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IntroductionKeeping Canadians safe requires a robust public health (PH) system. This is especially true when there is a PH emergency, like the COVID-19 pandemic. Social media, like Twitter and Facebook, is an important information channel because most people use the internet for their health information. The PH sector can use social media during emergency events for (1) PH messaging, (2) monitoring misinformation, and (3) responding to questions and concerns raised by the public. In this study, we ask: what is the Canadian PH risk communication response to the COVID-19 pandemic in the context of social media?Methods and analysisWe will conduct a case study using content and sentiment analysis to examine how provinces and provincial PH leaders, and the Public Health Agency of Canada and national public heath leaders, engage with the public using social media during the first wave of the pandemic (1 January–3 September 2020). We will focus specifically on Twitter and Facebook. We will compare findings to a gold standard during the emergency with respect to message content.Ethics and disseminationWestern University’s research ethics boards confirmed that this study does not require research ethics board review as we are using social media data in the public domain. Using our study findings, we will work with PH stakeholders to collaboratively develop Canadian social media emergency response guideline recommendations for PH and other health system organisations. Findings will also be disseminated through peer-reviewed journal articles and conference presentations.

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BACKGROUND The potential uses and benefits of social media (SM) for public health (PH) are wide-ranging. Health behavior intervention studies using SM have shown some promise for PH practice, and such interventions are appealing due to their ubiquitous nature, mobile accessibility and possible opportunities for research, surveillance and health education. Several systematic reviews have emerged in the PH and SM literature. These syntheses have varied in format, methodologies and other quality markers, such as inclusion and exclusion criteria, types of SM reviewed, and appraisal tools. Umbrella reviews can provide an overall picture of the evidence base, particularly when contradictory findings exist. An umbrella review synthesizes review articles, such as systematic reviews, meta-analyses, as well as reviews in the grey literature. OBJECTIVE Identify, critically appraise and summarize the review literature on how SM is used within PH practice and research. Our research questions were 1) How is SM currently used to support the five core functions of PH practice (e.g., health surveillance, health promotion, health protection, disease and injury prevention, population health assessment)? 2) How is SM used for health equity, social justice and to support action on the social determinants of health? The intended outcome of this paper is to assist practitioners and researchers in navigating the plethora of evidence on using SM for PH. METHODS This umbrella review uses methods from the Joanna Briggs Institute on the reporting of umbrella reviews. Inclusion criteria were: published 2005 or later; peer-reviewed or grey literature employing a review methodology; focused on the five core functions of PH practice; English-language. Two reviewers performed the data collection and extraction. RESULTS A total of 3,571 records were identified from database searches. Forty-eight full-text articles were selected for analysis using the inclusion criteria. The most frequently studied SM platforms were Facebook and Twitter. Most syntheses focused on the ‘health promotion’ theme (n=29), reporting on SM being used for general health, child and youth health, and sexual health promotion interventions. Health surveillance emerged as the second most common theme (n=7), and included topics such as infoveillance and infectious diseases and vaccine uptake. We were unable to locate any relevant synthesis that focused solely on population health assessment, health equity, social justice and the social determinants of health in the context of SM and PH. CONCLUSIONS SM is currently being used in a variety of ways that support PH functions, including health promotion, health surveillance, health protection, and disease and injury protection. While the syntheses included in this report found support for the usage of SM in PH, many primary studies were descriptive or exploratory, and syntheses varied in their study designs and methods. This paper draws attention to the need for additional evidence for the use of SM in PH and highlights the need for future PH-focused studies using SM to focus on health equity and action on the social determinants of health.

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