title: Twitter as a Tool for Health Research: A Systematic Review.
abstract: Researchers have used traditional databases to study public health for decades. Less is known about the use of social media data sources, such as Twitter, for this purpose.
  
  
  
  To systematically review the use of Twitter in health research, define a taxonomy to describe Twitter use, and characterize the current state of Twitter in health research.
  
  
  
  We performed a literature search in PubMed, Embase, Web of Science, Google Scholar, and CINAHL through September 2015.
  
  
  
  We searched for peer-reviewed original research studies that primarily used Twitter for health research.
  
  
  
  Two authors independently screened studies and abstracted data related to the approach to analysis of Twitter data, methodology used to study Twitter, and current state of Twitter research by evaluating time of publication, research topic, discussion of ethical concerns, and study funding source.
  
  
  
  Of 1110 unique health-related articles mentioning Twitter, 137 met eligibility criteria. The primary approaches for using Twitter in health research that constitute a new taxonomy were content analysis (56%; n = 77), surveillance (26%; n = 36), engagement (14%; n = 19), recruitment (7%; n = 9), intervention (7%; n = 9), and network analysis (4%; n = 5). These studies collectively analyzed more than 5 billion tweets primarily by using the Twitter application program interface. Of 38 potential data features describing tweets and Twitter users, 23 were reported in fewer than 4% of the articles. The Twitter-based studies in this review focused on a small subset of data elements including content analysis, geotags, and language. Most studies were published recently (33% in 2015). Public health (23%; n = 31) and infectious disease (20%; n = 28) were the research fields most commonly represented in the included studies. Approximately one third of the studies mentioned ethical board approval in their articles. Primary funding sources included federal (63%), university (13%), and foundation (6%).
  
  
  
  We identified a new taxonomy to describe Twitter use in health research with 6 categories. Many data elements discernible from a user's Twitter profile, especially demographics, have been underreported in the literature and can provide new opportunities to characterize the users whose data are analyzed in these studies. Twitter-based health research is a growing field funded by a diversity of organizations. Public health implications. Future work should develop standardized reporting guidelines for health researchers who use Twitter and policies that address privacy and ethical concerns in social media research.
authors.affiliation: Lauren Sinnenberg, Kevin Padrez, Christina Mancheno, and Raina M. Merchant are with Penn Medicine Social Media and Health Innovation Lab, University of Pennsylvania, Philadelphia. Lyle Ungar is with the Department of Computer and Information Science, University of Pennsylvania. Alison M. Buttenheim is with Department of Family and Community Health, School of Nursing, University of Pennsylvania, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania.
authors.forename: Lauren
authors.initials: L
authors.lastname: Sinnenberg
authors.affiliation: Lauren Sinnenberg, Kevin Padrez, Christina Mancheno, and Raina M. Merchant are with Penn Medicine Social Media and Health Innovation Lab, University of Pennsylvania, Philadelphia. Lyle Ungar is with the Department of Computer and Information Science, University of Pennsylvania. Alison M. Buttenheim is with Department of Family and Community Health, School of Nursing, University of Pennsylvania, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Buttenheim
authors.affiliation: Lauren Sinnenberg, Kevin Padrez, Christina Mancheno, and Raina M. Merchant are with Penn Medicine Social Media and Health Innovation Lab, University of Pennsylvania, Philadelphia. Lyle Ungar is with the Department of Computer and Information Science, University of Pennsylvania. Alison M. Buttenheim is with Department of Family and Community Health, School of Nursing, University of Pennsylvania, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania.
authors.forename: Kevin
authors.initials: K
authors.lastname: Padrez
authors.affiliation: Lauren Sinnenberg, Kevin Padrez, Christina Mancheno, and Raina M. Merchant are with Penn Medicine Social Media and Health Innovation Lab, University of Pennsylvania, Philadelphia. Lyle Ungar is with the Department of Computer and Information Science, University of Pennsylvania. Alison M. Buttenheim is with Department of Family and Community Health, School of Nursing, University of Pennsylvania, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania.
authors.forename: Christina
authors.initials: C
authors.lastname: Mancheno
authors.affiliation: Lauren Sinnenberg, Kevin Padrez, Christina Mancheno, and Raina M. Merchant are with Penn Medicine Social Media and Health Innovation Lab, University of Pennsylvania, Philadelphia. Lyle Ungar is with the Department of Computer and Information Science, University of Pennsylvania. Alison M. Buttenheim is with Department of Family and Community Health, School of Nursing, University of Pennsylvania, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania.
authors.forename: Lyle
authors.initials: L
authors.lastname: Ungar
authors.affiliation: Lauren Sinnenberg, Kevin Padrez, Christina Mancheno, and Raina M. Merchant are with Penn Medicine Social Media and Health Innovation Lab, University of Pennsylvania, Philadelphia. Lyle Ungar is with the Department of Computer and Information Science, University of Pennsylvania. Alison M. Buttenheim is with Department of Family and Community Health, School of Nursing, University of Pennsylvania, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania.
authors.forename: Raina M
authors.initials: RM
authors.lastname: Merchant
mesh_terms: D035843:Biomedical Research; D006801:Humans; D033181:Information Dissemination; D062486:Public Health Surveillance; D011639:Public Opinion; D061108:Social Media