Phase 3-Evaluation of a research study (Due by WEEK 9) 
In phase 3 we will examine a research study titled: 
“Translating evidence to practice in the health professions: a randomized trial of Twitter vs Facebook” 
As future advance practice clinicians, how are you going to translate your evidence into the health field? 
Your assignment for phase three is to read the attached article and analyze it based on its merit by answering the following questions: 
1-  Has the author formulated an appropriate research question based on the problem/issue? 
2-  Is the research question clearly defined in terms of its cope and relevance? 
3-  What is the author’s orientation towards the research problem/issue- is it critical analysis or interpretation based? 
4-  How does this article contribute to your understanding of possible research modalities and methods? 
5-  What are the strengths, limitation of the study? 

6-  Which Essentials do you see represented in this article and why?
Phase 3-Evaluation of a research study (Due by WEEK 9)
In phase 3 we will examine a research study titled:
“Translating evidence to practice in the health professions: a
randomized trial of Twitter vs Facebook”
As future advance practice clinicians, how are you going to translate
your evidence into the health field?
Your assignment for phase three is to read the attached article and
analyze it based on its merit by answering the following questions:
123456-
Has the author formulated an appropriate research question based
on the problem/issue?
Is the research question clearly defined in terms of its cope and
relevance?
What is the author’s orientation towards the research
problem/issue- is it critical analysis or interpretation based?
How does this article contribute to your understanding of possible
research modalities and methods?
What are the strengths, limitation of the study?
Which Essentials do you see represented in this article and why?
This paper should follow APA rules for grammar and citations. It should
be 5- 6 pages in length.
Cohesiveness
12.5%
Ties together
information
from all sources.
Paper flows
from one issue
to the next with
no headings.
Author’s writing
demonstrates an
understanding of
the relationship
among material
obtained from all
sources
Mostly, it ties
together
information
from all sources.
Paper flows with
only some
disjointedness.
The author’s
writing
demonstrates an
understanding of
the relationship
among material
obtained from all
sources.
Spelling and
Grammar
12.5%
Minimal spelling Some spelling
and/or grammar and or grammar
mistakes
mistakes.
Sources
12.5%
Over 5 current
sources, of
which at least 3
are peer-review
journal articles
or scholarly
books.
Sources include
both general
background
sources and
specialized
sources.
Special-interest
sources and
popular
literature and
acknowledged as
such if they are
cited.
All web sites
utilized are
authoritative.
5 current
sources, of
which at least 2
are peer-review
journal articles
or scholarly
books.
All web sites
utilized are
authoritative.
Sometimes ties
together
information
from all sources.
Paper does not
flow.
Disjointedness is
apparent.
The author’s
writing does not
demonstrate an
understanding of
the relationship
among material
obtained from all
sources.
Noticeable
spelling and
grammar
mistakes.
Fewer than 5
current sources
or fewer than 2
of 5 are peerreviewed journal
articles or
scholarly books.
All web sites
utilized are
credible.
It does not tie
together
information.
Paper does not
flow and appears
to be created
from disparate
issues.
Headings are
necessary to link
concepts.
Writing does not
demonstrate
understanding
any relationship
An unacceptable
number of
spelling and/or
grammar
mistakes
Fewer than 5
current sources
or fewer than 2
of 5 are peerreviewed journal
articles or
scholarly books.
Not all web sites
utilized are
credible, and/or
sources are not
current.
Citations
12.5%
Cites all data
obtained from
other sources.
APA citation
style is used in
both text and
bibliography
Cites most data
obtained from
other sources.
APA citation
style is used in
both text and
bibliography.
Cites some data
obtained from
other sources.
Citation style is
inconsistent or
incorrect.
Does not cite
sources.
Journal of the American Medical Informatics Association, 24(2), 2017, 403–408
doi: 10.1093/jamia/ocw085
Advance Access Publication Date: 29 June 2016
Brief Communication
Brief Communication
Translating evidence to practice in the health professions:
a randomized trial of Twitter vs Facebook
Jacqueline Tunnecliff,1 John Weiner,2 James E Gaida,3 Jennifer L Keating,1
Prue Morgan,1 Dragan Ilic,2 Lyn Clearihan,4 David Davies,5 Sivalal Sadasivan,6
Patitapaban Mohanty,7 Shankar Ganesh,7 John Reynolds,2 and Stephen Maloney1
1
Department of Physiotherapy, Monash University, Frankston, Australia, 2Department of Epidemiology and Preventive Medicine,
Monash University, Melbourne, Australia, 3Discipline of Physiotherapy and University of Canberra Research Institute for Sport
and Exercise (UCRISE), University of Canberra, Canberra, Australia, 4School of Primary Health, Monash University, Melbourne,
Australia, 5Warwick Medical School, University of Warwick, Coventry, United Kingdom, 6JC School of Medicine & Health Sciences, Monash University Malaysia and 7Swami Vivekanand National Institute of Rehabilitation Training and Research, Odisha,
India
Correspondence to Associate Professor Stephen Maloney, Department of Physiotherapy, Monash University, PO Box
527, Frankston, 3199, Victoria, Australia; [email protected]
Received 7 October 2015; Revised 21 April 2016; Accepted 30 April 2016
ABSTRACT
Objective: Our objective was to compare the change in research informed knowledge of health professionals
and their intended practice following exposure to research information delivered by either Twitter or Facebook.
Methods: This open label comparative design study randomized health professional clinicians to receive
“practice points” on tendinopathy management via Twitter or Facebook. Evaluated outcomes included knowledge change and self-reported changes to clinical practice.
Results: Four hundred and ninety-four participants were randomized to 1 of 2 groups and 317 responders analyzed. Both groups demonstrated improvements in knowledge and reported changes to clinical practice. There
was no statistical difference between groups for the outcomes of knowledge change (P ¼ .728), changes to clinical practice (P ¼ .11) or the increased use of research information (P ¼ .89). Practice points were shared more by
the Twitter group (P < .001); attrition was lower in the Facebook group (P < .001). Conclusion: Research information delivered by either Twitter or Facebook can improve clinician knowledge and promote behavior change. No differences in these outcomes were observed between the Twitter and Facebook groups. Brief social media posts are as effective as longer posts for improving knowledge and promoting behavior change. Twitter may be more useful in publicizing information and Facebook for encouraging course completion. Key words: social media, evidence-based practice, communication, education, professional, computer-assisted instruction INTRODUCTION A significant gap remains between research generated healthcare knowledge and clinical practice.1–3 Social media can rapidly link researchers and clinicians from diverse geographical regions, disciplines, and areas of practice; making it an ideal medium for knowledge exchange and education. Approximately 25% of health professionals currently use social media for obtaining research information.4 Social media has been defined as a “collection of web-based technologies that share a user-focused approach to design and functionality, where users can actively participate in content creation C The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. V For Permissions, please email: [email protected] 403 404 Journal of the American Medical Informatics Association, 2017, Vol. 24, No. 2 and editing through open collaboration between members of communities of practice.”5 The use of social media in education may lead to positive learning experiences,5,6 increases in knowledge and skills,7–10 and changes to the clinical practices of health professionals.10,11 However, there is a need for studies to evaluate the relative effectiveness of different social media based applications.12 Two of the largest social media applications are Facebook (1.49 billion monthly active users) and Twitter (316 million monthly active users).13,14 Both sites promote user interaction and allow posting of text, videos, and weblinks; however, Twitter limits posts to 140 characters. Neither site charges access costs. The popularity and features of these sites indicate their potential application in communicating research information and, therefore, were chosen for investigation in this study. OBJECTIVE The primary objective of this study was to determine if research information delivered by Twitter or Facebook would result in greater changes in research informed knowledge and practices of health professionals. The secondary aim was to compare participant behavior and engagement with the two mediums. METHODS Design An open label randomized comparative design was used, with a mixed methods approach to data collection and analysis. The Monash University Human Research Ethics committee (CF 14/1372 – 2014000640) approved the study. Participants Health professional clinicians of any discipline (e.g., medicine, physiotherapy, podiatry), geographical location, or level of expertise (including undergraduate students), were eligible to participate. Recruitment occurred via an email invitation distributed to clinical affiliates and departments of Monash University, Faculty of Medicine, Nursing and Health Sciences, Australia; Monash University Malaysia; Swami Vivekanand National Institute of Rehabilitation Training and Research, India; and the University of Southern California. Professional associations representing professions registered with the Australian Health Practitioner Regulation Agency15 were also invited to distribute the invitation to participate via email or their own social media sites. Intervention A short course, consisting of the same 8 “practice points” or key educational messages of 140 characters or less, on topics related to tendon management were delivered to each group via posts on Twitter16 and Facebook17 web pages. Each practice point was linked to supplementary information in the form of peer-reviewed journal articles or podcasts by clinical experts. The course was designed by educational, clinical, and research experts, and was identical except that the Facebook posts contained the practice point plus an additional 2–6 short written statements (1–2 sentences) that highlighted key concepts from the supplementary information. The practice points were delivered evenly over a 2 week period, to both groups at the same time points. The pages were not restricted access. Procedure Clinicians consented to participate by providing contact details through an online survey. Those who provided a valid email address were enrolled. Participants were stratified by role (student, clinician, or other) and randomized to receive the practice points via Twitter or Facebook. Participants received video and written instructions on obtaining a social media account and accessing the practice points from their allocated site. The instructions also encouraged interaction on the allocated site. Participants were sent three reminder emails at each data collection point to minimize attrition. The study was conducted between August and October 2014. Outcomes Data was obtained via an anonymous online survey completed 1 week before (baseline assessment) and after (post-intervention assessment) the short course. A password was used to match preand post-course data. Demographic details, information on tendon management experience, and current use of social media were obtained. Outcomes were determined based on the Kirkpatrick hierarchical levels of evaluation 1–3.18 Participation and engagement data was also collected. A data collection summary can be found in Appendix 1. Kirkpatrick Level 1: Participant Reactions The Social Media Use and Perception Instrument (SMUPI), a questionnaire of 10 items with high internal consistency,19 measured attitudes towards using social media in continuing professional development. Kirkpatrick Level 2: Knowledge Sixteen multiple choice questions assessed knowledge (A–E responses) (Appendix 2). One question correlated with each “practice point” and one correlated with information from each piece of supplementary information. The questions in both assessments were identical, but question and response order were randomized to minimize score improvements based on pattern recognition. Participants were not given assessment answers until the conclusion of the study. Self-rated measures of tendon management confidence and knowledge were also obtained. Kirkpatrick Level 3: Behavior Change Participants were asked “has the education you have received via social media during this trial changed the way you practice, or intend to practice, with musculoskeletal clients?” and “has the education you have received during this trial increased your use of research evidence within your clinical practice?” Participation was evaluated via the number of participants who connected with the social media pages and completed the assessments. Data on interaction was obtained through participant selfreport and from the number of times posts were approved of (“liked” or “favorite”), shared or commented on. Analysis Mixed linear models were used to analyze the repeated measurements (pre- and post-exposure to the intervention) on the participants. The restricted maximum likelihood method (REML), as implemented in the GenStat statistical package,20 was used to fit the models, calculate predicted means and test, using F-tests, the main effects of group (Twitter vs Facebook) and time (pre vs post) as well Journal of the American Medical Informatics Association, 2017, Vol. 24, No. 2 Expressed interest in par cipa ng (n=500) Table 1. Participant demographics and participant characteristics Twitter N (%)a Excluded (n=6) n=1 complaint about process n=5 no email address provided Randomized (n=494) Allocated to Twi er (n=247) Allocated to Facebook (n=247) Withdrew (n=1) Reason unknown Comple on of baseline Assessment (n=128) Comple on of baseline Assessment (n=144) Comple on of post interven on assessment (n=86) Comple on of post interven on assessment (n=132) Figure 1. Consort flow chart showing attrition of study participants. as their 2-way interaction. Pairwise least significant difference tests of the group-by-time means were based on these analyses and conducted at the 5% significance level. Diagnostic plots of residuals were checked for assumptions on which these methods are based. Analyses of the 5-point Likert scale responses also used the restricted maximum likelihood method as is customary with large datasets.21 The analyses of binary response outcomes, measured post intervention, were based on logistic regression models, also fitted using GenStat. Discrete count data from Twitter and Facebook sites were analyzed using a variancestabilizing transformation in an analysis of variance. RESULTS Five hundred clinicians consented to participate. Five were excluded due to an invalid email address, and one participant asked to be removed. Four hundred and ninety-four participants were randomized. The attrition rates from randomization to baseline assessment were 48.2% for the Twitter group and 41.7% for the Facebook group; the difference was not significant [v2 (1, n ¼ 494) ¼ 2.09, P ¼ .148]. Attrition from baseline assessment to post intervention assessment was 32.8% for the Twitter group and 8.3% for the Facebook group; this difference was significant [v2 (1, n ¼ 494) ¼ 17.37, P < .001]. Three hundred and seventeen responses were analyzed (140 Twitter, 177 Facebook). There were 99 baseline assessments, 45 post intervention assessments, and 173 matched baseline and post intervention assessments. A consort flow-chart is available in Figure 1. Demographics Demographic data and data on tendon management experience and social media use was obtained from the baseline assessment and is presented in Table 1. Kirkpatrick levels 1, 2 and 3 Following the intervention, (the short course consisting of practice points) there were statistically significant increases in SMUPI score, self-rated confidence, self-rated knowledge and multiple choice assessment score; but no statistically significant differences between the groups in their changes over time. Participants in both groups reported a change in practice/intended practice and increased use of research in practice/intended practice as a result of the intervention but there was no statistically significant difference between the groups. This is shown in Table 2. 405 Baseline demographic data sets Area of practice Physiotherapy/physical therapy Medicine Osteopathy Podiatry Other Not stated Role Undergraduate Student Postgraduate Clinical Trainee Clinician Other Not stated Age Under 18 18–24 25–34 35–44 45–54 55–64 65þ Sex Male Female Not stated Country Australia India Malaysia UK USA Other Not stated Tendon management experience Provide health care to clients with tendon disorders once a week or more Social Media experience Use Twitter Use Facebook Facebook N (%)a 128 144 95 (74.2) 18 (14.1) 2 (1.6) 7 (5.5) 4 (3.1) 2 (1.6) 98 (68.1) 19 (13.2) 3 (2.1) 11 (7.6) 11 (7.6) 2 (1.4) 33 (25.8) 9 (7.0) 78 (60.9) 8 (6.3) 0 (0.0) 36 (25.0) 13 (9.0) 78 (54.2) 17 (11.8) 0 (0.0) 0 (0.0) 28 (21.9) 59 (46.1) 31 (24.2) 8 (6.3) 2 (1.6) 0 (0.0) 0 (0.0) 39 (27.1) 64 (44.4) 28 (19.4) 8 (5.6) 4 (2.8) 1 (0.7) 79 (61.7) 47 (36.7) 2 (1.6) 71 (49.3) 71 (49.3) 2 (1.4) 48 (37.5) 14 (10.9) 5 (3.9) 29 (22.7) 12 (9.4) 19 (14.8) 1 (0.8) 59 (41.0) 14 (9.7) 6 (4.2) 23 (16.0) 17 (11.8) 24 (16.7) 1 (0.7) 61 (47.7) 62 (43.1) 75 (58.6) 106 (82.8) 66 (45.8) 130 (90.3) a Percent of group (Twitter or Facebook) that provided baseline data. The Twitter page developed 428 “followers” and the Facebook page received 155 “likes.” An estimated 10.0% (8/80) of the Twitter group and 7.8% (9/115) of the Facebook group reported interacting online. The difference between groups was not significant [v2 (1, n ¼ 195) ¼ 0.28, P ¼ 0.597)]. An estimated 42.6% (20/47) of the Twitter group and 34.8% (24/69) of the Facebook group reported lack of time as a reason for lack of interaction on the social media sites. Statistically significant differences were found between groups for number of times information was shared (mean shares per post Twitter 10.40, Facebook 0.20, SED 3.030, P < .001) and approved of (“liked”/”favourite”) (mean Twitter 14.00, Facebook 8.00, SED 1.414, P ¼ .005). DISCUSSION This study has demonstrated that research information delivered by either Twitter or Facebook can improve clinician knowledge and 406 Journal of the American Medical Informatics Association, 2017, Vol. 24, No. 2 Table 2. Kirkpatrick level 1–3 outcomes Baseline measures Predicted Mean (n) Post-Intervention measures Predicted Mean (n) Kirkpatrick level 1 outcomes SMUPIa Twitter 40.34 (126) 41.85 (86) Facebook 39.53 (143) 40.86 (127) Difference (SED)b 0.81 (0.82) 0.99 (0.91) P-value .326 .277 Kirkpatrick level 2 outcomes Self-rated confidence in tendon managementc Twitter 3.380 (128) 3.784 (86) Facebook 3.216 (143) 3.644 (131) 0.164 (0.106) 0.141 (0.116) Difference (SED)b P-value .124 .227 Tendon management self-rated knowledgec Twitter 3.181 (127) 3.727 (86) Facebook 3.027 (143) 3.570 (131) 0.154 (0.102) 0.157 (0.112) Difference (SED)b P-value .135 .163 Multiple choice assessment total score (max score 16) Twitter 7.649 (123) 10.308 (80) Facebook 6.599 (136) 9.435 (118) 1.050 (0.469) 0.874 (0.521) Difference (SED)b P-value .026 .095 Assessment score for questions that addressed the practice points (max score 8) Twitter 4.155 (123) 5.523 (80) Facebook 3.789 (136) 5.431 (118) 0.366 (0.259) 0.093 (0.293) Difference (SED)b P-value .159 .752 Assessment score for questions addressing the supplementary information (max score 8) Twitter 3.485 (123) 4.819 (80) Facebook 2.848 (136) 4.025 (118) 0.637 (0.255) 0.793 (0.211) Difference (SED)b P-value .013* .006* Number reporting change (n) % of group (95% CI) Kirkpatrick level 3 outcomes Reported change in practice due to intervention Twitter 59 (77) Facebook 77 (117) Reported increased use of research in practice Twitter 55 (78) Facebook 80 (115) Difference (SED)b 1.51 (0.66) 1.33 (0.58) P-value .024 .022 .841d 0.404 (0.083) 0.428 (0.072) Purchase answer to see full attachment