Using Twitter’s keyword search, the phrases “public health practitioner,” “MPH” (Master’s in Public Health), “public health,” and “APHA” (American Public Health Association) were used to identify potential participants. The researchers sifted through the results to achieve the sample of 200 public health–affiliated Twitter users. Inclusion criteria comprised Twitter users with active accounts and minimums for number of tweets and followers (over 150 followers). Active accounts were defined as users who had posted content on their Twitter page in the past 3 weeks. Additionally, omitted from the sample were users who primarily were not engaged in general public health topics, public health organizations, and those who were identified as working solely in academia. Practicing public health professionals were the target population. The 200 public health professionals identified were asked through a direct Twitter message whether they would participate in a survey asking questions on their Twitter usage related to public health and their professional experiences. Those responding affirmatively were sent a direct link for our survey housed on an encrypted direct server, which was available for 1 month; ultimately, 49 people participated.

The first 5 survey items asked for demographic characteristics and the following 5 items specifically asked about Twitter usage. A modified version of an existing scale assessing perceived usefulness and ease of use regarding technology was applied [11]. The following questions asked participants to rate the following questions on a 1 (strongly disagree) to 5 (strongly agree) Likert scale: (1) using Twitter improves my job performance; (2) using Twitter increases my productivity; (3) using Twitter enhances my effectiveness on the job; (4) using Twitter makes it easier to expand my networking opportunities; and (5) I find Twitter useful for professional development. The last 3 questions were open-response questions providing a participant the opportunity to not only address personal meaningful practices but also gather insight on how Twitter has been used to advance professional development. Open-ended questions specifically asked included the following: (1) How has Twitter affected your standing within the field of public health? (2) How has Twitter affected your work in the field of public health? and (3) What advice would you give to other public health professionals considering the use of Twitter?

Through the use of a college departmental Twitter account, specifically set up for this study, a single tweet briefly linked individuals to the electronic questionnaire on Qualtrics (Qualtrics, Provo, UT, USA). Interested participants were routed to a consent webpage before proceeding with the survey. All responses were confidential, and researchers were blind to which public health professionals responded from the 200 participants who were sent the initial direct message. Respondents did not receive any compensation for their participation. All research was approved by the institutional review board of the University of Florida.

Frequency counts were used to determine the demographics of the survey respondents (Table 1). Mean, variance, and standard deviation were used to calculate the usefulness and ease of Twitter (Table 2). All quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS). The constant comparison method was used to analyze the open-response survey questions. This method is specifically used to reduce the text (data) into manageable units and, in turn, coded information [12-14]. The process began with 2 trained researchers (SI and NS) open-coding the responses to discover themes and subthemes [12-14]. After open-coding, specific themes were chosen, with both researchers (SI and NS) separately coding the responses by themes [12-14]. After the final coding, the 2 researchers checked to ensure that the responses matched, and discrepancies were decided by a third party who was also a trained researcher in the constant comparison method (MH) [12-14].

Overall, 49 participants responded and completed the survey (response varied by question). Of those, 51% were females (n=25), 47% were males (n=23), and 2% did not identify with a gender (n=1). The majority of participants were aged between 25 and 34 years (45%, n=22). The second majority of participants were aged between 35 and 44 years (24%, n=12; Table 1). Whereas 59% (n=27) of the participants were located in the United States, 41% (n=19) were located outside the United States. The majority of the participants have worked in the field of public health for more than 10 years (43%, n=21), followed by 5 to 9 years (20%, n=10), and 0 to 4 years (37%, n=18). The majority of participants had obtained their master’s degree (52%, n=25; Table 1).

The scale asked 5 questions about the usefulness and ease of Twitter on a 5-point Likert scale. “Using Twitter improves my job performance” has a mean of 3.80 (standard deviation [SD] 0.82, n=49), “Using Twitter increased my productivity” has a mean of 3.35 (SD 0.86, n=49), “Using Twitter enhances my effectiveness on the job” has a mean of 3.80 (SD 0.89, n=49), “Using Twitter makes it easier to expand to my networking opportunities” has a mean of 4.57 (SD 0.74, n=49), and “I find Twitter useful for professional development” has a mean of 4.43 (SD 0.76, n=49; Table 2, modified from Davis [11]). Overall, results show that public health professionals find Twitter the most useful and easiest to use for networking and professional development over job performance, productivity, and effectiveness.

Qualitative inquires comprised the last 5 items on the electronic survey. Common across sections emerged from the data, resulting in 4 major themes: (1) geography, (2) continuing education, (3) professional gain, and (4) communication.

Along with being a social media outlet to connect to peers, Twitter has become a digital platform for public health professionals to enhance their professional development in a time of continual budget cuts and lack of funding. Whereas many public health workers are still receiving formal professional development to satisfy continuing education credits or certification needs, budget cuts have often resulted in lower staffing, which does not allow for as much informal learning that used to occur more naturally among colleagues in a work location. Twitter specifically eliminates geographical and locational boundaries; it provides informal continuing education, opportunities for growing career profiles, and a space to converse and collaborate with other public health professionals, often by connecting those in the same field or in other subspecialties of public health through avatar biographies and hashtags. Furthermore, Twitter is often an integral information conduit for many followers, as new notifications are often alerted to them through their electronic devices in real time.

A consistent use of the words “connect” and “connected” was found in the open-response section of the survey. Users also characterize the sharing of information in an outward direction, with many respondents discussing building their “brand,” blogs, websites, and so on, as well as an inward direction, where it is obvious that many of these public health workers are using Twitter as a major source of obtaining news and current events, often to gain different perspectives. One respondent’s claim of seeking “Twitter users’ feelings on issues” shows that users are not only seeking information and current events through the SNS but also allowing the collective voice help shape how they feel about certain issues. The real-time global expanse of Twitter also appeals to many in public health as they seek the perspective of witnessing a potential health crisis in real time from those “on the ground.” To see an edited news package on, perhaps, an Ebola outbreak is different than reading how people are dealing with the issue in the moment, at the center of the outbreak. Public health workers often compromise our first line of defense for a health emergency; therefore, using Twitter allows workers to see a health crisis from a new perspective. Twitter can provide a timeline of an event and allows users to read the collective voice of the response, often providing opportunities for learning what the most critical issues are and observing how those present there are trying to coordinate services.

Through the elimination of traditional boundaries, Twitter encourages public health professionals to be more creative in their work and research, as they can receive instant feedback and new ideas from public health professionals around the globe through informal interdisciplinary teamwork. Interdisciplinary teamwork among public health professionals could promote better health outcomes and more successful behavior change interventions as interdisciplinary teamwork in medicine has been shown to improve overall health outcomes and patient quality of care [15]. This study reflects the specific areas in which public health workers are using Twitter and how it can have value for their work and professional development. This work, however, is often done in their free time, or on their personal devices, as many local health departments and organizations block SNS through their Internet filters. This study should further the discussion on the value of removing these blocks to allow public health professionals to truly connect and collaborate with others working in the field of public health, or even those in the community they serve.

This study’s sample comprised active Twitter users, making it likelier that their feedback would overall be more positive. The aim, however, focused on how Twitter could potentially be beneficial for public health professionals, and an engaged group of users was critical in acquiring this information. The second limitation was the small sample size. Although only 49 of the 200 participants were recruited, this study was exploratory and did not seek to discover trends emerging among all public health professionals. The small sample size limits our study’s generalizability. Looking at the research of how public health organizations are using Twitter, however, parallels how individual public health professional use Twitter, making findings more generalizable.

Overall, Twitter provides a unique platform for professional development, enhancing the work and research being conducted in the field. This study shows how public health professionals self-reported the potential benefits of using Twitter, whereas future research can focus on content analysis of how they are actually using the tool.