Family physicians' utility of social media: a survey comparison among family medicine residents and physicians

Introduction Social media has become ubiquitous and has brought a dramatic change in health services. Little is known about its use by family physicians and residents for personal or professional purpose. The aim of the current study was to evaluate the utility of social media among family medicine residents and consultants. Methods The collection of data was through the use of a five part questionnaire developed by researchers. The questionnaire was delivered to 70 physicians and 100 residents, out of which 132questionnaires were completed, representing a 78 percent response rate. Results Our findings demonstrate that there was an overall high use of social media. Females used social media more for general education and professional purposes. Men, by contrast, used it more frequently for personal purposes. The participants in this study appeared to consider social media as having several useful dimensions, such as: enabling them to accomplish job tasks, improve job performance, productivity and more effective patient care when using social media. Conclusions To date, limited studies have compared social media use among family physicians and residents. This study may serve as an initial step for future studies explaining the pattern of use among physicians.


Introduction
Social media use has grown substantially in the past decade 1 . It has become an integral tool for physicians to solicit medical information 2 . Recent estimates of social media usage by doctors has risen dramatically from 41% in 2010 to 90% in 2011 3 . A major rationale for its widespread utilization is its ease of use 4 . According to uses and gratifications theory, media consumption is purposive and users search for relevant sites to fulfill their needs 5 . A systematic review on social media use in medical edu-cation using the nine databases (MEDLINE, CINAHL, ERIC, Embase, PsycINFO, ProQuest, Cochrane Library, Web of Science, and Scopus) conducted a literature search using the following defined terms: medical education, undergraduate medical education, graduate medical education, continuing medical education, medical student education, and resident education in combination with variations of the following "All Fields" terms: social media, social network, Facebook, Web 2.0, Web log, blog, Twitter, podcast, and Webcast from the start of each database till 2011 and found that interventions using social media tools are associated with improved knowledge, attitudes, and skills 6 . Social media channels are increasingly used as an educational source, and as powerful platforms to allow physicians to use and disseminate information 7,8 . As a universal information nidus, it provides a comprehensive database of answers. Its importance in clinical practice has been documented in the academic literature 9,10,11,12 . According to technology acceptance model (TAM) an individual's acceptance of technology is determined by its perceived utility (perceived usefulness, relevance, importance, timeliness, accessibility or ease of use of information or of a source.) 13 . Perception and use may differ between various age cohorts 14 . Younger doctors use social media more frequently than seniors, since juniors may have more familiarity with the technology and find it easy to use 15 . When facing the broad range of patients' ailments, family physicians require a timely access to knowledge from trustworthy sources to help in clinical decisions. To comprehend this phenomenon amongst family physicians and residents, an understanding of how this group currently utilizes (perceived usefulness, relevance, importance, timeliness, accessibility or ease of use of information) social media is required. There has been limited research on family physicians' utility of this technology or their attitudes towards it 16,17 . A literature search found limited studies comparing social media use between Family physicians and residents 18 . Hence, this study aimed to: 1. Assess the pattern and extent of social media use, among residents and practicing family physicians, and association with the socio-demographic variables.
2. Identify the attitudes, the perceived usefulness, and barriers to its use.

Methodology
Study design: Cross-sectional descriptive study. Study population: The study targeted the Family Physicians and Residents (from the joint program) at the King Saud University, Riyadh, Saudi Arabia during the year 2014-15. The residents were almost all Saudi (a homogenous set with similar ethnicity and cultural backgrounds). However, the physicians are a mix from different ethnic and cultural backgrounds.

Data sampling method
All the physicians and residents in the joint program were invited to participate.

Survey instrument development:
A self-administered questionnaire was designed by the study team based on the existing literature 19,20 ; the items were reviewed by a team of experts. Only those items which were relevant for our study, guided by research questions were included. The statements were ordered in a logical sequence so that the questionnaire would be easy to work through. The survey instrument examined four content areas: A) Basic characteristic of the study population; B) Usage of social media C) Frequency of Social Media Usage D) Attitudes toward Social Media Usage which covered areas such as Usefulness, ease of use and Barriers E) Types of social media use (Appendix 1). The collected demographic dataincluded age, gender, marital status, highest degree and the type of practice. The survey instrument was piloted with ten residents and practicing physicians. The reliability of the survey items was calculated for all questionnaire items. The alpha coefficient for our variables was 0.954.

Ethics approval:
The current study was approved by the Institutional Review Board of the College of Medicine; King Saud University (reference # E-14-1284). Participation was voluntary. Informed written consent was obtained from the participants and anonymity was assured.

Data collection
The survey questionnaire was distributed and collected as a hard copy (manually) from all the participants. The first page of the questionnaire explained the aims of the study and assured of anonymity and confidentiality. Data collection lasted around two months. No incentives were offered for survey completion.

Data analysis plan:
The Statistical Package for the Social Sciences (SPSS) version 21 was used for data analysis. Descriptive statistics such as frequency, percentages, mean, and standard deviation were calculated. Comparisons were made between different categorical variables using Chi-square and other parametric tests as appropriate. A p value < 0.05 was considered significant.

Results
The survey was delivered to 70 physicians and 100 residents. The total number who filled out the questionnaire was 132. The overall response rate was 78%. Out of 100 residents, 92 responded 92.0% and out of 40 physicians, 57% responded. Men outnumbered women with a ratio of (7/3). The mean age of the participants was 34.63 +9.50 years. Most of the physicians were younger than 40 years (77.0%) and were married (71.2%). (Table 1). Nearly all participants reported having social media accounts and reported checking them at least once a day (95.4%); half of the participants (51%) checked them four times or more daily (51%). The median time spent on social media sites during a typical working day was 120 minutes with an interquartile range of 60-180 minutes. Most of the participants (80%) were happy with their social media usage (Table 2).     In comparing the significance of the internetto other sources of accessing clinical information, participants favored the internet (78%), followed by books (65.2%), and, finally colleagues (39%). Less preferred sources were conferences (37%), scientific journals (32%), and pharmaceutical representatives (10%). Overall, on a daily basis, 33% of respondents used social media to explore medical information and 23.4 % to contribute information to others. Once a week or more, the corresponding figures were 39% and 33%. Female participants admitted that they would contribute information to others (p=0.029), seek specific information (p=0.005), and explore medical knowledge (p=0.041) as compared to their male counterparts (Table 4). Residents were more likely to be actively seeking information as compared to physicians, specifically about a medical problem or situation. (p=0.055).  Regarding the participants attitude towards social media use; approximately one-third of respondents considered them an essential use of time (65.9%), beneficial (77.3%), very engaging (72.0%) and a great way to get high-quality current information (76.3%) (Figure 1).
Approximately, more than 80% of physicians felt it was easy to use social media, and 65% believed that social media increased their job performance and improved the quality of patients' care (62%). As expected, barriers identified were time constraint (50%) and skills for use of social media (66%).

Discussion
Our findings demonstrate that there was an overall high use of social media among family medicine residents and practitioners of both sexes. Generally, females used social media more for general education and professional purposes. Men, by contrast, used it more frequently for personal purposes. The most common types of social media used by participants were YouTube, Facebook and Wikipedia. Physicians considered social media to be beneficial and preferred social media over traditional approaches such as conferences and scientific journals for learning. They also thought it a great way to get high quality information, found it to be very engaging, and an effective use of time.
Lately, the use of social media by health care professionals has increased significantly 21 . The higher use of social media in our study is consistent with previous literature that have shown that more than 90% of the physicians are social network users 18 . The use of social networking sites among youth and adults alike has risen significantly, however there are difference in trends of use amongst various age cohorts. We found a ''digital divide'' between physicians and residents in terms of using the social media. Residents were more likely to use social media than the physicians, although it was not significant. This is in keeping with other studies reporting young age as a pre-dictor of social network users 6,22,23,24 . The rate at which social media use is diffusing among the older generation is escalating, and the digital immigrants 16 are striving to close the gap by adopting social media habits similar to digital natives; still, it lags behind the figures of the young users 25 . A plausible explanation could be that for young doctors, social media has been an integral part of their life and they feel perfectly comfortable with it. In contrast, older physicians got a taste of this new technology at a later stage in their lives. As a result, comfort level and fluency may vary. Moreover, another possible explanation for our results, which issubstantiated by evidence, 24,26 is that physicians, being more medically experienced, might feel less need for professional use compared to younger residents. Historically, women have been more avid users of social media than men, but these differences are no longer statistically significant 27 . This is in line with our study finding. A variety of covariates are found to be associated with its use, but little systematic research has actually explored the reasons for these differences. An explanation for these differences seems like an important question, yet to be answered.
In general, adults as a whole remain less likely than the younger generation to use the technology 28 , and the number further goes down with increasing age 29 .
Family Physicians used social media more for personal, than for professional or educational purposes. This result is in line with the findings of other studies among health care professionals 19,30 . A study among US physicians reported that 90% of physicians used social media for personal purposes and 65% for professional purposes 22 .
However, for exploration of medical knowledge, physicians reported higher frequency of use as compared to residents. One of the reasons could be that the seniors emphasize the informational and educational aspects of the internet, while their younger counterparts use it for entertainment. As a result, its use can vary greatly among a cohort of doctors within the same institute. The digital immigrants are however trying to adopt social media habits similar to digital natives 22 . These results are exploratory and need further validation with larger scale studies using other physicians as well.
Men and women have varying degrees of activity across different social media sites. Not much is known about the factors that might influence the actual use of social media for personal purposes. Our findings show the male gender to be positively associated with personal social media use. These are comparable to those shown in other studies 24,31 . A possible reason could be a higher use of internet by males in this region 32 . This issue deserves attention in future studies, since it might be associated with cultural differences.
Our study provides insight into family physicians' relationship with social media by investigating which source of information physicians and residents use for general and learning purposes. YouTube in this study was ranked the number one site for general and learning purposes. This finding contrasts a previous study on clinician use of social media that reported the use of Facebook 33 and Wikipedia as high 21 . However, in a longitudinal study from 2009 to 2011, the use of social media increased tremendously, especially in the use of YouTube (from 2% to 20%) 34 .
A plausible explanation could be that YouTube videos are search engine friendly and are easily accessible from both desktop and mobile devices, and healthcare professionals might come across them while doing Web searches. We suggest that future studies on this topic should include usage metrics, such as the amount and type of content consumed, and the number of connections made for better understanding of web usage.
A higher proportion of respondents in our study as well as in other studies 22 were interested in updates through medically related social media sites The participants in this study appeared to consider social media as having several useful dimensions such as: enabling them to accomplish job tasks, improve job performance, productivity, and more effective patient care. Their attitudes towards its use were also positive, and the majority thought social media to be engaging, beneficial, and an effective use of time. Nonetheless, participants also identified several barriers, which were similar to previous research 22 findings. The barriers hindering the use of social media were a busy schedule, and investment of time and skill.. A highly possible explanation could be the time investment, as most doctors are usually pressed for time, trying to balance work and life 35 .

Limitations:
Several limitations of the current study must be noted. First, the current study was conducted on a relatively small number of residents and physicians who were from the same region, which may not be a representative group of full network of physicians on social media. This reduces the generalizability of the findings. Second, the questionnaire was pilot tested, but not validated. Additionally, social media usage and barriers were measured using only few items, which limits our ability to generalize to a wide variety of issues. To address this, future in depth studies should attempt to explore the issue by using more comprehensive measures. Thirdly, social media usage and attitudes are changing at a fast pace, and they might have changed over this period. Finally, the results of this study need to be supplemented with qualitative study to better understand this phenomenon. The gender differences found in the use of social media for professional purposes in this study may have impact on how the different genders approach patient care. Although physician sex doesnot determine patient outcomes, it can serve as a sign of difference in practice. However, these attributes may change as the technologies evolve and will require further observation over time.
Despite limitations, the study may serve as an initial step for future studies explaining the pattern of use in different cultures.

Conclusion
This study demonstrates that social media was very popular among physicians and residents. YouTube emerged as the most frequently used application. Females and physicians used social media more for professional purposes than did residents. Male physicians used social media less for educational and learning purposes, and instead used it for personal reasons and leisure. Majority found it to be an effective use of time, and a beneficial and engaging way to get high-quality information. Further research is required to evaluate this difference to verify whether it is culture or career specific.

Declarations
Ethics approval and consent to participate: Informed written consent was obtained from all participants prior to data collection. All the selected respondents were given assurance of confidentiality that the information gathered will be used exclusively for research purposes. The current study was approved by the Institutional Review Board of the College of Medicine; King Saud University (reference no E-14-1284).

Consent for publication: Not applicable.
Financial Support: This work was supported by the Deanship of Scientific Research, King Saud University for funding through Vice Deanship of Scientific Research Chairs.

Availability of data and materials:
The datasets used during the current study are available from the corresponding author on request.