Background An increasing number of medical journals are using social media to promote themselves and communicate with their readers. However, little is known about how medical journals use Twitter and what their social media management strategies are. Objective This study aimed to understand how medical journals use Twitter from a global standpoint. We conducted a broad, in-depth analysis of all the available Twitter accounts of medical journals indexed by major indexing services, with a particular focus on their social networks and content. Methods The Twitter profiles and metadata of medical journals were analyzed along with the social networks on their Twitter accounts. Results The results showed that overall, publishers used different strategies regarding Twitter adoption, Twitter use patterns, and their subsequent decisions. The following specific findings were noted: journals with Twitter accounts had a significantly higher number of publications and a greater impact than their counterparts; subscription journals had a slightly higher Twitter adoption rate (2%) than open access journals; journals with higher impact had more followers; and prestigious journals rarely followed other lesser-known journals on social media. In addition, an in-depth analysis of 2000 randomly selected tweets from 4 prestigious journals revealed that The Lancet had dedicated considerable effort to communicating with people about health information and fulfilling its social responsibility by organizing committees and activities to engage with a broad range of health-related issues; The New England Journal of Medicine and the Journal of the American Medical Association focused on promoting research articles and attempting to maximize the visibility of their research articles; and the British Medical Journal provided copious amounts of health information and discussed various health-related social problems to increase social awareness of the field of medicine. Conclusions Our study used various perspectives to investigate how medical journals use Twitter and explored the Twitter management strategies of 4 of the most prestigious journals. Our study provides a detailed understanding of medical journals’ use of Twitter from various perspectives and can help publishers, journals, and researchers to better use Twitter for their respective purposes.

BACKGROUND An increasing number of medical journals are using social media to promote themselves and to communicate with their readers. However, little is known about how medical journals use Twitter and what their social media management strategies are. OBJECTIVE To understand how medical journals use of Twitter from a global standpoint, we conducted a broad, in-depth analysis of all the available Twitter accounts of medical journals indexed by major indexing services, with a particular focus on their social networks and content. METHODS The Twitter profiles and metadata of medical journals were analyzed, along with the social networks on their Twitter accounts. RESULTS The results showed that overall, publishers used different strategies regarding Twitter adoption, Twitter usage patterns, and their subsequent decisions. The following specific findings were noted. 1) Journals with Twitter accounts had a significantly higher number of publications and a greater impact than their counterparts. 2) Subscription journals had a slightly higher (2%) Twitter adoption rate than open access journals. 3) Journals with higher impact had more followers. 4) Prestigious journals rarely followed other lesser-known journals on social media. Additionally, an in-depth analysis of 2,000 randomly selected tweets from four prestigious journals revealed that The Lancet had dedicated considerable effort to communicating with people about health information and fulfilling its social responsibility by organizing committees and activities to engage with a broad range of health-related issues; The New England Journal of Medicine and the Journal of the American Medical Association focused on promoting research articles and attempting to maximize the visibility of their research articles; while the British Medical Journal provided copious amounts of health information and discussed various health-related social problems to increase social awareness of the field of medicine. CONCLUSIONS Our study used various perspectives to investigate how medical journals use Twitter and explored the Twitter management strategies of four of the most prestigious journals. Our study provides a detailed understanding of medical journals’ use of Twitter from various perspectives and can help publishers, journals, and researchers better utilize Twitter for their respective purposes.