Medical journals have begun to harness the power of social media to interact with their readers online.1–5 Defined as “the creation and exchange of user-generated content via virtual networks and communities using Internet applications,”6 many journals use social media to engage readers and promote their articles.2,7–11 Journals often track their content’s online dissemination using “altmetrics” (short for alternative metrics), such as PlumX Metrics and the Altmetric Attention Score, which each use their own proprietary scoring system. These scoring systems combine measures of web traffic; social media shares on sites such as Twitter, Facebook, and blogs; and mentions in online and traditional news media.12 Journals’ social media presence has been shown to correlate with other metrics of readership and impact, such as citations.13,14 However, little is known about best practices in social media promotion for medical research or the positions, function, and expertise of the individuals shepherding this new area of knowledge dissemination. Increasingly, journals are incorporating social media editors (SMEs) into their editorial boards. These SMEs may craft tweets,9,10,15 Facebook posts,15,16 blog posts,16,17 infographics,11,16 and/or podcasts16,18 and may sometimes host Twitter chats9 or Twitter-based journal clubs19 to promote and foster discussion about an article. In some cases, the journal will publish “postpublication feedback” from their social media efforts in later issues of the journal.17,18,20

Given the novelty of the SME positions, little is known about how these positions affect the individuals that hold them. We aimed to determine the responsibilities that SMEs fill within their journals, while also describing their goals and barriers and facilitators to their position. We hope that this information will provide valuable guidance for both journals with existing SMEs and journals considering the creation of an SME position, and for SMEs in terms of starting discussions about best practices for the SME position in general, including managing journal social media promotion and engagement.

Method

The institutional review board of the University of Chicago determined that this study was exempt (IRB no. 16-0349) from review.

Sample

In June 2016, we identified potential participants through the Association of Medical Journal Social Media Editors, an informal listserv of SMEs coordinated by two authors (N.S.T. and T.M.C.), and used the snowball sampling technique to identify additional SMEs.

Study design

Then, in June 2016, we designed an interview survey that consisted of questions about SMEs’ position, including how they entered their position, their responsibilities as SME, their goals as SME, barriers and facilitators to their position, and attitudes and perceptions around the position from their journal editorial leadership and local institutions.21 These questions took multiple forms, including yes/no, Likert scale, and long-answer fill-in-the-blank questions. The full list of questions is given in Supplemental Digital Appendix 1 (at https://links.lww.com/ACADMED/A607).

Demographics and social media presence

We collected demographic data about the SMEs and their journals in June–July 2016. For SMEs, we collected gender, title at the journal, local institution (see below), academic rank, other professional social media activities, and number of Twitter followers on their publicly available personal account. The local institution of each SME was classified as academic or nonacademic, with academic institutions being those that had a formal affiliation with an Association of American Medical Colleges member medical school. For journals, we collected number of years on Twitter, number of Twitter followers, number of Facebook likes, and 2016 impact factor (as determined by Clarivate Analytics). Descriptive statistics were calculated using Excel 2013 (Microsoft Corporation, Redmond, Washington).

Participant recruitment

After compiling a list of SMEs and their e-mail addresses, we sent an introductory e-mail in June 2016 inviting the SMEs to participate in a phone interview lasting approximately 20 to 30 minutes. A copy of the consent form was attached to this e-mail. After two weeks, we sent a follow-up e-mail to those who had not yet responded, offering them the option of participating via e-mail rather than phone.

A member of our team (M.L.) called participating SMEs to initiate the interview and obtain verbal consent. A structured interview following the survey (see Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/A607) was recorded with an iPhone recording app (Call Recorder, TeleStar LTD, Nicosia, Cyprus), transcribed using InqScribe (Inquirium LLC, Chicago, Illinois), and then transferred to Word 2013 (Microsoft Corp., Redmond, Washington). All identifiers including medical specialty and institution names were removed from the transcription, and the original audio recording was destroyed. If participants were unable or unwilling to participate in a phone interview, they were given the option of responding to the survey questions via e-mail. All interviews were conducted in June–July 2016. Written responses were also deidentified as described above.

Qualitative analysis

Four representative transcripts were selected to develop the preliminary coding scheme. A coding team consisting of four authors (M.L., T.M.C., V.M.A., and N.S.T.) determined the preliminary codes. Themes and subthemes were identified through a thematic analysis and consensus-building approach, until the investigatory team determined a sufficiency of themes for the code book. Disagreements were discussed until consensus was reached. The remaining transcripts were coded by one of three authors (M.L., T.M.C., and N.S.T.) after the consensus process to ensure thematic sufficiency; no new themes or subthemes emerged from the remaining data.

Results

Thirty SMEs were invited to participate; 24 SMEs responded (80% response rate), representing 19 journals (see Supplemental Digital Appendix 2 at https://links.lww.com/ACADMED/A607). Nineteen SMEs were interviewed via phone, while 5 responded via e-mail. SME and journal demographics are presented in Table 1.

Table 1:

Social Media Editor and Journal Demographicsa

Origin stories

SMEs entered their positions through a variety of pathways, with most of them (19/24) being the first person who filled the role (Table 2). Some journals specifically recruited outside SMEs (13/24), either headhunting specifically targeted individuals or conducting an open application process. Recruited individuals and applicants generally had both a track record in the social media community of their medical specialty and some sort of leadership position at an established institution (e.g., chair of a specialty society’s social media committee). Other SMEs (11/24) had a preexisting position at the journal prior to the SME position (e.g., already an editor). Sometimes they had previously covered a related field (e.g., technology) or been a resident editor and were given additional duties as SME because of relevant experience.

Table 2:

Social Media Editor Roles and Creation of the Positiona

I was on the editorial board as the head section editor for the emerging technologies and techniques, which is kind of like new tech stuff, and we included social media under that first and then we just decided to make social media its own section. (Participant 21)

SMEs frequently reported support from editorial leadership as a key factor in the creation of the SME position. This support often came from an enthusiastic editor-in-chief (15/24) who drove or supported the creation of the position; many SMEs also reported support from other editorial board members (11/24).

[The editorial leadership is] fantastic. I couldn’t do this without them and certainly [name redacted]. I think he came up with this idea of merging the blog and podcast with [journal name redacted], and then we did it and the chief editor, [name redacted], was so impressed that he asked me to be the social media editor. (Participant 17)

The role was created by the editor-in-chief and the junior editorial team, so they recognize the importance of it. (Participant 9)

The job: Strategies described for knowledge dissemination

SME positions varied considerably but were broadly split into two categories: the traditional decision editor role and managing social media engagement strategies to better disseminate journal content. Only a small fraction of SMEs (3/24) described traditional editorial responsibilities (serving as decision editor for submissions), with one primarily managing manuscripts specifically related to social media (1/24), and a couple who served as generalist decision editors managing manuscripts on various topics (2/24). All SMEs described various responsibilities for managing journal social media engagement, including both managing social media accounts and creating the content for social media posts (see below). SMEs reported using multiple social media tools, primarily Twitter (22/24) but also Facebook (15/24) and, less frequently, other sites, such as Google Plus (3/24; Table 3).

Table 3:

Readership Engagement and Knowledge Dissemination Tools and Strategiesa

Responsibilities varied substantially, with many SMEs personally writing tweets (17/24) and managing journal social media accounts (i.e., posting content; 10/24; Table 2). Others manage a team of nonphysician journal staff who run the journal’s social media accounts (11/24), including student volunteers (4/24). Some SMEs also work with a team of other clinicians and editors to generate social media content (3/24) or solicit and edit social media content from authors (3/24).

Consistently, SMEs’ engagement strategies focused on highlighting new and potentially interesting articles and promoting them on social media to improve dissemination of new publications. More involved engagement strategies described by some SMEs including writing posts for or overseeing a journal-based blog (14/24). Similarly, some SMEs work with their journals to run Twitter-based journal clubs and/or Twitter chats (10/24) or on larger, unique projects, including an annual National Collegiate Athletic Association–style specialty-themed online competition called “NephMadness” (2/24).22 SMEs described a number of strategies they use to engage their readership and disseminate knowledge (Table 3).

Differing perspectives: SMEs’ journal and individual perspectives on goals, resources, and sustainability

We identified two broad SME perspectives: that of the journal and that of the individual. Within each of these perspectives, we identified three primary themes: goals, resources, and sustainability, each of which had multiple subthemes. These findings are summarized in Table 4.

Table 4:

Thematic Analysis Findings Related to SME Perspectives on Social Mediaa

Generally, SMEs described a duality in their perspectives as they related to goals: That is, they reported the journal’s social media goals and their individual goals as SMEs. From the individual perspective, SMEs described various resources that served as facilitators, as well as barriers they identified that hampered their productivity, as they attempted to fulfill both the journals’ and their own goals.

From both a journal and an individual perspective, participants noted that the sustainability of such positions may be dependent on a combination of increasing the perceived value of the SME position to the editorial leadership and at home institutions, and from the individual SME’s perspective, sustainability may also depend on access to adequate resources, such as metrics for quantifying social media activities, staff support, and direct remuneration. There was also a prevalent theme that a better understanding is needed of how SMEs’ work counts (if at all) toward academic credit and promotion and tenure, and if it currently does not count, that academic merit should be tied to these positions. This would both enable the journal to recruit future SMEs and allow the integration of the SME position into the broader academic careers of those filling these positions. To be sustainable, our participants thought that SMEs need to derive some value from their positions. For instance, if SMEs could receive academic credit from their local institutions for their work, this could provide SMEs some reward, and journals might not need to provide as many tangible resources (e.g., direct remuneration).

I think the big block that we had was getting … this sort of recognized as a scholarly activity, I think is an important next step to sort of keep this type of position sustainable. (Participant 7)

Discussion

As social media becomes ubiquitous in everyday communication,23 it is no surprise that many journals are embracing social media to increase their reach given the broad range of potential benefits it offers to key stakeholders (Figure 1). Collectively, many of the SMEs in our study have pioneered the use of social media as a platform for knowledge dissemination across 19 medical journals. This allowed us to describe the common responsibilities SMEs carried out, common barriers that they face, and SMEs’ perceptions of how their position was viewed by the editorial leadership and at their local institutions.

Figure 1:

A schematic illustration of the potential benefits to key stakeholders of journal social media activity.

We found many different social media content creation and account management practices at these journals, likely due to the novelty of the SME position and a lack of well-defined best practices. Among our participants, SMEs consistently reported focusing on sharing, across a range of social media platforms, new journal articles with the aim of improving dissemination of journal content. Approximately two-thirds of SMEs reported creating content themselves, with only a small fraction reporting that other editors and clinicians or authors aided in content creation for social media. Social media accounts were managed roughly equally by SMEs and nonphysician journal staff including student volunteers. Given the overall lack of tangible support reported by SMEs, we suggest that journals may need to provide nonphysician staff to help manage social media accounts to support SMEs in their position. Engagement strategies such as Twitter-based journal clubs and Twitter chats were less prevalent; we believe this is because they are more complex, require more resources than sharing new journal content, and have demonstrated mixed results.9,24 Future research may help delineate which engagement strategies are worthwhile investments, which might allow journals and SMEs to more effectively focus their limited resources.

Journals can both promote and hinder the productivity of an SME. Multiple SMEs pointed to supportive editors-in-chief and other editorial leadership facilitating the SME’s productivity. If there was a lack of engagement or understanding from the editorial leadership (mostly described as coming from other members of the editorial board), then SMEs often felt isolated. Other barriers included a lack of funding, lack of administrative support, requirement of multiple responsibilities (i.e., they also had other traditional editorial duties like decision editing), and lack of time. These and similar barriers could be alleviated with increased social media fluency of editorial leadership and at the local institution, as well as more tangible support. Supports could include the development of a social media team (e.g., other physicians working with the SME to generate and share content),7 resources (such as staff support and financial support), and the engagement of SMEs’ local institutions25–28 to ensure that they attain academic credit for their work in these positions.

Our SME participants expressed a desire for increased understanding of social-media-based academic promotion from both their journals and local institutions. They recognized that the lack of standardized methods to quantify and qualify their social media activities for academic credit exacerbated this problem. Some institutions, notably the Mayo Clinic,27 have begun to incorporate guidelines25–27 that delineate criteria for counting social media as scholarly activity. We hope that other academic institutions follow suit. Future directions could include the integration of these criteria with the effort to develop a system for quantifying social media activities.28

Limitations

As with all qualitative studies, researcher reflexivity may have affected our results because our analytic team included several current or former SMEs. Also, our study focused on the perceptions of those with an official title of SME or known to be substantially engaged in journal social media activity, which may not have been inclusive. For example, journal editors-in-chief or journal or publisher employees may also be highly involved in developing the social media strategy for a journal. Additionally, nonphysician journal staff were not included in our analysis. Our identification of potential participants began with SMEs who we were already aware of through our professional networks; we attempted to mitigate selection bias by using the snowball sampling technique. Further, journal impact factors have well-described shortcomings, including cautions against comparing impact factors of journals from different specialties.12,29

Conclusions

Numerous journals have created an SME position to manage their social media engagement and content. We identified many common goals and strategies among various journals and SMEs, but specific best practices for the SME position in general, including managing journal social media promotion and engagement, are not well described. Qualitative support from editorial leadership was reported as high; tangible support, however, was reported to be low and generally limited to support from journal staff. Uncertainty about how to report and quantify social media activities for academic credit and/or a lack of receiving academic credit for these activities remains a barrier for SMEs. We hope our findings facilitate fruitful discussions among journal leaders and academic institutions and assist SMEs with discussions around best practices.

Acknowledgments: The authors would like to thank each of the social media editors who participated in and shared their valuable time for this study. The authors would also like to thank the University of Chicago for support.

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