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      Pandemics in the Age of Twitter: Content Analysis of Tweets during the 2009 H1N1 Outbreak

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      Journal: PLoS ONE
      Publisher: Public Library of Science

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          Abstract

          Background

          Surveys are popular methods to measure public perceptions in emergencies but can be costly and time consuming. We suggest and evaluate a complementary “infoveillance” approach using Twitter during the 2009 H1N1 pandemic. Our study aimed to: 1) monitor the use of the terms “H1N1” versus “swine flu” over time; 2) conduct a content analysis of “tweets”; and 3) validate Twitter as a real-time content, sentiment, and public attention trend-tracking tool.

          Methodology/Principal Findings

          Between May 1 and December 31, 2009, we archived over 2 million Twitter posts containing keywords “swine flu,” “swineflu,” and/or “H1N1.” using Infovigil, an infoveillance system. Tweets using “H1N1” increased from 8.8% to 40.5% ( R 2 = .788; p<.001), indicating a gradual adoption of World Health Organization-recommended terminology. 5,395 tweets were randomly selected from 9 days, 4 weeks apart and coded using a tri-axial coding scheme. To track tweet content and to test the feasibility of automated coding, we created database queries for keywords and correlated these results with manual coding. Content analysis indicated resource-related posts were most commonly shared (52.6%). 4.5% of cases were identified as misinformation. News websites were the most popular sources (23.2%), while government and health agencies were linked only 1.5% of the time. 7/10 automated queries correlated with manual coding. Several Twitter activity peaks coincided with major news stories. Our results correlated well with H1N1 incidence data.

          Conclusions

          This study illustrates the potential of using social media to conduct “infodemiology” studies for public health. 2009 H1N1-related tweets were primarily used to disseminate information from credible sources, but were also a source of opinions and experiences. Tweets can be used for real-time content analysis and knowledge translation research, allowing health authorities to respond to public concerns.

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          Early Assessment of Anxiety and Behavioral Response to Novel Swine-Origin Influenza A(H1N1)

          James Holland Jones, Marcel Salathé (2009)
          Background Since late April, 2009, a novel influenza virus A (H1N1), generally referred to as the “swine flu,” has spread around the globe and infected hundreds of thousands of people. During the first few days after the initial outbreak in Mexico, extensive media coverage together with a high degree of uncertainty about the transmissibility and mortality rate associated with the virus caused widespread concern in the population. The spread of an infectious disease can be strongly influenced by behavioral changes (e.g., social distancing) during the early phase of an epidemic, but data on risk perception and behavioral response to a novel virus is usually collected with a substantial delay or after an epidemic has run its course. Methodology/Principal Findings Here, we report the results from an online survey that gathered data (n = 6,249) about risk perception of the Influenza A(H1N1) outbreak during the first few days of widespread media coverage (April 28 - May 5, 2009). We find that after an initially high level of concern, levels of anxiety waned along with the perception of the virus as an immediate threat. Overall, our data provide evidence that emotional status mediates behavioral response. Intriguingly, principal component analysis revealed strong clustering of anxiety about swine flu, bird flu and terrorism. All three of these threats receive a great deal of media attention and their fundamental uncertainty is likely to generate an inordinate amount of fear vis-a-vis their actual threat. Conclusions/Significance Our results suggest that respondents' behavior varies in predictable ways. Of particular interest, we find that affective variables, such as self-reported anxiety over the epidemic, mediate the likelihood that respondents will engage in protective behavior. Understanding how protective behavior such as social distancing varies and the specific factors that mediate it may help with the design of epidemic control strategies.
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            Widespread public misconception in the early phase of the H1N1 influenza epidemic.

            Joseph Lau, Sian Griffiths, Kai Chow Choi … (2009)
            To investigate the community responses and preparedness for a possible epidemic of H1N1 influenza in Hong Kong shortly after an imported case was confirmed. A random sample of 550 Chinese adults in the Hong Kong general population was interviewed during May 7-9, 2009. The public did not perceive a high likelihood of having a local H1N1 outbreak, nor did they regard H1N1 as a threatening disease. Frequent hand-washing (73.6%) and use of face-masks in case of flu symptoms (47.9%) were prevalent. The public approved of governmental policies including the quarantining of hotel guests, was not panicking and perceived a high self-efficacy of self-protection. However, misconceptions were prevalent and the public avoided visiting crowded places (9.3%), which many people wrongly believed was a government recommendation. Although the public response demonstrated vigilance and preparedness there were signs of complacency. Clear communication, updated scientific information and transparency on government decision making are warranted. Data of the study provide a baseline for an ongoing surveillance program to help shape policy and provide information to the international community.
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              Awareness, attitudes, and practices related to the swine influenza pandemic among the Saudi public

              Hanan Balkhy, Mostafa Abolfotouh, Rawabi H Al-Hathlool … (2010)
              Background During an infectious disease outbreak, it is critical to learn as much as possible about the concerns, knowledge, attitudes, and behavior of the public. Such information can be crucial to the improvement of communication efforts by public health officials and clinicians. The aim of this study was to identify awareness, attitudes, and practices related to influenza A (H1N1) among the Saudi public. Methods A cross-sectional study of 1,548 adult subjects recruited from various shopping malls in Riyadh and Jeddah was conducted. All of the subjects were interviewed using a questionnaire that tested their knowledge, attitudes, and use of precautionary measures in relation to the H1N1 influenza pandemic. Results More than half (54.3%, 840/1548) of the participants showed high concern, 43.7%(677/1548) showed a low level of knowledge, and 60.8%(941/1548) had taken minimal or no precautionary measures. After adjusting for other variables, education level was the only significant predictor of the level of concern (p < 0.001), while greater precautionary measures were taken by participants who were male (p < 0.001), older (p = 0.047), better educated (p = 0.04), and more knowledgeable (p < 0.001). More than one-third (38.3%) of participants were not convinced that the MOH reports about the disease were true, and only 16.1% of the participants reported receiving information from health providers. Conclusions High concern did not translate into a higher compliance with precautionary recommendations, possibly due to the low level of knowledge about the disease among the public. Frequent communication between physicians and the public is recommended to help dispel myths about the disease and to spread better information about the role that the public can play in limiting the spread of the disease.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2010
                Publication date (Electronic): 29 November 2010
                Volume: 5
                Issue: 11
                Electronic Location Identifier: e14118
                Affiliations
                [1 ]Centre for Global eHealth Innovation, University Health Network, Toronto, Canada
                [2 ]Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada
                Children's Hospital of Eastern Ontario, Canada
                Author notes

                Conceived and designed the experiments: CMC GE. Performed the experiments: CMC GE. Analyzed the data: CMC GE. Contributed reagents/materials/analysis tools: GE. Wrote the paper: CMC GE.

                Article
                Publisher ID: 10-PONE-RA-20327R2
                DOI: 10.1371/journal.pone.0014118
                PMC ID: 2993925
                PubMed ID: 21124761
                SO-VID: 838dfcb5-eb40-41ce-9501-e431922106a6
                Copyright © Chew et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 26 June 2010
                Date accepted : 4 November 2010
                Page count
                Pages: 13
                Categories
                Subject: Research Article
                Subject: Public Health and Epidemiology
                Subject: Non-Clinical Medicine/Communication in Health Care
                Subject: Non-Clinical Medicine/Medical Informatics
                Subject: Non-Clinical Medicine/Research Methods
                Subject: Public Health and Epidemiology/Health Services Research and Economics

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