The content of social media's shared images about Ebola: a retrospective study

Highlights

• We compared the content on Instagram and Flickr to identify discourse about Ebola.

• Instagram images are mainly joke images.

• Flickr images primarily depicted health care workers and other professionals.

• It is helpful to understand public sentiment for providing targeted interventions.

Abstract

Objective

Social media have strongly influenced awareness and perceptions of public health emergencies, but a considerable amount of social media content is now carried through images, rather than just text. This study's objective is to explore how image-sharing platforms are used for information dissemination in public health emergencies.

Study design

Retrospective review of images posted on two popular image-sharing platforms to characterize public discourse about Ebola.

Methods

Using the keyword ‘#ebola’ we identified a 1% sample of images posted on Instagram and Flickr across two sequential weeks in November 2014. Images from both platforms were independently coded by two reviewers and characterized by themes. We reviewed 1217 images posted on Instagram and Flickr and identified themes.

Results

Nine distinct themes were identified. These included: images of health care workers and professionals [308 (25%)], West Africa [75 (6%)], the Ebola virus [59 (5%)], and artistic renderings of Ebola [64 (5%)]. Also identified were images with accompanying embedded text related to Ebola and associated: facts [68 (6%)], fears [40 (3%)], politics [46 (4%)], and jokes [284 (23%)]. Several [273 (22%)] images were unrelated to Ebola or its sequelae. Instagram images were primarily coded as jokes [255 (42%)] or unrelated [219 (36%)], while Flickr images primarily depicted health care workers and other professionals [281 (46%)] providing care or other services for prevention or treatment.

Conclusion

Image sharing platforms are being used for information exchange about public health crises, like Ebola. Use differs by platform and discerning these differences can help inform future uses for health care professionals and researchers seeking to assess public fears and misinformation or provide targeted education/awareness interventions.

Introduction

The first cases of Ebola were reported almost 40 years ago in Nzara, Sudan, and Yambuku, Democratic Republic of Congo.1, 2 The most recent outbreak in West Africa however has elevated consciousness of the disease in the United States (US) and around the world.3, 4 As of December 2014, there have only been two Ebola deaths in the US, compared to over 5000 in West Africa. In a Gallop poll released on November 17th 2014, however, Ebola ranked third among Americans' top health care concerns, at 17%.⁵ Almost one in six reported Ebola as the nation's top health problem, while the number one and two concerns were health care costs (19%) and access (18%).⁵

The media, U.S. midterm elections, varying responses from government and health care organizations, and the pernicious nature of the disease itself have all helped to shape public perception of current Ebola outbreak.4, 6 Social media has changed how news and information is digested around the world and it has played a pivotal role in prior public health emergencies.⁶ For example after Haiti's 2010 earthquake, social media was used to link health care providers in need of supplies with sources that had supplies.⁷ Ebola represents a different kind of public health emergency because it is contagious.

Social media are also different now. Social media now often takes the form of images rather than words. On December 10th 2014, Instagram announced it surpassed Twitter in popularity, with over 300 million active users compared to Twitter's 284 million users last quarter.⁸ In 2013, a Pew Research Internet Project survey found that 54% of adult Internet users post original photos or videos; 47% of users repost and share images that they have found on the Internet; and 62% of Internet users have done at least one of these activities.⁹ Tweets using Pic.Twitter.com images are 94% more likely to be shared than posts containing only text.¹⁰ Images represent an important and growing means of communication with the general public.

Images represent an area ripe for study as a potential channel for communication about important public health events and topics, and for population health surveillance. We sought to evaluate public images from two popular image sharing platforms, Instagram (>300 million users) and Flickr (>92 million users), to characterize content related to Ebola, and to compare the differences between the two platforms.11, 12