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. 2021 May 28;16(5):e0252472. doi: 10.1371/journal.pone.0252472

Building a community of practice through social media using the hashtag #neoEBM

Amy Keir 1,2,3,*, Nicolas Bamat 4,5, Bron Hennebry 2,3, Brian King 6, Ravi Patel 7, Clyde Wright 8, Alexandra Scrivens 9, Omar ElKhateeb 10, Souvik Mitra 11, Damian Roland 12,13
Editor: Barbara Guidi14
PMCID: PMC8162580  PMID: 34048469

Abstract

Objectives

Social media use is associated with developing communities of practice that promote the rapid exchange of information across traditional institutional and geographical boundaries faster than previously possible. We aimed to describe and share our experience using #neoEBM (Neonatal Evidence Based Medicine) hashtag to organise and build a digital community of neonatal care practice.

Materials and methods

Analysis of #neoEBM Twitter data in the Symplur Signals database between 1 May 2018 to 9 January 2021. Data on tweets containing the #neoEBM hashtag were analysed using online analytical tools, including the total number of tweets and user engagement.

Results

Since its registration, a total of 3 228 distinct individual Twitter users used the hashtag with 23 939 tweets and 37 259 710 impressions generated. The two days with the greatest number of tweets containing #neoEBM were 8 May 2018 (n = 218) and 28 April 2019 (n = 340), coinciding with the annual Pediatric Academic Societies meeting. The majority of Twitter users made one tweet using #neoEBM (n = 1078), followed by two tweets (n = 411) and more than 10 tweets (n = 347). The number of individual impressions (views) of tweets containing #neoEBM was 37 259 710. Of the 23 939 tweets using #neoEBM, 17 817 (74%) were retweeted (shared), 15 643 (65%) included at least one link and 1 196 (5%) had at least one reply. As #neoEBM users increased over time, so did tweets containing #neoEBM, with each additional user of the hashtag associated with a mean increase in 7.8 (95% CI 7.7–8.0) tweets containing #neoEBM.

Conclusion

Our findings support the observation that the #neoEBM community possesses many of the characteristics of a community of practice, and it may be an effective tool to disseminate research findings. By sharing our experiences, we hope to encourage others to engage with or build online digital communities of practice to share knowledge and build collaborative networks across disciplines, institutions and countries.

Introduction

A community of practice (CoP) is a group of people who share a concern or a passion for something they do, and learn how to do it better through regular interaction [1]. Social media use is associated with the development of CoPs as it promotes the transfer of information at scale and crosses institutional and geographical boundaries faster than previously possible. These forums allow shared conversations around awareness and critical appraisal of new research evidence that is transparent, accessible to users and timely [1].

The timely implementation of medical research evidence into clinical practice is an important public health challenge, with the evidence-to-practice gap famously described as taking up to 17 years [2]. New approaches to narrow this gap are urgently needed, and online CoPs may be a valuable tool in an era of growing digital interaction [3, 4]. An attempt to organise and build a CoP for those involved in neonatal care was made in May 2018 by an international group of physicians following the Pediatric Academic Societies (PAS) meeting in Toronto, Canada. The group meeting idea originated on Twitter and coordinated via the same platform. Collectively, all members of this group were already using the social media platform Twitter to disseminate new research findings relevant to neonatal practice.

Twitter is an interactive social media microblogging platform established in 2006 that allows users to send 280-character messages or links, known as tweets, to each other. Hashtags are words or phrases preceded by the hash or pound sign (#) and used on social media platforms to classify digital content as relating to a specific topic. As a result of the meeting at PAS in 2018, the hashtag #neoEBM was selected to potentially disseminate and track evidence-based neonatology content [5]. This observational cohort study aims to describe the use of #neoEBM over time and the impact of this social-media based intervention on the evolution of an online CoP among neonatal healthcare professionals and stakeholders on Twitter.

Materials and methods

Our study was a descriptive, observational cohort study utilising the social media health analytic website Symplur as the data source. User generated posts (“tweets”) met inclusion criteria if they were generated on Twitter and contained the hashtag #neoEBM between 1 May 2018 and 9 January 2021. All other tweets were excluded. This was a convenience sample of all eligible posts without formal sample size calculation. The hashtag was registered on 8 May 2018 on Symplur (www.symplur.com/submit-hashtag) allowing assessment of the use and impact of posts containing #neoEBM over time. We utilised the NOECO [6] statement, a standardised framework for reporting social media analytics, to hypothesise that on the digital platform Twitter (network) the use of the hashtag #neoEBM (object) led to the establishment of a community of practice (observation) using the network analysis system Symplur (engine). Symplur is an online tool integrated into the Twitter microblogging service and assimilates data on specific health-related hashtags. We purchased access to the database for one month through the Symplur Signals Self-Serve (research option for 10 datasets) option. We created a Symplur Signals database to analyse tweets and impressions (user views) that contained the registered #neoEBM hashtag. Data on the number of individual Twitter users using #neoEBM, the total number of tweets using #neoEBM (excluding retweets), impressions (user views) of #neoEBM and retweets (re-posting another users’ Tweet) were obtained. User description (e.g., neonatologist, medical journal, etc.) and global location were obtained when publicly available in the profile.

The study was approved by the University of Adelaide’s Low-Risk Human Research Ethics Review (HREC) Group (Faculty of Health and Medical Sciences) Approval No. H-2020-003. The HREC waived the requirement for individual consent. The data collection for this study was compliant with the terms and conditions of both Twitter and Symplur.

Results

The Symplur Signals database was interrogated from 1 May 2018 to 9 January 2021 (2 years and 8 months of data; 981 days) on 10 January 2021. Since the registration of the #neoEBM hashtag in May 2018, a total of 3 228 distinct Twitter users utilised the hashtag #neoEBM at least once (Figs 1 and 2).

Fig 1. Cumulative users of the hashtag #neoEBM over time.

Fig 1

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Fig 2. Cumulative tweets of the hashtag #neoEBM over time.

Fig 2

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The location of Twitter users included the United States of America (n = 494; 15%), United Kingdom (n = 467; 15%), Spain (n = 110, 3%) and Australia (n = 103; 3%). The 20 most frequent users of #neoEBM hashtag were neonatal providers or other stakeholders in neonatal research. These were neonatologists (n = 11), a neonatal fellow (n = 1), neonatal nurses (n = 2), peer-reviewed medical journals (n = 2), neonatal research/advocacy groups (n = 3) and one bot (a bot is a software application used to automatically generate messages and act as a follower of users on social media platforms) developed by a paediatric resident (n = 1) to retweet posts containing #neoEBM. Cumulatively, these top 20 users have a following of 35 361 accounts with an average of 1768 each with a range 152–8 827.

There have been 23 939 unique tweets using #neoEBM. The two days with the most significant number of tweets containing #neoEBM were Tuesday 8 May 2018 (n = 218) and Sunday 28 April 2019 (n = 340), both coinciding with the annual Pediatric Academic Societies meeting (Fig 3).

Fig 3. Time-series graph of numbers of new #neoEBM users (monthly average).

Fig 3

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The majority of Twitter users made one tweet using #neoEBM (n = 1843), followed by two tweets (n = 443) and more than 10 tweets (n = 347). The number of individual impressions (views) of tweets containing #neoEBM was 37 259 710.

Of the 23 939 tweets using #neoEBM, 17 817 (74%) were retweeted (shared), 15 643 (65%) included at least one link and 1 196 (5%) had at least one reply. There is an average of 100 new users of #neoEBM per month (Fig 3).

As #neoEBM users increased over time, so did tweets containing #neoEBM, with each additional user of the hashtag associated with a mean increase in 7.8 (95% CI 7.7–8.0) tweets containing #neoEBM (Fig 4).

Fig 4. Cumulative numbers of tweets and users over time.

Fig 4

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The top 10 words used in tweets containing #neoEBM were infants (n = 4 209), preterm (n = 2 885), neonatal (n = 2 354), study (n = 2 384), published (n = 1 551), outcomes (n = 1 326), trial (n = 1 438), use (n = 1 215), review (n = 1 181) and risk (n = 1 180).

A comparison of the core components of a CoP and the characteristics of the #neoEBM community are displayed in Table 1.

Table 1. Aveling’s core components of clinical communities of practice and alignment with the #neoEBM community.

Aveling’s core components of clinical communities of practice #neoEBM community
Interdependent groups and individuals #neoEBM hashtag connects individuals who demonstrate interactions with each other
Members cross clinical and organisational boundaries
Top 20 Twitter users of #neoEBM include: Neonatologists (n = 11)
Neonatal fellow (n = 1)
Neonatal nurses (n = 2)
Peer-reviewed medical journals (n = 2)
Neonatal research/advocacy groups (n = 3)
Bot tweeting #neoEBM (n = 1)
Users from various academic and medical organisations across the world participate.
Further details on these 20 users are available in the S1 Data.
Members are united by a common purpose of bridging the gap between best research evidence and current clinical practice Content of #neoEBM is focused on healthcare-related themes, centred on research study findings and access to neonatal research content
Members come together not only to learn or share knowledge but to achieve those aims Physical gatherings were responsible for the development and adoption of #neoEBM, publicized by the original Tweet t.co/xtcjQYotM7 and demonstrated by the ongoing use of #neoEBM. Physical gatherings by users have continued at subsequent academic meetings.
Exploits the networks’ inherent potential for effective and low-cost knowledge generation and diffusion #neoEBM is centred on an effort to diffuse new research evidence to promote knowledge generation at scale among neonatal stakeholders, and generates subnetworks around individuals, e.g., specific websites
Operates through both vertical and lateral structures The network expands through increasing individuals who influence others across increasingly broad geographic areas
Demonstrated by #neoEBM users located in the United States of America (n = 494; 15%), United Kingdom (n = 467; 15%), Spain (n = 110, 3%) and Australia (n = 103; 3%).
Harnesses the power of the community and its collective wisdom when seeking solutions to problems Interactions (measured through mentions) expand rather than contract over time
Demonstrated by increasing numbers of users of #neoEBM (Fig 1)
Deploys peer influence and uses primarily informal, social control mechanisms to achieve change Most frequent users (i.e., top 20 users described above) exert influence, but this changes over time
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Discussion

Our study provides preliminary evidence that the #neoEBM community contains the critical components of a CoP refined and expanded by Aveling in Table 1 [7]. These components include a community formed by interdependent groups and individuals from different professions and organisations, united by a common purpose of bridging the gap between neonatal research evidence and current clinical practice, coming together to build, share and disseminate knowledge. Additional components include exploiting a social media platform for knowledge diffusion, operation through vertical and horizontal structures, deployment of peer influence, usage of informal mechanisms to achieve change and harnessing community power to seek solutions to the challenges of knowledge dissemination [7]. This suggests those using the #neoEBM hashtag may be part of the development of an online CoP in neonatal care as a way to share knowledge with each other. This online CoP offers an open digital space for information sharing, with a flat hierarchy, strong group identity, high engagement (involvement), and rapid flow of information and knowledge translation consistent with other online healthcare CoPs [8]. Our findings are supported by the development of other online CoPs in healthcare [3, 4] and provide the foundation for using this CoP to impact healthcare quality in neonatal care [7]. The increases seen (Fig 3) in the use of #neoEBM around major paediatric conferences (Pediatric Academic Societies Annual Meeting) reflects the role of the #neoEBM hashtag as a tool to promote knowledge exchange. Academic conferences routinely serve as an opportunity to share new, impactful research evidence. The temporal association between these meetings and increased activity among the CoP is unlikely to be coincidence, but rather reflect the occurrence of new knowledge in need of sharing. Though it may seem paradoxical to observe increased digital activity within a CoP during a time of physical gathering, this highlights the important role that digital interaction plays in modern CoP, continuing to serve as a medium for communication despite physical proximity.

Limitations to our study include the inherent challenges to confirm alterations in clinical practices by CoP members. However, there is a suggestion through social media posts that the use of #neoEBM has allowed for faster dissemination of study findings that have changed practice (e.g., https://bit.ly/2ZiLjOq).

Potential criticism of our work includes that it is no different to an email listserv, that it is at high risk of being overtaken by opinion-based medicine and that it has or will have no impact on clinical practice. The size of the #neoEBM community and its sustainment suggest engagement through an evidence hierarchy that reaches beyond perceived or reported benefits. With the evidence-to-practice gap famously described as up to 17 years [2], different approaches to our current ones to close this gap are urgently needed. Synoptic, curated and accessible educational material for healthcare professionals [9] is an excellent place to start. Social media is widely accessible in resource-poor settings, whereas journals and email listservs are intrinsically exclusive and therefore often inaccessible in these settings.

Roger’s diffusion of innovations theory is often used to explain the spread of new ideas and practices in a wide variety of settings, including in healthcare [10]. It provides a framework for analysing the process of innovation as it unfolds to make more informed choices and decisions about how to guide the dissemination and diffusion of these new ideas [11]. The #neoEBM community is striving to enter into the ‘early majority’ phase to legitimise our innovation to bring us up to the described tipping point of ‘acceptance’ at 15–20% adoption. We are aware that the late majority are sceptical, perhaps reflected by the expressed criticism received of our work, and laggards put trust in the status quo. We will continue to question the status quo and reflect on Donald M Berwick’s statement on leading the improvement of systems that “Effective leaders challenge the status quo both by insisting that the current system cannot remain and by offering clear ideas about superior alternatives” [12]. We want the #neoEBM community to be a place for anyone working in or interested in neonatal care, including families and former patients, to learn and share knowledge about new research findings.

While we have demonstrated elements of organisation, the impact of the CoP on the practice of individual clinicians is yet to be determined. Further qualitative and quantitative study is needed to understand how practice may change through participation in the #neoEBM community. It cannot also be assumed that all CoPs will add value in the same way and further research is needed in different specialties and professions to see how widespread this approach is in healthcare.

Conclusions

The #neoEBM community possesses many of the characteristics of a CoP and appears to promote knowledge exchange within the community. By sharing our experiences, we hope to encourage others to engage with or build online digital CoPs to share knowledge and build collaborative networks across disciplines, institutions and countries. Further challenges for our emerging digital CoP include sustaining it into the future, the need to evaluate further the potential impact of #neoEBM on clinical practice and convince the ‘late majority’ that social media is a useful and accessible tool for evidence dissemination.

Supporting information

S1 Data

(XLSX)

Click here for additional data file. (39.4KB, xlsx)

Data Availability

The minimal dataset underlying this study is available within the manuscript and its Supporting Information files, and from the University of Adelaide Figshare (https://doi.org/10.25909/14329754.v1). Additional data are available from the Symplur Signals database and can be accessed through www.symplur.com with a fee-based account subscribed for the hashtag #neoEBM. The authors did not have any special access to the data that other researchers would not have.

Funding Statement

AK receives funding from the Australian National Health and Medical Research Council (NHMRC) www.nhmrc.gov.au (APP1161379). The contents of this paper are solely the responsibility of the individual authors and do not reflect the views of the NHMRC. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Decision Letter 0

Barbara Guidi

19 Feb 2021

PONE-D-21-01208

#neoEBM: Building a community of practice through social media

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"AK, RP, CW, SM, AS, OE and BK are current or previous social media editors and NB is immediate past lead social media editor for the International Society for Evidence-Based Neonatology (ebneo.org) and all tweet as part of these roles as @EBNEO. None are compensated for their role as social media editors. The authors have no financial relationships with the online analytical platform Symplur."

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Reviewer #1: Reviewer comments :

Building a community of practice through social media

The study was interesting to go through. These are my main concerns. Below comments follow the order of the manuscript.

Title

I recommend adding to the title as it is not clear enough (too broad).

Introduction

The authors should add to the introduction a paragraph on the importance of the practice and gap in knowledge. Also, they need to add some literature in this regard. Other comments in introduction part is indicated as below:

Line 65: the authors should change the numbering of the reference to number 5 into 2, so it will follow sequential order.

Line 70: please delete the word meeting, as it’s a repetition.

Line 73: start a new Paragraph-Twitter is an….

Line 78: Please clarify the type of the observational study conducted.

Material and Methods

-Lines 83-85: the study design should be clarified.

-Sample size and sample size calculation.

-Where there any exclusion criteria?

Results

Figure 1: the writing in the figure is not clear.

Table 1: Aveling’score- please edit the space between s c.

Discussion

-This should be supported by other studies in different medical fields that show an effect of social media on Cop.

-Need recommendations for further studies and what should be done.

Thank you

Reviewer #2: This is an article discussing on the use of social media to develop a community of practice. I appreciate the initiatives on such social media-based research and saw merits of this paper and should be considered for publication upon major corrections.

My comments and suggestions: The authors shall improve the manuscripts (also to serve the need of readers of PLOS ONE of different backgrounds, unlike medical journal of specialised readers). In brief, the manuscript needs to be better organised and provide further elaboration to support the ideas put forward in the manuscript as in the following areas:

Introduction:

The numbering of the reference is not according to the sequence. Perhaps, also some background on why or the driver of online CoP, perhaps from other established fields.

Materials and methods:

Some narration on NOECO by Roland et al shall be included to make your methods clearer.

Results:

I feel that all data reported by authors should be analyzed and interpreted further, rather than to report as is. For example, the authors reported the cumulative users over time; however, data is only slightly described by the authors in the section of engagement metrics. Interpretation such as the trend of users and tweets, projection in future numbers, the number of users with different number of tweets could add values to the manuscript.

I expect the information such as the locations and twitters can also be further described and interpreted, rather than simply reported the data. (For instance, rhe authors reported from selected countries with numbers, and what about the rest, since the readers will be curious to know, for instance, from a total of 3228, US, UK, Spain and Australia were 494, 467, 110 and 103, what about the other locations of the remaining 2054?)

Of course, the figures attached must be in good resolution, and the detailed information is difficult to read.

Table 1 compared the core components of a CoP and the characteristics of community. This is the key finding that #neoEBM community fits into the 8 features by Aveling. The information in this table shall be further explained by the authors. For example, the top 20 twitter users were identified by the authors, and they were said to be originated from interdependent groups and individuals, and the members cross clinical and organizational boundaries. How does this determination made by the authors were not described and it should be supported by the background data.

As for the content (second row), the authors stated that the twitter users were members united for a common purpose and come to achieve the same aim, how do the authors come to such determination shall be discussed and supported by the analysis. The same also goes to other points in Table 1. A further description on the data will benefit the readers for better understanding.

Discussion:

There were several issues which need attention by the authors. How the authors determined the identity of twitter users, the issue of robotic tweets, potential of mis-hashtag by the users, confidentiality of the tweeted message, issue of the authorship on tweeted information, and etc are factors that potentially affect the interpretation of the data.

Also, I expect the authors to provide some view how the findings will lead to a greater quality improvement (QI) in clinical community in general.

Reference:

The list needs some minor formatting.

Reviewer #3: In my opinion, the study titled “#neoEBM: Building a community practice through social media” is interesting but has major limitations:

� Introduction: A clear rationale for the current study along with use of tools such as “Aveling’s core component of clinical community” is missing.

� Materials and methods: missing inclusion exclusion criteria for evaluating the dependent variables. This is vaguely presented but the actual process must be clearly presented.

� The results section needs significant work. The figure axes are not legible. The quality of figure content is very poor. Additionally, the authors need to elaborate on the results and their relation to the presented figures.

� Figure 2: it is expected that the frequency of tweets would be higher around scientific events as highlighted by the authors. But it is important that the authors elaborate on what this means and involves in their discussion.

� Discussion needs significant work on the above factors.

� In the conclusion, the authors make a case that #neoEBM is an effective tool to disseminate research findings via social media platform (twitter in this case). What percentage of the research community would this reach? Are there any analyses to project the percentage of population it would reach compared to the standard Pubmed, google scholar and other scholar manager approaches? Is the information through #noEBM from twitter reliable? The significance and impact of these findings need to be discussed.

� Finally, the data were not easily accessible to review.

Reviewer #4: Thank you for giving me the opportunity to review this paper. This paper addresses an interesting topic of building a community through Twitter, in order to increase the dissemination of research recommendation. The idea is great, the team had done a good job in building this community. However, several information was missing. The comments below are intended to further strengthen the paper.

Title

1- The title could be improved by removing the hashtag, to be "Building a community of practice through social media".

Abstract

1- Line 57, can you please provide the long form of any abbreviation when you mention in it the first time, please?

Introduction

1- It was not clear about the context in which the hashtag was introduced. Was there any previous attempt to engage people using for example, a mailing list? Did all the group twitter users get any formal training for using twitter when it was introduced? were there anyone in charge of the hashtag? How many hours per week was spent in observing the hashtag? Was there any previous attempt to assess the utilization of the hashtag?

2- Line 65, can you please add the references numbers based on their appearance in the paper? As the introduction line 63 started with reference number 1, and line 65, the second appeared reference number is 5. Can you please clarify if this should be number 2?

3- Can you please provide a references to the statements in lines 74-76.

4- Can you please provide a definition for the word hashtag, line 77.

Materials and methods

1- Line 83, Can you please comment on the stage of hashtag registration please? Was this completed to assess the analysis using the Symplur software, or was this needed by Twitter, to register official hashtag?

2- Line 85, can you please confirm what is NOECO, please?

3- Line 88, can you please confirm if the "this online tool" refers to Symplur?

4- Line 108, 36% of user's demographics is presented in the paper, can you please confirm the location of the other users please?

5- Line 110, please clarify what is meant by top users?

6- Line 112, can you please define the word bot, please?

7- Can you please comment on the total number of tweets if all of them were about neonatology? Was all the tweets were read/ a sample of the tweets were assessed as part of quality assurance to confirm that the tweets are about neonatology? Or if they were include based on face value, that all tweets were about neonatology? Or were there any user used the hashtag to tweet about another topic?

8- Can you please confirm if there were any duplicated tweets?

9- Can you please provide the definition of the word engagement, please?

10- Have the team considered completing a content or thematic analysis of the tweets?

11- Can you please confirm if you had completed a word association thematic analysis, please?

12- Can you please comment on the analysis that was completed using the software, Symplur, please?

13- Can you please add the information mentioned the price of the software in the method section, please?

Results

1- Line 120-121, can you please clarify the numbers please, as the numbers are not the same as the numbers presented in the abstract line 47-48. Can you please clarify if the numbers should add up to 3,228, please?

2- Can you please clarify the content of the tweets? What are the main themes within the tweets?

3- Can you please confirm if the tweets were used for information dissemination, increase awareness about certain topics, or networking? And what is the percentage of each component?

4- What are the demographics of people tweeting using the hashtag? What was the gender of the people?

5- Can you please confirm what was the average engagement rate, please?

6- Can you please confirm if important information about the characterises of the tweets were factored in the analysis including, the length of the tweets, the time tweet was posted, the number of links in the tweets, and if these variables affected the engagement rate?

Discussion

1- Line 160-161, can you please comment that this statement is based on an observation from 3 reply to one tweet, please?

**********

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PLoS One. 2021 May 28;16(5):e0252472. doi: 10.1371/journal.pone.0252472.r002

Author response to Decision Letter 0

30 Mar 2021

Thank you again for the detailed and very helpful comments from all the reviewers. Please find our detailed responses below as well as in the marked up copy of the revised paper:

Reviewer #1: Reviewer comments:

Building a community of practice through social media. The study was interesting to go through. These are my main concerns. Below comments follow the order of the manuscript.

Comment 1:

Title

I recommend adding to the title as it is not clear enough (too broad).

Reply: We have altered the title to “Building a community of practice through social media using the hashtag #neoEBM”

Comment 2:

Introduction

The authors should add to the introduction a paragraph on the importance of the practice and gap in knowledge. Also, they need to add some literature in this regard.

Reply: Additional information about the evidence-to-practice gap is included now and referenced.

Comment 3:

Other comments in introduction part is indicated as below:

Line 65: the authors should change the numbering of the reference to number 5 into 2, so it will follow sequential order.

Reply: There was a referencing error and reference 5 has been corrected.

Line 70: please delete the word meeting, as it’s a repetition.

Reply: Deleted

Line 73: start a new Paragraph-Twitter is an….

Reply: New paragraph started.

Comment 4:

Line 78: Please clarify the type of the observational study conducted.

Reply: Cohort now included.

Comment 5:

Material and Methods

-Lines 83-85: the study design should be clarified.

-Sample size and sample size calculation.

-Where there any exclusion criteria?

Reply: We have included the following information in the Material and Methods section:

Our study was a descriptive, observational cohort study utilising the social media health analytic website Symplur as the data source. User generated posts (“tweets”) met inclusion criteria if they were generated on Twitter and contained the hashtag #neoEBM between 1 May 2018 and 9 January 2021. All other tweets were excluded. This was a convenience sample of all eligible posts without formal sample size calculation.

Comment 6:

Results

Figure 1: the writing in the figure is not clear.

Table 1: Aveling’score- please edit the space between s c.

Reply: Our apologies, the figure has been updated and the typographical error corrected.

Comment 7:

Discussion

-This should be supported by other studies in different medical fields that show an effect of social media on Cop.

Reply: Thank you for this comment, we have added further information and relevant citations into the discussion:

“Our findings are supported by the development of other online CoPs in healthcare.7, 8”

Comment 8:

-Need recommendations for further studies and what should be done.

Reply: “While we have demonstrated elements of organisation, the impact of the CoP on the practice of individual clinicians is yet to be determined. Further qualitative and quantitative study is needed to understand how practice may change through participation in the #neoEBM community. It cannot also be assumed that all CoP will add value in the same way and further research is needed in different specialties and professions to see how widespread this approach is in healthcare.”

Reviewer #2: This is an article discussing on the use of social media to develop a community of practice. I appreciate the initiatives on such social media-based research and saw merits of this paper and should be considered for publication upon major corrections.

My comments and suggestions: The authors shall improve the manuscripts (also to serve the need of readers of PLOS ONE of different backgrounds, unlike medical journal of specialised readers). In brief, the manuscript needs to be better organised and provide further elaboration to support the ideas put forward in the manuscript as in the following areas:

Comment 1:

Introduction:

The numbering of the reference is not according to the sequence.

Reply: Thank you for this comment, we have corrected our referencing.

Comment 2: Perhaps, also some background on why or the driver of online CoP, perhaps from other established fields.

Reply: We have now included the following in the introduction/background:

The timely implementation of medical research evidence into clinical practice is an important public health challenge, with the evidence-to-practice gap famously described as taking up to 17 years.2 New approaches to narrow this gap are urgently needed, and online CoPs may be a valuable tool in an era of growing digital interaction.

Comment 3:

Materials and methods:

Some narration on NOECO by Roland et al shall be included to make your methods clearer.

Reply: We have now included a brief explanation around NOECO in the methods section.

Comment 4:

Results:

I feel that all data reported by authors should be analyzed and interpreted further, rather than to report as is. For example, the authors reported the cumulative users over time; however, data is only slightly described by the authors in the section of engagement metrics. Interpretation such as the trend of users and tweets, projection in future numbers, the number of users with different number of tweets could add values to the manuscript.

Reply: We appreciate the request for further detail in the analysis, but we are currently limited by information provided by third party platforms. We have provided information commensurate with previous research in this area (reference 8) and hope that this work will enable future research groups, including ours, to push to expand data sources to enhance the information available.

Comment 5:

I expect the information such as the locations and twitters can also be further described and interpreted, rather than simply reported the data. (For instance, rhe authors reported from selected countries with numbers, and what about the rest, since the readers will be curious to know, for instance, from a total of 3228, US, UK, Spain and Australia were 494, 467, 110 and 103, what about the other locations of the remaining 2054?)

Reply: We have added language to the Methods to clarify that the location of the user is only available when publicly shared by the user and updated to Results to describe the proportion of users lacking this information. Unfortunately, no further information of the location much beyond what is supplied in the paper is available – the majority of users’ locations are deemed ‘unknown’.

Comment 6:

Of course, the figures attached must be in good resolution, and the detailed information is difficult to read.

Reply: Please accept our apologies, we have updated the figures to a higher resolution and reviewed them closely for legibility. These are now formatted in TIFF format at 600 dpi per PLOS One guidance.

Comment 7:

Table 1 compared the core components of a CoP and the characteristics of community. This is the key finding that #neoEBM community fits into the 8 features by Aveling. The information in this table shall be further explained by the authors. For example, the top 20 twitter users were identified by the authors, and they were said to be originated from interdependent groups and individuals, and the members cross clinical and organizational boundaries. How does this determination made by the authors were not described and it should be supported by the background data?

Reply: Further detailed data on the individual Twitter users identified within this group is now provided in the Supplementary Information.

Comment 8:

As for the content (second row), the authors stated that the twitter users were members united for a common purpose and come to achieve the same aim, how do the authors come to such determination shall be discussed and supported by the analysis. The same also goes to other points in Table 1. A further description on the data will benefit the readers for better understanding.

Reply: We have included additional information in the Supplementary Material and ensured that there is a clear justification for each assertion in Table 1.

Comment 9:

Discussion:

There were several issues which need attention by the authors. How the authors determined the identity of twitter users, the issue of robotic tweets, potential of mis-hashtag by the users, confidentiality of the tweeted message, issue of the authorship on tweeted information, and etc are factors that potentially affect the interpretation of the data.

Reply:

Twitter users were identified by the use of the #neoEBM hashtag. It would be possible for some of the users to have been ‘bots’ however these numbers are likely to be small because (i) NeoEBM is a very niche hashtag and there is little or no commercial value and (ii) the authors of the study have lived experience in twitter and are able to recognise individuals outside of social media norms. Twitter is a public forum in which you sign an agreement at the outset that your tweets will be made public unless you specifically specify them to be private. Access to this data set means all tweets have been made publicly available. Finally, while it is possible that people were tweeting on behalf of other users this would have to have occurred at a massive scale to have impacted on the results, especially given the homogeneity shown in the content themes, and so we feel this is of limited concern.

Comment 10:

Also, I expect the authors to provide some view how the findings will lead to a greater quality improvement (QI) in clinical community in general.

Reply:

We hope that our work is a facilitator for the change processes needed at collective, organisational and cultural levels to improve the use of evidence in everyday clinical practice. We have briefly touched on and cited the following paper in the response to the reviewer’s comment:

Aveling EL, Martin G, Armstrong N, Banerjee J, Dixon-Woods M. Quality improvement through clinical communities: eight lessons for practice. J Health Organ Manag. 2012;26(2):158-74. doi: 10.1108/14777261211230754. PMID: 22856174.

Comment 11:

Reference:

The list needs some minor formatting.

Reply: Thank you, we have done this.

 

Reviewer #3:

In my opinion, the study titled “#neoEBM: Building a community practice through social media” is interesting but has major limitations:

Comment 1:

� Introduction: A clear rationale for the current study along with use of tools such as “Aveling’s core component of clinical community” is missing.

Reply: Thank you for this comment. We have more clearly written in the introduction that there is evidence (referenced) that highlights social media communities on twitter may act as communities of practice. There is therefore a theoretical link between the development of emerging communities of practice and improvements in care (although the extent of this link needs further evaluation). Communities of practice have previously not been described in neonatal medicine and this study sought to examine this.

Comment 2:

� Materials and methods: missing inclusion exclusion criteria for evaluating the dependent variables. This is vaguely presented but the actual process must be clearly presented.

Reply: We have included (in addition to more detail about the study design in response to reviewers’ other comments), the following:

“Our study was a descriptive, observational cohort study utilising the social media health analytic website Symplur as the data source. User generated posts (“tweets”) met inclusion criteria if they were generated on Twitter and contained the hashtag #neoEBM between 1 May 2018 and 9 January 2021. All other tweets were excluded. This was a convenience sample of all eligible posts without formal sample size calculation.”

Comment 3:

� The results section needs significant work. The figure axes are not legible. The quality of figure content is very poor. Additionally, the authors need to elaborate on the results and their relation to the presented figures.

Reply: The figures have been updated to be legible (again, please accept our apologies for this) and we have adjusted the axis labelling to improve legibility. These are formatted in TIFF format at 600 dpi per PLOS One guidance. Please also see response below.

Comment 4:

� Figure 2: it is expected that the frequency of tweets would be higher around scientific events as highlighted by the authors. But it is important that the authors elaborate on what this means and involves in their discussion.

Reply: Thank you for this comment and this demonstrates that our findings mimic real-life observations (thus validating our work) and we have included in the discussion the following “highlight how communities of practice benefit from face-to-face interactions at conferences.”

Comment 5:

� Discussion needs significant work on the above factors.

Reply: Please see our responses and additions to the paper in response to the above (and other significant additions to the discussion).

Comment 6:

� In the conclusion, the authors make a case that #neoEBM is an effective tool to disseminate research findings via social media platform (twitter in this case). What percentage of the research community would this reach? Are there any analyses to project the percentage of population it would reach compared to the standard Pubmed, google scholar and other scholar manager approaches? Is the information through #noEBM from twitter reliable? The significance and impact of these findings need to be discussed.

Reply: Further details regarding the additional limitations to our work has been added to the discussion. We have also included further information in the discussion around future research directions that hopefully also addresses this comment.

Comment 7:

� Finally, the data were not easily accessible to review.

Reply: We have included our basic dataset as Supplementary Information.

 

Reviewer #4:

Thank you for giving me the opportunity to review this paper. This paper addresses an interesting topic of building a community through Twitter, in order to increase the dissemination of research recommendation. The idea is great, the team had done a good job in building this community. However, several information was missing. The comments below are intended to further strengthen the paper.

Comment 1:

Title

1- The title could be improved by removing the hashtag, to be "Building a community of practice through social media".

Reply: Thank you for this comment. It does conflict with another reviewer’s comment to make the title more specific.

At this point we have altered it to state:

“Building a community of practice through social media using the hashtag #neoEBM”. However, we would be happy to alter it again as needed.

Comment 2:

Abstract

1- Line 57, can you please provide the long form of any abbreviation when you mention in it the first time, please?

Reply: We have removed the abbreviation and used the long-form.

Comment 3:

Introduction

1- It was not clear about the context in which the hashtag was introduced. Was there any previous attempt to engage people using for example, a mailing list? Did all the group twitter users get any formal training for using twitter when it was introduced? were there anyone in charge of the hashtag? How many hours per week was spent in observing the hashtag? Was there any previous attempt to assess the utilization of the hashtag?

Reply: The formation of #neoEBM was a spontaneous event by clinicians already engaged and knowledgeable about twitter. The reason this started was that the group were keen to more dissemination of research beyond email lists, and we were all familiar with twitter.

By definition, there is no one in charge of hashtag, as this is the way in which an organic community of practice develops. Some previous work on this has been published (reference 5: Keir et al, EBM_BMJ 2019).

Comment 4:

2- Line 65, can you please add the references numbers based on their appearance in the paper? As the introduction line 63 started with reference number 1, and line 65, the second appeared reference number is 5. Can you please clarify if this should be number 2?

Reply: Our apologies, there was an error in the referencing, and we have corrected it.

Comment 5:

3- Can you please provide a references to the statements in lines 74-76.

Reply: We have referenced these statements.

Comment 6:

4- Can you please provide a definition for the word hashtag, line 77.

Reply: We have provided a definition for the word hashtag accordingly.

Comment 7:

Materials and methods

1- Line 83, Can you please comment on the stage of hashtag registration please? Was this completed to assess the analysis using the Symplur software, or was this needed by Twitter, to register official hashtag?

Reply: We registered the hashtag #neoEBM within 3 days of our meeting at PAS in 2018 with the concept to monitor its usage over time using the Symplur software. Registration was required by Symplur to allow us to use their analytics platform.

Comment 8:

2- Line 85, can you please confirm what is NOECO, please?

Reply: Please see our reply to Reviewer 2, Comment 3. It is a standardised framework for reporting social media analytics research.

Comment 9:

3- Line 88, can you please confirm if the "this online tool" refers to Symplur?

Reply: Yes, it does, we have made it clearer in the paper.

Comment 10:

4- Line 108, 36% of user's demographics is presented in the paper, can you please confirm the location of the other users please?

Reply: Unfortunately, it is not possible to define the rest of the users’ locations as the majority of users’ locations are ‘unknown’. We have explained this more clearly in the update methods section.

Comment 11:

5- Line 110, please clarify what is meant by top users?

Reply: We have clarified this by including the definition of ‘top’:

“The top 20 Twitter users of #neoEBM, defined as the most frequent users of the hashtag,….”

Comment 12:

6- Line 112, can you please define the word bot, please?

Reply: A bot is a software application used to automatically generate messages, advocate ideas, act as a follower of users on social media platforms. We have elaborated on this definition when the term is introduced in the results section.

Comment 13:

7- Can you please comment on the total number of tweets if all of them were about neonatology? Was all the tweets were read/ a sample of the tweets were assessed as part of quality assurance to confirm that the tweets are about neonatology? Or if they were include based on face value, that all tweets were about neonatology? Or were there any user used the` hashtag to tweet about another topic?

Reply: Not all tweets were individually read but a word cloud highlights the content were universally related to neonatal practice (we can provide the word cloud if necessary). We can find no evidence that #NeoEBM is used by any other group or community

Comment 14:

8- Can you please confirm if there were any duplicated tweets?

Reply: There were no duplicated tweets – all were unique.

Comment 15:

9- Can you please provide the definition of the word engagement, please?

Reply: We are using the word engagement to mean “being involved with something (aka the CoP).” We have highlighted this in the revised paper by including the word “involvement” next to engagement to clarify its intended use in the paper.

Comment 16:

10- Have the team considered completing a content or thematic analysis of the tweets?

Reply: Yes, thank you for this suggestion. As this is significant piece of work, we think it would be better placed as a further piece of work.

Comment 17:

11- Can you please confirm if you had completed a word association thematic analysis, please?

Reply: Thank you for this query. No, we have not done this and would like to do this as an additional piece of work. Please see our response to the above.

Comment 18:

12- Can you please comment on the analysis that was completed using the software, Symplur, please?

Reply: Symplur is a twitter analytics platform which has developed trademarked algorithms to analyse content and also uses a taxonomy of 35000 terms mapped to 1 million social profiles which are then broken down into relevant healthcare stakeholders. Their software collates information around a specific hashtag and allows for deep content analysis via national language processing algorithms.

Comment 19:

13- Can you please add the information mentioned the price of the software in the method section, please?

Reply: We have added the following:

”We paid US$499 for access to the database for one month through the Symplur Signals Self-Serve (research option for 10 datasets) option.”

Comment 20:

Results

1- Line 120-121, can you please clarify the numbers please, as the numbers are not the same as the numbers presented in the abstract line 47-48. Can you please clarify if the numbers should add up to 3,228, please?

Reply: The number of users of #neoEBM across the study period was 3 228, this is consistent is the abstract and result sections.

To further clarify: “The majority of Twitter users made one tweet using #neoEBM (n=1843), followed by two tweets (n=443) and more than 10 tweets (n=347).” These numbers do not add up to 3 228 as some users made between 3-9 tweets and are not included in this breakdown of numbers.

We have corrected our error in the abstract and the main text. Thank you for picking this up.

Comment 21:

2- Can you please clarify the content of the tweets? What are the main themes within the tweets?

Reply: Please see our reply to Comment 13 (Reviewer 4) and previous comments about a thematic analysis.

Comment 22:

3- Can you please confirm if the tweets were used for information dissemination, increase awareness about certain topics, or networking? And what is the percentage of each component?

Reply: Thank you for this query. Unfortunately, it is not possible to draw inferences from the data regarding these points unfortunately due to the limitations of the third-party software currently available.

Comment 23:

4- What are the demographics of people tweeting using the hashtag? What was the gender of the people?

Reply: We have provided some of this data in the details regarding the top 20 users and in the Supplementary Material. Further, we have clarified in the methods that characteristics of users were obtained when publicly available in the profile.

Comment 24:

5- Can you please confirm what was the average engagement rate, please?

Reply: This was not formally calculated as part of this project. Our rationale was that as it is not part of the Aveling’s principles, and we did not formally calculate this.

Comment 25:

6- Can you please confirm if important information about the characterises of the tweets were factored in the analysis including, the length of the tweets, the time tweet was posted, the number of links in the tweets, and if these variables affected the engagement rate?

Reply: Thank you for these comments. hese factors were not factored into the analysis. Our rationale was that as it is not part of the Aveling’s principles, and we did not formally calculate this.

Comment 26:

Discussion

1- Line 160-161, can you please comment that this statement is based on an observation from 3 reply to one tweet, please?

Reply: Thank you for this comment. These statements were meant to highlight the potential criticisms of our work. Consequently, we have re-worded the sentence to hopefully make this more clear:

“Potential criticism of our work includes that it is no different to an email listserv, that it is at high risk of being overtaken by opinion-based medicine and that it has or will have no impact on clinical practice.”

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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Decision Letter 1

Barbara Guidi

28 Apr 2021

PONE-D-21-01208R1

Building a community of practice through social media using the hashtag #neoEBM

PLOS ONE

Dear Dr. Keir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the detailed comments. No additional comments are available for now. The author addressed majority of the reviewers comments which improved from the paper status.

Reviewer #2: The authors have made significant improvement to the manuscript. The concerns that I raised earlier were appropriately taken into consideration, or with justification to why certain recommendations were not able to be included into the text.

Some minor things that the authors should take note:

Line 67 - should the reference in a square bracket?

Line 77 - a quick search on internet shows that twitter has 330 million accounts - ref 4 might not be an updated source.

Line 167 and Line 207 - the authors stated that #neoEBM as "a tool to disseminate new knowledge" and "disseminate research findings", respectively... this makes the platform to be deemed as a "one way traffic" communication, i.e. from those who know to those who don't, or to those who have conducted research to those who haven't..one-way flow of new information. I would prefer to use "a tool to share knowledge, or to promote knowledge exchange... (i.e. the element of two-way communication) simply because knowledge presented by someone might not necessarily be "new" to everyone. Also, not all member in #neoEBM are researchers, I think. I feel that it is important to point this out, though it is more like my personal opinion. The original concept of CoP by Wenger (1991) is to serve as a platform for novices to meet experts, and if you define CoP as such, it is ok to see that this platform disseminates "new" knowledge and "research findings. However, the authors define CoP based on [1], i.e. a broader and a newer definition of CoP as "a platform to support members to interact with each other, share knowledge, promote knowledge exchange, and build the sense of belonging to the group". .. (see abstract), and therefore it will be more inclusive for the authors to use proper wordings such as share or exchange.

Line 201: Should "all C" be "all CoPs"?

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2021 May 28;16(5):e0252472. doi: 10.1371/journal.pone.0252472.r004

Author response to Decision Letter 1

9 May 2021

Thank you to the reviewers for their feedback and please find our detailed responses below:

Reviewer #1: Thank you for the detailed comments. No additional comments are available for now. The author addressed majority of the reviewers’ comments which improved from the paper status.

Reply: Thank you.

Reviewer #2: The authors have made significant improvement to the manuscript. The concerns that I raised earlier were appropriately taken into consideration, or with justification to why certain recommendations were not able to be included into the text. Some minor things that the authors should take note:

Comment 1:

Line 67 - should the reference in a square bracket?

Reply: Yes, thank you and updated.

Comment 2:

Line 77 - a quick search on internet shows that twitter has 330 million accounts - ref 4 might not be an updated source.

Reply: Thank you for pointing this out. We have decided to remove this sentence as it will clearly get more and more out of date as time goes on and is general background only.

Comment 3:

Line 167 and Line 207 - the authors stated that #neoEBM as "a tool to disseminate new knowledge" and "disseminate research findings", respectively... this makes the platform to be deemed as a "one way traffic" communication, i.e. from those who know to those who don't, or to those who have conducted research to those who haven't..one-way flow of new information. I would prefer to use "a tool to share knowledge, or to promote knowledge exchange... (i.e. the element of two-way communication) simply because knowledge presented by someone might not necessarily be "new" to everyone.

Reply: We have updated both areas with the new (improved) wording – thank you.

Comment 4:

Also, not all member in #neoEBM are researchers, I think. I feel that it is important to point this out, though it is more like my personal opinion. The original concept of CoP by Wenger (1991) is to serve as a platform for novices to meet experts, and if you define CoP as such, it is ok to see that this platform disseminates "new" knowledge and "research findings. However, the authors define CoP based on [1], i.e. a broader and a newer definition of CoP as "a platform to support members to interact with each other, share knowledge, promote knowledge exchange, and build the sense of belonging to the group". .. (see abstract), and therefore it will be more inclusive for the authors to use proper wordings such as share or exchange.

Reply: Thank you for this point – we agree – we hope that our CoP is inclusive and have added this point in the paper in several places. Please see the marked up version of the paper for further details, including at line 200, where we have added:

We want the #neoEBM community to be a place for anyone working in or interested in neonatal care, including families and former patients, to learn and share knowledge about new research findings.

Comment 5: Line 201: Should "all C" be "all CoPs"?

Reply: Yes, thanks for picking this up and we have corrected it.

Decision Letter 2

Barbara Guidi

17 May 2021

Building a community of practice through social media using the hashtag #neoEBM

PONE-D-21-01208R2

Dear Dr. Keir,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Barbara Guidi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have addressed majority of issues raised and the manuscript have improved. No additional comments are

available for now.

Reviewer #2: Thank you for the response. I feel that it is now suitable for consideration to be published. It is hope that the authors would continue monitor the development of the platform and, perhaps, update the readers in a future publication.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Sara AL-Musharaf

Reviewer #2: No

Acceptance letter

Barbara Guidi

19 May 2021

PONE-D-21-01208R2

Building a community of practice through social media using the hashtag #neoEBM

Dear Dr. Keir:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Barbara Guidi

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Data

    (XLSX)

    Click here for additional data file. (39.4KB, xlsx)
    Attachment

    Submitted filename: Reviewer-plos one.docx

    Click here for additional data file. (14KB, docx)
    Attachment

    Submitted filename: Response_To_Reviewers_FINAL.docx

    Click here for additional data file. (46.7KB, docx)

    Data Availability Statement

    The minimal dataset underlying this study is available within the manuscript and its Supporting Information files, and from the University of Adelaide Figshare (https://doi.org/10.25909/14329754.v1). Additional data are available from the Symplur Signals database and can be accessed through www.symplur.com with a fee-based account subscribed for the hashtag #neoEBM. The authors did not have any special access to the data that other researchers would not have.

    Articles from PLoS ONE are provided here courtesy of PLOS

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