Characterizing Emergent Behaviors in Twitter Telehealth Communication during the COVID-19 Pandemic

Abstract

Telehealth has played a critical role in supporting healthcare delivery during the COVID-19 pandemic. Mitigation practices of physical distancing and sheltering-in-place continue to impose a significant burden on face-to-face healthcare visits. As a result, telehealth adoption and utilization have increased significantly after the U.S. Department of Health and Human Services waived telehealth payment requirements. These changes have been rapid and affect both individuals and organizations, ranging from healthcare and technology to news and policy. We turn to Twitter, as a broad-reaching communication platform, to elucidate and characterize Telehealth communication patterns. While different aspects of tweeting about telehealth have been used to answer specific questions, we sought to understand the collective telehealth tweeting behavior as a system of different types of users tweeting with various intent and sentiment. Such an approach combines the typically independent analysis of structure, using social network analysis, and purpose or function of communication, with topic analysis and sentiment analysis. In this paper, we apply a systems-based approach-called hetero-functional graph theory-to comprehensively describe the structure and function of the Twitter Telehealth communication system. We modeled 13 different types of telehealth users and 15 combinations of tweet intent and sentiment, which together describe 195 system capabilities. We applied machine learning to classify individual user tweeting behavior for different classes of telehealth stakeholders. We identified several patterns of longitudinal tweeting behaviors that varied by system form and function. By applying an interdependent methodology to understand both form and function, we provide deeper insights into tweeting behaviors between different classes of stakeholders. In doing so, we achieve a greater understanding of the various needs of different stakeholders, which can be leveraged as a valuable resource in informing more equitable policies as telehealth becomes a more permanent and scaled healthcare delivery service.