The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study.
BACKGROUND
Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences.


OBJECTIVE
Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines "Complementary and alternative medicine in multiple sclerosis" ("CAM in MS") and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations.


METHODS
Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians ("physicians"). The primary outcome was the difference in participants' intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS).


RESULTS
Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence interval: physicians 36%, 95% CI 25-46, and patients 10%, 95% CI 1-11) but did not increase further after novel dissemination (physicians 0%, 95% CI -11 to 11, and patients -4%, 95% CI -6 to 14). Intent to discuss CAM also increased after traditional dissemination but did not change after novel dissemination (traditional: physicians 12%, 95% CI 2-22, and patients 19%, 95% CI 3-33; novel: physicians 11%, 95% CI -1 to -21, and patients -8%, 95% CI -22 to 8). Knowledge of CPG recommendations and behavior regarding CAM use in MS did not change after either traditional dissemination or novel dissemination.


CONCLUSIONS
Social media-based dissemination methods did not confer additional benefit over print-, email-, and Internet-based methods in increasing CPG awareness and changing intent in physicians or patients. Research on audience selection, message formatting, and message delivery is required to utilize Web 2.0 technologies optimally for dissemination.
Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical school, Boston, MA, United States. pnarayan@bidmc.harvard.edu.
Pushpa
http://orcid.org/0000-0002-9412-7349
P
Narayanaswami
Gary
http://orcid.org/0000-0003-2861-8462
G
Gronseth
Richard
http://orcid.org/0000-0001-8496-2909
R
Dubinsky
Rebecca
http://orcid.org/0000-0001-7143-8040
R
Penfold-Murray
Julie
http://orcid.org/0000-0003-1271-7642
J
Cox
Christopher
http://orcid.org/0000-0001-7838-3222
C
Bever
Yolanda
http://orcid.org/0000-0002-3983-3531
Y
Martins
Carol
http://orcid.org/0000-0002-9224-1359
C
Rheaume
Denise
http://orcid.org/0000-0003-1578-9991
D
Shouse
Thomas S D
http://orcid.org/0000-0001-7295-1970
TS
Getchius
D000529:Complementary Therapies / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D061108:Social Media
alternative medicine; alternative therapies; clinical practice guidelines; complementary medicine; dissemination and implementation; information dissemination; medicine, complementary; multiple sclerosis; social media; therapy, complementary