Antonio Martínez-Millana

JOURNAL OF MEDICAL INTERNET RESEARCH Martinez-Millana et al Original Paper Evaluating the Social Media Performance of Hospitals in Spain: A Longitudinal and Comparative Study Antonio Martinez-Millana1*, MSc; Carlos Fernandez-Llatas1,2*, PhD; Ignacio Basagoiti Bilbao3*, MD; Manuel Traver Salcedo1*, BSc (Comp Eng); Vicente Traver Salcedo1,2*, PhD 1 ITACA, Universitat Politècnica de València, Valencia, Spain 2 Unidad Mixta de Reingeniería de Procesos Sociosanitarios (eRPSS), Instituto de Investigación Sanitaria, Hospital Universitario y Politecnico La Fe, Valencia, Spain 3 Hospital de Manises, Valencia, Spain * all authors contributed equally Corresponding Author: Antonio Martinez-Millana, MSc ITACA Universitat Politècnica de València Buildign 8G Access B 1st Fl Camino de Vera s/n. 46022 Valencia, Spain Phone:- Email:- Abstract Background: Social media is changing the way in which citizens and health professionals communicate. Previous studies have assessed the use of Health 2.0 by hospitals, showing clear evidence of growth in recent years. In order to understand if this happens in Spain, it is necessary to assess the performance of health care institutions on the Internet social media using quantitative indicators. Objectives: The study aimed to analyze how hospitals in Spain perform on the Internet and social media networks by determining quantitative indicators in 3 different dimensions: presence, use, and impact and assess these indicators on the 3 most commonly used social media - Facebook, Twitter, YouTube. Further, we aimed to find out if there was a difference between private and public hospitals in their use of the aforementioned social networks. Methods: The evolution of presence, use, and impact metrics is studied over the period-. The population studied accounts for all the hospitals listed in the National Hospitals Catalog (NHC). The percentage of hospitals having Facebook, Twitter, and YouTube profiles has been used to show the presence and evolution of hospitals on social media during this time. Usage was assessed by analyzing the content published on each social network. Impact evaluation was measured by analyzing the trend of subscribers for each social network. Statistical analysis was performed using a lognormal transformation and also using a nonparametric distribution, with the aim of comparing t student and Wilcoxon independence tests for the observed variables. Results: From the 787 hospitals identified, 69.9% (550/787) had an institutional webpage and 34.2% (269/787) had at least one profile in one of the social networks (Facebook, Twitter, and YouTube) in December 2015. Hospitals’ Internet presence has increased by more than 450.0% (787/172) and social media presence has increased ten times since 2011. Twitter is the preferred social network for public hospitals, whereas private hospitals showed better performance on Facebook and YouTube. The two-sided Wilcoxon test and t student test at a CI of 95% show that the use of Twitter distribution is higher (P3) confirm the leptokurtic distribution of all the variables. A similar study in the United States also reported skewed distribution of social media metrics [26]. In this case, statistical analysis was conducted by approximating the skewed distribution to a normal distribution with a lognormal transformation. Our approach is to be as realistic as possible without transforming raw data and using other kinds of statistical tests that can work with nonparametric distributions, such as the Wilcoxon signed-rank test [27]. In Figure 5, we show an example of the raw Twitter follower distribution for private hospitals (histogram) and superimposed the approximation to a normal distribution by applying a lognormal transformation (red line) and a nonparametric distribution (blue line). The goodness of fit or the nonparametric approach is more realistic than the lognormal transformation, and thus, closer to the actual real values of the distribution. J Med Internet Res 2017 | vol. 19 | iss. 5 | e181 | p.5 (page number not for citation purposes) JOURNAL OF MEDICAL INTERNET RESEARCH Martinez-Millana et al Table 1. Magnitude of the observed variables by means of median values, interquartile range, and kurtosis values for public and private hospitals with regard to December 2015. Variables Facebook friends Private hospitals Public hospitals Median IQRa K median IQR K 1253 - 4.329 740 - 63.880 1244 - 8.801 750 - 15.565 895 - 12.243 437.5 206-973 9.184 19 - 7.760 19 15.4-62 15.982 25 - 5.493 12 4-56.75 58.464 7386 1530-63,030 14.440 5908 -,318.25 50.3166 (n=266,311) Tweets (n=250,040) Twitter followers (n=172,691) YouTube videos (n=4269) YouTube subscribers (n=59,506) YouTube video replays (n=20,488,992) a IQR: interquartile range. Table 2 shows the results of the independent associations test between public and private hospitals for the observed raw magnitudes, by comparing the nonparametric distribution analysis (two-tailored Wilcoxon test , alpha=.05) and the lognormal approximation to a normal distribution (two-tailored t student test, alpha=.05). Table 2. Comparative table of the two-sided t student test and Wilcoxon test at a 95% CI for private and public hospital comparison on each of the observed variables. Variables Facebook friends Lognormal transformation Nonparametric distribution P CI P z