Melissa Brunner is a speech pathologist currently enrolled in her PhD which investigates the use of Twitter for communication and information exchange for those with Traumatic Brain Injury (TBI). In this interview, we explore how she ended up in this field, why it’s important, and the challenges she has faced to date.
Can you tell us a little about your research and what led you into this area?
As a speech pathologist, I am invested in the application of evidence based practice and achieving the best outcomes possible for people with acquired neurogenic communication or swallowing disorders. One of my first experiences in clinical research was through working at speechBITE (www.speechbite.com), a database of evidence in speech pathology, and from there I moved into eHealth research roles. In 2013 while providing social media support for speechBITE, my interest in social media, and in particular Twitter, grew as I could see technology being used to help spread high quality evidence, and improve health outcomes. I became aware that Twitter is starting to be used to improve communication and networking between health professionals and agencies globally, and as a way to link people with communication disability with information and communication partners. In 2014 I obtained a PhD scholarship and enrolled part-time in a PhD, which is now confirmed as I enter my third part-time year of study. I have also continued to work part time as a researcher in eHealth at the University of Sydney.
My PhD research is investigating the use of Twitter for communication and exchanging information for people who have had a TBI. People with TBI often have difficulties with social communication, cognitive-communication, and executive function, often resulting in a significant loss in friendships even within the first year after injury. Social networking sites, such as Twitter, use shorter messages, focus less on correct spelling and grammar, and enable @users to include photos or videos. The reduced demands on literacy skills and increased opportunities for online interactions potentially benefit people with TBI. Use of online communication platforms such as Twitter can give the person time to think, comprehend, and respond in a way that face-to-face conversations may not. Given social media is now common place in everyday life for many people, it is likely that people with a TBI already use social media prior to their injuries. Regaining function in their online social worlds may be a personally relevant and meaningful goal, which can facilitate improved outcomes in rehabilitation.
What implications do you think this work has in the field or practice (e.g. clinical care if relevant)?
My meta-synthesis review of the literature about social media and TBI highlighted the lack of research in social media use by people with a TBI (Brunner et al., 2015 – http://www.tandfonline.com/doi/full/10.3109/09638288.2015.1045992). Despite this group’s vulnerability to problems in social communication, people with TBI want to use social media but at present there is no research guiding the use of these platforms in the light of the brain injury or the person’s rehabilitation. Most literature at the moment focuses upon risks, but does not consider the potential benefits, or ways to support people with TBI to use social media, including Twitter which is a public platform, safely. Thus, there is no information on the benefits or risks this group face in Twitter, and no information on ways to reduce the risks associated with Twitter use by for people with communication disabilities after a TBI. Furthermore, most of the studies included in the review related to Facebook. People with TBI have the same rights as other people to use a wide range of social media tools and technologies, but to date there are no studies investigating ways to support them in using social media, including Twitter, safely.
I have also reviewed the use of technology in cognitive-communication rehabilitation after TBI (Brunner et al. (2017). Technology and its role in rehabilitation for people with cognitive-communication disabilities following a Traumatic Brain Injury (TBI). Brain Injury, in press – accepted 2 February 2017). Despite an extant literature on technology in TBI, there is very little relating to technology to treat ‘cognitive communication impairment’, and almost none reflecting the massive growth in information communication technologies that could help people with TBI. There is also no clinical guidance available on how to implement technology in TBI rehabilitation successfully. The outcomes of the review included a theoretical model showing the multiple factors relating to use of technology by or with people after TBI. These factors were : (i) individual needs, motivations, and goals in relation to technology; (ii) individual impairments, activities, participation, and environmental factors affecting technology use; and (iii) tools and technologies. The model provides an evidence-based framework for incorporating technology into clinical practice and research. However, more research is needed to investigate which interventions or combination of strategies might address factors fundamental for success in using technology in TBI rehabilitation.
The findings of my PhD research will address these knowledge gaps and provide guidance and information for helping people with TBI to use social media safely and enjoyably. My research involves multiple methods. I recently conducted a ‘hashtag study’ to examine the Twitter communities using TBI-related hashtags, determine the content of conversations about TBI in Twitter, and analyse the network density of people using Twitter to interact in relation to TBI. I am currently interviewing people with a TBI about their experiences using Twitter in the context of their use of other social media platforms. Following this, the aim is to develop, trial, and evaluate an intervention for them to learn ‘How to use Twitter’ to optimize their tweeting strategies, to reduce barriers and enhance facilitators for using the platform safely and enjoyably. This research will inform TBI cognitive-communication rehabilitation using social media technologies.
What have been the biggest challenges that you’ve faced in your research so far?
Communicative disabilities are common following TBI and so recruitment is a challenge in this ‘hard to reach’ population. Being persistent and having a positive approach to achievements, as well devising various ways of recruiting people with small modifications to recruitment sampling has helped build up the numbers of participants in my research progressively. Using social media for recruitment has been particularly helpful in reaching the minority population of people with TBI who might be interested in social media research and willing to participate.
Have you had any surprises or unexpected findings along the way?
Having just completed an analysis of tweets by TBI Twitter communities (Brunner et al. 2017, in prep), I was surprised to discover that many people with TBI were tweeting about their lives and feelings after their TBI, but rarely discussed their rehabilitation or research. It was also interesting to note how few health professionals use Twitter to discuss research and its clinical implications. Many health professionals were tweeting or retweeting links to new research, but not discussing it in the context of the real world and how it may apply to individuals with TBI. Findings in the study showed that Twitter is an important social media platform but as yet is underutilised by people with TBI and the communities that support them, and researchers engaged in TBI research translation.
What advice would you have for someone with an interest in this area of research? Any useful resources or networks they should know about?
Twitter research is multi-disciplinary, and there is a lot of information available now which explains Twitter research methods. Be prepared to immerse yourself in a ‘dynamic environment’ as social media platforms are constantly changing – along with the resources designed to help!
I would recommend anyone involved in health research or health service delivery join Twitter and become engaged in conversations and communities around their area of interest. Twitter is now recognised as a source of information and for networking, but does require some degree of skill and strategy to find credible sources and to build up networks that enable people to ‘be heard’ amidst all the tweets. The @WeSpeechies community is a ‘rotation curation’ Twitter account, among several others in the field of health and health research (try @WePublicHealth and @IndigenousX for other communities). Established Twitter networks and tweeters are often generous and can provide support and links to evidence, clinicians, and researchers worldwide. People also need to support the newly developed @digitalhealthn community – it will be growing to support researchers involved in eHealth research. Using hashtags to connect in the #eHealth space will also help, so a variety of tags are #MyHealthRecord (for Australia’s new eHealth record), #DigitalHealth, #mHealth. Taking part in ‘hashtag chats’ is also good practice for effectively using the medium. This will help people to learn more about how Twitter research works.
Melissa Brunner is a Certified Practising Speech Pathologist (CPSP) and PhD Candidate at the University of Newcastle investigating the use of social media, including Twitter, by people with traumatic brain injury (TBI). Her research will yield important insights into how people with TBI might be supported to use Twitter for communication, participation, and inclusion in online communities. Melissa’s research advisors are Associate Professor Bronwyn Hemsley at the University of Newcastle, Associate Professor Stuart Palmer at Deakin University, Dr Stephen Dann at the Australian National University, and Professor Leanne Togher at the University of Sydney. Melissa’s research is supported in part by an Australian Government Research Training Program Scholarship through the University of Newcastle.
Recent publications: Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)