Dermatology without dermatologists? Analyzing Instagram influencers with dermatology-related hashtags
2020; Elsevier BV; Volume: 83; Issue: 6 Linguagem: Inglês
10.1016/j.jaad.2020.05.039
ISSN1097-6787
AutoresVarun K. Ranpariya, Brian Chu, Ramie Fathy, Jules B. Lipoff,
Tópico(s)Advertising and Communication Studies
ResumoTo the Editor: The general public is increasingly turning to social media for health information, with Instagram representing an especially popular and growing forum for education and support communities.1Wong X.L. Liu R.C. Sebaratnam D.F. Evolving role of Instagram in #medicine.Intern Med J. 2019; 49: 1329-1332Crossref PubMed Scopus (23) Google Scholar However, serious concerns remain about reliability and accuracy. In this study, we sought to characterize the credentials of dermatology influencers on Instagram, that is, accounts creating the most popular dermatology content. This study was exempt from Institutional Review Board review. Content coding involved analysis of 11 hashtags, consisting of the top 5 dermatology-related diagnoses, the top 5 dermatology-related procedures, and #dermatology (Supplemental Table I, available via Mendeley at https://doi.org/10.17632/pmtr2fr66f.2).2American Society for Dermatologic SurgeryAmerican Society for Dermatologic Surgery Survey on Dermatologic Procedures: report of 2018 Procedures.https://www.asds.net/portals/0/PDF/procedures-survey-results-presentation-2018.pdfDate: 2019Date accessed: February 23, 2020Google Scholar,3Wilmer E.N. Gustafson C.J. Ahn C.S. et al.Most common dermatologic conditions encountered by dermatologists and nondermatologists.Cutis. 2014; 94: 285-292PubMed Google Scholar These hashtags were queried on Instagram for 14 days. The top 9, or the most popular posts for each hashtag, were recorded daily, totaling 1368 posts. Demographic data for associated accounts were recorded. Because criteria for labeling influencers have not been established, we used 2 different sets of criteria to define influencer status. The first required that an account have 40,000 followers to be considered an influencer. Under the second criterion, accounts were considered influencers if they were featured in the top 9 ≥5 times, including multiple top 9 features of the same post on separate days. We then manually characterized account type by medical occupation/credentials, presence of promotional content, and location (Table I).Table IDefinitions of characterizations of Instagram influencer accountsAccount characterizationDefinitionType of account BusinessNonhealth care accounts promoting their own products or services (eg, beauty products, make-up, supplements) Health care business or professionalBusiness or personal accounts of health care professionals or businesses (including physicians, nurses, estheticians, etc) PersonalNondisease centric, nonhealth care professional accounts of individuals PatientAccounts about a personal journey with a disease Disease advocacy/charityNonpersonal accounts promoting disease advocacy or a charity's social media account. Educational or informationalOnly educational or informational content OtherDoes not meet any other characterization criteriaCredentials NoneNo explicit credentials listed in account biography US physicianNondermatologist US physicianBoard certifiedUS board-certified nondermatology physician∗According to American Board of Medical Specialties at certificationmatters.org.Self-described onlySelf-described US physician, but not board certified∗According to American Board of Medical Specialties at certificationmatters.org. US dermatologistUS dermatologistBoard certifiedUS board-certified dermatologist∗According to American Board of Medical Specialties at certificationmatters.org.Self-described onlySelf-described US dermatologist, but not board certified∗According to American Board of Medical Specialties at certificationmatters.org. International physicianNon-US, nondermatologist, self-described physician International dermatologistNon-US, self-described dermatologist Physician assistantSelf-described physician assistant Nurse/nurse practitionerSelf-described nurse or nurse practitioner DentistSelf-described dentist EstheticianSelf-described estheticianPromotions PromotionalAny disclosures for promotional content (eg, hashtags or text indicating ad, ambassador, discounts, tags, etc)†According to the Federal Trade Commission: Disclosures 101 for Social Media Influencers (https://www.ftc.gov/tips-advice/business-center/guidance/disclosures-101-social-media-influencers). Self-promotionalAny disclosures for content promoting account's own products/services. Any links/tags to other accounts or stores with the same brand NoneNo promotional or self-promotional content identifiedLocation USUS location described in account biography or US location tagged in posts ForeignNon-US location described in account biography or non-US location tagged in posts or posts/biographies written in a non-English language BothBoth US and non-US locations described in account biography or tagged in posts UnknownNo location identifiedUS, United States.∗ According to American Board of Medical Specialties at certificationmatters.org.† According to the Federal Trade Commission: Disclosures 101 for Social Media Influencers (https://www.ftc.gov/tips-advice/business-center/guidance/disclosures-101-social-media-influencers). Open table in a new tab US, United States. More than 300,000 dermatology-tagged posts were created during the study period. Among the 1368 top 9 posts recorded, there were 649 unique posts by 420 unique accounts. We documented that 106 accounts had ≥40,000 followers, and 76 accounts were featured ≥5 times in the top 9, with 146 accounts meeting 1 or both influencer criteria. Health care professionals/businesses constituted 38% (55 of 146) of influencers, of which 73% (40 of 55) listed occupation/credentials on their account page. Dermatologists operated 7 of 146 accounts (5%), 6 of whom were board certified. Most (87% [48 of 55]) health care influencers promoted their personal products and services (self-promotion). Overall, 32% (46 of 146) of all influencers had promotional content (any nonpersonal promotional disclosures), and 61% (89 of 146) had self-promotional content (any disclosure of their own products, services, or brand). Influencer account characteristics varied by the criteria used to identify influencers (Table II).Table IIInfluencer characteristics associated with each set of influencer criteriaAccount characteristics≥40,000 followersTop 9 ≥5 timesAll influencersHealth care only(n = 106)(n = 76)(n = 146)(n = 55)Total%Total%Total%Total%Account type Business1817792014 Health care business/professional43413141553855100 Personal312914183725 Patient3321282215 Disease advocacy/charity220021 Education/informational773485 Other220021Credentials None72685674104711527 US physician (total)33003235Board-certified11001112Self-described only22002124 US dermatologist (total)770075713Board-certified660064611Self-described only11001112 International physician555764611 International dermatologist334564611 Physician assistant11111112 Nurse/nurse practitioner77681071018 Dentist11001112 Estheticians554564611 Other22002100Promotional content Promotional36341824463259 Self-promotional5148496489614887 None3391211824Location Foreign3432354654372342 US5956304074512953 Both44455335 Unknown987913900US, United States. Open table in a new tab US, United States. Board-certified dermatologists appear to comprise a small fraction (4% [6 of 146]) of the Instagram accounts with popular dermatology content. Most influencers (93% [135 of 146]) featured self-promotional posts or directly promoted brands, products, or services. This promotional content may create conflicts of interest that should be explicitly disclosed and addressed. Furthermore, account credentials were often unmentioned (71% [104 of 146] of all influencers, and 27% [15 of 55] of health care influencers). Medical information on social media should come from reliable sources, because patients use social media to join communities and make treatment decisions.4Yousaf A. Hagen R. Delaney E. Davis S. Zinn Z. The influence of social media on acne treatment: a cross-sectional survey.Pediatr Dermatol. 2020; 37: 301-304Crossref PubMed Scopus (13) Google Scholar,5Smailhodzic E. Hooijsma W. Boonstra A. Langley D.J. Social media use in healthcare: a systematic review of effects on patients and on their relationship with healthcare professionals.BMC Health Serv Res. 2016; 16: 442Crossref PubMed Scopus (287) Google Scholar Given the scant regulation in these arenas, medical information from unqualified sources may result in misguided management or unnecessary treatment. Thus, Instagram may represent an unrealized opportunity for dermatologists and dermatology organizations to share quality educational content to counter potentially biased promotional content and misinformation. Moreover, dermatologists should anticipate that many patients are using Instagram as a source of dermatologic information and be prepared to advise on awareness of promotional interests and qualifications on social media. Dermatologist influencers on social media: Instagram Reels and TikTok interactive short videosJournal of the American Academy of DermatologyVol. 85Issue 3PreviewTo the Editor: We congratulate Ranpariya et al1 for sparking an interesting discussion about the value of social media in disseminating quality dermatology information to the public. Bressler and Zampella2 offered intriguing commentary regarding the accurate measurement of dermatologist social media influence.3 Since followers, likes, and fake accounts may be created or purchased, complementary methods to assess the actual audience engagement are highly relevant. Interactive short videos as spearheaded by TikTok4 and recently added as "Reels" on Instagram are skyrocketing in popularity, and dermatologists should be aware of effective engagement strategies, especially because ongoing TikTok bans and governmental regulatory uncertainty may promote continued Instagram Reels expansion. Full-Text PDF Response to: "Dermatology without dermatologists? Analyzing Instagram influencers with dermatology-related hashtags"Journal of the American Academy of DermatologyVol. 83Issue 6PreviewTo the Editor: We read with great interest the recent research letter by Ranpariya et al, "Dermatology without dermatologists? Analyzing Instagram influencers with dermatology related hashtags."1 The authors show that board-certified dermatologists compose a minor fraction of popular dermatology content shared by influencers on Instagram. In a similar study, Park et al2 found as few as 5% of all dermatology content on Instagram was created by board-certified dermatologists, regardless of influencer status or post engagement. Full-Text PDF
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