Social Media and Urticaria - A Data Audit of Facebook^®, LinkedIn^®, and Twitter^® Posts

Abstract

Introduction:

Urticaria is a common debilitating dermatological disorder impairing a patient’s quality of life. Such patients are increasingly using socialmedia to manage their health and interact with peers, particularly during the ongoing COVID-19 pandemic.

Objectives:

To explore and analyse the quality of urticaria related social-media information available to patients.

Materials and Methods:

An in-depth data audit of the three most commonly used social networks viz. Facebook®, LinkedIn®, and Twitter® were done on a single day, as posts may change or lose relevance over time. The word “urticaria” was searched on three social media, and the first 100 posts in each were further analysed. The post-creator was either categorised as “individual” or “group”, and non-English posts were excluded. All types of posts have been analysed, including text, images, video, and website links. We also collected the comments/replies, share/re-tweet, and likes on the posts.

Results:

Among the total 300 social-media posts, the highest number of “individual” posts was on LinkedIn® followed by Twitter® and Facebook® (χ² = 82.86, P < 0.0001). Regarding thematic content, most Facebook® posts discussed disease symptoms, followed by the promotion of journal or blog posts, and discussion about causative and triggering agents. LinkedIn® was primarily used for the promotion of journal articles or blog posts, followed by educational webinars and urticaria treatment stories. Twitter® users mostly interacted with peers about their urticaria symptoms and perceived etiologic and triggering factors. Regarding the type of post, images were maximally shared on Facebook®, while video/video links and web links were highest on LinkedIn® (χ² = 21.59, P < 0.0001).

Conclusion:

The overall quality of urticaria related information on these 3 social media platforms is satisfactory for patients. Dermatologists may consider utilising social media to further educate such patients and improve the overall treatment outcome. The use of such networking channels will continue to grow, as communication remains crucial for urticaria management.

Introduction

Urticaria is a mast cell-driven skin disease, presenting with unpredictable wheals, angioedema, or both. The overall lifetime prevalence of acute urticaria is approximately 20%, and that of chronic urticaria is 4.4%.[1] While the acute form resolves within six weeks, chronic urticaria is characterised by symptoms persisting beyond six weeks often without an identifiable trigger, considerably worsening the patient’s quality of life.[2]

With the advent of newer information and communication technologies, social media has become increasingly popular among all sections of the population. Facebook®, Twitter®, and LinkedIn® have become a key tool for disseminating medical information. Millions of microblogs and online forums may be found on these platforms, where medical professionals as well as patients participate, discuss, exchange, and promote health-related news. They often serve as an additional source of evidence, therapy, or support for patients suffering from chronic diseases.[3] The coronavirus disease 2019 pandemic further increased the popularity of these platforms as channels to communicate health-related messages to a mass audience in an efficient manner and showed how information spreading on social media can strongly influence people’s behaviour.[4]

A recent UCARE study revealed almost 87.3% of chronic urticaria patients were interested in receiving disease information using such communication platforms. Most patients also expressed satisfaction by communicating with physicians and fellow patients using emails, messaging applications, web browsers, and social media.[5] Although several studies exist to review the quality and content of information related to various chronic diseases on social media, there is a dearth of similar data on urticaria. Surveys to identify the nature of social media posts on disease are imperative to give us an idea about public awareness regarding the condition and to what extent these platforms influence the lives of patients suffering from it. The present study aims to describe the quality of posts related to urticaria on social media and the extent to which they are followed by users, to understand the general awareness and perception of urticaria.

Materials and Methods

Social media

We selected three popular social media platforms – Facebook® (www.facebook.com), LinkedIn® (www.linkedin.com), and Twitter® (now known as X) (www.twitter.com). Facebook is an online social media where anyone can open an account to share posts and build a social network with other users. LinkedIn is a business and employment-oriented platform that is commonly used by professionals of various domains for networking and career development. Twitter is a microblogging social media where the users have a limitation of words per post (i.e., tweet). It is used by all segments of users to share their thoughts.

Data collection

We collected data on a single day (5^th Nov 2022) at a stretch as the posts may change or lose their relevance on the media with time. The word “urticaria” was searched on each of the three social media and the first 100 posts were selected for further analysis. A brief process of data collection method is shown in Figure 1.

Figure 1.

Brief data collection procedure

The word “urticaria” was searched on Facebook with filters such as “posts” and “recent post”. On LinkedIn, the same word was searched with a filter as “posts”. Tweets were searched similarly using the filter “top”. We excluded posts or tweets in languages other than English. Four such cases were faced on Facebook, two on LinkedIn, and three on Twitter. The text from the included posts was saved in a Notepad document for further analysis and generating the word cloud. The category of the post creator was either recorded as “individual” or “group.” The term “group” includes any professional association, group of individuals, company, and educational or other institutions. The total comments/replies, share/re-tweet, and likes on the posts were collected. The post content was collected as text, images, video, and website links. No posts were found with audio files; hence, it was not mentioned.

Statistical analysis

Categorical data were presented as numbers and percentages and compared statistically by the Chi-square test. Continuous data were presented by the median and interquartile range (Q1-Q3: first quartile – third quartile) and compared statistically by the Kruskal-Wallis test and Dunn’s post-hoc test. The non-parametric test was chosen as the data were not following a normal distribution. The textual data were thematically coded in QDA Miner Lite v2.0.8 (Provalis Research, Montreal, Canada). Other statistical analyses were carried out in GraphPad Prism 6.01 (GraphPad Software, San Diego, USA). A P < 0.05 was considered statistically significant.

Ethical considerations

This study involves only data audit and content analysis that are available on three social media – Facebook, LinkedIn, and Twitter. The text, image, video, website links, and other content are available to any registered user. While collecting and analysing the content of the posts, we did not collect or store any personal identifying data. Hence, this study ensures full data anonymisation.

Results

Among the 300 social media posts, the highest number of posts from “individuals” was on LinkedIn followed by Twitter and Facebook (χ² = 82.86, P < 0.0001). The number of posts according to “individual” and “group” is shown in Figure 2.

Figure 2.

Number of posts (out of 100) in the three social media according to the creator of the post

Thematic analysis of the posts on the three social media is shown in Table 1. The symptoms of the disease were discussed at the highest rate on Facebook, followed by promotion of journal or blog posts, and discussion about causative and triggering agents of urticaria. The maximum number of posts on LinkedIn was about the promotion of journal articles or blog posts, followed by the promotion of webinars, and discussion about precautions to take to avoid urticaria and treatment stories. Users on Twitter posted their limited-text tweets primarily about symptoms of urticaria, followed by a discussion on the etiology or triggering factors of urticaria and journal or blog post promotion. Posts on etiology and symptoms were highest on Twitter and lowest on LinkedIn. The promotion of articles was highest on LinkedIn and lowest on Facebook.

Table 1.

Number of posts according to various themes in three social media

Themes	Social media			P
	Facebook	LinkedIn	Twitter
Discussion on disease
Etiology	8	4	15	0.03*
Symptoms	14	6	22	0.01*
Treatment method	5	5	7	0.82
Treatment story	3	8	5	0.3
Precautions for avoiding attack	2	11	11	0.03*
Promotion
Journal or blog article	10	33	15	0.0005*
Clinic	3	3	5	0.75
Webinar or talk	4	11	6	0.16
Drug/beauty products	3	4	7	0.44
Alternative treatment method	7	7	6	0.93
Survey/Quiz	0	4	1	0.38
Professional announcement	2	6	4	0.37

*Statistically significant P value of the Chi-square test (values were compared with expected equal distribution; a significant P value indicates that the occurrence was not by chance). Column-wise sum may not yield 100 due to overlapping of themes in posts

The media content of the posts is shown in Figure 3. Facebook had the highest number of posts sharing images, followed by LinkedIn and Twitter. In contrast, video or video links were posted more on LinkedIn, followed by Twitter and Facebook. Web links along with the posts were also highest on LinkedIn, followed by Facebook and Twitter (χ² = 21.59, P < 0.0001).

Figure 3.

Media content of the posts in the three social media platforms. All the posts had text along with the media

When we created the text cloud from the textual content of the posts, we found the top 10 most frequently used words in the posts on each social media platform as shown in Table 2. For visual ideation, the word clouds are presented in Figure 4. The terms - ”urticaria” and “chronic urticaria” were common in all three social media texts. The term “allergy” was common on Facebook and LinkedIn. The word “symptoms” was common on Facebook and Twitter and “chronic spontaneous urticaria” was common on LinkedIn and Twitter. “Hive” was another word that was used commonly on Facebook and Twitter.

Table 2.

Top 10 words according to frequency in texts of the posts in three social media

Facebook	LinkedIn	Twitter
Urticaria	Urticaria	Urticaria
Skin	Patients	Day
Hive	Disease	Hives
Rash	Allergy	Symptoms
Allergy	Chronic spontaneous urticaria	Chronic urticaria
Symptoms	Chronic urticaria	Cold urticaria
Atopic dermatitis	Spontaneous urticaria	Antihistamine
Infection	Dermatology	Asthma
Allergic reaction	CSU	Chronic spontaneous urticaria
Chronic urticaria	Thanks	Last night

Frequency of words was generated from https://monkeylearn.com/word-cloud

Figure 4.

Word cloud showing the frequency of words (top 30) in 100 posts on – (a) Facebook (b) LinkedIn (c) Twitter (word cloud was generated from https://monkeylearn.com)

The impact of the social media posts expressed in shares, comments, and likes are shown in Table 3. The median number of comments and likes on posts was highest on LinkedIn, followed by Facebook and Twitter. However, the maximum share was on Facebook, followed by LinkedIn and Twitter.

Table 3.

Impact of posts in three social media according to comment, share, and like

Category	Facebook	LinkedIn	Twitter	P*
Comment/reply	0 (0-9)	3 (1-6)	0 (0-1)	<0.0001
Share/re-tweet	2 (0-11.75)	1 (0-3)	0 (0-1)	<0.0001
Like	18 (3-54)	34.5 (14.25-110.5)	1 (0-4.75)	<0.0001

*P value of Kruskal-Wallis test (non-parametric analysis of variance test), in post-hoc Dunn’s multiple comparison test, all pairs (Facebook vs. LinkedIn, Facebook vs. Twitter, and LinkedIn vs. Twitter) showed statistically significant difference

Discussion

In this era, social media provides a readily accessible resource for exchanging healthcare information, networking, and outreach in the field of dermatology. With a monthly average of 2.93 billion users and 1.97 billion daily active users, Facebook is one of the most popular social networking websites.[6] LinkedIn recorded more than 830 million users while Twitter reported 237.8 million daily active users in their recent statistical reports.[7,8]

The various collaborative features of social media have proven appealing to organisations as well as individual users seeking dermatology-related content online. Many influential dermatology journals as well as international organisations have accounts or pages on social media, where they post educational content and announce publication of newly conducted research.[9] Additionally, platforms like Facebook allow the creation of “groups” which serve as virtual communities and support systems for patients to learn about dermatological diseases and obtain psychological support from shared personal experiences, especially in chronic diseases. Iglesias Puzas et al. in their analysis of social media postings on atopic dermatitis reported that Facebook had the largest total number of pages on atopic dermatitis with patient support groups accounting for most of them (63%).[3] Social networks have also proven beneficial to patients with asthma by reducing their feelings of isolation and loneliness and boosting self-confidence.[10,11]

Our study shows that the contents of posts related to urticaria on the three social networks are diverse and vary depending on the main purpose of the platform. We noted that LinkedIn had more posts promoting blogs, journal articles, webinars, and talks on urticaria, possibly due to its users being more professionally oriented. Such posts may be considered more reliable from an academic point of view. Video and web links were also encountered more commonly on LinkedIn. However, Twitter and Facebook had more posts based on discussions related to various aspects of urticaria such as symptoms, etiology, and treatment methods, with images being the most common media shared through the posts. Therefore, these platforms are used more commonly by patients of urticaria to share personal experiences, as well as, receive a large amount of information from other users, patients, or organisations. Interestingly, advertisements of clinics, drugs, and beauty products were noted most commonly on Twitter, indicating that this micro-blogging network is often preferred by providers to promote their brand and practise.

The reach of social media posts is usually directly related to the number of likes, comments, and shares they get. Our results showed that although posts on LinkedIn are more academically reliable in terms of content, their overall reach among users is less compared to Facebook posts which tend to be shared more readily. This has been a cause of concern in recent years as often incorrect and misleading information is shared widely on social media due to the free, unlimited, and often uncontrolled ability to upload content on these sites.[3] The spread of misinformation among patients may adversely affect both their physical and psychological health.[4,11] Thus, while social media has served as a boon in health promotion and management, it is important to regulate the quality and ensure the veracity of the information made available to users.[12] Despite the potential risks associated with using social media, dermatologists have an opportunity to engage with audiences and combat misinformation using evidence-based knowledge.[13] They should actively build their social media presence to address patients’ online searches for medical information. Patient-physician relationships don’t seem significantly affected by these online searches from the patient’s perspective.[14] However, dermatologists must exercise caution, purpose, and transparency when using social media to avoid breaches of patient confidentiality, privacy violations, financial conflicts of interest, and the spread of incorrect information.[15]

Nevertheless, the benefits of using social media outweigh the risks for dermatologists. They should embrace this chance to educate patients and create informative content. Dermatologists should leverage these unique qualities to educate users ethically.[16] As more people turn to the internet for health information and education, dermatologists need to feel comfortable creating educational content on social media platforms.[17] Despite participants’ awareness of the issues surrounding social media use and the lack of validation for dermatological content, many still follow skincare advice from social media.[18] Adolescents, in particular, are vulnerable to social influence, making it crucial for dermatologists to grasp the prevalence of skin-related content on these platforms.[19]

Limitations

Although our study aims to depict the current picture of urticaria-related content and its reach on social media, our findings may not represent the entire picture as we analysed only three of the numerous social media platforms available currently, and could not include others like YouTube, TikTok, and Instagram. Additionally, we could only access posts that were open to all, while private posts with a limited audience could not be analysed. Moreover, the data were collected on a cross-section of time where we might miss any additional information that was added after that time. These factors should be considered that several variables such as the number of followers or shares on a post, are constantly changing depending on the trending topics at a particular time.

Conclusion

Following social media often gives us an idea about the level of awareness and concerns among users on a particular disease. Our study gives an insight into the current situation of urticaria on three of the most popular social networks. Our findings indicate that a wide range of urticaria-related information is available to users, with LinkedIn having a maximum number of posts with academic content and Facebook having the highest overall reach. So, the potential of these platforms needs to be utilised in a constructive manner to benefit both patients and health professionals in the management of a frustrating condition like urticaria, while regulating the quality of shared information to minimise any negative impact.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.