RESEARCH ARTICLE Evolving use of social media among Chinese urologists: Opportunity or challenge? Xingbo Long1¤a¤d, Lin Qi1¤b, Zhenyu Ou1¤b, Xiongbing Zu1¤b, Zhenzhen Cao2¤c, Xiting Zeng3¤b, Yuan Li1¤b, Minfeng Chen1¤b, Zhao Wang1¤b, Long Wang1¤b* 1 Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China, 2 Department of Gynecologic Oncology, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China, 3 Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China ¤a Current address: Tianyuan district, Changsha, Hunan, China ¤b Current address: Kaifu district, Changsha, Hunan, China ¤c Current address: Yuelu district, Changsha, Hunan, China ¤d Current address: Department of Urology, ZhuZhou Central Hospital (the affiliated ZhuZhou Hospital Xiangya Medical College Central South University), Zhuzhou, Hunan, China. a1111111111 * [email protected] a1111111111 a1111111111 a1111111111 a1111111111 Abstract Background Social media has revolutionized the way people communicate, and it has been widely incor- OPEN ACCESS porated into medical practice. However, limited data are available regarding the use of social Citation: Long X, Qi L, Ou Z, Zu X, Cao Z, Zeng X, media by Chinese urologists in their practice. et al. (2017) Evolving use of social media among Chinese urologists: Opportunity or challenge? PLoS ONE 12(7): e0181895. https://doi.org/ Methods 10.1371/journal.pone.0181895 From 2014 to 2016, during the China Urological Association's (CUA) Annual National Mini- Editor: Neal Shore, Carolina Urologic Research mally Invasive Urology Academic Conference, an anonymous survey on social media Center, UNITED STATES usage was distributed to participant urologists. Received: January 22, 2017 Accepted: July 10, 2017 Results Published: July 28, 2017 The results of the survey, which was completed by 665 participants, indicate a conspicuous increase in social media use during the last three years. Regression analysis showed that Copyright: © 2017 Long et al. This is an open access article distributed under the terms of the year (2014 compared to 2016 and 2015), institute location (in the eastern region of China) Creative Commons Attribution License, which and age (<35 y) were independent predictors of social media use. Rather than for personal permits unrestricted use, distribution, and use, an increasing number of respondents said they used social media for professional pur- reproduction in any medium, provided the original poses, and for most respondents, social media has had a positive impact on their practice. author and source are credited. However, when posting information on social media, few respondents were aware of the Data Availability Statement: All relevant data are issue of protecting patients' privacy. within the paper and its Supporting Information files. Conclusions Funding: The authors received no specific funding for this work. Our study demonstrates a dramatic increase in social media use among Chinese urologists, Competing interests: The authors have declared which provides great opportunities for online academic communication and medical educa- that no competing interests exist. tion. However, unprofessional use of social media in the medical practice may bring about PLOS ONE | https://doi.org/10.1371/journal.pone.0181895 July 28, 2017 1 / 11 Social media use among Chinese urologists potential risks and challenges for the further development of social media in medical practice. Introduction With the rise of the Internet and smart phones, social media has revolutionized people's daily lives and business interactions as well as how they develop personal and professional relation- ships. This new technology provides easy access to rapid networking, communication, and instantaneous consultations and lectures [1]. The limits of time and space have been overcome, and everyone can obtain desired information anytime or anywhere simply by touching their smart phones. The use of social media by medical staff has grown substantially over the past decade. Social media, including blogs, Facebook, Twitter, LinkedIn and many other networking options, has been widely used in areas throughout medical practice, such as medical meetings and confer- ences[2,3], peer communication[4], medical education[5,6], patient management and educa- tion[7], public health[8], patient recruitment for studies and trials[9] and medical advertising [7]. Although emerging social media brings great merits and conveniences to medical practice, professionals and medical students alike continue to find themselves in ethical, professional, and/or legal trouble[10, 11,12]. Today, social media use is on the rise in urology, with participation from all of the major urology organizations, journals and meetings [13±16]. It has been reported that 74% of Ameri- can Urological Association members [3] and 70% of Australian and New Zealand urologists [15] own social media accounts. A previous study reported a dramatic increase in the number of tweets sent at the annual meetings of the American Urological Association (AUA) and Canadian Urological Association (CUA) between 2012 and 2013[15]. Moreover, social media use was considered beneficial for networking, sharing information about research and technol- ogy, career development, and advocacy by urologists during the annual meetings of the AUA and the European Association of Urology in 2014[17,18]. However, until recently, the role of social media among Chinese urologists has been some- what limited. Most social media platforms used in Western countries are not available in China. Chinese people have their own original social media platforms such as WeChat, QQ and RenRen (a hybrid open social media platform similar to Facebook) as well as microblog (an open social media platform similar to blogs and Twitter). The purpose of this study was to evaluate social media use among Chinese urologists and the perceived impact of social media on their practice. Materials and methods Our study was approved by the ethics committee of Xiangya Hospital, Central South Univer- sity. From 2014 to 2016, during the CUA Annual National Academic Conference on Mini- mally Invasive Urology, attendees of the meeting of urological surgeons were invited to complete an anonymous 19-item questionnaire (in 2016, 3 more questions were added to the survey, for 22 questions in total; see S1 Fig). The questionnaire was piloted by the authors and a separate group of urologists in Hunan Province based on two previous surveys[19,20]. The survey took approximately 10 minutes to complete and queried respondents about their per- sonal and professional use of social media. The survey was randomly sent to urologists present at the conference. All of those surveyed were screened to ensure that they were active in clinical PLOS ONE | https://doi.org/10.1371/journal.pone.0181895 July 28, 2017 2 / 11 Social media use among Chinese urologists practice. Demographic information in the survey questionnaire included the respondent's age, field of expertise, years in practice, gender, level of the hospital and institute location. In regard to institute location, we provided three options based on China's economic geography from which participants chose: the eastern region (relatively developed areas), the western region (underdeveloped areas), and central region (between east and west). Before the survey was closed on 10 June 2016, 200, 300 and 320 anonymous questionnaires were sent out during the CUA's Annual Meeting on Minimally Invasive Urology in the years 2014, 2015 and 2016, respectively. Statistical analysis The completed questionnaires were carefully collected and analyzed, and variables regarding respondents' demographic information of respondents and social media use in the different years were compared using a chi-square test or Fisher's exact test as appropriate. To determine predictive factors for having social media accounts, logistic regression analysis was used in uni- variate and multivariate models. Statistical tests were two-sided, and a P value <0.05 was taken as a measure of statistical significance. Data were analyzed using SPSS version 19.0. (IBM Corp., Armonk, NY, USA). Results A total of 157, 242 and 266 survey questionnaires were completed, resulting in response rates of 78.5%, 80.7% and 83.1% during the years 2014, 2015 and 2016, respectively. No significant differences could be found between the years. Table 1 shows the demographics of the study population grouped by year. Social media use increased dramatically in the last three years, and more respondents used social media for professional purposes There was a significant increase in the percentage of survey respondents who indicated that they have an online social media presence, which rose from 50.3% in 2014 to 82.7% in 2016 (Fig 1A, P<0.001). The survey results also suggested that the frequency with which respon- dents accessed their social media accounts increased over the years (Fig 1B). A regression analysis showed that year (2016 and 2015), institute location (in the eastern region of China) and age (<35 y) were independent predictors of respondents having social media accounts (Table 2). Of all the respondents with an online social media account, WeChat accounts were the most common (92.8%), followed by QQ (83.5%), Weibo (63.0%), RenRen (26.0%), and Linke- dIn (11.2%). No significant differences could be found between the years.