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

Citation: Chew C, Eysenbach G ( Pandemics in the Age of Twitter: Content Analysis of Tweets during the 2009 H1N1 Outbreak Cynthia Chew 0 Gunther Eysenbach 0 Margaret Sampson, Children's Hospital of Eastern Ontario, Canada 0 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 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% (R2 = .788; p,.001), indicating a gradual adoption of World Health Organizationrecommended 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 - Funding: Mrs. Chew was generously supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Masters Award. Infovigil.com is a non-commercial project/website, partly funded by the Canadian Institutes of Health Research (CIHR) [Pandemics in the Age of Social Media: Content Analysis of Tweets for Infoveillance and Knowledge Translation Research, PI: Gunther Eysenbach]. Other parts of the project costs may in the future be defrayed by consulting and collaborating with commercial entities. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. In the era of the 24-hour news cycle, the traditional once-a-day press conference featuring talking heads with a bunch of fancy titles has to be revamped and supplemented with Twitter posts, YouTube videos and the like. The public needs to be engaged in conversations and debate about issues of public health, they dont need to be lectured to. -Andre Picard [1] Public health agencies do not act in a void, but rather are part of a larger feedback loop that includes both the media and the public. The social amplification of risk framework postulates that psychological, social, cultural, and institutional factors interact with emergency events and thereby intensify or attenuate risk perceptions [2]. Traditionally, print media, TV and radio are the major transmitters of information from public health agencies to the public and play a large role in risk intensification and attenuation. However, during the most recent public health emergency, 2009 H1N1, respondents cited the internet as their most frequently used source of information on the pandemic [3]. With the rise of the participatory web and social media (Web 2.0) and resulting proliferation of user-generated content, the public potentially plays a larger role in all stages of knowledge translation, including information generation, filtering, and amplification. Consequently, for public health professionals, it is increasingly important to establish a feedback loop and monitor online public response and perceptions during emergency situations in order to examine the effectiveness of knowledge translation strategies and tailor future communications and educational campaigns. Surveys are the traditional methods for public health officials to understand and measure public attitudes and behavioural responses. Several studies have used telephone, internet, and inperson surveys to elicit such information during the H1N1 pandemic (e.g., [4,5]). Rapid-turnaround surveys best capture changes in attitudes and behaviour influenced by specific events and produce the most relevant information for agency intervention [6]. Unfortunately, time is needed to gather resources, funding, and survey instruments for polling [6]. New infoveillance methods such as mining, aggregating, and analysing online textual data in real-time are becoming available [7,8]. Twitter (www.twitter.com) is potentially suitable for longitudinal text mining and analysis. The brief (,140 characters) text status updates (tweets) users share with followers (e.g., thoughts, feelings, activities, opinions) contain a wealth of data. Mining these data provides an instantaneous snapshot of the publics opinions and behavioural responses. Longitudinal tracking allows identification of changes in opinions or responses. In addition to quantitative analysis, the method also permits qualitative exploration of likely reasons why sudden changes have occurred (e.g., a widely read news report) and may indicate what is holding the publics attention [9]. H1N1 marks the first instance in which a global pandemic has occurred in the age of Web 2.0 and presents a unique opportunity to investigate the potential role of these technologies in public health emergencies. Using an infoveillance approach we report on: 1) the use of the terms H1N1 versus swine flu over time on Twitter, to establish the feasibility of creating metrics to Personal Opinion and Interest Tweet contains H1N1 news, updates, or information. May be the title or summary of the linked article. Contents may or may not be factual. Twitter user mentions a direct (personal) or indirect (e.g., friend, family, co-worker) experience with the H1N1 virus or the social/economic effects of H1N1. Twitter user posts their opinion of the H1N1 virus/situation/ news or expresses a need for or discovery of information. General H1N1 chatter or commentary. Tweet contains a H1N1 joke told via video, text, or photo; or a humourous opinion of H1N1 that does not refer to a personal experience. Tweet is unrelated to H1N1 China Reports First Case of Swine Flu (New York Times): A 30year-old man who flew from St. Louis to Chengdu is.. http:// tinyurl.com/rdbhcg Ways To Prevent Flu http://tinyurl.com/r4l4cx #swineflu #h1n1 Swine flu panic almost stopped me from going to US, but now back from my trip and so happy I went :-)) Oh we got a swine flu leaflet. clearly the highlight of my day My sister has swine flu! More people have died from Normal Flu than Swine flu, its just a media hoax, to take peoples mind off the recession Currently looking up some info on H1N1 Swine flu is scary! If youre an expert on the swine flu, does that make you Fluent? musicmonday MM lamarodom Yom Kippur Polanski Jay-Z H1N1 Watch FREE online LATEST MOVIES at ht (...truncated)