PurposeThis study aims to examine how different hospitals utilize social media to communicate risk information about COVID-19 with the communities they serve, and how hospitals' social media messaging (firm-generated content and their local community's responses (user-generated content) evolved with the COVID-19 outbreak progression.Design/methodology/approachThis research proposes a healthcare-specific social media analytics framework and studied 68,136 tweets posted from November 2019 to November 2020 from a geographically diverse set of ten leading hospitals' social media messaging on COVID-19 and the public responses by using social media analytics techniques and the health belief model (HBM).FindingsThe study found correlations between some of the HBM variables and COVID-19 outbreak progression. The findings provide actionable insight for hospitals regarding risk communication, decision making, pandemic awareness and education campaigns and social media messaging strategy during a pandemic and help the public to be more prepared for information seeking in the case of future pandemics.Practical implicationsFor hospitals, the results provide valuable insights for risk communication practitioners and inform the way hospitals or health agencies manage crisis communication during the pandemic For patients and local community members, they are recommended to check out local hospital's social media sites for updates and advice.Originality/valueThe study demonstrates the role of social media analytics and health behavior models, such as the HBM, in identifying important and useful data and knowledge for public health risk communication, emergency responses and planning during a pandemic.