Emergency Physicians and Personal Narratives Improve the Perceived Effectiveness of COVID-19 Public Health Recommendations on Social Media: A Randomized Experiment

Background: Containment of the coronavirus disease 2019 (COVID-19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study is to assess the effectiveness of COVID-19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives. Methods: On April 30, 2020, we randomly assigned 2007 U.S. adults to an online survey using a 2x2 factorial design. Participants rated 1 of 4 simulated Twitter posts varied by messenger type (emergency physician vs federal official) and content (personal narrative vs impersonal guidance). Main outcomes were: perceived message effectiveness (35-point scale); perceived attitude effectiveness (15-point scale); likelihood to share Tweets (7-point scale); and writing a letter to their governor to continue COVID-19 restrictions (write letter or none). Results: The physician/personal message had the strongest effect and significantly improved all main messaging outcomes except for letter-writing. Unadjusted mean differences between physician/personal and federal/impersonal were: perceived messaging effectiveness (3.2 [95%CI, 2.4-4.0]); perceived attitude effectiveness (1.3 [95%CI, 0.8-1.7]); likelihood to share (0.4 [95%CI, 0.15-0.7]). For letter-writing, physician/ personal made no significant impact compared to federal/ impersonal (odds ratio 1.14 [95%CI, 0.89-1.46]). Conclusions: Emergency physicians sharing personal narratives on Twitter are perceived to be more effective at communicating COVID-19 health recommendations compared to federal officials sharing impersonal guidance.