By Suzanne Fredericks RN, PhD, FESC, FCAN

Tommy Lin

Julie Sanders, MSc, PhD

Rochelle Wynne, PhD

Rafaela Pedrosa, PhD

Citation: Fredericks, S., Lin, T., Sanders, J., Wynne, R. & Pedrosa, R. (2024). Evaluating a social media strategy for an international cardiothoracic research network: A cross sectional study. Canadian Journal of Nursing Informatics, 19(1).  https://cjni.net/journal/?p=12744

Abstract

Background: An international research network titled CONNECT (Cardiac surgery international nursing and allied professional research network) was created to expand research opportunities and to support nurses and allied professionals’ engagement in global collaborative research.

Objective: The objective of this social media campaign was to publicize CONNECT by increasing its brand awareness, user familiarity and membership. Specifically, the objectives of this campaign were to increase: 1. the number of impressions and 2. the number of engagements.

Methods & Results: A one-group cross sectional study was used to examine the effectiveness of a Twitter (X) campaign in increasing number of impressions (number of times a tweet was seen) and number of engagements (number of times a Twitter user interacted with a tweet such as clicks anywhere on the tweet, including retweets, replies, likes, user profile clicks, and URL clicks over a specific time interval.). A social media strategy in the form of a Twitter campaign was developed and implemented. Four tweets were sent out daily over a period of 40 days (May 1, 2023- June 23, 2023). In total, 160 tweets were developed and posted. The data were not normally distributed. As a result, non-parametric tests were conducted that included Spearman correlation analysis and Kruskal–Wallis one-way analysis of variance followed by Dunn’s post-test. Results suggest a significant rise in the number of impressions and engagement with CONNECT occurred.

Conclusions: Even though this campaign was found to be effective, there is a need for CONNECT to actively engage with its followers.

Keywords: Branding, Engagement, Impression, Research Network, Twitter Messaging

Background

An international research network titled CONNECT (Cardiac surgery international nursing and allied professional research network) was created to expand research opportunities and to support nurses and allied professionals (NAP) engagement in global collaborative research. Building cardiac surgery NAP research capacity is important as it enhances the ability of individuals to design, implement and evaluate research efficiently and effectively that can result in both developmental and transitional changes in cardiac surgery (Matus et al., 2018). Currently, there is an international shortfall of NAP clinical academics who have the skills, as well as resources and support, to engage in research that addresses global cardiac surgery challenges. CONNECT provides a robust virtual research environment with appropriate mentorship and support to address this. The value of engaging in CONNECT is it allows for collaborative cardiac surgery research, shared initiatives, supervision, mentorship, workplace exchange programs and multi-site clinical research at an international level.

With any new initiative, there is a need to engage in branding to ensure the initiative is understood and embraced (Mitchell, 2002). For this to occur, techniques are required to differentiate the identity of the new initiative, while emphasizing its uniqueness and potential value (Pritchard & Morgan, 1998). To market this initiative, a brand campaign was created that served to introduce and explain CONNECT using Twitter (X) as a medium to communicate messages that reinforce the presence of this virtual research network, its mission, as well as core values. The purpose of this campaign was to increase brand saliency, through the creation and dissemination of highly choreographed and focused communication messages (Pritchard & Morgan, 1998). The goal of brand saliency is to promote top-of-mind awareness of a brand (Romaniuk & Sharp, 2004). In relation to CONNECT, brand saliency for this international research network related to increasing awareness of the virtual research platform.

A scoping review was undertaken to determine the different types of social media platforms and strategies used to promote cardiac research initiatives (Fredericks et al., 2023). Fifteen articles were included in the review. Twitter appeared to be the most common form of social media used to promote cardiac initiatives, with daily posts being the most frequent type of engagement. Frequency of views, number of impressions and engagement, link clicks, and content analysis were the most common types of evaluation metrics that were identified. Even though social media campaigns have been used to advertise, promote, and/or market upcoming events, researchers, and workshops within the field of cardiac surgery, there is limited description of these campaigns throughout the literature (Fredericks et al., 2023).

Objective

The objective of this social media campaign was to publicize CONNECT by increasing its brand awareness, user familiarity and membership. Specifically, the objectives of this campaign were to increase: 1. the number of impressions and 2. the number of engagements.

Methods

A one-group cross sectional study was used to examine the effectiveness of a Twitter (X) campaign in increasing number of impressions (number of times a tweet was seen) and number of engagements (number of times a Twitter user interacted with a tweet such as clicks anywhere on the tweet, including retweets, replies, likes, user profile clicks, and URL clicks over a specific time interval.). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement (STROBE Initiative, n.d.). was used for the reporting of cross-sectional data (Table 1).

Table 1

STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies

A social media strategy in the form of a Twitter campaign was developed and implemented using Bartholomew et al.’s. (1998) Intervention Mapping Theory (IMT). Similar social media campaigns do not appear to be guided by theory. This campaign is unique since it was used to provide a systematic approach to the social media intervention design, implementation, and evaluation. The theory consists of six steps, with the first step being the presentation of the problem, which in the case of CONNECT was to publicize the brand in such a way that it strengthened the relationship between the target audience and the network (Fredericks et al., 2023). The second step of the IMT concerns the objectives of the intervention. In terms of the CONNECT Twitter campaign to publicize the brand, the objective was to increase brand awareness, grow membership, and promote various opportunities offered (Fredericks et al., 2023). This is demonstrated through frequency of views, the number of impressions and engagement, and link clicks over a specific time interval. The third step of the IMT is the identification of the theoretical and empirical methods to describe the context of the intervention and potential outcomes. The CONNECT content included social media posts and the evaluation of specific parameters (i.e., number of followers, impressions, retweets, number of views and clicks, total of downloads, likes, hashtags, in addition to a qualitative analysis) which were identified following careful, systematic review of the empirical and theoretical literature (Fredericks et al., 2023). The fourth step of the IMT relates to the structure of the Twitter campaign. Theoretical and empirical evidence were used to guide the scheduling of posts and the creation of an intervention protocol (Table 1 Supplemental File) to ensure consistency in the creation and dissemination of tweets. Step five relates to the implementation of the Twitter strategy, while Step six pertains to the evaluation of outcomes. This paper presents the results of the evaluation of the outcomes related to the implementation of the CONNECT Twitter campaign.

Table 1 Supplemental File (MS Excel)

Scheduling of Posts

Prior to the start of the study, a series of social media content were created that focused on advertising 1. CONNECT as a new virtual international research network; 2. its founding members; 3. its existing members; and 4. specific CONNECT related outputs (Table 1 Supplemental File). This set of content became the social media strategy. Each tweet was classified as either an endorsement or a broadcast. A posting was classified as an endorsement if it included a portion of a member’s biography or profile, while broadcasts consisted of general messaging about CONNECT and/or an overview of the various means of connecting with the virtual research network through social media. Four tweets were sent out daily, during the week (Monday through to Friday), over a period of 40 days (May 1 to June 23, 2023) . Each grouping of tweets contained 2 endorsements and 2 broadcasts. A schedule for posting of content was determined (Table 1 Supplemental File). In total, 160 tweets were developed and posted. The tweets were delivered during different time intervals (specifically, either morning or afternoon) to determine if there were any significant differences between date tweets were sent and outcomes of interest, as well as time-of-day tweets were sent and outcomes of interest.

Research ethics board approval was not required, as personal data were not solicited from individuals who viewed or interacted with the tweets that were posted. All data acquired were obtained directly through publicly accessible channels on Twitter that included Twitter Analytics that measures web traffic.

Data were downloaded from Twitter analytics in Microsoft Excel format and uploaded onto IBM SPSS (Version 23), which was also used to analyze the data. The data were not normally distributed. As a result, median and range were calculated, and non-parametric tests were used. Spearman correlation analysis was conducted to determine the relationship between retweets, like, user profile clicks, URL clicks and engagement and engagement rates. Finally, the Kruskal–Wallis one-way analysis of variance test was conducted, along with Dunn’s post-test to determine if differences in outcomes of interest (number of impressions, engagement, engagement rate, retweets, like, user profile clicks, URL clicks) existed based on category of tweet (profiling CONNECT, profiling founding member, profiling member, profiling papers) that was sent.

Results

Descriptive analysis

Number of impressions

Prior to the start of the study, the CONNECT Twitter account had 37 followers. Following the end of the 40-day Twitter campaign, the number of followers rose to 170, which is an increase of over 250%. On average, tweets were seen 127,032 times over the 40-day period, with an impression rate of 66.1%.

Tweets were more likely to be seen on Tuesdays (142.53 +/- 186.17) followed by Mondays (137.75 +/- 110.38). In terms of the time when tweets were most likely to be seen, 1030 (190.22 +/- 329.80), 0930 (179.56 +/- 266.87), and 1100 (174.33 +/- 318.04) were the most common times during the day for tweet impressions.

Degree of engagement with Tweets

The total number of engagements (inclusive of clicks, retweets, replies, follows, likes, links, cards, hashtags, embedded media, username, profile photo, or Tweet expansion) was 4954, while an engagement rate of 3.9% was found. These tweets were interacted with approximately 5.76 (SD = 9.00) times, with the most common interactions being likes (1.86 +/- 1.73), URL clicks (1.85 +/- 2.67), retweets (.66 +/- 0.82), and profile clicks (.49 +/- 0.83). The least common interaction was in the form of replies to a tweet (0.006 +/- 0.79). 

Interaction with a tweet was more likely on Mondays (6.69 +/- 8.11) rather than Tuesdays (6.53 +/- 9.89). Mondays appeared to be the most common day of the week for Twitter users to retweet (0.81 +/- 1.08) and/or like (1.97 +/-1.62) a tweet, while Wednesdays and Fridays were the most common day of the week for users to engage with users’ profiles (0.78 +/- 1.34) and/or click on URLs (2.34 +/- 3.88), respectively (Table 2).

Table 2

Degree of engagement with tweets –  Day of the week

Furthermore, Twitter user interactions occurred around 1030 (9.11 +/- 18.26), 0930 (8.44 +/- 12.20), and 1330 (8.38 +/- 9.47). Specifically, users retweeted most often at 1030 (0.89 +/-  1.76), 1300 (0.88 +/-  1.73), and 1630 (0.88 +/-  1.13). Tweets were most often to be liked at 1030 (2.89 +/- 4.76), 0800 (2.11 +/- 2.47), 1700 (2.13 +/- 2.53). Twitter users were most likely to click on a profile at 1330 (1.75 +/- 3.62), 1230 (1.13 +/- 1.46), or 1030 (1.11 +/- 2.62). Finally, Twitter users were more likely to click on a URL at 1700 (3.75 +/- 8.60), 1130 (3.00 +/- 3.91), 1030 (2.67 +/- 5.61) (Table 3).

Table 3

Degree of engagement with tweets – Time of day

Relationship based analysis

Number of impressions

Moderate to strong monotonic positive correlations were found between impressions and retweets (r = 0.76, p < 0.001), likes (r = 0.77, p < 0.001), and URL clicks (r = 0.78, p < 0.001). A moderate monotonic positive correlation was found between impressions and profile clicks (r = 0.60, p < 0.001). No statistically significant monotonic relationship was noted between impressions and replies (r = 0.00, p = 0.98).

Tweets sent during the morning hours had a statistically higher number of impressions (p < 0.000) than those sent during the afternoon.

Finally, tweets that profiled CONNECT (p < 0.003), its founding members (p < 0.003), and its current members (p < 0.030) generated the highest number of impressions.

Degree of engagement with tweets

Strong monotonic positive correlations were found between engagement and retweets (r = 0.83, p < 0.000), likes (r = 0.9, p < 0.000), and URL clicks (r = 0.87, p < 0.000); while a moderate monotonic positive correlation was found between engagement and user profile clicks (r = 0.65, p < 0.000). As well, moderate monotonic positive correlations were noted between engagement rate and retweets (r = 0.63, p < 0.000), likes (r = 0.68, p < 0.000), user profile clicks (r = 0.52, p < 0.000), and URL clicks (r = 0.58, p < 0.000).

No differences (p > 0.05) were found among outcomes of interest (number of impressions and engagement) based on three of the four (profiling CONNECT, profiling founding member, and profiling member) different types of tweets that were sent.

Tweets that profiled papers written by CONNECT members (p < 0.049) generated the highest number of retweets.

Discussion

The Twitter campaign appeared to be effective. On average, the growth in the number of followers increased over 250%. This number was significantly higher than the anticipated 6-8% average growth rate per month of number of Twitter followers (Bruns et al., 2014). This significant rise in the number of followers may be due to the quality of the tweets that were created and posted. Each tweet was intentionally designed to elicit user engagement and interaction. Significant time and research went into drafting each tweet to ensure they were visually appealing, short and simple, integrated use of emojis and relevant hashtags, and had a hint of humour and/or intrigue. As well, every effort to tag relevant individuals, organizations, and influencers in the field of cardiovascular surgical nursing and allied professional research was made. Evidence suggests, tweets that are visually enticing have higher rates of engagement than tweets that present basic information (Wadhwa et al., 2017).

In addition to the significant rise in the number of followers during this campaign, a very high impression rate of 66.1% was identified. Thus, over two thirds of CONNECT’s followers saw the tweets that were sent out. On average, an impression rate of 20% is very good (Mui & Ming, 2020). The increased visibility may be due to the varied intervals during which the tweets were sent, which enhanced CONNECT’s impression rate by targeting different time zones as well as days of the week. The followers’ of CONNECT’s Twitter account span over 18 time zones and were from various regions of the globe. To maintain this high impression rate, the continued use of Twitter scheduling to ensure the organization of tweets, and to maintain a regimented and consistent posting schedule is needed.

Furthermore, an engagement rate of 3.9% was identified. Thus, approximately 4% of CONNECT’s followers engaged with the tweets through likes, URL clicks, retweets, and profile clicks. This engagement rate is very high (Wadhwa et al., 2017) and may be due to the quality of the tweets that were created. In this study, endorsements, specifically tweets related to CONNECT members’ research activity, as well as their research profile were more likely to be liked, retweeted, or have their URL clicked. Most of these tweets had links to videos, research articles, photos, and/or websites which appeared to fuel interest in members’ profiles. Many of these tweets also contained hashtags which helped to make the Twitter content searchable. By using hashtags, the CONNECT tweet was added to other tweets that contain a similar hashtag. Thus, when a specific hashtag was searched, the CONNECT tweet appeared which enhanced its overall visibility, discoverability and reach making it more likely to be liked, retweeted, or having its URL clicked on (Bruns & Burgess, 2011).

In addition, the start of the week, specifically, Monday and Tuesdays appeared to be the days of the week that solicited the most interactions with tweets. Interactions with tweets tended to occur between mid-morning and early afternoon (0930-1330). Alwagait and Shahzad (2014) also identified Mondays as the day of the week most Twitter engagement occurred. This may be due to individuals intentionally accessing and interacting with tweets right after a weekend, as engagement on social media platforms on Saturdays and Sundays tended to be reduced due to other personal responsibilities (Alwagait & Shahzad, 2014).

Implications

CONNECT should actively engage in conversations with its followers by replying and liking their posts, as well as retweeting their content, even if the followers do not interact with CONNECT. In doing so, this activity may spur followers to reply to CONNECT posts. This is also a means through which CONNECT can let its followers know that its Twitter account is consistently active and engaged (Alwagait & Shahzad, 2014).

As well, a portion of CONNECT posts should routinely be in the form of open-ended questions. By posing questions on Twitter, CONNECT is inviting conversations across its social media platform. CONNECT should attempt to curate content by sharing high quality content related to innovations in cardiovascular research, research opportunities, cardiovascular grants and conferences, and international collaborative cardiovascular research opportunities for NAPs. Curating content will serve to raise the quality and traffic across the CONNECTcardiac Twitter feed, increase engagement, specifically replies, and increase the overall number of followers (Duh et al., 2012).

Limitations

One area of concern that emerged from the data is the low number of replies. Replies are responses to a tweet. They tend to initiate conversations and can serve to attract more followers to respond to a specific conversation thread (Bruns et al., 2014). Based on the results, followers are engaging with tweets that focus on research activities. Thus, this is an area that CONNECT should optimize moving forward. For example, when a follower retweets or likes a post, CONNECT members should scroll through this follower’s Twitter feed to see if there is a post related to research activities that CONNECT can also retweet or like. This allows for the focus of CONNECT’s Twitter activity to focus on research, while also providing CONNECT with the opportunity to respond to engagement from its followers, which can potentially lead to conversation (Bruns et al., 2014).

Conclusion

A cardiac surgery international nursing and allied professional research network titled CONNECT was created to expand research opportunities and to support nurses and allied professionals (NAP) working in clinical and academic cardiac surgery areas. To market this new initiative, a social media branding campaign was undertaken in which a Twitter social media intervention was designed and implemented over a 40-day period. Following the branding campaign, a significant rise in the number of impressions and engagement with CONNECT occurred. Even though this campaign was found to be effective, there is a need for CONNECT to actively engage with its followers by responding to comments and providing an opportunity for open ended dialogue. This may lead to even higher numbers of engagement with both CONNECT’s social media platform, as well as the CONNECT research group.

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Author Bios

Suzanne Fredericks RN, PhD, FESC, FCAN 

Professor; Daphne Cockwell School of Nursing, Toronto Metropolitan University; 350 Victoria St.; Toronto, ON; Canada; M5B 2K3; sfrederi@torontomu.ca; 416-979-5000 ext. 557978

ORCID: https://orcid.org/0000-0002-7335-2803; @SuzFredericks

Tommy Lin

Research Assistant; Daphne Cockwell School of Nursing, Toronto Metropolitan University

350 Victoria St.; Toronto, ON; Canada; M5B 2K3; q1lin@torontomu.ca

Julie Sanders, MSc, PhD

Director Clinical Research; St Bartholomew’s Hospital, Barts Health NHS Trust and Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London; UK; j.sanders@qmul.ac.uk; https://orcid.org/0000-0002-7335-2803; @julessanders2

Rochelle Wynne, PhD

Clinical Nurse Consultant (Cardiothoracic Surgery); The Royal Melbourne Hospital; 300 Grattan Street (corner of Royal Parade); Parkville, Victoria 3050; Australia; Rochelle.Wynne@mh.org.au; https://orcid.org/0000-0003-1814-3416; @rochellemwynne

Rafaela Pedrosa, PhD

Assistant Professor; University of Campinas (UNICAMP); Cidade Universitária Campinas; São Paulo, Brazil; 13083-970; rpedrosa@unicamp.br; +55 19983015493; @rafapedrosa2016