To minimise the spread of the COVID-19 pandemic, the World Health Organisation (WHO), Centers for Disease Control and Prevention (CDC), and other health agencies across the globe have mandated numerous protective measures such as maintaining good hygiene, practising social distancing and staying at home. Although wearing face masks is also one of the notable recommendations, the opinions and adoption in public, community, and service settings vary substantially and are somewhat polarised.
The results from several experimental studies on respiratory infections suggest that wearing a face mask can potentially protect wearers and others around from transmitting or acquiring infections in healthcare and household settings (Lau, Tsui, Lau, and Yang 2004; Davies, Thompson, Giri, Kafatos, Walker, Bennett 2013; Cowling et al. 2009; Rodonovich et al. 2019). Likewise, recent studies suggest that compliance with face masks at a community level can effectively suppress the transmission of COVID-19 and reduce hospitalisations and deaths (Eikenberry et al., 2020).
Physical distancing, masks, and other preventive measures are some ways people have employed to shield themselves from COVID-19. Among other measures, health authorities and governments have prescribed the use of masks as a way to prevent people who may have COVID-19 from spreading the virus to others (Greenhalgh, 2020).
According to the U.S. Centers for Disease Control (CDC), widespread mask use can protect the wearer from others, but significantly masks decrease transmission from people unknowingly infected to others (Prather 2020). This is because masks prevent airborne respiratory droplets from spreading the virus (Leung 2020). However, such measures have also become a source of controversy as many people refuse to wear masks in public and social gatherings, as evident from anti-mask protests. This may stem from a lack of understanding, following certain personalities and politicians who may believe in the same, or deliberate ignorance. The mixing of politics with science can often lead to adverse consequences for society. It is also very likely that hotly debated issues during crises such as the COVID-19 pandemic can lead to a myriad of opposing opinions, especially on social media, that have the potential to confuse and mislead common individuals in a society (Khan, Malik, Ruhi, Al-Busaidi, 2022).
Health services researchers have noted the potential benefits of using commercially available online advertising and social media platforms for targeted public health interventions (Huesch et al., 2016). However, social media may serve as a conduit for spreading conspiracy theories, misinformation, and confusion that can negatively affect health services and patient safety. A toxic mix of political partisanship, inability to recognise misinformation based on information skills and behaviour of sharing information without verification may be some of the factors promoting the menace of misinformation (Khan & Idris, 2019). Misinformation sometimes has serious repercussions. For example, the spread of 5G conspiracy theories via social media led to the burning of cell phone towers in the U.K, including that of a hospital (Ahmed et al., 2020).
Social media companies have often been criticised for being complacent in allowing misinformation to spread. Especially for the anti-vaccine movement on social media, although their numbers are relatively small, they do manage to become concentrated clusters engaging with undecided online users, thus gaining prominence (Burki, 2020).
Mask-related social media content has undoubtedly increased during the COVID-19 pandemic. Sanders et al. (2020) employed natural language processing, text clustering, and sentiment analysis of over a million tweets and found that discussions and opinions about Donald Trump, people not wearing masks, and government COVID-19 instructions were quite negative. Discussions surrounding pro-mask and anti-masks have often spilt over into other controversies about gender, politics, and race, as a sense of hypermasculinity associating masks with feminism (Bhasin, 2020).
Face masks have been found to be effective in reducing the transmission of COVID-19. Many public health professionals use Twitter for public outreach. Health professionals have been promoting the use of face masks on Twitter, such as N95 respirators. However, not all N95 masks provide adequate protection in reducing COVID-19. This is because industrial N95 masks protect the wearer from particulate matter but have an exhalation valve, thus not protecting others. These masks were widely available when medical N95s were difficult to purchase in January 2021, when COVID-19 hospitalisations and deaths were rising. Use of industrial N95s would not achieve the desired reduction in transmission.
The aim of this study is to understand the effectiveness of health messaging and to identify and analyse whether qualifiers and guidance were added to tweets making recommendations to wear N95 masks by medical professionals.
The overall aim of this study was to investigate whether medical influencers on Twitter were providing adequate information when recommending N95 masks. Our time period of interest is January 2021. It was a time when most people had not received vaccines, masking was key to reducing transmission, and we were in the middle of a winter surge where medical supplies were still limited.
Based on initial observations and activity on Twitter as users of the platform, the following hypotheses were tested:
Hypothesis 1
The most significant influencer in the network will be a practising medical professional
Hypothesis 2
The most influential medical professionals will not specify specific N95 models
Hypothesis 3
The most influential medical professionals will not provide links to specific N95 models