Keywords
Instagram - spine - traumatic spine injury - social media - spine fracture
Introduction
With the advent of social media and the Internet, the medical field has been evolving
rapidly, making it challenging to stay up-to-date with the latest research. In the
current era of emerging social media and new modes of disseminating knowledge, research
evaluation is taking on a new dimension. Traditional bibliometrics alone can no longer
fully gauge the impact of research. In the contemporary digital landscape, the importance
of altmetrics has surged significantly. Altmetrics measure engagement with scholarly
articles across online platforms, including social media posts, likes, comments, and
shares.[1]
Social media has also seen an upward trend in discussing specific health issues. A
study reported that 8 out of 10 Internet users have searched online for health information
at least once.[2] With over a billion active users, Instagram is a leading social media platform that
has become a powerful tool for sharing diverse content, from personal experiences
to professional insights. Its visually driven interface and widespread popularity
across demographics make it an ideal platform for disseminating medical information.
Hashtags are commonly employed by users as a means to engage with the accounts that
align with their interests. This makes Instagram integral for exploring health care-related
content, particularly regarding traumatic spine injuries.[3]
Social media platforms are progressively evolving into essential educational tools,
serving not only medical students but also a broader audience comprising patients,
their families, and friends.[4]
[5] A significant number of individuals utilize these platforms to gain insights into
the progression of various medical conditions. Specifically, individuals may seek
information online in response to a persistent medical condition, a recent diagnosis,
the prescription of a new drug or treatment, or feeling inadequately informed despite
consulting a physician.[6]
Recently, Instagram has become a key platform for patients and survivors of traumatic
spine injuries to share updates about their well-being, recovery, and prognosis over
weeks to months. Similarly, health care practitioners, including neurologists, and
organizations supporting individuals affected by spine trauma use Instagram to educate
the public about neurological conditions caused by spine injuries and methods of prevention.
Due to the growing focus on traumatic spine injuries on Instagram, it is crucial to
evaluate the content related to spine trauma on this public social platform.
Traumatic spine injuries are associated not only with severe physical morbidity but
also with significant psychological consequences. Analyzing the representation of
these injuries on Instagram is not only relevant from a health care standpoint but
also from a societal perspective. As social media increasingly influences public behavior,
the way medical conditions are depicted on it can profoundly influence awareness,
perceptions, attitudes, and health care-seeking practices.[7]
Although Instagram offers an abundance of medical information regarding spine injuries,
the quality, accuracy, and scientific reliability of this content remain uncertain.[8]
[9] Given the potential implications for patient education, clinical practice, and public
health, it is essential to evaluate spine trauma-related content on Instagram. This
study utilizes various hashtags to assess the type of content being posted about spine
injuries by different types of accounts. By employing altmetrics to evaluate the reach
and influence of this content, we aim to assess the information available on spine
injuries, the level of public awareness about spine trauma, and potential gaps in
the dissemination of medical information on Instagram.
Materials and Methods
A search of Instagram was conducted by three reviewers using hashtags “#spinetrauma,”
“#spinefracture,” “#spinetraumasurgeries,” “#spinalcordinjuryrecovery,” “#spinetraumasurvivor,”
and “#spinalcordinjury.” These hashtags were divided among the reviewers and each
reviewer independently reviewed posts and reels. No third-party application was employed
to conduct a search on Instagram for pertinent posts. The top 1,000 posts and reels
were reviewed on Instagram for each hashtag. In the final analysis, 345 posts and
reels were included. Before statistical analysis, a consensus on the selected posts
was reached among the authors. Any discrepancies between reviewers were ultimately
addressed through formal discussions involving all authors of the study. Since the
posts were publicly available, ethical approval was deemed unnecessary, and no personally
identifiable information was extracted for the study.
The study divided the posts and reels found on Instagram under specified hashtags
into four account categories; surgeons/physicians' accounts, patients' accounts, advertisement
accounts, and medical education platforms. Both English and non-English posts and
reels were included and they were mentioned separately in the spreadsheet and results
section. Each post was subjected to an evaluation of various variables, including
a description of pathology, a quiz, survivor stories, or educational content. Posts
and reels were also evaluated under the headings of country, likes, and comments.
The data was subjected to analysis, encompassing the mentioned variables. The analysis
was done using the SPSS version 26. Raw data was extracted and used as numeric inputs
and accordingly scaled, nominated, or ordinated. The frequencies, mean, median, and
quartiles were analyzed. The significance of the results on the likes and comments
was calculated using the chi-square test in the cross tables and statistical significance
was determined by assessing p-values, with significance typically defined as p < 0.05.
Results
There was a total of 345 Instagram posts/reels (Ps/Rs) that fulfilled our eligibility
criteria, with 183 Ps/Rs (53%) composed in English, while 162 Ps/Rs (47%) were in
non-English ([Fig. 1]).
Fig. 1 Distribution of English and non-English posts related to traumatic spine injury.
Account Type
A total of 210 Ps/Rs (60.8%) were written by surgeons/physicians' accounts, 63 Ps/Rs
(18.3%) were written by patients' accounts, 49 Ps/Rs (14.2%) were written by advertisement
accounts, and 23 Ps/Rs (6.7%) by medical education platforms ([Fig. 2]).
Fig. 2 Distribution of main account types posting about traumatic spine injury.
Country Origin
Out of 263 Ps/Rs with known country of origin, 56 Ps/Rs (16.2%) were published from
the United States, 38 (11%) from the United Arab Emirates (UAE), 34 (9.9%) from India,
29 (8.4%) from Brazil, and 27 (7.8%) from Russia ([Fig. 3]).
Fig. 3 Distribution of country origin for posts related to traumatic spine injury.
Content Type
Note that 114 Ps/Rs (33%) focused on pathology, 118 Ps/Rs (34.2%) posted radiological
images, and 83 Ps/Rs (24.1%) described postmanagement images. A total of 114 Ps/Rs
(33%) mentioned the management delivered and 32 Ps/Rs (9.3%) talked about the findings
in the follow-up periods. Sixty-six Ps/Rs (19.1%) were discussing a survivor story,
while only 3 Ps/Rs were published as quizzes ([Fig. 4]). Note that 144 Ps/Rs (41.7%) talked about fractures, 14 (4.1%) talked about back
pain, 11 (3.2%) were in the category of awareness or motivational, and a similar group
discussed the surgical experience, with 9 Ps/Rs (2.6%) about spondylosis and spondylolisthesis.
Disc herniations, spine deformity, and promotions each were mentioned in 6 Ps/Rs (1.7%).
Pathological fractures and stenosis each were mentioned in 5 Ps/Rs (1.4%). Out of
the available 83 Ps/Rs mentioning the affected spine region, 36 Ps/Rs (36/83, 43.4%)
were about the lumbar region, 17 (17/83, 20.5%) were about the cervical region, 13
(13/83, 15.7%) thoracic region, and 9 (9/83, 10.8%) were about the craniocervical
region ([Fig. 5]).
Fig. 4 Distribution of content type for posts related to traumatic spine injury.
Fig. 5 Distribution of the spine region involved for posts related to traumatic spine injury
(total posts that mention about spine region are 83).
Audience Interaction
We studied the audience interaction and engagement for the content by analyzing the
number of followers for each account type, and the number of likes and comments regarding
each content type. [Fig. 6] illustrates that medical platforms tend to attract a substantial following, with
over 10k followers (k represents 1,000), whereas patient accounts, focused on personal
experiences, typically have fewer than 1k followers. Physician accounts had a follower
range of 2k to 4k. These findings were statistically significant, with a p-value of < 0.05, indicating a meaningful impact. The mean likes per Ps/Rs were 114
(standard deviation [SD] = 263), and the mean number of comments per post was 6 (SD = 2).
The survivor stories had the highest mean likes and comments per post, 126.5 (p = 0.107) and 8.7 (p = 0.018), respectively. It was followed by pathology-related content (mean likes/post:
117.4 [p = 0.015], mean comments/post: 6.9 [p = 0.003]) and educational content (mean likes/post: 99.2 [p = 0.021], mean comments/post: 2.4 [p = 0.038]). Quiz-related content had the least likes and comments [mean likes/post:
62.3 (p = 0.595), mean comments/post: 8.3 [p = 0.181]) ([Table 1]).
Fig. 6 Distribution of the followers among the different types of accounts for posts related
to traumatic spine injury.
Table 1
Average number of likes and comments according to content type with p-values
|
Content type
|
Mean likes (L) and comments (C) per post
(range) (p-Value)
|
|
Pathology-related
|
L: 117.4* (2–621) (p = 0.015)
C: 6.9* (2–46) (p = 0.003)
|
|
Educational posts
|
L: 99.2* (1–3,247) (p = 0.021)
C: 2.4* (1–23) (p = 0.038)
|
|
Survivor stories
|
L: 126.5 (8–1,909) (p = 0.107)
C: 8.7* (1–81) (p = 0.018)
|
|
Quiz posts
|
L: 62.3 (15–148) (p = 0.595)
C: 8.3 (0–25) (p = 0.181)
|
Note: * indicated that the value mentioned is statistically significant (p- Value is less than 0.05).
Discussion
In our study, several hashtags were used to analyze Instagram posts and reels, evaluating
the content related to spinal cord injury. Accounts were categorized into four main
groups: surgeon/physician accounts, patient accounts, advertisement accounts, and
medical education platforms. Posts were analyzed based on their content, which included
pathology, management, and radiological images, as well as educational content, quizzes,
and survivor stories.
Instagram over Other Platforms
Instagram stands out as a platform for online information dissemination due to its
visually driven interface and engagement tools, such as reels, posts, and stories,
which allow users to interact dynamically. The platform's wide demographic reach and
use of hashtags make it easier to connect users with specific topics. Compared to
other platforms like Facebook or Twitter, Instagram's focus on visuals enhances the
accessibility of complex medical content, such as imaging studies or infographics.[10] Additionally, Instagram's reel and story features promote real-time sharing, increasing
the immediacy of knowledge dissemination.[11]
Geographic Analysis
Our findings revealed that the majority of spinal cord injury-related content originated
from the United States, followed by the UAE and India. This higher proportion of content
from the United States could be attributed to its high literacy rate, greater public
awareness, and more prevalent use of social media for professional and educational
purposes.[12] Moreover, health care professionals and patients in the United States may feel more
empowered to share their experiences online, driven by a culture of openness and community
engagement.[13]
Account Ownership
Most accounts posting content about spinal cord injuries were owned by surgeons and
physicians, followed by patients, advertisement accounts, and medical education platforms.[14] Surgeons/physicians use Instagram to share cases and insights for several reasons.
Social media platforms like Instagram allow them to educate peers and the public,
showcase their expertise, and build professional credibility. Sharing educational
content, including medical advancements and case studies, helps establish themselves
as thought leaders while contributing to public health awareness. Additionally, Instagram
offers a visual medium to effectively explain complex medical concepts, which appeals
to professionals and the general public, both. Moreover, surgeons use Instagram to
foster patient education by providing accurate information about conditions, treatments,
and preventive care. This effort can reduce misinformation, empower patients, and
enhance doctor–patient communication. It also creates a professional online presence
that can improve their reputation and attract more patients.[15]
[16] Patients post about their journeys to share their experiences, provide hope, and
connect with others who have faced similar challenges. These stories often humanize
medical conditions and foster a sense of community.[14] Medical education platforms use these accounts to disseminate reliable and accessible
medical knowledge, using Instagram as a medium to reach medical students, health care
professionals, and the general public.[17] Advertisement accounts use these accounts to typically market products or services,
including assistive devices or therapeutic options, targeting individuals with spinal
injuries.[14]
Engagement and Interactions
Among the different types of posts analyzed, those sharing patients' personal stories
garnered the highest number of likes and interactions. This could be attributed to
the emotional connection and empathy they evoke, making them more relatable to a broader
audience. Posts focused on pathology followed in engagement levels, likely because
they satisfy the audience's curiosity about the medical details, such as underlying
causes and mechanisms of diseases. Educational posts ranked next, offering informative
content that appeals to those seeking to learn. Lastly, quiz posts had the lowest
interaction rates. However, this might be due to the limited number of quiz posts
included in the data set (only three), making it difficult to draw definitive conclusions
about their engagement potential. Content that garners high engagement on social media,
particularly on platforms like Instagram, Twitter, and LinkedIn, often reflects the
perceived authority and emotional resonance of the content. Surgeons and physicians
consistently generate strong interaction with their posts due to their expertise and
the educational value they bring to their audiences. This can include tutorials, explanations
of medical procedures, or insights into the latest research, which resonate particularly
well with medical professionals and students. On the other hand, posts from patients
or individuals sharing personal stories of medical experiences tend to engage audiences
emotionally. These posts humanize medical conditions, offering inspiration, support,
and connection, making them particularly compelling for followers who are seeking
comfort or relatability in their own journeys.[17] The number of followers symbolizes popularity and social influence. Surgeons and
physicians are increasingly gaining traction on social media by engaging in more interactive
content formats such as reels, posts, and videos. These professionals are not just
sharing information but also showcasing their work, engaging in self-promotion, and
positioning themselves as thought leaders in their fields. This rise in popularity
is not limited to Instagram; Twitter and LinkedIn also reflect a growing presence
of health care professionals who use these platforms to share insights, network with
peers, and engage in broader conversations about health care and innovation.[17] When it comes to likes and comments, these interactions signify responsiveness and
engagement. Likes indicate that the content resonates with the audience, while comments
show a deeper level of engagement, where people feel compelled to contribute their
thoughts, ask questions, or share experiences.[10]
Language Usage
The dominance of English content on Instagram and other social media platforms can
be attributed to its global reach. English serves as the international language for
communication, enabling content creators to connect with audiences across borders.
This global appeal is why English-language posts make up the majority of content on
platforms like Instagram, Twitter, and LinkedIn. However, non-English content also
plays an important role, catering to regional audiences and reflecting the linguistic
diversity of users. While English content is universal, platforms like Instagram allow
for posts in other languages such as Portuguese, Hindi, and Spanish, especially when
creators want to engage specific communities. This multilingual approach enhances
engagement by speaking to users in their native languages, which can increase interaction
and customer loyalty, particularly in regions with large populations of non-English
speakers.[18]
Content Themes and Regional Analysis
The posts focused primarily on pathology, survivor stories, quizzes, and educational
purposes. The majority of Ps/Rs on Instagram discussed fractures while only a low
proportion of Ps/Rs talked about spondylosis and spondylolisthesis. Pathological fractures
and stenosis were also discussed in several Ps/Rs, although they form a very minor
proportion of the overall content. Among the posts discussing pathology, the lumbar
spine was the most frequently mentioned, followed by the cervical spine and thoracic
spine. The cervicothoracic and thoracolumbar regions were the least frequently discussed.
Lumbar spine: as the longest and most mobile region of the spine, the lumbar spine
is particularly susceptible to trauma and degenerative conditions.[19] Cervical spine: its flexibility and proximity to vital neurological structures make
it a critical area of focus. Thoracic spine: though less mobile than the cervical
or lumbar regions, it may still be affected by specific types of trauma.[20] Cervicothoracic and thoracolumbar regions: these transitional areas are less commonly
reported due to their relatively lower incidence of isolated injuries. However, when
injured, these regions often involve complex cases requiring specialized management.
Limitations
Our study has a few limitations, the most notable being the choice of Instagram as
the platform for analysis, as certain demographics and communities may be more active
on Instagram than others. The subjective nature of evaluating posts also presents
a limitation. When contrasting posts were found, they were discussed among the team,
and a unanimous decision was reached regarding their content. Additionally, the use
of specific hashtags could limit the scope of the study. To mitigate this, we employed
several hashtags to capture a broader range of posts and reels. Another limitation
is that findings from Instagram may not be fully generalizable, as the platform's
user base does not represent the entire population of the demographic regions studied.
Content related to spinal trauma was predominantly posted by users from a select number
of countries. As a result, we were unable to evaluate content from lower-income countries,
where post distribution was significantly lower.
Conclusion
In conclusion, this study explored Instagram posts and reels related to spinal cord
injury through diverse account perspectives. While providing valuable insights into
the distribution of content types, including pathology, radiological images, as well
as educational content and survivor stories, it also helped in evaluating the trends
of posts from different countries and users' interaction on the posts. Despite the
several inherent limitations and constraints, our findings contribute to the understanding
of how spine trauma is portrayed on social media, highlighting opportunities for future
research and emphasizing the need for careful consideration of ethical and methodological
challenges in social media studies within the medical domain.
