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An increasing number of medical journals are using social media to promote themselves and communicate with their readers. However, little is known about how medical journals use Twitter and what their social media management strategies are.
This study aimed to understand how medical journals use Twitter from a global standpoint. We conducted a broad, in-depth analysis of all the available Twitter accounts of medical journals indexed by major indexing services, with a particular focus on their social networks and content.
The Twitter profiles and metadata of medical journals were analyzed along with the social networks on their Twitter accounts.
The results showed that overall, publishers used different strategies regarding Twitter adoption, Twitter use patterns, and their subsequent decisions. The following specific findings were noted: journals with Twitter accounts had a significantly higher number of publications and a greater impact than their counterparts; subscription journals had a slightly higher Twitter adoption rate (2%) than open access journals; journals with higher impact had more followers; and prestigious journals rarely followed other lesser-known journals on social media. In addition, an in-depth analysis of 2000 randomly selected tweets from 4 prestigious journals revealed that
Our study used various perspectives to investigate how medical journals use Twitter and explored the Twitter management strategies of 4 of the most prestigious journals. Our study provides a detailed understanding of medical journals’ use of Twitter from various perspectives and can help publishers, journals, and researchers to better use Twitter for their respective purposes.
Social media has become increasingly important in our everyday lives, as it is the means through which we acquire and share information. Individuals, corporations, organizations, and governments are increasingly using social media to broadcast information to various audiences. Social media use is also becoming increasingly prevalent in academia. Despite disciplinary differences, researchers use social media to discuss research ideas, share information and knowledge, and provide feedback on published materials [
Social media is also increasingly influencing medicine and health care [
Medical journals have traditionally used news media to increase visibility [
Although multiple studies have investigated how medical journals have used Twitter, our overall understanding remains limited, mainly because existing studies have focused on particular medical specialties, such as radiology [
To fill this gap, we aimed to analyze all the available Twitter accounts of medical journals indexed by major indexing services by focusing on their social networks and content posted on social networks. Specifically, we created 3 research questions (RQs) that focused on Twitter profiles and metadata, the social networks of Twitter accounts, and Twitter content:
RQ1: What are the adoption and use rates and the patterns of Twitter use of medical journals?
RQ2: What are the structures of the social networks of medical journals’ Twitter accounts, and how do they interact on Twitter?
RQ3: What are the major Twitter management strategies of medical journals, and how do these strategies differ among prestigious medical journals?
The remainder of this paper is organized as follows. In the Methods section, we introduce the data collection and preprocessing approaches as well as the data analysis. The following sections then interpret the results of the data analysis, discuss the major findings and limitations of the study, and finally conclude the paper.
We collated all journal titles in the “Medicine” category of the SCIMago Journal Rank (SJR) [
Data description of all the journals in the “Medicine” category of SCIMago Journal Rank (N=7322).
Item | Values, n (%) |
Journals with Twitter accounts | 3895 (53.2) |
Journals with unique Twitter accounts | 1450 (19.8) |
Journals with publisher Twitter accounts | 2431 (33.2) |
Journals with editor Twitter accounts | 14 (0.19) |
Journals without Twitter accounts | 3427 (46.8) |
Publishing countries among the journals | 96 (1.31) |
Publishers among the journals | 2199 (30.03) |
To understand the various factors that could affect the adoption and use rates and patterns of Twitter use, we explored factors such as the SJR indicator, h-index, total documents (3 years), total citations (3 years), citations per document (2 years), country, established year, subject area, publisher, and subscription type. These factors were investigated to identify the differences in Twitter adoption and use rates among medical journals.
Description of the analyzed factors.
Factor | Description |
SCIMago Journal Rank indicator | Average number of weighted citations received in 2020 by articles published in the journal in the preceding 3 years |
h-index | The number of articles cited at least “h” times |
Total documents (3 years) | The number of journal documents published in the preceding 3 years |
Total citations (3 years) | The number of journal citations in the preceding 3 years |
Citations per document (2 years) | Average number of citations per document in the preceding 2 years |
Country | Country of journal publication |
Established year | Year of a journal’s establishment |
Subject area | Journal’s specific subject categories according to Scopus classification |
Publisher | Journal publisher |
Subscription type | Open access or standard subscription-based publication |
Medical journals interact with each other on Twitter by following and being followed by other medical journals. By collecting all the followers of each medical journal, we constructed a social network for medical journals and collated their social interactions. Specifically, we explored the social networks of journals, publishers, and countries.
The content of various tweets was investigated to understand the various social media management strategies of the medical journals. We began by manually reviewing a random sample of 1000 tweets out of the total tweets posted by 1450 journals and identified major categories related to their social media management strategies. Next, we reviewed 500 tweets from the accounts of each of the 4 most prestigious medical journals (
The interrater reliability reached a Cohen κ value of 0.763, which was considered a substantial agreement [
No ethics review was sought because the study only explored the medical journals’ use of publicly available data on social media and did not conduct any experiments on human subjects.
We compared the SJR indicator, h-index, total documents (ie, number of documents published in 2018, 2019, and 2020), total citations (ie, citations in 2021 received by documents published in 2018, 2019, and 2020), citations per document (ie, average citations per document in a 2-year period), established year, country, subject area, publisher, and the percentage of open access journals for journals with and without Twitter accounts in the group. A Student 2-tailed
The bars in
Distribution of countries, publishers, subject areas, and subscription types among journals with unique Twitter accounts. BMJ: British Medical Journal.
Among the journals with unique Twitter accounts, we investigated factors that could be related to Twitter use.
Correlation matrix between journal and Twitter use variables.
Journals | Period of use (month) | Tweets | Followings | Followers | |||||
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0.14 | 0.14 | -0.02 | 0.31 | ||||
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<.001 | <.001 | 0.378 | <.001 | |||||
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0.20 | 0.25 | -0.05 | 0.54 | ||||
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<.001 | <.001 | 0.080 | <.001 | |||||
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0.09 | 0.23 | 0.00 | 0.22 | ||||
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<.001 | <.001 | 0.894 | <.001 | |||||
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0.11 | 0.24 | -0.01 | 0.50 | ||||
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<.001 | <.001 | 0.739 | <.001 | |||||
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0.11 | 0.12 | -0.01 | 0.26 | ||||
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<.001 | <.001 | 0.673 | <.001 | |||||
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−0.11 | −0.10 | 0.06 | −0.20 | ||||
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<.001 | <.001 | 0.021 | <.001 |
Distribution of countries, publishers, subject areas, and subscription types in relation to Twitter use variables.
In each subfigure shown in
We conducted a network analysis using Gephi 0.9.2 [
Social networks of medical journals’ Twitter accounts, (a) in-degree vs (b) out-degree. BJS: British Journal of Surgery, BMJ: British Medical Journal, JAMA: Journal of the American Medical Association, NEJM: New England Journal of Medicine.
Among the top 10 in-degree lists, journals with higher impact factors generally had more followers, as can be seen by the presence of
Journals with the highest in-degree and out-degree proportions.
Journal | Size | Impact factor (2020) | Publisher | Country | Open access or Subscription | Category | |||||||
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515 | 91.2 | Massachusetts Medical Society | United States | Subscription | Medicine (miscellaneous) | ||||||
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466 | 79.3 | Elsevier | United Kingdom | Subscription | Medicine (miscellaneous) | ||||||
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435 | 56.3 | American Medical Association | United States | Subscription | Medicine (miscellaneous) | ||||||
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242 | 53.4 | Springer Nature | United Kingdom | Subscription | Medicine (miscellaneous) | ||||||
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192 | 11.1 | Public Library of Science | United States | Open access | Medicine (miscellaneous) | ||||||
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164 | 21.9 | American Medical Association | United States | Subscription | Internal medicine | ||||||
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135 | 25.4 | American College of Physicians | United States | Subscription | Internal medicine and medicine (miscellaneous) | ||||||
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132 | 6.3 | Project Hope | United States | Subscription | Health policy and medicine (miscellaneous) | ||||||
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104 | 6.0 | BMJa Publishing Group | United Kingdom | Subscription | Cardiology and cardiovascular medicine | ||||||
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93 | 8.1 | eLife Sciences Publications | United Kingdom | Open access | Medicine (miscellaneous) | ||||||
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96 | 2.9 | BMJ Publishing Group | United Kingdom | Subscription | Health policy | ||||||
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93 | 6.0 | BMJ Publishing Group | United Kingdom | Subscription | Cardiology and cardiovascular medicine | ||||||
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88 | 30.0 | Wolters Kluwer | United States | Subscription | Cardiology and cardiovascular medicine and physiology (medical) | ||||||
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81 | N/Ab | BMJ Publishing Group | United Kingdom | Open access | Cardiology and cardiovascular medicine | ||||||
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80 | 3.4 | Wiley | United States | Subscription | Surgery | ||||||
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79 | 46.8 | Springer Nature | United Kingdom | Subscription | Gastroenterology and hepatology | ||||||
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66 | 3.4 | Wiley | United Kingdom | Open access | Surgery | ||||||
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62 | 2.6 | Wolters Kluwer | United States | Subscription | Gastroenterology and hepatology | ||||||
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61 | 6.3 | Springer Nature | United States | Open access | Medicine (miscellaneous) | ||||||
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60 | 9.4 | American College of Chest Physicians | United States | Subscription | Cardiology and cardiovascular medicine, critical care and intensive care medicine, and pulmonary and respiratory medicine |
aBMJ: British Medical Journal.
bN/A: not applicable.
Social networks of (a) countries and (b) publishers of medical journals. BMJ: British Medical Journal.
Unsurprisingly, the United States and the United Kingdom were the 2 countries that published the largest number of journals, followed by the Netherlands and Swiss. Springer Nature, Wolters Kluwer, Elsevier, BMJ Publishing Group, Wiley, and American Medical Associations were the 6 biggest publishers in terms of the number of followers. SAGE Publications—the fifth-largest publisher in terms of the number of published medical journals—had a smaller number of followers. However, the BMJ Publishing Group, which publishes less than half the number of journals published by Wiley (
To understand the various purposes of Twitter use, we crawled 2,769,939 historical tweets posted by the medical journals analyzed in this study and reviewed a random sample of 1000 tweets.
In total, 15 categories were identified, and their proportions, in descending order, are listed in
As shown in
On the basis of the identified categories, we compared the Twitter management strategies of 4 prestigious journals (
Among the identified 15 categories in
Fifteen categories of Twitter management strategies (N=1000).
Category | Example | Values, n (%) |
Descriptions of research articles or perspectives or reviews or case reports along with links to full-text versions | “Understanding the strengths and limitations of established and emerging techniques of pediatric lung MRI can allow practitioners to select and combine the optimal techniques. https://ajronline.org/doi/abs/10.2214/AJR.20.23104” | 604 (60.4) |
Descriptions of journals’ new issues or research collections | “Is This the Kind of Country We Want to Be? http://dlvr.it/CnV5Pp #BlogsCouchinCrisis” | 89 (8.9) |
News about nonmedical or health-related information | “Three teens were among many shot in Kansas City during a violent weekend. http://emsworld.com/11501544” | 75 (7.5) |
Notices or reports of academic conferences | “After @Peter_Ashman handles the intros @fgodlee delivers a ‘state of the nation’ on data sharing & patient partnerships #bmjeds14” | 69 (6.9) |
Health information | “@WHO announces list of eight diseases that may spark #publichealth emergency, as #Ebola outbreak may occur soon.” | 59 (5.9) |
Description of research articles with links to explanatory blog posts | “Simple exercise routines may outweigh the threats of air pollution, study shows. http://bit.ly/1WBw7F9” | 30 (30) |
Journal news | “With 9.499 citations, @ejsotweets new IF rises to 3.959 from 3.379 (2018)! We are strongly committed to clinical research and all aspects of surgical oncology which can advance the care of our patients” | 24 (2.4) |
Podcasts for specific health topics | “Video interview with @PaulLikeMe discussing patient-led research https://youtube.com/watch?v=XQZ5M9oLkXw&feature=youtu.be @patientslikeme #personalizedMed” | 12 (1.2) |
Discussions of health-related questions | “Do you think we can extrapolate these findings to men who do not suffer from gout & suggest they take allopurinol? What’s your take?” | 12 (1.2) |
Live Twitter chats for discussing health topics | “8 p.m. U.K. time tonight #BMJLeaderchat #Kindness & #Compassion in #leadership during #coronavirus” | 10 (1) |
Podcasts for research articles | “Listen on #Soundcloud to last week's trending Oncotarget paper: ‘Genomic markers of #midostaurin drug sensitivity in FLT3 mutated and FLT3 wild-type acute myeloid #leukemia patients’ #medEd #oncology #cancer #medicine” | 8 (0.8) |
Researcher introductions | “One of the stars of sport & exercise medicine in the world. Dr. Margot Putukian, MD. @MPutukian @MLS @Princeton” | 4 (0.4) |
Surveys of journal management strategies | “Take our ACS Open Access iPad Survey and win a cool fan! #ACSDallas” | 2 (0.2) |
Introductions to research projects | “The NFL is creating a partnership with researchers at Boston University who are studying the long-term effects of... http://bit.ly/6zGRaa” | 1 (0.1) |
Descriptions of research norms or ethics | “Plagiarism is the most heard word in scholarly publishing. Some papers are rejected only based on plagiarism. I am sharing herewith a link that will be useful to get insights about plagiarism: * Ethics of plagiarism *... http://ithenticate.com/resources/papers” | 1 (0.1) |
The Twitter management strategies of 4 prestigious medical journals.
Category | The Lancet (n=500), n (%) | NEJMa (n=500), n (%) | JAMAb (n=500), n (%) | BMJc (n=500), n (%) |
Descriptions of research articles or perspectives or reviews or case reports along with links to full-text versions | 36 (72) | 386 (77.2) | 415 (83) | 267 (53.4) |
Descriptions of journals’ new issues or research collections | 49 (9.8) | 34 (6.8) | 6 (1.2) | 29 (5.8) |
Descriptions of research articles with links to explanatory blog posts | 0 (0) | 16 (3.2) | 3 (0.6) | 11 (2.2) |
Notices or reports of academic conferences | 40 (8) | 11 (2.2) | 21 (4.2) | 9 (1.8) |
Infographics for research articles | 1 (0.2) | 1 (0.2) | 1 (0.2) | 4 (0.8) |
Podcasts for research articles | 5 (1) | 32 (6.4) | 49 (9.8) | 2 (0.4) |
Podcasts for specific health topics | 13 (2.6) | 12 (2.4) | 1 (0.2) | 4 (0.8) |
Journal news | 4 (0.8) | 1 (0.2) | 0 (0) | 22 (4.4) |
Health information | 2 (0.4) | 3 (0.6) | 3 (0.6) | 103 (20.6) |
Researcher introductions | 11 (2.2) | 0 (0) | 0 (0) | 7 (1.4) |
Discussions of health-related questions | 0 (0) | 0 (0) | 1 (0.2) | 0 (0) |
Live Twitter chats for discussing health topics | 6 (1.2) | 0 (0) | 0 (0) | 3 (0.6) |
Surveys of journal management strategies | 0 (0) | 0 (0) | 0 (0) | 1 (0.2) |
News about nonmedical or health-related information | 0 (0) | 1 (0.2) | 0 (0) | 8 (1.6) |
Descriptions of research norms or ethics | 2 (0.4) | 0 (0) | 0 (0) | 0 (0) |
Other | 7 (1.4) | 3 (0.6) | 0 (0) | 30 (6) |
aNEJM: New England Journal of Medicine.
bJAMA: Journal of the American Medical Association.
cBMJ: British Medical Journal.
In contrast, we found that each journal has its own unique Twitter management strategy. Compared with the other 3 journals,
Compared with the other 3 journals, tweets introducing and promoting articles accounted for 83% (415/500) tweets of all tweets posted by
Although it introduced research articles less frequently than the other 3 journals,
Furthermore, to understand the social media use of the 4 prestigious journals regarding the COVID-19 pandemic, we explored their tweets related to COVID-19 written in 2020. Overall, 32.05% (4237/13,222) of the tweets written in 2020 by the 4 journals were related to COVID-19. Among the 4 journals,
In this study, we investigated how medical journals use Twitter by analyzing the metadata, networks, and content of their Twitter accounts. Among the 7322 journals investigated, only 1450 (19.8%) had unique Twitter accounts. We also found that journals with Twitter accounts had a significantly greater number of publications and a higher impact than their counterparts that did not use Twitter. Journals with a higher impact may be more active in promotional aspects and would therefore be more likely to use social media such as Twitter. This active use of social media may improve the visibility of journals in the academic community and provide their articles with a higher probability of being read and subsequently cited. However, other factors could also be at play, and the study’s design was not sufficient to make any causal claims.
The journals of some publishers showed higher percentages of Twitter use. For example, 77% (190/246) and 83% (49/59) of journals published by Wolters Kluwer and the BMJ Publishing Group, respectively, had unique Twitter accounts, which shows their active involvement on social media. This is vastly greater than most other publishers who have Twitter adoption rates of ≤30%. Although Wolters Kluwer, Springer Nature, and Wiley all published similar numbers of medical journals, there were huge differences between their Twitter adoption rates (77%, 22%, and 34%, respectively). These 3 publishers created their Twitter accounts in January 2009, February 2011, and March 2010, respectively. Wolters Kluwer was undoubtedly an early adopter of Twitter and encouraged its journals to use the medium. Among the investigated subject areas, psychiatry and mental health had the lowest Twitter adoption rate (17%), whereas orthopedics and sports medicine had the highest Twitter adoption rate (28%). Although we assumed that open access journals would be more aggressive in their Twitter adoption rate, as one of their goals was to reduce access barriers to research and increase their audience, subscription journals actually showed a slightly higher (2%) Twitter adoption rate. This is because subscription journals have a more established business model and consistent revenue and may therefore have the financial resources to maintain several social media accounts.
Medical journals and their publishers were compared regarding Twitter use statistics. Journals with a higher impact in terms of the h-index and citations had more followers. Although citation-based impact measures are not sufficient for comparatively measuring journals’ values, they may act as an important indicator of when journals decide to follow each other, as journals tend to be more willing to follow high-impact journals. Prestigious medical journals such as
We found that Wolters Kluwer had used Twitter for much longer than other publishers, SAGE Publications journals posted fewer tweets than others, and Springer Nature journals had more followers than others. However, in the publisher-level network, Springer Nature had a relatively small number of followers, which may indicate that it had a large number of followers from a relatively small number of publishers. The BMJ Publishing Group and American Medical Association were the 2 publishers with the highest publisher-level network followers, despite publishing only a relatively small number of journals, thereby showing the importance of these 2 publishers in this field. Therefore, these findings show that at the publisher-level social network, quality may be more important than the quantity of published journals.
We identified 15 major categories of Twitter management strategies used by medical journals. Among them, the promotion of articles and the promotion of journals’ new issues or collections were the main reasons for medical journals using Twitter. In addition to research-related purposes, they also tweeted to provide health information and live Twitter chats, which may help increase public health literacy.
Of the 4 prestigious medical journals compared in this study (
This study has a few limitations. First, we only collected the medical journals indexed in SJR, which is a major academic database. Therefore, other journals that were not indexed in SJR were excluded. As a result, the findings of this study should be considered only within this specific context. Second, regarding content analysis, we were unable to conduct an exhaustive investigation of the types of content posted by medical journals and their major purposes for using Twitter because of the large number of tweets. Instead, we randomly sampled 3000 tweets, and the reported results were based on the analysis of the sample. Finally, Twitter adoption and the use of data are dynamic; even at the time of writing, there may be many journals creating Twitter accounts, writing posts, and following others. Therefore, the results of this study provide a snapshot of a historical time and may change in the future.
In this study, we analyzed the Twitter accounts of major medical journals indexed by SJR. Specifically, we investigated the Twitter use of 1450 medical journals by analyzing the metadata, social network, and content of their respective Twitter accounts. We found that journals with Twitter accounts had significantly more publications and a higher impact than their counterparts without a Twitter account. Journals with a higher impact in terms of h-index and citations had more followers than those with a lower impact. Prestigious medical journals such as
British Medical Journal
Journal of the American Medical Association
New England Journal of Medicine
research question
SCIMago Journal Rank
DK and YZ developed the study design. DK, WJ, and TJ collected and analyzed the data. DK wrote the first draft of the manuscript. YZ supervised and implemented the study. All authors contributed to critical edits and approved the final manuscript.
None declared.