The influence of digital innovation on publishing to date

Compared with mainstream media, digital innovation has had minimal impact of the academic journal publishing model. Transition from analogue to digital publishing improved distribution (reader/user access) and began to be adopted by most journal publishers in the mid-1990s.6 This reduced resource and infrastructure costs associated with printing.7 However, major publishers claim that the costs of digital innovations to improve user experience (eg, various typeset formats for different devices/operating systems) and reach have prevented them from passing on savings created through digitalisation of production.7 8 However, data suggest that journal subscription costs have increased more rapidly than inflation during the 25 years of digital innovation,7 and journals are considered highly profitable businesses with profits margins exceeding 30%.9

It is time to reshape the path to improve knowledge translation

To improve KT, we highlight the very useful simple framework of Dan Heath and Chip Heath (2010)20 in their book titled ‘Switch—How to change things when change is difficult’. Their engaging analogy can help us highlight the potential value of digital and social media dissemination to improve KT to the health professional (or patient). It involves considering three broad potential barriers to an elephant rider reaching a destination, which should be addressed where needed:

1. Motivate the elephant: health professional is motivated to offer the most evidence-based care they can.

2. Direct the rider: health professional is aware of their knowledge gaps.

3. Shape the path: access and engagement of KT resources is optimal.

Using this model, we can place the health professional in the place of the rider. Optimistically, we could consider that most healthcare practitioners are motivated and are aware of current knowledge gaps. To date however, we argue that academic journals have poorly facilitated the third consideration, persisting with a text heavy and unengaging format of publishing. Based on the simple concept of ‘Switch’, a working group born out of Australia’s La Trobe University, called TREK—Translating Research Evidence and Knowledge—has been established to bring like-minded people together to help reshape the path for KT from academic journals.

TREK’s multidisciplinary group uses digital and social media dissemination to facilitate KT to consumers who need it—health professionals and patients, with content customised to the target audience. We propose this approach will better capture the major consumer market by improving access, comprehension and engagement of content in a more time efficient manner. Ultimately, adding digital multimedia and social media innovation to the academic journal publishing process could build on a currently incomplete KT process (see figure 1).

How digital and social media can reshape knowledge translation for health professionals

Social media (including social networks, blogs, media-sharing platforms, among others) are user-centred internet-based tools that foster online collaboration, sharing, communication, participation and creation of user-generated content.21–23 Twitter, Facebook and YouTube are currently the most commonly reported platforms used for professional purposes.24–26 Social media based health research has gradually begun to appear since the mid-2000s and seen a near doubling year on year based on indexation in PubMed.27

Health professionals place a high importance on delivering evidence-based practice (EBP). However, they find themselves with limited resources and/or time to source, critique and apply new evidence with their patients.28–30 In healthcare, social media can facilitate KT via providing sources of health information, health intervention delivery, health professional networking, disease surveillance, health promotion and patient communities.24 28 They offer exciting opportunities to efficiently bring new research to patient’s and health professional treatment rooms through more accessible, timely and engaging formats.31

Sources of information from social media are generally not formally peer reviewed. However, compared with academic journals, information on social media platforms may be considered: (1) easier to access; (2) more time efficient for the consumer; (3) more engaging and comprehensible for health professionals and patients; (4) more rapidly disseminated and (5) foster better two-way communication between researcher and end-user (ie, health professionals and patients) (see table 1).25

Although many health professionals might feel comfortable using social media in their personal lives, professionally they tend to report less confidence.25 However, according to numerous reports,24 25 29 health professionals of all ages use social media for professional development, with the highest proportion in those aged 18–34 years. Health professionals report benefits that include: networking with colleagues or peers, disseminating, sharing and accessing of information in a timely fashion, improving disease-specific knowledge, continuing professional development and medical education, crowd-sourcing advice and keeping up to date with news and research. Importantly, social media use can lead to intended changes in practice including seeking of evidence and use of EBP, monitoring of patients and greater shared-decision making between patient and health professional.24 25 29 32 33 These benefits highlight social media’s potential in the future of KT in healthcare.

How social media based knowledge translation can help the researcher

For individual researchers and their associated institutions, we believe a transition from ‘publish or perish’ to ‘get visible or vanish’ is inevitable.34 Traditionally, an individual’s scientific research impact has been measured by citations in other academic publications, that is, as signalled by the H-index.33 However, citation counts can be slow to build33 and are only a true measure of the research’s acceptance or uptake among its niche scientific community. What they fail to capture is the impact of the research on the wider KT to the consumer who need it most—health professionals and patients. Notably, societal or real-world influence is inherently difficult to assess.33 According to a recent mixed-methods study evaluating the potential value of social media to KT,29 no publication has yet reported the impact of social media on translating research evidence into practice and its effects.25 29 However, we believe there are at least five clear opportunities where digital and social media can help the researcher to improve KT to healthcare professionals and patients (see box).

Since 2011, there has been an impetus to include social media as a new source of research impact data—not to be seen as a replacement, but to complement traditional publication practice and metrics.32 33 Twitter has been the most researched medium in the digital KT space from the perspective of its complementarity to citation indices as well as use in online journal clubs.32 33 This is not exclusive though, and a similar methodology can be applied to other popular social media, such as Facebook.29 33 Impact is currently measured through the social media footprint—for example, what content has been searched for, tagged, shared and mentioned.33 Research exploring this practice is still relatively in its infancy and questions outweigh answers. For example, do the research impact metrics available through social media correlate to traditional citation metrics? Is it traditional citations that generate social media chatter or vice versa?

An immersive discussion about all forms of social media is beyond the scope of this piece. However, two freely available and popular options are worthy of mention due to their popularity among health professionals—Twitter and Facebook.25 Both Twitter and Facebook can help researchers or a journal draw attention to newly published work with immediacy. When comparing which site promotes greater content sharing among colleagues, there is a paucity of research which has compared the two. Findings from Tunnecliff et al 26 did indicate limited evidence that Twitter may be better in this regard. However, more research is needed in this area, and it is likely to depend on the target audience’s preferences. It has also been postulated that there is a correlation between journals with an active Twitter profile having a higher mean impact factor.32 However, the 140-character limit has previously made it hard to provide informative messages beyond one key point in most instances. Interestingly, this may no longer be as big a barrier. Twitter is no longer counting media attachments and usernames replied-to in character counts, and posts can easily link to more detailed contents housed on blogging, video or podcast platforms. Facebook allows for up to 60 000 characters per post and may be preferable to explore due to its more than 1.7 billion active Facebook users each month (continuing to rise), unlike Twitter’s stalling 313 million.35 This growing gap in user numbers may be particularly relevant for KT to patients.

There are several other social media platforms and content types suited to facilitating KT, including blogs, podcasts, infographics and video.22 23 27 Blogging inherently presents a less scientific rhetoric without the same peer-review process of traditional academic articles. However, this makes it well suited to presenting content in a more succinct, digestible and engaging format, with readily accessible inexpensive or free blogging platforms, such as WordPress now able to easily embed other multimedia like video and audio.22 Podcasts may offer a similarly attractive format for content delivery in this context, allowing KT through expert commentary and research summaries via easy to access audio channels (including smart phones).

A further consideration for digital KT is ‘visual imagery’. Graphs, images and infographics all have the ability to complement well written messages to optimise engagement. Yet, in academic journal articles, the number of figures is frequently limited, creating a barrier to engaging the end user. Additionally, creating a figure for KT may require different formatting and size (eg, infographic) to a traditional data figure—to date most journals have not offered to take that cost to their side of the ledger. Impactful infographics typically take just 2 –3 min to digest, which is a significant improvement on the time burden needed to read and comprehend a lengthy journal article of a few thousand words.36 Content presented in a visual format has hence been known to be more engaging and retained compared with text-based information.36 37 We encourage institutions and research teams to ensure that current and future researchers develop the required skills to produce digital KT resources like infographics. Although the training and time needed to produce KT resources or costs of outsourcing production in parallel to traditional academic papers may add to the cost of research completion, it may be essential to optimise research impact.

Like infographics, video-based content is also highly engaging and most commonly published and viewed on YouTube.22 One report even suggests that video is six times more likely to be shared (retweeted) than stand-alone images.38 Additionally, it is hypothesised that by 2018 video will account for around 80% of all internet traffic,39 highlighting its current and future potential for KT. It is time for researchers and journals to embrace the use of video to summarise research findings via author interviews, animations and other formats to ensure that research impact and KT are optimised. Additionally, video also lends itself well to provide ‘how to’ guidance on implementing research into practice. Like other visually engaging resources like infographics, the challenge will be identifying who covers the added cost of video content creation. Regardless, embracing video and other KT resources will significantly enhance the visibility of research findings to the consumer, particularly health practitioners and patients.

Limitations, challenges and future considerations

Social media offers vast possibilities to KT in healthcare. However, ongoing concerns exist regarding their alignment to EBP and academic rigour, including: reputability of information, accuracy of content, privacy of individuals and professional obligations for use.24 25 This may also have to do in part with social media having created a paradigm shift and challenging the status quo.29 Regardless, best practice for digital KT may be assisted in future with greater focus on governance and standards for quality controlled websites and platforms maintained by our various professional regulatory bodies, academic journals as well as training of health professionals on the use of social media.25 We also encourage the establishment of peer review systems for resources such as infographics, videos and podcasts to ensure the validity of information shared on social media.

Using digital technologies and social media to facilitate KT remains a niche and under-researched area. As such, reviews about social media based KT are still relatively few. The research landscape is in its infancy and currently faced with limited evidence of the impact of social media use in this space and how best to harness its potential value. Key considerations noted from the current social media KT research available24 25 29 32 33 must be considered in light of a number of limitations, including:

• Studies examining social media use by health professionals have examined relatively small sample sizes.

• Many have studied primarily effects on physicians and not a broad range of health professionals.

• Most research has been conducted on already active online health professionals, biasing towards self-selecting likely social media users.

• There is a bias towards journals that publish about the internet and technology.

• Much of the research also comes from a digitally enthusiastic community (ie, Journal of Medical and Internet Research).

• Twitter activity can be skewed by journals with a strong social media presence and strategy.

There are now useful ways to examine social media footprints with traditional metrics like article citations.33 However, the influence of social media on more real-world indicators, such as professional practice, patient outcomes and attitudes towards healthcare is yet to be adequately evaluated. Healthcare is not like other industries. While popularity might be a useful gauge in a commercial sense, it is fraught with danger in health if not considered in conjunction with a raft of other factors and analytics.33 At this stage, we would be wise to consider social media metrics about research impact as a measure of awareness or attention about specific research, not overall societal impact and implementation. However, it may be a useful next step if we were to suggest that attention about an issue is a requisite for change.33