The Use of Social Media among Saudi Ophthalmologists: A Descriptive Cross-Sectional Study.

PURPOSE: The purpose of this study is to evaluate the use of and beliefs toward social media (SM) among Saudi ophthalmologists.
METHODS: This was a cross-sectional descriptive study. A web-based, self-administered questionnaire was e-mailed to ophthalmologists within Saudi Arabia.
RESULTS: Out of 392 recipients, 293 completed the survey (74.7% response rate). The vast majority (90.1%) used at least one platform for personal and professional purposes or either. The three most commonly used applications were Twitter (72.3%), Snapchat (65.9%), and Instagram (51.9%). The opinions of respondents with regard to the different aspects of SM varied widely. Around half (56.7%) believed that it was permissible for ophthalmologists to promote themselves on SM and 70.6% agreed that SM usage by health-care professionals should be regulated. Participants believe that SM had both a positive and a negative impact on their daily life and clinical practice. For example, 94 (32.1%) respondents stated that it improved their ability to educate patients, on the other hand, 80 (27.3%) reported that SM wastes quality time that can be spent on something more productive.
CONCLUSION: Our results demonstrate an increased utilization of SM among Saudi ophthalmologists. The ethical aspects of SM usage were a matter of controversy among our respondents. This necessitates the establishment of guidelines by regulatory bodies and/or individual health-care organizations. Copyright:

Introduction

Social media (SM) is a term used to describe a group of internet services that allow users to interact and share information. The use of SM services has exponentially increased over the last few years, it is estimated that Facebook has over 2.7 billion active users worldwide[1] and there are 187 million daily active users on Twitter. In addition, Saudi Arabia is considered one of the top countries on Twitter based on the number of active users with 12 million accounts as of October 2020.[2]

The adoption of SM in health care has become widely prevalent in recent years. Several peer-reviewed ophthalmology journals, professional organizations, and patient advocacy groups have active SM accounts through which they update their followers about the latest news and events.[3] The uses of SM in the medical field are wide-ranging including medical education,[4] patient engagement,[5] and to aid in recruiting patients for clinical trials.[6] Moreover, SM platforms are also used to market physicians' practices and acquire more patients.[7]

Despite the widespread use of SM within Saudi Arabia, little is known about the adoption of SM among Saudi ophthalmologists. Therefore, the current research study aimed to objectively define the usage of and beliefs toward SM among ophthalmologists in Saudi Arabia. In addition, we sought to study the impact that SM had on their practices.

Methods

This was a cross-sectional study based on a web-based self-administered questionnaire. The study protocol was conducted in accordance with the ethical standards set by the World Medical Association Declaration of Helsinki.[8] The questionnaire was developed by a focus group that started by reviewing the literature pertinent to the topic. Following that, the initial draft of the questionnaire was created and it was divided into the following domains: Demographic information, usage of SM, beliefs toward SM, and the impact of SM on individual practices. A pilot survey was sent to 20 health-care professionals, not included in the study, and their feedback was used to refine the questionnaire for better readability and understanding.

The final form of the questionnaire was delivered through a secure online portal (SoGoSurvey). Data collection took place during the period from December 2017 to October 2018. E-mail invitations to participate were sent to all ophthalmologists within Saudi Arabia, including those currently in training (i.e., residents and fellows). In order to ensure a high response rate and minimize nonresponse bias, a modified Dillman method[9] was used. First, the questionnaire was sent through e-mail to all the target population. Following that, two E-mail reminders were sent to nonresponders after 2 weeks and 4 weeks, respectively. Finally, those that still did not respond were approached either personally or through a phone call. All responses were anonymous, and the completion of the survey was voluntary. An entry to a draw for a prize was used to incentivize participants.

Data were exported to Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) for the analysis. Incomplete surveys were not included. Descriptive statistics were used to present frequencies, means, standard deviation, and percentages.

Results

Out of 392 recipients, 293 completed the survey (74.7% response rate). The mean age of participants was 35.8 years, approximately two-thirds (67.9%) were males, half (52.9%) resided in Riyadh, and 46.1% were attendings, whereas the remainder were still in training. Detailed demographic details are shown in Table 1.

Table 1

Demographics (n=293)

Characteristic	n (%)
Age (years)
Mean±SD	35.83±10.72
Sex
Male	199 (67.9)
Female	94 (32.1)
Region
Riyadh	155 (52.9)
Dammam	55 (18.8)
Jeddah	54 (18.4)
Aseer	12 (4.1)
Medina	17 (5.8)
Level
Resident	146 (49.8)
Fellow	12 (4.1)
Attending	135 (46.1)

SD: Standard deviation

Usage of social media

The majority (90.1%) of respondents had one or more active accounts on SM, whereas 29 did not use SM at all. The most commonly used platform was Twitter (72.3%) followed by Snapchat and Instagram, respectively [Figure 1]. Most ophthalmologists (64.4%) described their use of SM as personal, one third (33.7%) used SM for both personal and professional purposes, and only five respondents (1.9%) reported sole professional use. The frequency of posting on SM also differed among respondents. Whereas some (7.2%) post more than once daily, others (2.3%) reported that they have never posted at all [Figure 2]. The reported reasons for usage were also variable with the most common reason being personal use (94.3%). The remainder of the reported reasons is shown in Figure 3.

Figure 1

The most commonly used platforms among ophthalmologists in Saudi Arabia. N (%). *: Owns a YouTube channel

Figure 2

Frequency of social media usage among Saudi ophthalmologists. N(%)

Figure 3

Reasons for using social media among Saudi ophthalmologists. N(%)

Looking at nonusers, the most commonly reported reason for not using SM was the limitation of time, as 89.7% of those that reported not using SM thought that it was time-consuming. Other reported reasons for nonusage included: Being too difficult to maintain the presence on SM, difficulty in drawing a boundary between personal and professional usage, and concern about patient confidentiality.

Beliefs about social media

Table 2 summarizes the beliefs of ophthalmologists about SM. Survey respondents had conflicting opinions about SM. Only 56.7% thought that is was permissible for an ophthalmologist to promote himself on SM. In addition, the use of SM for direct communication with patients was acceptable for 58% of respondents. Finally, 70.6% stated that regulatory bodies should have policies for SM usage among health-care professionals.

Table 2

Beliefs about social media among Saudi ophthalmologists (n=293)

Item	n (%)
SM should be used as an archive for practice-related material, for example, articles, presentations	164 (56)
An ophthalmologist can postinformation about his practice (location, hours, and contacts) to his patients through SM	203 (69.3)
It is permissible for an ophthalmologist to market and promote himself through SM	166 (56.7)
SM can be used for inter-professional discussion (e.g., consulting a colleague about a case you have, discussing a research article)	202 (68.9)
SM can be used for direct communication with patients, and it may be beneficial for patient care	170 (58)
SM should be used for teaching junior doctors	215 (73.4)
Unprofessional activity on SM should subject the ophthalmologist to legal action	220 (75.1)
Regulatory bodies should stay out of my SM activity	166 (56.7)
Hospitals and regulatory bodies should have policies for SM usage	207 (70.6)

SM: Social media

Impact of social media on clinical practice

The opinions of respondents with regard to the impact of SM on clinical practice were variable. Whereas some stated that it had both a negative and positive impact, others thought that SM did not impact their practice at all [Table 3]. The main reported positive impact was that it improved ophthalmologists' ability to educate patients (59.1%). On the other hand, the main reported negative impact of SM was that it wastes quality time that could be spent on something more productive (87.9%).

Table 3

Impact of social media on clinical practice among Saudi ophthalmologists (n=293)

	n (%)*
Positive impact (n=159)
I have received new patients due to my social media activity	31 (10.6)
It improved my efficiency in communicating with my existing patients	47 (16.0)
It improved my ability in patient education	94 (32.1)
It improved my ability to educate junior colleagues	63 (21.5)
I have received positive feedback from my patients and colleagues	57 (19.5)
Negative impact (n=91)
I am wasting my quality time that can be spent on something more productive	80 (27.3)
I have received negative feedback from patients which compromised my clinical practice	4 (1.4)
Patient privacy has been compromised	9 (3.1)
My professional appearance has been compromised	6 (2.0)

*Percentage of the total number of respondents in the survey

Discussion

There is no doubt that SM has become an integral part of our daily lives. Individuals, including health-care professionals, are currently using SM platforms for many purposes such as looking up information, reading news, and personal communication. Our current descriptive study sought to shed some light on SM use by ophthalmologists in Saudi Arabia. Our response rate (74.7%) indicates that data were obtained from a good number of ophthalmologists within Saudi Arabia and that results could be generalized.

Our study demonstrated a high rate of SM usage (90.1%) among Saudi ophthalmologists, such a figure has also been reported previously by studies reflecting physicians in other specialties.[10] The reason for such a high usage is that communication, whether personal or professional, has evolved in the current era of digital technology to include various SM platforms. For instance, a lot of Saudi physicians currently use outlets such as Twitter and Snapchat to deliver health education to the public and communicate with peers on a personal and a professional level.

The most popular SM website among our participants was Twitter (72.3%). This is a reflection of the popularity of this platform in particular within Saudi Arabia. In addition, most governmental and health-care institutions such as the Ministry of Health, the Saudi Commission for Health Specialties, and the Saudi Ophthalmology Society have their own active Twitter accounts. Snapchat came second with almost two thirds (65.9%) of ophthalmologists using it. The main reason behind the widespread use of Snapchat among ophthalmologists is that it provides a simple, yet effective, way to instantly deliver recorded video to followers. Ophthalmologists are using this platform to convey educational videos to the community which in turn may increase their popularity.

Our survey revealed that 33.7% of participants used SM for both personal and professional purposes. One of the challenges that face physicians during their online presence is the difficulty to balance between personal and professional use. A personal photo that is posted by a physician on Instagram may be viewed as inappropriate by patients and followers. Thus, physicians utilizing SM for professional purposes may be forced to maintain a certain image to avoid receiving negative feedback from patients.

Online advertisement through different SM outlets is a marketing approach that has been adopted by some businesses in the health-care sector. In our study, although 56% of respondents believe that it is permissible for an ophthalmologist to market himself through SM, only 8% intentionally use SM to promote themselves. This low figure could be attributed to the fact that respondents believe that direct personal promotion of a physician on SM may compromise his professional appearance, and that most respondents promote themselves indirectly through patient education. We believe that as long as regulatory bodies do not prohibit SM advertisement for physicians and practices, it is an acceptable marketing approach that can be utilized.

The majority (70.6%) of respondents believe that regulatory bodies should have policies for SM usage. In Saudi Arabia, the Law of Practicing Health-care Professions contain items that are related to SM activity, for example, it is clearly stated that it is prohibited for the healthcare practitioner to publish surgical procedures or photographs without prior written consent from the patient and institute. Thus, ophthalmologists posting photos or videos of actual procedures on real patients for marketing purposes should be aware of such regulations to avoid any legal ramifications.

There are two major limitations in our study. First, the survey was subject to nonresponse bias, meaning that nonresponders probably do not utilize SM; thus, they were less likely to participate; however, we tried to minimize the effect of such bias by inviting nonrespondents through a phone call. Second, it is possible that responses to sensitive questions such as using SM for marketing or the negative impact of SM on respondents were subject to reporting bias.

Conclusion

In conclusion, the majority of Saudi ophthalmologists utilize various SM websites. Around two-thirds use SM for personal purposes, whereas one-third utilize it for both professional and personal purposes. Most respondents believe that SM usage by health-care professionals should be regulated by hospitals and governmental agencies. Finally, using SM has had both a positive and a negative impact on their clinical practice. Positive effects include receiving new patients from SM and improving patient communication, whereas the negative effects of SM include wasting quality time and compromising the professional appearance of ophthalmologists.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.