Twitter and nursing research: how diffusion of innovation theory can help uptake


All is not well for nursing in the new world. The use of social media to share research, access information and build professional networks – although gaining in popularity – has been met mostly with a slow response from those in nursing and its research (Ferguson 2013). Twitter is used by over 550 million people, with 135,000 new users every day (Statistics Brain 2012). Approximately 11% of nurses use Twitter compared with 20% of adults – which places nurses a year behind the general population's usage (Robinson 2013). This inertia is curious, given that reputable health organizations, such as the World Health Organization, now use Twitter (Redfern 2013).

Do nurses understand the potential benefits of Twitter? With mainstream popularity and increasing reliance in daily social life, Twitter can allow nurse researchers to connect directly, rapidly and cheaply with communities, disseminate information, and promote translation of research into practice and policy. It has also been found to be effective in engaging with and recruiting potentially hard-to-reach populations (O'Connor et al. 2014). This provides huge potential for methods and dissemination and broadens our understanding of change. Academic institutions now have to consider the merits of ‘virtual impact’ alongside traditional metrics of evaluation, such as publications. As Ferguson lamented in JAN: ‘it is time for the nursing profession to leverage social media’ (2013, p. 745). However, identifying this need does nothing to address how nurses can use Twitter better. Diffusion of Innovations Theory can help.

Proposed by sociologist Everett Rogers in 1962, Diffusion of Innovations Theory has become a commonly applied theory for understanding how and at what rate innovations are adopted in different settings. Five characteristics of innovations influence this rate (Rogers 1962/2003):

• Relative advantage: ‘…the degree to which an innovation is perceived as being better than the idea it supersedes’. (Rogers 1962/2003, p.229)

The purpose of Twitter may not be apparent to nurse researchers. Is Twitter a social networking site; a venue to confer and communicate celebrity status; a networking platform; a venue to disseminate research findings; a site for recruiting participants; or all of the above? This versatility of Twitter actually reduces its perceived relative advantage because it is unclear what Twitter can and should be compared to.

Most of these appraisals of Twitter occur in an evidence vacuum. While other widely used forms of media – such as textbooks, television and the internet – are not subject to a similar burden of proof, academics focused on evidence and value may well bemoan the lack of evaluation measures available for Twitter. Given the lack of previous comparable social media platforms, the added value of Twitter to busy professional lives may be unclear.

Twitter can create a new world that is highly responsive to each member's needs and interests. Because only tweets (messages of 140 characters or fewer) from followers are viewed, twitter ‘feeds’ tend to reflect common themes. Hashtags can be used to categorize tweets and organize twitter feeds. Based on these tailored preferences, papers, blogs and news stories come to one's attention that would not otherwise have done so. This ability to both benefit from and contribute to tailored twitter feeds is a reciprocal advantage that is very useful.

The relative advantage of innovations such as Twitter can be expressed through economic gains and social visibility. Academics can ‘tweet’ at zero cost. Other cost investments such as buying open access for publications can be leveraged through Twitter by tweeting links to online papers and web profiles. Academics may conflate social visibility with social prestige – reflecting a lingering perception of Twitter as a celebrity-oriented/pop culture social platform. However, as high-profile organizations such as the Canadian Nurses Association and leading journal editors in nursing harness Twitter, the social status draw of Twitter may gain appeal for nursing academics. Using Twitter may come to symbolize contemporary thinking and innovation.

• Compatibility: ‘The degree to which an innovation is perceived as consistent with existing values, past experiences and needs of potential adopters’. (Rogers 1962/2003, p. 229). (Rogers 1962/2003, p. 240)

Twitter's predecessors, particularly Facebook, also influence perceptions of Twitter. Largely a social platform, Facebook's infamous ‘status updates’ contributed to perceptions of Twitter as a social site for quick quips and celebrity updates. Although researchers may not distinguish between such forms of social media, in reality, different platforms can serve distinct purposes (Ferguson 2013).

This perception of Twitter as another social media site means that it has come to be seen as being part of a ‘technology cluster’ – a ‘set of distinguishable elements of technology that are perceived by individuals as being interrelated’ (Rogers 1962/2003, p. 249). The implication of the technology cluster is the tendency for users to group otherwise distinguishable technological innovations together (e.g. Twitter, Facebook, LinkedIn) without recognizing their distinctive nature and merits. When the blurring of boundaries occurs for adopters, the potential benefits of specific platforms may not be recognized. That said, introducing innovations as part of a technology cluster may increase uptake and harness synergies between innovations. Twitter can be used with LinkedIn (a professional networking profile site) through which strategic use of a tweet can refer followers to a full professional profile. As the introduction of technologies has been sequential, beginning with email, faculty websites, LinkedIn, Facebook and many more that have preceded Twitter, the ‘added benefit’ of new social media innovations may not be recognized.

It is natural to contrast the anticipated processes of Twitter to how academic dissemination has previously occurred – through longer formal academic journal articles that are read mostly by other academics. Twitter has been proposed as an alternative means to disseminate academic research; however, assuming that Twitter would be accepted readily as a supplementary form of dissemination risks committing the ‘empty vessels fallacy’ (Rogers 1962/2003, p. 256) wherein the previous knowledge and experiences of potential adopters are neglected. Compatibility with existing experiences is important and necessary for Twitter to ‘fit’ with nurse's existing knowledge related to academic dissemination. Developing links between Twitter and traditional avenues of dissemination can increase compatibility. For instance, integrating Twitter into conference activities by use of a conference hashtag, for example, may help.

Indeed, Twitter's name alone could challenge many academics' values. Twitter is synonymous with chatter – the antithesis of academic discourse. Views of Twitter as a time-consuming platform not meritorious for academic career progression and promotion can further reduce its compatibility with extant values. As such, how Twitter is positioned within the nursing community, how it is incentivized as a knowledge translation tool and which of its benefits are emphasized influence its adoption.

• Complexity: ‘The degree to which an innovation is perceived as relatively difficult to understand and use’ (Rogers 1962/2003, p. 257)

As with any innovation, Twitter has a learning curve. New terminology (e.g. Tweet, Twittersphere, twitterites) and ostensibly mysterious abbreviations (e.g. RT, FFF, BFN, T/J etc.) abound and necessitate a ‘Twittonary (n.d)’ of key definitions (see for an example). This learning is complex, especially for people less familiar with technology. Generally, different generations define and use social media in different ways (Cain et al. 2010, Taylor et al. 2010, Jones & Hayter 2013). Generational divides in the use of Twitter persist, but may diminish as technological literacy increases (Cresci et al. 2010). As such, the demographic characteristics and background of researchers in nursing also influence perceptions of complexity and use.

• Trialability: ‘degree to which an innovation may be experimented with on a limited basis’ (Rogers 1962/2003, p. 258)

Trialability is a mixed bag for Twitter. Twitter can be experimented with easily through establishing, trying and deleting a user account. However, it takes time and effort to establish followers, identify other users to follow and both read and produce tweets regularly. Time and efforts are needed to understand the potential benefits of Twitter, but these also reduce its perceived trialability.

This trialability is also constrained by preconceptions. For many academics, tweeting is a formative risk – tweets can potentially be read by many people, cannot be retracted and have been subject to high-profile legal debate and litigation in some countries. For those who have experimented with or regularly use Twitter, perceptions of such risk are diminished as tweets are only shared with and read by one's followers. Trialability is greatly enhanced by personal trials – suggesting a potential avenue for institutions looking to facilitate the uptake of Twitter by academic staff – via peer presentations on social media or hands-on ‘Twitter-sessions’ similar to library database search sessions.

• Observability: ‘The degree to which the results of an innovation are visible to others’ (Rogers 1962/2003, p. 258)

Twitter is a virtual innovation that requires no new hardware and an internet connection. The platform itself is less observable. Aside from the occasional tweet showcased in print, radio or television, tweets are not visible to those not on Twitter. Promoting Twitter through educational sessions and generating awareness of communities of scholars who have adopted the innovation may enhance Twitter's observability. Finally, as researchers and academic institutions alike can be outcomes-driven, finding ways to qualify the impact and effectiveness of Twitter, and to communicate and value these measures within academic research communities are important.

Diffusion of Innovations Theory promotes understanding of how academics use Twitter and offers some direction for developing strategies to increase its use in academic settings. Twitter's popularity is increasing and may soon reach a critical mass, tipping the balance in favour of further adoption (Toole et al. 2012). As the time for early adoption of Twitter has passed, waiting for this critical mass is not enough. Institutions can help by emphasizing the relative advantages of Twitter, such as its low cost, possible reach and high impact potentials. Highlighting parallels between Twitter and other dissemination strategies can promote compatibility with values and experiences. To minimize complexities, promote trialability and increase observability guidelines on Twitter, researchers should benefit from guidelines (e.g. Mollett et al. 2011), Twitter training opportunities and better integration of Twitter into professional conferences and meetings.


M.A. acknowledges the Canadian Child Health Clinician Scientist Program and the Women and Children's Health Research Institute.