Introduction
In modern health care, social media has become an important tool for both patients and professionals. On platforms like Twitter and Instagram, patients can express their experiences, attitudes, and emotions regarding their orthodontic treatment or the available treatment options. This study aimed to investigate orthodontic-related social media use by analyzing the contents of posts made by patients and/or peers and exploring potential differences of users’ attitudes on Twitter and Instagram.
Methods
During a 30-day period, we collected 361 orthodontic-related posts—153 from Twitter and 208 from Instagram—using the same search strategy on both platforms. A mixed-methods approach was applied. First, all posts were structured according to a qualitative content analysis. Subsequently, quantitative analysis was performed to detect potential differences between posts on Twitter and Instagram.
Results
The following main themes were identified: “Getting braces” and “Getting braces removed,” “Limitations due to braces,” “Seeking information,” and “Comedy.” In addition to this classification, all posts were categorized as positive, negative, or neutral. Pictures and emoticons were frequently used to express experiences, attitudes, and emotions regarding orthodontic appliances. There were significant differences between posts on Twitter and those on Instagram; that is, the latter contained more posts that were categorized as positive.
Conclusions
To date, only a few studies addressed the role of social media for orthodontic patients. This study provided insights into the experiences, attitudes, and emotions of patients and their peers regarding orthodontics and helped to reveal the potential impact of social media use on the field of orthodontics. Attention must be paid to the functional differences between Twitter and Instagram because these might lead patients to express themselves in specific ways.
Highlights
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Social media users express both positive and negative thoughts about orthodontics.
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Getting braces and getting them removed are crucial events for orthodontic patients.
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Significant differences in attitudes were found between Twitter and Instagram users.
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The demand for evidence-based information on social media platforms is growing.
Social media is omnipresent. “Follow me on Twitter” or “Follow me on Instagram” can be read almost everywhere in daily life—whether it is in politics, lifestyle, or health care. Social media offers a way to communicate and share information dynamically and interactively. People can express their experiences, thoughts, feelings, and opinions in real time and share these with other social media users. In modern health care, social media has become increasingly important for both professionals and patients. Patients can share personal experiences with their specific treatment or their opinions about the available treatment options. This approach offers new and promising opportunities for researchers and practitioners.
Twitter and Instagram are 2 of the most frequently used social media platforms. On Twitter, founded in 2006, users generally share text-based posts with 140 characters or less and might optionally add pictures or videos, whereas on Instagram, founded in 2010, users generally share pictures and/or short videos and might optionally add a short text. Thus, these social media platforms differ in nature. However, the worldwide use of both platforms has grown exponentially, and with it, their potential importance for health care and health research has also grown. Most posts are publicly available and thus represent an extraordinary research possibility. Users can be observed without disturbing their natural environment, thus there is no Hawthorne effect. In contrast, researchers have to deal with social media–based big data in accordance with crucial principles of traditional human research ethics. To date, there are still no distinct ethical guidelines for using social media data for health research, resulting in a potential dilemma of deciding what should be regarded as private and what should be regarded as public information. However, researchers are obliged to respect certain ethical principles to the best of their judgment.
To date, few studies exist about the use of Twitter related to orthodontics, while there is no study of the use of Instagram in this specific field of health care. Henzell et al qualitatively analyzed orthodontic-related posts on Twitter in New Zealand. Noll et al looked at potential differences between patients’ experiences with braces vs Invisalign by analyzing data on Twitter. Both studies revealed interesting results revolving around positive as well as negative thoughts of orthodontic patients and their meaning for orthodontic care. Another qualitative study about the use of Twitter in the field of orthodontics was conducted by Chan et al with the aim of investigating bullying concerning dentofacial features. Because of the attempt for perfection and beauty among some adolescents and the accompanying danger of being unhappy about not being perfect, this study seems to be crucially important. The authors concluded that social media might help to detect valuable information about the reasons and social settings associated with oral health–related bullying.
Social media might help to identify specific aspects of orthodontic treatment that are relevant for patients but that practitioners are not necessarily aware of at the time. It can be regarded as a mirror of modern culture and current trends. “People are complex and should be studied by watching them, joining in, talking, and reading what they write.” This truthful sentence by Pope and Mays reflects the high importance of the studies, as mentioned above, and further research in this field. Continual investigation of the content on platforms like Twitter and Instagram will lead to a broader view of patients’ perspectives regarding different treatments as such, but also regarding their motivation for treatment and psychosocial impact of orthodontics and/or dentofacial abnormalities on their everyday lives. Importantly, attention has to be paid to the different nature of various social media platforms because it might lead patients to present themselves in specific ways. In this context, Blight et al investigated the potential differences of users’ motives on Twitter and Instagram on a general level. Their findings imply that the visual focus of Instagram might encourage specific behaviors more than it is the case on the primarily text-based platform Twitter. Social interaction motives were reported more often among Instagram users. Lee et al also detected social and psychological motives for using Instagram that might also play a major role for users within our study. One of these motives was self-expression and as a consequence thereof, a favorable presentation of one’s personality and lifestyle. Whether these findings can be replicated with regards to orthodontic-related social media use was a central research question in this study.
The current study used a mixed-methods approach. First, we qualitatively analyzed orthodontics-related posts on Twitter and Instagram to identify major themes for patients. In addition, we quantitatively analyzed the data concerning the potential differences between the two platforms. This research adds new insights into the importance of social media use in the field of orthodontics.
Material and methods
During a 30-day period orthodontic-related, consecutive posts were collected using the same search strategy for both social media platforms. A previous pilot study helped to identify a strategic time for gathering posts as well as to come up with the relevant keywords; these were “braces,” “orthodontics,” and “orthodontist.” In addition, we incorporated the search strategies of relevant literature. The search was limited to German-language posts, originating mainly from predominantly German-speaking countries like Germany, Switzerland, and Austria. Posts were excluded if they were either (1) entirely written in a foreign language, (2) detached from their context and therefore not understandable, (3) advertisements by companies and/or orthodontists, or if they (4) had been reposted by the same or another user. This study was approved by the faculty’s ethical review board (approval no. 19-084).
Data analysis
The study was conducted as a mixed-methods research approach; both qualitative and quantitative research methods were used for different research questions. First, all posts were structured according to Mayring’s qualitative content analysis. This approach combines 2 complementary methodological principles: openness and theory-guided investigation. It facilitates a controlled, inductive step-by-step way of analyzing the given data. Initially, only parts of the collected posts were viewed to come up with relevant themes and categories. Subsequently, all data were analyzed and categorized according to the previously established category system. If there was a novel theme derived from the data, the category system was adapted. This iterative process was performed by two investigators separately as well as jointly to reach a consensus if they arrived at different interpretations. Several main categories were identified. Furthermore, all posts were classified as either positive, negative, or neutral. The digital tool used for qualitative studies and data management was MAXQDA (MAXQDA Standard 12; Release 12.3.6; VERBI GmbH, Berlin, Germany). We used the so-called word clouds to visualize the frequency of words within positive, negative, and neutral posts (MAXQDA 18.2).
In addition, we performed quantitative analyses to investigate potential differences between posts on Twitter and Instagram. We used Pearson chi-square test ( P ≤0.05) to test for differences based on cross-tabulations.
Results
Three hundred and sixty-one orthodontic-related posts—153 from Twitter and 208 from Instagram—were consecutively collected, while 188 posts were excluded. As a result of the categorizing process, according to Mayring, the following main categories were identified: “Getting braces removed” as well as “Getting braces,” “Limitations due to braces,” “Seeking Information,” and “Comedy” ( Fig 1 ). Whenever applicable, posts were categorized into 1 of these categories. Some posts did not match any of these categories but were categorized as being positive, negative, or neutral.
Users frequently used several language tools such as capital letters (eg, OHMYGOD ), long-drawn-out words (eg, I’m soooo excited ) and specific punctuation (eg, !, <3 instead of writing out the word ‘heart’ ). In addition, pictures and special symbols and/or emoticons (eg, xD, =), 😉 ) were posted to express and emphasize feelings and experiences regarding orthodontic appliances.
A large number of users posted their thoughts about getting braces and— even more often—getting their braces removed. Many of them were largely excited about the appointment of appliance removal, while many users who posted about getting new braces appeared to have mixed feelings, both positive and negative. Many posts about getting braces removed contained some sort of count-down to the day of the bracket and/or braces-removal. Most of these posts were accompanied by special symbols and/or emoticons to accentuate thoughts and feelings. First, here are some representative examples of users who posted about getting braces (I, posts on Instagram; T, posts on Twitter).
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(I) Hey guys, I’ll soon get my braces…xD… I can’t wait, so excited about my braces.
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(T) Getting braces in a little while and I am so excited and it’ll start at 8:45 <3
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(T) I really hope that I won’t look like sh∗∗ when I get my braces
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(I) The first hours with my new braces are weird…
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(I) # braces, not happy :/
The following are examples of posts about getting braces removed:
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(I) 1 ½ years have come to an end xD
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(I) After 419 days, 25 pairs of aligners and some pain my attachments were removed today any I got my retaining aligners. That means Project Teeth is successfully finished! =)
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(I) Hello, omg in 8 # days my # braces will be removed… =) I am sooo happy about it… Biting into an # apple again, eating # spinach without worries, chewing on # caramel 😉 OHMYGOD
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(T) As soon as I’ll get my braces off, I’ll be the happiest person 😉 My smile will be a lot nicer 😛
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(T) DONE WITH BRACES !!!
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(T) Btw my orthodontist can keep her promise! In exactly 4 months I’ll get my braces off!
We also identified posts that were related to limitations because of braces. Users posted their experiences with their braces in daily life. Among other things, they made dental pain a subject of discussion. Moreover, issues being raised were eating and speaking problems with regards to their braces and/or appliances. Interestingly, the majority of posts in this category included a touch of irony and/or comedy. Here are some examples of this category:
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(T) I was so happy to be able to chew again and then my orthodontist came up with the fantastic idea of elastics between teeth!
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(T) Yeeeah, just got braces and lisp so hard that I can’t even take myself seriously 😀
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(I) This is how broccoli, kohlrabi and chicken (yes, there’s chicken in it) looks like when you’re not able to eat it . # eatclean # noexcuses # braces # outch , # dentalpain # mash # dinner
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(T) Living with braces is hell. Seriously.
To know what other users think about braces in general but also about their treatment in specific seemed to be relevant for some users. They sought information about treatment options as well as about their own ongoing or planned treatment. Some posts contained questions about other user’s experiences and recommendations.
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(T) Maybe I should see the dentist unscheduled tomorrow or directly go to the orthodontist? Have pain in jaw.
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(I) I am now a braces-wearer; don’t know what to really think about it yet. To everyone who also has braces, please post.
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(I) I have braces now! Should I post some news about it? 3 likes and I’ll do it. Or 1 comment (positive).
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(T) Did you get a retainer after # braces, too? Retainer is broken again…
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(T) Guys, how long does it take when you get braces? And does it hurt at first?
A large portion of posts included comedic elements. Users posted funny aspects of their daily life with their braces as well as fun moments with their orthodontist. Even if users reported about limitations because of braces, as mentioned above, they often added an amusing character to their posts. The irony seemed to play a role within this category. On Instagram, comedic posts were mostly related to funny pictures of the users’ faces. Examples of comedic posts on Twitter are:
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(T) # BrexitOrNot- I always have to think about my braces when it comes to this Brexit-topic. It’s not all that bad: Remain inside and everything will be ok.
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(T) My orthodontist told me to come back next summer rather than in 4 years again xD
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(T) I think I’m the only human being that voluntarily wants to get braces-SOS
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(T) Esch telfsch gescht nescht — Sorry, I don’t really understand what you mean — Oh! (drooling) My fault, I just had to remove my braces before talking
In addition to these categories, all posts were categorized as either positive, negative, or neutral. There were significant differences between these attributes of posts on Twitter and those on Instagram. Posts on Instagram were more likely to be classified as “positive” than posts on Twitter (57.2 % vs 21.6 %, respectively; P <0.001 for total crosstab; Table ).
