Abstract
Background
Healthcare professionals (HCPs), including doctors of dental medicine (DMDs) and doctors of medicine (MDs), use social networking sites (SNSs) for personal and professional purposes. This study aims to: (i) explore DMDs and MDs awareness of their online presence, (ii) examine how frequently and for what reasons DMDs and MDs monitor their online images, (iii) determine the prevalence of finding inaccurate, incomplete, or unprofessional information about themselves, examine that experience, and investigate actions performed regarding unprofessional or embarrassing posted material, (iv) assess concerns about their own SNSs usage and the content they post.
Methods
A cross-sectional study was conducted among DMDs and MDs in Croatia using a questionnaire.
Results
Out of 1,013 participants, 753 were active SNS users. Facebook (91.6%) and Instagram (63.1%) were the predominant SNSs used. DMDs exhibited a significantly higher inclination to utilize SNSs for professional purposes than MDs. Both groups reported a high level of proficiency in using Facebook (M=3.2, SD=0.827) and Instagram (M=2.44, SD=1.162). Approximately 55.4% of the participants repored monitoring their online presence, typically once a year or less frequently. DMDs emphasized the completeness of posted information more than MDs (U=25,623.0, p=0.001). Their highest level of concern pertained to confidentiality breaches and inaccurate medical and dental information. There are similar results for MDs and DMDs for finding erroneous information posted on SNSs.
Conclusions
This study offers insights into HCPs' online presence, and their concerns regarding SNS usage. It underscores the significance of e-professionalism, and provides recommendations for maintaining a positive online presence while mitigating potential risks.
Key words: Health-care professionals, Social networking sites, Self-perception, E-professionalism, Social networking, Medicine, Dental medicine
Keywords: MeSH Terms: Dentists, Medical Staff, Online Social Networking, Self Concept
Introduction
In the digital age, our online identity and presence play crucial roles in shaping how we are perceived. Online identity encompasses all information we leave online, including digital tracks and traces, and represents our presence in the digital realm (1, 2). Online presence, however, refers to the overall visibility and existence of an individual or entity on the internet. While an online presence is about being present and discoverable, online identity focuses on deliberately portraying and maintaining a particular image or representation (3-6).
The image of healthcare professionals (HCPs) is becoming increasingly important as it is exposed to public evaluation, thus affecting public trust, patient satisfaction, and the overall perception of medical decisions (7). Research shows that knowledge and proficiency in using social networking sites (SNSs) are essential factors influencing HCPs’ decision to use SNSs (8, 9). For instance, Bartsch and Dienlin noted that individuals with higher levels of online privacy literacy tend to be more cautious in their SNS activity (10).
Maintaining a professional image of SNS is essential, as unprofessional content can cast HCPs, students, and affiliated institutions in an unfavorable light (11). SNS platforms convey an individual's personality, values, and priorities, thus leaving a lasting impact. According to Ferguson et al., users establish their self-image through posting, commenting, and following others, forming perceptions about the values and character of fellow users based on their posts (12). This is particularly relevant for dental and medical professionals, who emphasize maintaining a professional image as an integral part of their socialization process beginning in their studies and persisting throughout their careers (13, 14).
Pronk et al.’s qualitative research identified various unprofessional posts considered by HCPs including pictures of individuals in an intoxicated state, work-related clinic posts, sharing patients' and colleagues’ information, sexually suggestive content, and political posts. Less frequently mentioned were posts depicting partying or costumes, inappropriate gestures, smoking, and drug use (15).
Managing online identity is often a daunting challenge in practice. Even with minimal information, web searches can quickly connect an individual's professional and personal online presence. Paradoxically, recommendation systems acknowledge this challenge while still advocating for maintaining separate online identities (16, 17). Selective control of information shared online is vital for self-presentation and managing the image one leaves for others to assess (18). HCPs are aware of others closely observing their online content. Therefore they actively manage their image by passively self-monitoring and actively responding to undesirable content. Concerns for HCPs revolve around patient confidentiality breaches. They can monitor their online presence by conducting self-searches on search engines (called ego-surfing or Googling) and, if necessary, deleting any unwanted unprofessional content (6, 19, 20).
In general, concerns regarding the use of SM by HCPs frequently center on the potential for negative repercussions resulting from the breach of patient confidentiality (21). Each social platform (e.g., Facebook, Instagram, Twitter, LinkedIn, YouTube, TikTok, Snapchat) can serve a different purpose, thus constantly evolving and providing users with opportunities for self-presentation through new features such as reels and shorts. Instant information gives an edge to Instagram and YouTube, respectively. The concept of microblogging and the use of hashtags can have a significant professional impact (22). Microblogging allows users to post short, real-time updates, effectively engaging audiences and serving as a valuable tool for both personal and professional communication (22). For example, notifying about new research, live-tweeting events, and sharing resources via URLs or DOIs can enhance academic visibility (22). However, the personal and professional online presence of professionals can be a source of bias in the SNS presence of DMDs (23).
SNSs play a crucial role in self-presentation, with HCPs using them to share knowledge and connect with patients. While HCPs benefit from their online presence, concerns persist about their professional image and public perception (21). The professional image of HCPs significantly affects public trust, patient satisfaction, and the perception of the medical profession (24). E-professionalism pertains to HCPs' conduct in the digital realm, specifically on SNSs and online platforms, where even private behaviors reflect traditional professionalism through digital media (25, 26).
A distinction exists between DMDs and MDs in their workplace settings, with DMDs primarily in the private sector, being more active on SNSs for personal and professional purposes. DMDs communicate with patients, self-promote, and utilize various SNS features more frequently than MDs (22, 27). The risks associated with SM result from its influential features, where a single misjudged post can damage one's professional reputation, including unverified information, unprofessional content, and inappropriate disclosures (28). This highlights the crucial link between the workplace and e-professionalism in the healthcare sector.
Facebook's popularity suggests that a significant number of DMDs and MDs currently use the platform, potentially exposing themselves to unprofessional risks (29). In Croatia, Instagram is the second most popular SNS platform. However, it lags behind Facebook in popularity (30). Interestingly, Instagram is primarily oriented toward photo and video content, which DMDs have recognized as holding significant marketing potential as a continuation of newspaper advertisements (31, 32). Understanding the concerns of MDs and DMDs about their online presence and its impact on their professional competence and credibility is vital for developing guidelines and strategies to address potential issues stemming from their online activities.
Despite voicing privacy concerns, participants willingly share their personal information on SNS platforms and inadequately control the visibility of their posts. This disconnection may explain the relatively cautious approach to e-professionalism and the heightened sensitivity to unprofessional conduct on SNS (33). Conversely, there is a prevailing negative attitude manifested in self-doubt regarding one's SNS skills, worries about personal and patient privacy (34, 35), and even statements indicating that SNS has disrupted the balance between a healthcare professional's private and public life (35).
This study aims to explore the awareness of DMDs and MDs regarding their online presence, examine the frequency and reasons for monitoring their online images, determine the prevalence of encountering inaccurate or unprofessional information, investigate their responses to such experiences, and assess concerns regarding their social networking usage and posted content.
Methods
Design
The instruments used in this study were developed within the project “Dangers and benefits of social networks: E-professionalism of healthcare professionals—SMePROF” (36, 37), as part of an extensive questionnaire composed of multiple instruments (21).
To achieve the study aims, we analyzed data gathered from three instruments of the SMePROF questionnaire: (1) sociodemographic characteristics and habits of SNS usage, (2) impression management on SNSs and (3) concerns regarding their social networking usage and posted content.
Study questionnaire
The data for this study were collected using a survey-specific questionnaire named the “SMePROF Project Survey Questionnaire on Social Media Usage, Attitudes, Ethical Values and E-professional Behavior of Doctors of Medicine and Doctors of Dental Medicine (SMePROF)” (the complete questionnaire is available as an additional file in Viskić et al. (21)).
Using the first instrument, “Sociodemographic characteristics and habits of SNS usage” we measured the purpose of SNS usage, using an ordinal five-point scale item, ranging from “exclusively for personal purposes” to “exclusively for professional purposes”. The item was originally developed by Bosslet et al. and was modified from an original three-point scale and translated into Croatian (38).
The same instrument was used to measure the self-evaluation of SNS usage skills focused on seven SNS platforms: Facebook, Twitter, LinkedIn, YouTube, Instagram, TikTok and Snapchat. It employed a four-point scale, ranging from “not at all competent” to “highly competent”. This instrument was adapted from Kitsis et al. and was translated into Croatian (19).
The second instrument used, “Impression management on SNSs”, assessed three variables: awareness of the threat to one's identity, monitoring self-image, and reaction to undesirable content.
The first variable, awareness of the threat to one's image, refers to respondents’ knowledge of the content published about them and their identification of undesirable content. The experience of finding such information is measured in binary terms (yes or no).
The second variable, monitoring self-image, is measured as the frequency of searching their names using the Google search engine (googling) on an ordinal six-point scale, ranging from “never” to “almost every day”.
The third variable measures the respondent’s reaction to the publication of undesirable (inaccurate, incomplete, unprofessional) information. This is assessed in binary (yes or no) through three actions: (1) deleting people from their friends list; (2) deleting comments on their profile made by other people and (3) un-tagging themselves (removing their identifying tag from a post). These three actions are based on previous studies regarding e-professionalism (21, 36, 37).
The third instrument used, “Concerns regarding SNSs usage”, measured six items with a three-level agreement scale ranging from “does not worry me at all” to “worries me a lot”. The six items measured the respondent's concern related to e-professionalism, unprofessional behavior that the respondent may engage in on SNSs, the concern about family’s and public’s perception about their unprofessional behavior, the public's perception of the respondent's profession, concern about the violation of the patient's confidentiality, and publishing inaccurate medical or dental information that can be seen by patients.
Data collection and analysis
In this study, two professions were observed as representatives of HCPs: MDs as a profession predominantly in the public sector and DMDs as a profession predominantly in the private employment sector.
The final version of the questionnaire was implemented using the online survey-generating application Microsoft Forms. Before the questionnaire, participants were presented with an informed consent form, which included an “opt-out” option.
A non-probabilistic convenience sample was used for this study. The recruitment of participating DMDs and MDs in Croatia occurred through two rounds of survey email invitations conducted between 16 February and 13 July 2021 (the second reminder was sent on 4 May 2021) (21).
Demographic data were analyzed using descriptive statistics. Comparisons of DMDs’ and MDs’ responses were calculated using the chi-square test for categorical variables and the Mann–Whitney U test for ordinal variables. The Yates correction for continuity was employed in chi-square tests conducted on 2 × 2 contingency tables (39). The Bonferroni correction was used as a multiple-comparison correction when several independent statistical tests were performed simultaneously.
Results
A total of 1,013 questionnaires were collected, resulting in a response rate of 4.4% (1,013/23,178). Out of the 999 questionnaire respondents, 246 (24.6%) reported not using SNSs, leaving 753 completed questionnaires for analysis. Among the respondents, 507 (67.3%) were MDs and 246 (32.7%) were DMDs.
As previously reported in Viskić et al. (21) the sample consisted predominantly of females (72.1%), with a median age of 35. Significant demographic differences were observed between DMDs and MDs, where MDs were older than DMDs with an average age of 39.26 years as opposed to 36.58 years, (t642.643=3,552, p<0.001). Furthermore, a higher percentage of DMDs (69.1%) were employed in the private sector compared to only 20.6% of MDs (χ21=164,481, p<0.001).
Regarding SNSs usage, statistically significant differences were found between DMDs and MDs. DMDs accessed SNSs significantly more often per day (U=54,641.5, p=0.003) (21). However, both groups (n=588, 78%) predominantly use SNSs at least once per day.
Regarding the usage of Facebook and Instagram, there was a significant difference found in presence on these SNS sites, Facebook DMDs (96.7%) vs MDs (90.1%) (χ21 = 9.271, p<0.001); Instagram DMDs (74.4%) vs MDs (57.6%) (χ21 = 19.350, p<0.001) (21).
A statistically significant difference was observed between DMDs and MDs regarding the intended purpose of using SNSs (Table 1). This was assessed on a scale ranging from “solely for personal purposes” to “solely for professional purposes”. DMDs exhibited a significantly higher inclination to utilize SNSs for professional purposes than MDs (U=51,640, p<0.01). Furthermore, this disparity was substantiated by analyzing the item related to professional communication as a motive for using SNSs. The analysis confirmed that DMDs, compared to MDs, employed SNSs more extensively for professional purposes (U=52,609, p<0.01).
Table 1. SNS usage purpose (N=753).
| Usage purposes | All doctors N (%) | Medical n (%) | Dental n (%) | χ2, df, p |
|---|---|---|---|---|
| Solely personal purposes | 234 (31.0) | 176 (34.7) | 58 (23.6) | 19.386,4,0.001** |
| Mostly personal, less professional | 310 (41.1) | 212 (41.8) | 98 (39.8) | |
| Both (personal and professional purposes) | 137 (18.1) | 80 (15.8) | 57 (23.6) | |
| Mostly professionals, less personal | 57 (7.5) | 29 (5.7) | 28 (11.4) | |
| Professional purposes only | 14 (1.8) | 10 (2.0) | 4 (1.6) |
**p<0.01
In terms of self-rated proficiency, participants reported the highest level of proficiency in using Facebook (Mean=3.2, SD=0.827), followed by Instagram (Mean=2.44, SD=1.162), with LinkedIn ranking third in terms of proficiency (Mean=1.88, SD=0.983).
MDs reported a significantly higher level of proficiency in utilizing LinkedIn (U=53.008, p<0.001) and YouTube (U=54,000, p=0.002) than DMDs (Table 2). DMDs reported a significantly higher level of proficiency in using Instagram (U= 53,836.5, p<0.001) than MDs. No statistically significant differences in self-rated proficiency were observed between the two groups on Facebook (U=61,811.5, p=0.829), TikTok (U=60,277, p=0.157), and Snapchat (U=60,325, p=0.169).
Table 2. Self-evaluation of proficiency on SNS platforms (N=753).
| SNS platforms | Medical | Dental | U, p |
|---|---|---|---|
| Mean (SD) | Mean (SD) | ||
| 3.17 (0.882) | 3.25 (0.699) | 61811.5, 0.83 | |
| 1.31 (0.722) | 1.21 (0.636) | 583008.0, 0.02* | |
| 1.96 (0.994) | 1.70 (0.938) | 53008.0, 0.00** | |
| YouTube | 2.51 (1.129) | 2.24 (1.103) | 54000.0, 0.00** |
| 2.34 (1.178) | 2.63 (1.105) | 53836.5, 0.00** | |
| TikTok | 1.17 (0.584) | 1.20 (0.606) | 60277.0, 0.16 |
| Snapchat | 1.16 (0.560) | 1.21 (0.601) | 60325.0, 0.17 |
Ranging from “1 not at all competent” to “4 highly competent”
* With Bonferroni correction for seven comparisons, p<0.05;
** With Bonferroni correction for seven comparisons, p<0.01
The findings regarding the frequency of monitoring one's online presence, commonly known as "googling oneself" (e.g., “google” your name, search for your images on g-image, etc.), among MDs and DMDs are presented in Table 3. Approximately one-third of the participants (29.9%) reported never engaging in this activity, while slightly over half of the participants (55.4%) indicated that they performed this task once a year or less frequently. Approximately 10.8% of the participants reported self-monitoring their online presence approximately once a month, while a very small percentage of participants engaged in this activity weekly or more frequently. There were no differences between MDs and DMDs in the frequency of monitoring their online presence.
Table 3. Monitoring online presence (N=753).
| Google searches for themselves | ||||
|---|---|---|---|---|
| All doctors N (%) | Medical n (%) | Dental n (%) | U, p | |
| Never | 225 (29.8) | 149 (29.4) | 76 (30.9) | 60,476.5, 0.452 |
| Once a year or less | 417 (55.3) | 279 (55.0) | 138 (56.1) | |
| About once a month | 81 (10.7) | 58 (11.4) | 23 (9.3) | |
| About once a week | 14 (1.8) | 11 (2.2) | 3 (1.2) | |
| Almost every day | 12 (1.5) | 8 (1.6) | 4 (1.6) | |
| Several times a day | 4 (0.5) | 2 (0.4) | 2 (0.8) | |
Table 4 presents the reasons for monitoring their online presence by ensuring accuracy, completeness, and professionalism in the posted information. On the scale, a higher value indicates greater agreement. To ensure completeness, MDs had a mean score of 1.94 (SD=0.704), while DMDs had a statistically significant (U=25,623.0, p=0.001), higher mean score of 2.15 (SD=0.662). The difference between the two groups indicates that DMDs place a higher importance on the completeness of posted information than MDs.
Table 4. Extent of reasons for monitoring oneself online presence (N=753).
| Reasons | Mean (SD) | Mean (SD) | U, p |
|---|---|---|---|
| To ensure that published information is true. | 2.01 (0.739) | 2.12 (0.712) | 28140.0, 0.132 |
| To ensure that published information is complete. | 1.94 (0.704) | 2.15 (0.662) | 25623.0, 0.001** |
| To ensure that published information is professional. | 2.18 (0.737) | 2.35 (0.683) | 26545.0, 0.010* |
Ranging from “1 not at all important” to “4 very important”
* p<0.05;
** p<0.01
Regarding professionalism, MDs had a mean score of 2.18 (SD=0.737), while DMDs had a higher mean score of 2.35 (SD=0.683). The difference between the two groups was statistically significant (U=26,545.0, p=0.010), suggesting that DMDs prioritize professionalism in posted information more than MDs.
Concerns about SNSs usage are shown in Table 5. Overall, participants demonstrated the least concern regarding their families and the public’s perception. Conversely, their highest level of concern pertained to confidentiality breaches and inaccurate medical and dental information.
Table 5. Concerns that respondents have about SNS usage (N=753).
| Mean (SD) | Mean (SD) | U, p | |
|---|---|---|---|
| Public perceptions of unprofessional behaviour on my part. | 1.78 (0.694) | 1.73 (0.640) | 60634.0, 0.498 |
| Family perceptions of unprofessional behaviour on my part. | 1.58 (0.702) | 1.52 (0.680) | 59707.0, 0.287 |
| Public perceptions of unprofessional behaviour by my colleagues. | 1.83 (0.662) | 1.66 (0.668) | 53743.5, 0.001** |
| Public perceptions of my profession. | 1.99 (0.711) | 1.97 (0.714) | 61401.5, 0.710 |
| Violations of patient confidentiality. | 2.28 (0.783) | 2.23 (0.791) | 60084.0, 0.378 |
| Posting of inaccurate medical/dental information available to patients. | 2.56 (0.643) | 2.54 (0.661) | 61840.5, 0.826 |
Ranging from “1 does not worry me at all” to “3 it worries me a lot”
** p<0.01
Both DMDs and MDs have similar concerns about public perceptions (U=60,634.0, p=0.498) and family perceptions (U=59,707.0, p=0.287) of their unprofessional behavior. MDs with a mean score of 1.83 (SD=0.662) showed statistically significantly (U=53,743.5, p=0.001) higher levels of concern about the public perceptions of unprofessional behavior by their colleagues compared to DMDs with a mean score of 1.66 (SD=0.668).
There were no significant differences (U=61,401.5, p=0.710) between MDs (mean score 1.99; SD=0.711) and DMDs (mean score 1.97; SD=0.714) regarding concerns about public perceptions of the medical/dental profession.
Both MDs (mean score of 2.28; SD=0.783) and DMDs (mean score of 2.23; SD=0.791) shared similar concerns about patient confidentiality violations (U=60,084.0, p=0.378).
In the end, regarding posting inaccurate medical/dental information for patients, there were no significant differences found between MDs and DMDs (U=61,840.5, p=0.826), with MDs at 2.56 (SD=0.643) and DMDs at 2.54 (SD=0.661).
The occurrence of negative experiences can be found in Table 6. The first part shows the results of discovering information about oneself on SNSs.
Table 6. Experience of encountering inaccurate, incomplete, or unprofessional information and actions taken regarding such material on SNS.
| The discovery of information about oneself on SNS is (N= 753): | ||||||
|---|---|---|---|---|---|---|
| Medical n (%) | Dental n (%) | |||||
| Answer Yes | Answer Yes | |||||
| Inaccurate | 100 (19.7) | 47 (19.1) | ||||
| Incomplete | 194 (38.3) | 92 (37.4) | ||||
| Unprofessional | 100 (19.7) | 47 (19.1) | ||||
| Finding material about oneself on SNS, posted by others, that was embarrassing or unprofessional (N=753) | ||||||
| All doctors N (%) | Medical N (%) | Dental N (%) | χ2, df, pa | |||
| Yes | 160 (21.2) | 116 (22.9) | 44 (17.9) | 2.179, 1, 0.140 | ||
| No | 593 (78.7) | 391 (77.1) | 202 (82.1) | |||
| Action was taken regarding such material on SNS (MD n=116; DMD n=44) | ||||||
|
Medical n (%)
Answer Yes |
Dental n (%)
Answer Yes |
|||||
| Deleting people from my friends list. | 26 (22.4) | 11 (25.0) | 0.019, 1, 0.891 | |||
| Deleting other people's comments from my profile. | 52 (44.8) | 24 (54.5) | 0.850, 1, 0.357 | |||
| Un-tagging myself. | 71 (61.2) | 35 (79.5) | 4.013, 1, 0.045* | |||
* p<0.05
a Yates correction
The second part, finding material about oneself on SNSs was calculated as a binary variable, where those respondents who discovered any undesirable information about themselves (incorrect, incomplete, or unprofessional) were one group, and those who did not find any such information were another group. A total of 160 participants (21.2%) found undesirable information about themselves, which indicates engagement in SNS impression management. There were no significant differences between MDs and DMDs in the prevalence of finding undesirable information. Among the participants, 21.2% indicated encountering unpleasant or unprofessional material about them posted by others. Additionally, 32.8% of respondents reported the experience of posting content on SNSs and later regretted it.
The third part of Table 6 provides an overview of the actions taken by participants who found undesirable material about themselves on SNS. The most frequently reported action was deleting their name from tagged photos (66.3%), followed by removing comments from their profile (47.5%). Deleting the person responsible for inaccurate content from their friend list was the least commonly chosen action by the participants (23.1%). Of 160 respondents who reported finding uncomfortable posts, 40 (25%) opted not to respond in any of the measured ways.
Discussion
All participants (N=753) in the study used at least one SNS, and DMDs accessed SNS sites more frequently than MDs (U=54,641.5 p<0.001) (21). Following the purpose of SNS usage in this study, most HCPs employ SNS platforms more for personal purposes and less for professional purposes. However, a significant difference in the type of usage exists between MDs and DMDs, where DMDs employ SNSs more for professional purposes (U=51,640, p<.01). This can be explained by the fact that DMDs in Croatia predominantly work in the private sector and utilize SNSs as a platform for cultivating and representing their professional identity (19, 21).
Recent research by Freire et al. examined the influence of the use of dental practice SM on patients when they last changed their dental care provider and which factors were considered important when choosing a dental practice (40). According to their results, patients who had changed practice within the last five years used dental practice SM more often. In addition, those who had changed in the present/past year reported that the use of these media had significantly influenced their decision to change (40).
Due to the increased influence of SM on healthcare in recent years, researchers have begun to investigate its impact on professional credibility and the professional-patient relationship. They have pointed out that the public’s perceptions of professionalism and credibility are essential for developing guidelines regarding professionalism in digital media, and encouraging best-use practices for SM (41, 42). HCPs should prioritize the integration of their SM identities with their professional personas, as the online HCP image is evolving and becoming an essential part of medical and dental practice (7). This includes regular review and monitoring of their online profiles, in line with guidelines such as those outlined (16, 42). However, the choice to share personal elements rests with the HCPs alone (6, 16, 17, 21).
Some guidelines directly advise HCPs to "Think before you post" (42), meaning that the more often users access SNSs, the greater the chance they may engage in unprofessional behavior because they posted something before they had a chance to "think" about it.
Alongside the benefits of creating networks and spreading information broader and faster than is possible with traditional communication channels, SM presents ethical and legal challenges. For HCPs, it poses a threat to confidentiality and privacy owed to patients, colleagues, and employers. HCPs must acknowledge that the same ethical and legal standards apply online and offline and are accountable to professional bodies and the law for their online activities (16). SM contributes to changes such as interpersonal relationships, and HCPs should develop and maintain their professional identity on the highest ethical principle (43).
Importantly, it seeks to create awareness about the cyberpsychology phenomenon called the 'online disinhibition effect', which is responsible for lowering restraint during online activities (43).
In this study, when assessing their proficiency in SNS usage, MDs reported significantly higher levels of utilizing LinkedIn (U=53,008.0, p<0.001) and YouTube (U=54,000.0, p<0.001) than DMDs. However, DMDs demonstrated a statistically higher level of proficiency in using Instagram (U=53,836.5, p<0.001) compared to MDs. One potential explanation for this difference is that Instagram is a visual medium, and dental profession inherently possesses a visual nature. Dentists frequently work with visual materials such as photographs and X-ray images of teeth. As a platform for sharing images and video content, Instagram enables dentists to showcase their work and procedures to patients efficiently. It allows dentists to promote their dental practices by posting images of their facilities, team, and positive patient experiences, thereby attracting new clients and building their brand (25, 29, 43). However, DMDs have become aware of the need to analyse the public perception of professional credibility and willingness to become a client, based on images posted by dentists on Instagram (44, 45).
HCPs should be aware of their online identity and monitor their online presence. According to the study results, MDs tend to do this more frequently than DMDs (MD n=358 (70.6%); DMD n=170 (69.1%)). In the case of DMDs, the reasons for monitoring their online presence are primarily driven by a desire to prioritize professionalism and ensure the completeness and accuracy of posted information, compared to MDs.
The primary concern among MDs and DMDs in this study is the violation of patient confidentiality and posting of inaccurate medical/dental information available to patients. Specifically, these data underscore a noteworthy level of professionalism among the concerns of the surveyed participants. A significant number of them were primarily concerned about preserving patient trust and upholding their knowledge integrity regarding public perception. This finding underscores the imperative for further research and educational initiatives in the fields of medicine and dentistry. Such endeavors can contribute substantively to addressing issues that deeply trouble medical and dental professionals. The substantial averages, approaching 2.5 out of 3, emphasize the gravity of these concerns.
Regarding MDs’ and DMDs’ concerns about public perception, MDs expressed greater concerns regarding the public perception of the unprofessional behavior of their colleagues compared to DMDs. However, both groups of professionals shared similar concerns about public perception of their professionalism.
Of the 753 participants in the total sample, only 160 (21.2%) reported experiencing uncomfortable posts. Among these 160, merely 40 opted not to take any action. We regard the variable of reacting to the discovery of such posts (referred to as "reaction") as a significant predictor of e-professionalism. This importance arises not only from the observable trend of the majority of respondents with negative experiences choosing to react but also because such reactions serve as tangible manifestations of action and behavior, both integral aspects of e-professionalism (21).
Regarding actions taken in response to embarrassing or unprofessional material, there was a statistically significant difference between MDs (61.2%) and DMDs (79.5%) in un-tagging themselves as a response to embarrassing or unprofessional material. The results obtained from the sample show that DMDs are more active in un-tagging themselves from unwanted material from SNSs than MDs.
While SNS users can be selective in what they share, a significant number of them are not fully aware of the power they possess to shape their online image intentionally. It is crucial to recognize that sharing unprofessional content on SNS can substantially impact one’s professional opportunities. This concern depends on the perception created by the online identity, the way information is controlled, and the motivations behind such actions.
The main strength of this research lies in its ability to provide valuable insights into healthcare professionals’ monitoring of their online image and concerns about inaccurate or unprofessional information online, thus offering crucial data on the frequency and motivations behind this practice. Furthermore, this research encompasses both DMDs and MDs from the private and public sectors. This comprehensive representation enhances the study’s applicability and generalizability, thus making it relevant across various healthcare contexts.
A major limitation is the low response rate of 4.4%, which raises concerns about the representativeness of the sample. Another limitation is the potential for social desirability bias, as concerns are measured through self-reporting items, creating a risk of respondents exaggerating their concerns. This aspect challenges the reliability of the collected data and requires careful consideration in interpreting the study’s findings. Also, a preference for using a particular social platform, which is reflected in the tendency to use the same platform professionally and personally, can be a source of bias in this type of study.
Conclusion
By addressing these research aims, this study contributes to the current knowledge surrounding HCPs' online presence and the potential impact on their professional image. The findings will help inform healthcare organizations, policymakers, and HCPs about the importance of online professionalism and provide recommendations for maintaining a positive online presence while mitigating potential risks. This study supports previous studies that show that the awareness of online identity increases through systematic education and the implementation of professional use of SM among HCPs (39, 40, 45, 46). Building on these studies, guidelines for using social networks and promoting the development of e-professionalism for doctors of medicine and doctors of dental medicine in Croatia were published in October of 2023 (47).
It is imperative for HCPs to conscientiously delineate the boundaries between their personal and professional online presence. Striking this balance is essential to safeguarding one's right to a private life, thereby ensuring that any missteps or inefficiencies in SM usage do not unduly impede one’s career prospects. Achieving this equilibrium preserves personal privacy and fosters a harmonious coexistence of our digital and professional selves, ultimately contributing to a more secure and prosperous future (41).
In the digital environment, exerting over every situation or aspect is impossible. Nevertheless, the HCP's responsibility remains to exert control over the narrative, profile, and identity to maintain e-professionalism on SNSs.
Acknowledgments
A quantitative cross-sectional study on the use of SNSs and attitudes toward e-professionalism among MDs and DMDs was conducted in collaboration with the CMC and the CCDM. The authors thank all participants who were involved for their contribution to the study.
Ethics declarations
Ethics approval and consent to participate
The study and the questionnaire received approval from the ethical boards of the University of Zagreb School of Medicine (641–01/18–02/01) and the University of Zagreb School of Dental Medicine (05-PA-24-2/2018), as these institutions were responsible for overseeing the study. Additionally, formal approval was obtained from the governing bodies of both the Croatian Medical Chamber (CMC) (900-06/20-01/11) and the Croatian Chamber of Dental Medicine (CCDM) (900-01/21-01/02) to utilize the complete mailing lists of MDs and DMDs who were members of the CMC and CCDM.
All participants were informed in the guidelines statement that their participation is voluntary and anonymous. All participants gave electronic informed consent to participate before starting the survey.
All methods were carried out according to relevant guidelines and regulations.
Footnotes
Conflict of interest statement
The authors attest that they have no financial or other conflict of interest that could influence the content of the article.
Funding
This study was funded by the Croatian Science Foundation under project UIP-05-2017 “Dangers and benefits of social networks: E-Professionalism of healthcare professionals – SMePROF”.
Data availability statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.