David Kerr: T(w)eaching – using Twitter to teach patients

David Kerr

In the UK, we usually do it in groups – that is teaching patients with diabetes and other chronic disease how to self manage their condition. For example, a group approach is now used commonly for teaching patients with newly diagnosed type 2 diabetes, for those moving from oral hypoglycemic agents to insulin or when individuals need to start insulin pump therapy. One of the attractions of group teaching is that it is more cost effective for healthcare providers compared to a one on one approach. 

Nevertheless, for the many people living with a chronic disease such as diabetes, learning about complex treatments and monitoring regimes is daunting at the best of times, but particularly so for the poor, the depressed, those with low literacy, and those with English as a second language. Therefore limited literacy and numeracy is likely to be an important barrier preventing many patients from benefitting from using complex medical technologies especially if a high numeracy skill level is required, as is the case for insulin pump therapy. Despite clinicians appearing to approve of receiving notification of patients’ level of health literacy prior to a consultation, in practice they often do not test their patients’ subsequent levels of recall and understanding when discussing new topics and ideas.

SMS (text) messaging has been used as a successful prompt for patients in certain circumstances such as reminders to take insulin or perform a blood glucose test. Wireless transmission of data is also being used to deliver feedback when data are self collected and increasingly start-up technology companies here in Silicon Valley, are becoming involved in developing biofeedback loops using algorithms embedded in smart phone platforms.

The question is whether Twitter (or an equivalent) could be used to support patient education? This would have the advantage that information can be shared at two levels and providing a two-way format – between the group being taught and the wider audience outside. The limitation of 140 characters would have the potential to reduce the possibility of introducing literacy and numeracy barriers as there is not enough space for big words and complex calculations. But this approach will require a Twitter dictionary of health terms and abbreviations to be available and agreed by healthcare providers.

The other advantage of T(w)eaching is the opportunity for standardising the content of an education program. At present there are many different ways to teach insulin initiation or how to use an insulin pump. It must be possible to describe and summarise the steps involved into 140 character twitter “bites” that could be used to support patient training. These could be tweeted at specific intervals following the initial patient education session and may also have the additional benefit of reducing the need for multiple return visits to the hospital or GP surgery. T(w)eaching also has the huge advantage of  allowing two way communication between patients and education providers and also input from others experienced in the use of the medical technology. The content of a live stream of “tweets” will need to be policed by the healthcare provider at regular intervals.

The media use Twitter to promote their headlines and news, and celebrities like it for its PR potential. Businesses use it to hype their products but beyond these the value of Twitter is difficult to determine. Increasingly healthcare professionals are using the genre to communicate with each other but perhaps the time has come to use Twitter for improving communication between clinicians and patients. T(weaching) will never become a substitute for “eyeball to eyeball” teaching and especially group programs but it could add significant value and perhaps reduce cost. After all patient education, at least in diabetes, is moderately successful at best and as school reports use to say – there is room for improvement.”

David Kerr is the managing editor of the Journal of Diabetes Science and Technology.

  • amcunningham

    I know you are the editor of a Journal of Diabetes Science and Technology but you demonstrate little understanding of the principles of education here. People with diabetes are not empty vessels to be filled with a standardised education programme. They are people who already have full lives with many stresses, strains and joys. Managing diabetes is about figuring out how the strategies which help improve outcomes can be fitted into one's life. It is a messy process. It involves ongoing dialogue with professionals, friends, family and patient peers.
    Some may choose to use public social media for part of that dialogue. Peer to peer communication is likely to be very useful. But they should at least have the choice of using a private and secure channel if they wish.
    Please see the comments on this post to understand who nuanced this discussion can be.
    Best wishes,
    Anne Marie

  • Passerby

    I'm an Ed Tech who's main professional network is twitter. Because of this, I'm doing my best to conceal that I'm a recently diagnosed Type I diabetic. This is not the thing I wish bandied about twitter by realtive strangers. My employment prospects will nose dive. All of my knowledge and motivation has come from family and my excellent diabetic team – not from relative strangers.

  • Dear David Kerr,

    You may need to consider also all the issues related with the several eHealth digital divides, otherwise we would have to start talking about 'Inverse care law 2.0'


  • Info

    Anne Marie
    Thank you. May I refer you to the final paragraph – twitter will never become a substitute for “eyeball to eyeball teaching and especially group programs”.. My point is the potential of the new media to support patient education. I have been involved with diabetes patients for more than 20 years and I understand many of the issues. My plea is to guide technology development and application for patients although the point about the exisitng digital divide is well taken.

    David Kerr

  • amcunningham

    Yes, I did read the last paragraph. As you know from our Twitter discussion yesterday, my very strong belief is that one has to spend some time seeing what it is like to learn and interact in open, public social media spaces, before thinking about how to guide development for patients. 

    My plea is that we spend longer thinking about the problems we are trying to solve with technology. It's then much more likely that we will see success in implementation. Technology may have changed the way that many of us access the news or buy books, but that doesn't mean it will have much impact on those with difficulties managing their diabetes.

    If you have time please have a look at this post as well and see our discussion in the comments.

    Thanks for your reply.