above a certain threshold of gamma probabilities, especially considering specific categories, and consistently with the validation of the labels on naive datasets, this technique remained reliable for a majority of biographies. Additionally, this technique accounted for specific distributions of all words included in the biographies to ascertain a category, and not just to specific words. This allowed better discrimination compared to the presence of a single or multiple keywords. Third, only biographies with the most recent tweet composed in English were included, so all other biographies certainly also expressing related professional categories were excluded. Fourth, no other unsupervised or supervised models were performed on the dataset, so repeatability of findings was not assessed. Fifth, we only captured tweets that included the official hashtag of the conference (#ICPIC2019), this might have introduced a selection bias as it is possible that conference-related tweets were sent without the official hashtag [24]. Nonetheless, the use of this performant analysis on a large dataset was able to identify the diversity of biographies from users and followers participating in the online discussion around ICPIC2019. These results add to the body of knowledge on Twitter use from diverse professional background and impact during academic scientific conferences focused on IPC and provide novel insights on the aforementioned points.

This study offers a unique perspective of the widespread reach of IPC messaging through the use of Twitter social media platform from a single conference. It highlights the potential to increase the dissemination of research across on an array of networks thereby increasing the total Twitter output generated from in-person and virtual scientific conferences. The systematic analysis based on Twitter biographical information can be a useful adjunct to other methods utilised in data science, providing a feasible and useful future direction for the exploration of reach. Furthermore, the present study also suggests that patient-included™ conferences may have a positive impact on overall reach not only to other patients and the public in general, but for the engagement of numerous stakeholders ranging from media to industry, key for IPC. Congress organizers should implement a social media strategy and promote the use of Twitter conference hashtag pre, post and during the event. This strategy offers a useful direction to help disseminate timely information and increase virtual participation of patients, the public and non-attending individuals as highlighted in the patient-includedTM conference charter clauses.