PONE-D-23-19309Impact of the Covid-19 Pandemic on Audiology Service Delivery: Observational Study of the Role of Social Media in Patient CommunicationPLOS ONE

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Additional Editor Comments:

Thanks for submitting your paper to Plos One. It is an important topic and these impacts will most likely have long-term impacts. I have some additional concerns that are not mentioned by the two reviewers. They are listed here.

1--Please spell out NHS the first time. I know in the UK it is well known but it took me a minute to get it.

2--On line 22, please start a new paragraph

3--line 32 has a change in topic so please be sure your paragraph is internally consistent

4--Your introduction is extremely brief. COVID was not the first time that this type of service was online. I checked and there is a long history of moving towards this type of service. Please expand the introduction.

5--CrowdTangle (notice the Capital T) is not common knowledge. Therefore, you are going to need to explain that system in more detail. Also you have it spelled two different was":Crowd Tangle and Crowdtangle. Please use the correct name.

6--please define API

7--It is not clear what parameters you are targeting. Please expand on exactly what are your parameters of interest.

8--Please separate the results and discussion

9--you need a better key to explain Figure 1. I still am not clear what the colors mean

10--Table 1 is redundant to the text so please delete it. Rule is either a table or in the text--one or the other

11--You need more interpretation of your results

12--Table 2 needs to be expanded for clarity.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Reviewer comments re: "Impact of the Covid-19 Pandemic on Audiology Service Delivery: Observational Study of the Role of Social Media in Patient Communication"

See article comment bubbles for grammar and related comments.

The methodology employed in the study appears to be sound for the specific research question and objectives stated in the paper. The researchers aimed to investigate how NHS audiology departments in the UK utilized social media to communicate service changes during the Covid-19 pandemic. To achieve this goal, they collected data from Facebook and Twitter, focusing on a specific time frame (March 23 to April 30, 2020) that coincided with the initial announcement of the first UK lockdown.

The use of data extraction tools like Crowd tangle and Twitter API for collecting relevant posts aligns with the objective of analyzing social media communication. The researchers applied specific search terms to ensure comprehensive results and filtered the data manually to include only posts directly linked to NHS audiology service communication. Moreover, the study considered ethical considerations and data privacy laws, as the information was gathered from the public domain.

The geospatial mapping and interaction analysis were appropriate methods for analyzing the geographic distribution of posts and understanding user engagement with the content. The study also acknowledged its limitations, such as the inability to access private communications, which may have impacted the comprehensive understanding of all communication strategies.

Considering the research question and objectives, the methodology used allowed the researchers to gain insights into how NHS audiology departments used social media to communicate service changes during the pandemic. However, it is essential to recognize that the study's scope is specific to social media usage during a particular period and may not address all aspects of audiology service changes comprehensively.

SUGGESTIONS - To further enhance the study's depth and gain additional insights, the researchers could have considered conducting the following analyses:

Content Analysis: Instead of solely focusing on the number of interactions (likes, shares, comments), the researchers could have performed a content analysis of the posts. This analysis would involve categorizing the posts based on the type of information shared (e.g., changes in appointments, teleaudiology services, hearing aid maintenance), the tone of the messages (e.g., informative, reassuring, urgent), and the overall effectiveness of the communication.

Sentiment Analysis: By employing sentiment analysis, the researchers could assess the emotional tone of the social media posts. This analysis would help determine whether the messages conveyed by the audiology departments were perceived positively, negatively, or neutrally by the audience. Sentiment analysis can provide valuable insights into how well-received the service changes were among patients.

Comparison with Traditional Communication Channels: In addition to analyzing social media usage, the researchers could have compared the effectiveness of social media as a communication channel with more traditional methods like emails, SMS, or letters. By surveying patients who received information through different channels, the researchers could gauge the preferences and efficacy of various communication methods.

Longitudinal Analysis: The study focused on a specific six-week period during the initial announcement of the UK lockdown. A longitudinal analysis covering multiple time periods (e.g., before, during, and after the lockdown) could reveal how communication strategies evolved over time and how patients' responses changed as the pandemic progressed.

Qualitative Interviews or Surveys: To gain a more comprehensive understanding of patient perspectives and experiences, the researchers could have conducted qualitative interviews or surveys with patients who interacted with the audiology departments' social media posts. These interviews could provide valuable insights into patients' satisfaction, comprehension of information, and suggestions for improvement.

Comparison with Other Healthcare Specialties: The study focused on audiology service changes, but a broader analysis comparing social media communication practices across various healthcare specialties could highlight similarities, differences, and best practices for effective communication during a public health crisis.

Analysis of Responses to Misinformation: Since the study touched upon concerns about the credibility of information shared on social media, the researchers could have analyzed responses to misinformation related to audiology services during the pandemic. This analysis could help identify potential challenges in combating false or misleading content.

Cost-Benefit Analysis: A cost-benefit analysis of using social media as a communication channel could provide insights into the resource allocation for social media efforts compared to other communication methods. This analysis would be useful in determining the most cost-effective ways to reach and engage with patients.

By incorporating these additional analyses, the researchers could have gained a more comprehensive understanding of the role and impact of social media in engaging audiology consumers during the Covid-19 pandemic and beyond.

Reviewer #2: p. 2, lines 32-33: You cite a study concluding that Facebook and Twitter are the most commonly used types of social media. Was any effort made to determine the types of social media most commonly used by the ages and other demographics of people who tend to use audiology services more regularly than others? Given that older adults are one of the largest groups seen by audiologists and that "presbycusis" was one of your search terms, I'm wondering whether your choices of Facebook and Twitter were based at all on older adult social media use patterns.

Also on the topic of populations that use audiology services: the search terms that you list seem primarily focused on adult audiology services. Were pediatric audiology services included in the social media posts that you analyzed? Or was this study primarily about adult audiology services?

p. 3, lines 94-95: Is there a reason to believe that only hearing aid users are interacting with these posts and therefore represented in the total number of interactions? The meaning of the sentence here isn't entirely clear to me. Are you trying to point out that not all hearing aid users are being reached by social media posts? Something else?

p. 4, lines 110-111: Why is YouTube coming up this far into the paper when Facebook and Twitter were the platforms used for collecting data for the study? And if 40% of participants reported using Facebook and YouTube in the study you cite at this point in the paper, is there a reason that you didn't use YouTube as a data source? I see that later in the paper, you mention YouTube as a future direction. Still, the mention of YouTube in the Results and Discussion section is somewhat confusing.

This paper addresses an important topic for audiology services. The transition from in-person to virtual services at the beginning of the pandemic was jarring for many audiologists around the world, and understanding how different health systems used social media to keep patients informed will be helpful for improving how we use social media in audiology.

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Reviewer #1: No

Reviewer #2: No

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Submitted filename: PONE-D-23-19309_reviewer.pdf

Impact of the Covid-19 Pandemic on Audiology Service Delivery: Observational Study of the Role of Social Media in Patient Communication

PONE-D-23-19309R1

Dear Dr. Hussain,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Mary Diane Clark, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for your work on this revision. I enjoyed reading this revision and believe it will make an important contribution. I have recommend acceptance.

Reviewers' comments: