The Potential Role of Social Media Platforms in Community Awareness of Antibiotic Use in the Gulf Cooperation Council States: Luxury or Necessity?
Identifieur interne : 000046 ( Pmc/Corpus ); précédent : 000045; suivant : 000047The Potential Role of Social Media Platforms in Community Awareness of Antibiotic Use in the Gulf Cooperation Council States: Luxury or Necessity?
Auteurs :Source :
- Journal of Medical Internet Research [ 1439-4456 ] ; 2015.
Abstract
The increasing emergence and spread of antimicrobial resistance (AMR) is a serious public health issue. Increasing the awareness of the general public about appropriate antibiotic use is a key factor for combating this issue. Several public media campaigns worldwide have been launched; however, such campaigns can be costly and the outcomes are variable and difficult to assess. Social media platforms, including Twitter, Facebook, and YouTube, are now frequently utilized to address health-related issues. In many geographical locations, such as the countries of the Gulf Cooperation Council (GCC) States (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain), these platforms are becoming increasingly popular. The socioeconomic status of the GCC states and their reliable communication and networking infrastructure has allowed the penetration and scalability of these platforms in the region. This might explain why the Saudi Ministry of Health is using social media platforms alongside various other media platforms in a large-scale public awareness campaign to educate at-risk communities about the recently emerged Middle East respiratory syndrome coronavirus (MERS-CoV). This paper discusses the potential for using social media tools as cost-efficient and mass education platforms to raise awareness of appropriate antibiotic use in the general public and in the medical communities of the Arabian Peninsula.
Url:
DOI: 10.2196/jmir.3891
PubMed: 26471079
PubMed Central: 4642378
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PMC:4642378Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Potential Role of Social Media Platforms in Community Awareness of Antibiotic Use in the Gulf Cooperation Council States: Luxury or Necessity?</title></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26471079</idno><idno type="pmc">4642378</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642378</idno><idno type="RBID">PMC:4642378</idno><idno type="doi">10.2196/jmir.3891</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000046</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000046</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Potential Role of Social Media Platforms in Community Awareness of Antibiotic Use in the Gulf Cooperation Council States: Luxury or Necessity?</title></analytic><series><title level="j">Journal of Medical Internet Research</title><idno type="ISSN">1439-4456</idno><idno type="eISSN">1438-8871</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The increasing emergence and spread of antimicrobial resistance (AMR) is a serious public health issue. Increasing the awareness of the general public about appropriate antibiotic use is a key factor for combating this issue. Several public media campaigns worldwide have been launched; however, such campaigns can be costly and the outcomes are variable and difficult to assess. Social media platforms, including Twitter, Facebook, and YouTube, are now frequently utilized to address health-related issues. In many geographical locations, such as the countries of the Gulf Cooperation Council (GCC) States (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain), these platforms are becoming increasingly popular. The socioeconomic status of the GCC states and their reliable communication and networking infrastructure has allowed the penetration and scalability of these platforms in the region. This might explain why the Saudi Ministry of Health is using social media platforms alongside various other media platforms in a large-scale public awareness campaign to educate at-risk communities about the recently emerged Middle East respiratory syndrome coronavirus (MERS-CoV). This paper discusses the potential for using social media tools as cost-efficient and mass education platforms to raise awareness of appropriate antibiotic use in the general public and in the medical communities of the Arabian Peninsula.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zowawi, H" uniqKey="Zowawi H">H Zowawi</name></author><author><name sortKey="Balkhy, H" uniqKey="Balkhy H">H Balkhy</name></author><author><name sortKey="Walsh, T" uniqKey="Walsh T">T Walsh</name></author><author><name sortKey="Paterson, D" uniqKey="Paterson D">D Paterson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lipsitch, M" uniqKey="Lipsitch M">M Lipsitch</name></author><author><name sortKey="Samore, M" uniqKey="Samore M">M Samore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mauldin, P" uniqKey="Mauldin P">P 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Med Internet Res</journal-id><journal-id journal-id-type="iso-abbrev">J. Med. Internet Res</journal-id><journal-id journal-id-type="publisher-id">JMIR</journal-id><journal-title-group><journal-title>Journal of Medical Internet Research</journal-title></journal-title-group><issn pub-type="ppub">1439-4456</issn><issn pub-type="epub">1438-8871</issn><publisher><publisher-name>JMIR Publications Inc.</publisher-name><publisher-loc>Toronto, Canada</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26471079</article-id><article-id pub-id-type="pmc">4642378</article-id><article-id pub-id-type="publisher-id">v17i10e233</article-id><article-id pub-id-type="doi">10.2196/jmir.3891</article-id><article-categories><subj-group subj-group-type="heading"><subject>Viewpoint</subject></subj-group><subj-group subj-group-type="article-type"><subject>Viewpoint</subject></subj-group></article-categories><title-group><article-title>The Potential Role of Social Media Platforms in Community Awareness of Antibiotic Use in the Gulf Cooperation Council States: Luxury or Necessity?</article-title></title-group><contrib-group><contrib contrib-type="editor"><name><surname>Eysenbach</surname><given-names>Gunther</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="reviewer"><name><surname>Dunais</surname><given-names>B</given-names></name></contrib><contrib contrib-type="reviewer"><name><surname>Castro-Sánchez</surname><given-names>Enrique</given-names></name></contrib></contrib-group><contrib-group><contrib id="contrib1" contrib-type="author"><name><surname>Zowawi</surname><given-names>Hosam Mamoon</given-names></name><degrees>BSc, MSc (Hons)</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-9718-6475</contrib-id></contrib><contrib id="contrib2" contrib-type="author"><name><surname>Abedalthagafi</surname><given-names>Malak</given-names></name><degrees>MD, MBA</degrees><xref ref-type="aff" rid="aff4">4</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-1786-3366</contrib-id></contrib><contrib id="contrib3" contrib-type="author"><name><surname>Mar</surname><given-names>Florie A</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff5">5</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-8342-5976</contrib-id></contrib><contrib id="contrib4" contrib-type="author"><name><surname>Almalki</surname><given-names>Turki</given-names></name><degrees>MBBS</degrees><xref ref-type="aff" rid="aff6">6</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-7540-8954</contrib-id></contrib><contrib id="contrib5" contrib-type="author"><name><surname>Kutbi</surname><given-names>Abdullah H</given-names></name><xref ref-type="aff" rid="aff6">6</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-8964-1052</contrib-id></contrib><contrib id="contrib6" contrib-type="author"><name><surname>Harris-Brown</surname><given-names>Tiffany</given-names></name><degrees>RN, MPH</degrees><xref ref-type="aff" rid="aff1">1</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-1229-7863</contrib-id></contrib><contrib id="contrib7" contrib-type="author"><name><surname>Harbarth</surname><given-names>Stephan</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="aff7">7</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-3551-1025</contrib-id></contrib><contrib id="contrib8" contrib-type="author"><name><surname>Balkhy</surname><given-names>Hanan H</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-6968-2834</contrib-id></contrib><contrib id="contrib9" contrib-type="author"><name><surname>Paterson</surname><given-names>David L</given-names></name><degrees>MBBS, PhD</degrees><xref ref-type="aff" rid="aff1">1</xref><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-0826-0654</contrib-id></contrib><contrib id="contrib10" contrib-type="author" corresp="yes" equal-contrib="yes"><name><surname>Hasanain</surname><given-names>Rihab Abdalazez</given-names></name><degrees>BSc, MA (Hons)</degrees><xref ref-type="aff" rid="aff8">8</xref><address><institution>School of Public Health</institution><institution>Queensland University of Technology</institution><addr-line>Victoria Park Rd Kelvin Grove QLD 4059</addr-line><addr-line>QLD, </addr-line><country>Australia</country><phone>61 7 3138 5879</phone><fax>61 7 3138 5880</fax><email>Rihab.Hasanain@student.qut.edu.au</email></address><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-8757-8398</contrib-id></contrib></contrib-group><aff id="aff1"><sup>1</sup><institution>The University of Queensland, UQ Centre for Clinical Research</institution><addr-line>Herston QLD 4029</addr-line><country>Australia</country></aff><aff id="aff2"><sup>2</sup><institution>King Saud bin Abdulaziz University for Health Sciences</institution><institution>College of Medicine</institution><addr-line>Riyadh</addr-line><country>Saudi Arabia</country></aff><aff id="aff3"><sup>3</sup><institution>WHO Collaborating Centre for Infection Prevention and Control and GCC Center for Infection Control</institution><addr-line>Riyadh</addr-line><country>Saudi Arabia</country></aff><aff id="aff4"><sup>4</sup><institution>Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School</institution><addr-line>Boston, MA 02215, MA</addr-line><country>United States</country></aff><aff id="aff5"><sup>5</sup><institution>Department of Pathology, University of California, San Francisco</institution><addr-line>CA 94143, USA, CA</addr-line><country>United States</country></aff><aff id="aff6"><sup>6</sup><institution>Faculty of Medicine</institution><institution>Taif University</institution><addr-line>Taif</addr-line><country>Saudi Arabia</country></aff><aff id="aff7"><sup>7</sup><institution>Infection Control Programme and WHO Collaborating Centre on Patient Safety</institution><institution>University Hospitals of Geneva</institution><addr-line>Rue Gabrielle-Perret-Gentil 4,</addr-line><country>Switzerland</country></aff><aff id="aff8"><sup>8</sup><institution>School of Public Health</institution><institution>Queensland University of Technology</institution><addr-line>QLD</addr-line><country>Australia</country></aff><author-notes><corresp>Corresponding Author: Rihab Abdalazez Hasanain <email>Rihab.Hasanain@student.qut.edu.au</email></corresp></author-notes><pub-date pub-type="collection"><month>10</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>15</day><month>10</month><year>2015</year></pub-date><volume>17</volume><issue>10</issue><elocation-id>e233</elocation-id><history><date date-type="received"><day>24</day><month>9</month><year>2014</year></date><date date-type="rev-request"><day>22</day><month>4</month><year>2015</year></date><date date-type="rev-recd"><day>5</day><month>6</month><year>2015</year></date><date date-type="accepted"><day>21</day><month>6</month><year>2015</year></date></history><permissions><copyright-statement>©Hosam Mamoon Zowawi, Malak Abedalthagafi, Florie A Mar, Turki Almalki, Abdullah H Kutbi, Tiffany Harris-Brown, Stephan Harbarth, Hanan H Balkhy, David L Paterson, Rihab Abdalazez Hasanain. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.10.2015. </copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an open-access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0/">http://creativecommons.org/licenses/by/2.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on <ext-link ext-link-type="uri" xlink:href="http://www.jmir.org/,">http://www.jmir.org/,</ext-link> as well as this copyright and license information must be included.</license-p></license></permissions><self-uri xlink:type="simple" xlink:href="http://www.jmir.org/2015/10/e233/"></self-uri><abstract><p>The increasing emergence and spread of antimicrobial resistance (AMR) is a serious public health issue. Increasing the awareness of the general public about appropriate antibiotic use is a key factor for combating this issue. Several public media campaigns worldwide have been launched; however, such campaigns can be costly and the outcomes are variable and difficult to assess. Social media platforms, including Twitter, Facebook, and YouTube, are now frequently utilized to address health-related issues. In many geographical locations, such as the countries of the Gulf Cooperation Council (GCC) States (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain), these platforms are becoming increasingly popular. The socioeconomic status of the GCC states and their reliable communication and networking infrastructure has allowed the penetration and scalability of these platforms in the region. This might explain why the Saudi Ministry of Health is using social media platforms alongside various other media platforms in a large-scale public awareness campaign to educate at-risk communities about the recently emerged Middle East respiratory syndrome coronavirus (MERS-CoV). This paper discusses the potential for using social media tools as cost-efficient and mass education platforms to raise awareness of appropriate antibiotic use in the general public and in the medical communities of the Arabian Peninsula.</p></abstract><kwd-group><kwd>social media</kwd><kwd>antibiotics</kwd><kwd>awareness</kwd><kwd>health campaigns</kwd><kwd>Gulf States</kwd></kwd-group></article-meta></front><body><sec><title> Introduction</title><p>Antibiotic resistance has become a severe public health threat worldwide, including in the Gulf Cooperation Council (GCC) states [<xref rid="ref1" ref-type="bibr">1</xref>]. Hence, various initiatives across the globe have been launched to combat this issue. In 2011, the World Health Organization (WHO) themed its annual day to address this issue with the slogan “No action today, no cure tomorrow” and listed the actions to be undertaken. These actions included providing education to achieve effective antibiotic use [<xref rid="ref2" ref-type="bibr">2</xref>]. Antibiotic misuse, such as demanding unneeded antibiotics, purchasing antibiotics over-the-counter without a prescription, and not completing a course of antibiotics, is associated with the emergence and selection of antibiotic-resistant bacteria [<xref rid="ref3" ref-type="bibr">3</xref>]. Nosocomial infections caused by antibiotic-resistant pathogens are significantly associated with an increased length of hospital stay and increased cost [<xref rid="ref4" ref-type="bibr">4</xref>].</p><p>European surveys have shown that the general public still misunderstands the function and correct use of antibiotics [<xref rid="ref5" ref-type="bibr">5</xref>,<xref rid="ref6" ref-type="bibr">6</xref>]. On many occasions, the WHO has highlighted the importance of involving the general public alongside health care professionals for combating the emergence of antimicrobial resistance (AMR) [<xref rid="ref7" ref-type="bibr">7</xref>,<xref rid="ref8" ref-type="bibr">8</xref>]. To alleviate the public’s lack of cognizance about AMR, various countries in Europe [<xref rid="ref7" ref-type="bibr">7</xref>,<xref rid="ref9" ref-type="bibr">9</xref>], as well as the United States [<xref rid="ref10" ref-type="bibr">10</xref>] and other countries, have initiated public campaigns to raise awareness about the appropriate use of antibiotics.</p><p>Considering Saudi Arabia and other Gulf countries, various studies have addressed the issue of antibiotic misuse in hospital settings and the easy over-the-counter access to prescription antibiotics. For example, antibiotic use in intensive care units (ICUs) in Saudi Arabia has been found to be 10 times greater than that in the United States and some European countries [<xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref11" ref-type="bibr">11</xref>-<xref rid="ref13" ref-type="bibr">13</xref>]. This issue also extends to the wider GCC community. A Saudi study found that 77.6% of pharmacies dispensed antibiotics without a prescription primarily to treat scenarios consistent with viral infections [<xref rid="ref14" ref-type="bibr">14</xref>], whereas 68.4% of antibiotics from Abu Dhabi pharmacies were sold over-the-counter [<xref rid="ref15" ref-type="bibr">15</xref>], suggesting lack of antibiotics knowledge [<xref rid="ref16" ref-type="bibr">16</xref>].</p><p>These examples of antibiotics misuse and others suggest the urgent need for a public campaign in Saudi Arabia and beyond to provide greater education on the proper use of antibiotics along with the concept of reserving antibiotics for use only when they are truly needed. In April 2015, the GCC Center for Infection Control released the multilevel GCC Strategic Plan for Combating Antimicrobial Resistance, which sets the framework for the regional and national plans [<xref rid="ref17" ref-type="bibr">17</xref>]. One of the 5 strategic roadmaps addressed is the importance of preserving and restricting the available antimicrobial agents for human use. Interventional methods include educating antibiotic prescribers, patients, and the general public on the importance of appropriate antimicrobials use and basic infection prevention and control (eg, immunization and hygiene) [<xref rid="ref17" ref-type="bibr">17</xref>].</p><p>Social media platforms are being widely used for health promotion advocates and to endorse traditional awareness campaigns. They have unique characteristics for sharing open access information, providing a platform for dynamic conversations with communities and social groups, and keeping users connected with their topics of interest [<xref rid="ref18" ref-type="bibr">18</xref>]. They have been used to raise awareness for obesity, diabetes [<xref rid="ref19" ref-type="bibr">19</xref>], and adolescent dating violence [<xref rid="ref20" ref-type="bibr">20</xref>]. As an outreach effort, the European Antibiotic Awareness Day released a toolkit to advise on how to engage in social media activities promoting prudent antibiotic use [<xref rid="ref18" ref-type="bibr">18</xref>]. Information provided in the toolkit relates to European countries and may not fully apply to the GCC states.</p><p>In this paper, we discuss the planning, setup, and potential effectiveness of developing a mass education campaign via social media platforms to raise general public and medical awareness of appropriate antibiotic usage in the GCC states.</p><sec><title>The Influence of Educational Campaigns on Antibiotic Use and Antibiotic Resistance</title><p>Before initiating an educational media campaign, it is important to review the effectiveness of previous initiatives that were developed and launched in other parts of the world to raise awareness and provide guidance on responsible antibiotic use (<xref ref-type="table" rid="table1">Table 1</xref>).</p><table-wrap id="table1" position="float"><label>Table 1</label><caption><p>Summary of selected antibiotic awareness campaigns worldwide.</p></caption><table frame="hsides" rules="groups" width="620" border="0" cellpadding="8" cellspacing="0"><col width="89" span="1"></col><col width="62" span="1"></col><col width="66" span="1"></col><col width="117" span="1"></col><col width="86" span="1"></col><col width="104" span="1"></col><thead><tr valign="top"><td rowspan="1" colspan="1">Name</td><td rowspan="1" colspan="1">Site (country)</td><td rowspan="1" colspan="1">Duration</td><td rowspan="1" colspan="1">Method used</td><td rowspan="1" colspan="1">Target audience</td><td rowspan="1" colspan="1">Reduction rate</td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">Belgian Antibiotic Policy Coordinating Committee (BAPCOC ) establishment [<xref rid="ref21" ref-type="bibr">21</xref>]</td><td rowspan="1" colspan="1">Belgium</td><td rowspan="1" colspan="1">Launched in 1999-present</td><td rowspan="1" colspan="1">Multimedia campaigns, national campaigns, publication of clinical practice guidelines, support for the establishment of antibiotic management teams (AMTs)</td><td rowspan="1" colspan="1">Belgian community</td><td rowspan="1" colspan="1">36% reduction in outpatient antibiotic use per 1000 inhabitants per day during winter season</td></tr><tr valign="top"><td rowspan="1" colspan="1">“Les antibiotiques c’est pas automatique” (“Antibiotics are not automatic”); part of the national campaign “Keep antibiotics working” [<xref rid="ref22" ref-type="bibr">22</xref>]</td><td rowspan="1" colspan="1">All 22 regions across France</td><td rowspan="1" colspan="1">2001-2007</td><td rowspan="1" colspan="1">Mass media campaigns, one-on-one physician education sessions</td><td rowspan="1" colspan="1">General public and health care professionals</td><td rowspan="1" colspan="1">26.5% reduction of antibiotic prescriptions per 100 inhabitants during winter season over a 5-year period</td></tr><tr valign="top"><td rowspan="1" colspan="1">Antibiotics Awareness Week [<xref rid="ref23" ref-type="bibr">23</xref>]</td><td rowspan="1" colspan="1">Australia</td><td rowspan="1" colspan="1">2012-present</td><td rowspan="1" colspan="1">Facebook, Twitter, online pledging</td><td rowspan="1" colspan="1">All Australians</td><td rowspan="1" colspan="1">Unknown as yet</td></tr><tr valign="top"><td rowspan="1" colspan="1">Local low-cost information campaign [<xref rid="ref9" ref-type="bibr">9</xref>]</td><td rowspan="1" colspan="1">Emilia-Romagna region (Northern Italy)</td><td rowspan="1" colspan="1">November 2011-Februrary 2012</td><td rowspan="1" colspan="1">Brochures, posters, local media advertisements, and visual aids</td><td rowspan="1" colspan="1">General public</td><td rowspan="1" colspan="1">4.3% reduction in defined daily doses of prescribed antibiotics in intervention group</td></tr><tr valign="top"><td rowspan="1" colspan="1">English public antibiotic campaigns [<xref rid="ref7" ref-type="bibr">7</xref>]</td><td rowspan="1" colspan="1">England and Scotland</td><td rowspan="1" colspan="1">2008</td><td rowspan="1" colspan="1">Posters displayed in magazines and newspapers</td><td rowspan="1" colspan="1">General public</td><td rowspan="1" colspan="1">No improvement observed in postsurvey of public’s understanding</td></tr><tr valign="top"><td rowspan="1" colspan="1">e-Bug [<xref rid="ref24" ref-type="bibr">24</xref>]</td><td rowspan="1" colspan="1">European countries and Saudi Arabia</td><td rowspan="1" colspan="1">Launched in 2006-present</td><td rowspan="1" colspan="1">Website-based games</td><td rowspan="1" colspan="1">Junior and senior school students</td><td rowspan="1" colspan="1">Not assessed</td></tr></tbody></table></table-wrap><p>Data from Belgium and France have also revealed a reduction in the misuse of antibiotics after educational interventions. A decrease of 26.5% in antibiotic prescriptions was observed in France between 2002 and 2007 compared with the preintervention period (2000-2002), with the largest reduction observed in children [<xref rid="ref22" ref-type="bibr">22</xref>]. A 36% reduction in antibiotic prescriptions was also observed in Belgium from 1999-2000 to 2006-2007 [<xref rid="ref21" ref-type="bibr">21</xref>]. Both countries also reported a decrease in the incidence of infection with invasive penicillin- and macrolide-resistant <italic>Streptococcus pneumoniae</italic>. It was noted that the decrease in Belgium occurred before the wider use of the pneumococcal conjugate vaccine (PCV7), indicating that the vaccine did not contribute to this initial reduction in the incidence of infection with invasive penicillin-resistant pneumococci [<xref rid="ref5" ref-type="bibr">5</xref>,<xref rid="ref6" ref-type="bibr">6</xref>]. These data suggest the effectiveness of antibiotic awareness media campaigns in decreasing the use of antibiotics and hence in reducing the impact of antibiotic resistance.</p><p>Recently, Formoso et al [<xref rid="ref9" ref-type="bibr">9</xref>] reported the effectiveness of a low-cost media campaign on antibiotic use in an Italian province that lasted for 5 months during the cold season. The intervention materials included visual aids, such as posters, brochures, and advertisements, which were used in the local media. The key messages of the campaign were codesigned by a physician practicing in the intervention area. Antibiotic prescriptions were significantly reduced by 4.3% in the intervention area compared with the control area. However, the general population’s knowledge and attitudes about antibiotic resistance were not changed by the campaign [<xref rid="ref9" ref-type="bibr">9</xref>].</p><p>In 2008, antibiotic awareness campaigns were carried out in England and Scotland by broadcasting key messages in advertising published in magazines and newspapers. Unfortunately, the campaign did not show any positive effects in either England or Scotland. No improvement was observed in the general public’s understanding of antibiotic misuse to treat coughs and colds despite the fact that in 2009 more public respondents agreed that “resistance to antibiotics is a problem in British hospitals” than in 2008 [<xref rid="ref7" ref-type="bibr">7</xref>]. In fact, this is not the only documented failure of antibiotic awareness campaigns. Huttner et al [<xref rid="ref5" ref-type="bibr">5</xref>] reviewed 22 campaigns launched in high-income countries between 1990 and 2007. At least 3 of these campaigns failed and the effect of 3 others is unknown because of a lack of follow-up assessment on antibiotic use [<xref rid="ref5" ref-type="bibr">5</xref>].</p><p>The e-Bug project is an example of an innovative approach to raise awareness about microbes and infection prevention. The aim of the e-Bug project is to disseminate educational materials about microbes (both beneficial and pathogenic) to junior and senior school students across Europe. The project relies on website-based gaming and entertainment-based lessons [<xref rid="ref24" ref-type="bibr">24</xref>]. The e-Bug project now has partners in 26 different European countries, as well as Saudi Arabia, providing educational materials in different European languages and in Arabic [<xref rid="ref25" ref-type="bibr">25</xref>]. On May 2015, the e-Bug website had a total of 17,391 visitors and the Saudi Arabian site had 76 visitors in total [<xref rid="ref26" ref-type="bibr">26</xref>]. The impact of the e-Bug project is not clear because no evaluation of its implementation and impact on behavioral changes in targeted groups was ever performed [<xref rid="ref24" ref-type="bibr">24</xref>].</p><p>Various factors have been suggested to be necessary to achieve success in antibiotic awareness campaigns. These include carefully designing key messages that are clear and simple, targeting both general public individuals and clinicians, and using television and radio [<xref rid="ref6" ref-type="bibr">6</xref>,<xref rid="ref7" ref-type="bibr">7</xref>]. Moreover, motivating physicians to be involved in communicating with patients about the appropriate use of antibiotics and antibiotic resistance is also important [<xref rid="ref7" ref-type="bibr">7</xref>]. Physicians’ participation in developing campaign messages and communicating with the general public might significantly improve the chances of success. Early engagement can also have an impact on the sense of ownership of the campaign and facilitate physicians’ consistent support [<xref rid="ref27" ref-type="bibr">27</xref>]. This may indirectly influence physicians, focusing their attention on antibiotic prescribing and providing greater patient education.</p></sec><sec><title>Variable Sociological Factors</title><p>Awareness messages that display local surveillance data or amount of antibiotics locally misused may be important. Sharing with the general public the real-life experiences of individuals who have been infected with “superbugs” could be useful and may help the audience identify with those affected. Sharing real-life medical experience has been shown to be a useful communication platform from which to clarify public health-related stories, such as acne and cancer [<xref rid="ref28" ref-type="bibr">28</xref>,<xref rid="ref29" ref-type="bibr">29</xref>]. Considering these factors when designing awareness campaigns about antibiotics may help make an impact in GCC communities. Based on the Health Belief Model, perceived susceptibility (ie, you are at risk of getting infected) can be used to raise awareness [<xref rid="ref30" ref-type="bibr">30</xref>,<xref rid="ref31" ref-type="bibr">31</xref>]. However, delivering known messages to the target audience might result in a loss of interest and later disengagement. Educational interventions would be more successful if local contexts and barriers are adequately analyzed and addressed.</p><p>Replicating campaign strategies that have been initiated in different global regions outside the GCC region might not result in an effective outcome. It is crucially important to study the cultural factors and antibiotic distribution infrastructure in the GCC before thinking about the awareness messages. For example, the United States’ Get Smart campaign [<xref rid="ref32" ref-type="bibr">32</xref>] highly recommends that parents do not demand antibiotics for their children from the treating physician. We do not believe that this message line will be as effective as it might be in the United States because antibiotics can be purchased without a prescription from community pharmacies; therefore, a doctor’s refusal might not make a difference. Approximately 37% of the total population of the GCC states consists of nonnational expatriates [<xref rid="ref33" ref-type="bibr">33</xref>]; hence, it is important to consider cultural differences and not to neglect this segment when setting up a public awareness campaign. For example, the Saudi Ministry of Health has generated educational materials in multiple languages to fulfill this requirement [<xref rid="ref34" ref-type="bibr">34</xref>].</p><p>Community pharmacies have a significant role in dispensing antibiotics in GCC communities. For example, 24.4% of 1645 recently surveyed antibiotic transactions in community pharmacies in Abu Dhabi were carried out without a prescription, including amoxicillin-clavulanic acid for sore throats and ceftriaxone for sexually transmitted infections [<xref rid="ref35" ref-type="bibr">35</xref>]. The illegal practice of selling antibiotics over-the-counter, without a prescription, did not favor expatriates over citizens in the surveyed pharmacies in Abu Dhabi [<xref rid="ref15" ref-type="bibr">15</xref>].</p><p>The self-prescription of antibiotics is another sociological factor that must be considered when designing antibiotic awareness campaigns in the GCC states [<xref rid="ref36" ref-type="bibr">36</xref>,<xref rid="ref37" ref-type="bibr">37</xref>]. This factor is strongly associated with the availability of antibiotics over-the-counter.</p><p>Before creating content to be used for awareness campaigns, it is necessary to conduct formative research to assess the public’s existing knowledge of antibiotics resistance, understand the motivations for inappropriate antibiotics use, and learn about the social and cultural backgrounds for the targeted population. That will subsequently help to develop tailored key messages that can potentially encourage behavioral change [<xref rid="ref30" ref-type="bibr">30</xref>]. Knowing these critical elements has lead to the success of many awareness campaigns, such as The Magic Glasses video to prevent soil-transmitted helminthes in China [<xref rid="ref31" ref-type="bibr">31</xref>,<xref rid="ref38" ref-type="bibr">38</xref>]. On the other hand, content produced for social media-based campaigns can be unrelated to the campaign’s target. For example, it was found that the majority of Movember campaign-related tweets did not associate with prostatic and testicular cancer awareness [<xref rid="ref39" ref-type="bibr">39</xref>], and the majority of tweets produced during breast cancer awareness week did not promote any specific preventive behaviors [<xref rid="ref40" ref-type="bibr">40</xref>]. Despite the importance of developing related content, research into the correlation between social media-based awareness campaigns and behavior change is minimal because it is a new avenue in public health awareness [<xref rid="ref41" ref-type="bibr">41</xref>].</p><p>Social media platforms can also contain contradictory health messages with potentially negative impact. Because social media platforms give users the freedom to publish their content, some of that content can contain medically misleading information, as found in YouTube videos promoting anorexia [<xref rid="ref42" ref-type="bibr">42</xref>].</p></sec><sec><title>Funding</title><p>Funding is an important factor that may significantly affect a campaign’s functionality and outcome. A systematic review of more than 20 international campaigns aimed at raising awareness of antibiotic use showed that these campaigns sourced their funding from different sectors, including the pharmaceutical industry [<xref rid="ref6" ref-type="bibr">6</xref>]. The funding spent by pharmaceutical companies on promoting and marketing antibiotics is massive. For example, in 1998, it was estimated that pharmaceutical companies in the United States spent approximately US $1.6 billion to promote antibiotics [<xref rid="ref43" ref-type="bibr">43</xref>]. On the other hand, media campaigns that encourage the prudent use of antibiotics are not widely supported [<xref rid="ref6" ref-type="bibr">6</xref>]. Government funding is important. Because antibiotic awareness campaigns might translate into wiser use of antibiotics and potentially lead to a reduced selection of resistant bacteria, public funding should be offered to support awareness campaigns.</p><p>The cost of running a traditional mass media campaign to promote prudent antibiotic use in the community can be very expensive. For example, developing and conducting the French antibiotic awareness campaign carried out from 2002 to 2007 cost approximately €500 million over a 6-year period [<xref rid="ref44" ref-type="bibr">44</xref>], whereas the Belgian campaign cost considerably less at approximately €400,000 per year [<xref rid="ref21" ref-type="bibr">21</xref>]. The “Get Smart Colorado” campaign, which took place for 4 months in 2002, reported a cost of US $88,500 to purchase advertising space that included bus tails, bus stop posters, interior bus signs, and national public radio spots [<xref rid="ref10" ref-type="bibr">10</xref>]. Similarly, the recent Italian campaign in 2013 cost approximately US $60,800 for purchasing media spots on television and radio, and in newspapers. Approximately the same cost was spent to develop and print written visual aid materials, such as posters [<xref rid="ref9" ref-type="bibr">9</xref>].</p><p>Considering social media platforms are free, establishing a social media-based campaign may be far cheaper than traditional media-based campaigns. However, in order to maintain continuous cyber presence and followers scalability, social media managers are usually hired [<xref rid="ref45" ref-type="bibr">45</xref>], which can be an additional cost burden on social media-based campaigns. The key advantage of social media is the possibility to measure and track impressions and responses to online posts. These data can be used to guide social media campaigns to improve marketing strategy. However, platforms available to analyze big data generated from social media can be costly and may require technical expertise.</p></sec><sec><title>Time</title><p>Repeating the educational intervention over a long period of time is essential for the awareness success of mass media campaigns. Repetition over a long period of time has been demonstrated for causes such as smoking cessation and has helped achieve effectiveness [<xref rid="ref46" ref-type="bibr">46</xref>]. The vast majority of antibiotic awareness campaigns launched in high-income countries between 1990 and 2007 were conducted over a period of more than 1 year [<xref rid="ref6" ref-type="bibr">6</xref>]. Other campaigns, such as European Antibiotic Awareness Day (on November 18 each year) [<xref rid="ref47" ref-type="bibr">47</xref>], are seasonal and have a long-term sustainable plan. However, the “Get Smart Colorado” campaign, which lasted for only 4 months, successfully showed a 3.8% net reduction in antibiotic dispensing at retail pharmacies as well as an 8.8% net decrease in managed care-associated antibiotic dispensing [<xref rid="ref10" ref-type="bibr">10</xref>].</p><p>The ease of using social media, along with the indirect community contribution via “share” and “retweet” features, might provide long-term exposure and awareness messages to the wider general public. However, it is important to consider the temporal effect of social media feeds due to their short lifespan. It was found that the half-life of a tweet is approximately 24 minutes, whereas the half-life of Facebook posts is approximately 90 minutes [<xref rid="ref48" ref-type="bibr">48</xref>]. A hashtag is a keyword preceded by a hash sign (#) that is used to identify and categorize messages on a specific topic, which can give the topic a longer lifespan in social media [<xref rid="ref49" ref-type="bibr">49</xref>,<xref rid="ref50" ref-type="bibr">50</xref>]. Keeping the audience engaged and interested in the topic is another important consideration. This might be achieved by ensuring that the key messages and materials are not overrepeated throughout the campaign’s duration. Updating campaign materials with new and relevant data might keep the audience more engaged and keen to receive updated educational materials. Lastly, the time chosen to post the social media message can be critical for the lifespan of social media posts [<xref rid="ref51" ref-type="bibr">51</xref>].</p></sec><sec><title>The Value of Social Media Platforms to Communities in the Gulf Cooperation Council States</title><p>The total number of users of the social networking website Facebook in the Arab world (22 countries) had grown to 54,552,875 by the end of May 2013; 33.4% of users are female and 68% are younger than 30 years [<xref rid="ref52" ref-type="bibr">52</xref>]. Facebook users in the GCC states represent approximately 22% (12 million) of the total Facebook users in the Arab world [<xref rid="ref52" ref-type="bibr">52</xref>] (<xref ref-type="table" rid="table2">Table 2</xref>).</p><table-wrap id="table2" position="float"><label>Table 2</label><caption><p>The use of Internet and social media platforms in the GCC states.</p></caption><table frame="hsides" rules="groups" width="639" border="0" cellpadding="8" cellspacing="0"><col width="119" span="1"></col><col width="92" span="1"></col><col width="95" span="1"></col><col width="127" span="1"></col><col width="126" span="1"></col><thead><tr valign="bottom"><td rowspan="1" colspan="1">Country</td><td rowspan="1" colspan="1">Population (million)<sup>a</sup></td><td rowspan="1" colspan="1">Internet users (million), n (%)<sup>b</sup></td><td rowspan="1" colspan="1">Facebook users (million),<sup>c</sup> n (%)</td><td rowspan="1" colspan="1">Twitter users (million),<sup>d</sup> n (%)</td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">28.4</td><td rowspan="1" colspan="1">13.0 (45.8)</td><td rowspan="1" colspan="1">6.4 (22.5)</td><td rowspan="1" colspan="1">1.9 (6.7)</td></tr><tr valign="top"><td rowspan="1" colspan="1">United Arab Emirates</td><td rowspan="1" colspan="1">8.3</td><td rowspan="1" colspan="1">5.7 (71.0)</td><td rowspan="1" colspan="1">3.4 (41.7)</td><td rowspan="1" colspan="1">0.4 (4.8)</td></tr><tr valign="top"><td rowspan="1" colspan="1">Kuwait</td><td rowspan="1" colspan="1">3.1</td><td rowspan="1" colspan="1">2.0 (63.2)</td><td rowspan="1" colspan="1">0.8 (26.8)</td><td rowspan="1" colspan="1">0.2 (7.3)</td></tr><tr valign="top"><td rowspan="1" colspan="1">Bahrain</td><td rowspan="1" colspan="1">1.2</td><td rowspan="1" colspan="1">1.0 (80.0)</td><td rowspan="1" colspan="1">0.3 (25.1)</td><td rowspan="1" colspan="1">0.1 (5.6)</td></tr><tr valign="top"><td rowspan="1" colspan="1">Qatar</td><td rowspan="1" colspan="1">1.7</td><td rowspan="1" colspan="1">1.7 (99.9)</td><td rowspan="1" colspan="1">0.6 (34.4)</td><td rowspan="1" colspan="1">0.1 (4.4)</td></tr><tr valign="top"><td rowspan="1" colspan="1">Oman</td><td rowspan="1" colspan="1">3.3</td><td rowspan="1" colspan="1">2.1 (63.6)</td><td rowspan="1" colspan="1">0.5 (16.4)</td><td rowspan="1" colspan="1">0.04 (1.2)</td></tr></tbody></table><table-wrap-foot><fn id="table2fn1"><p><sup>a</sup> Population figures obtained from [<xref rid="ref53" ref-type="bibr">53</xref>].</p></fn><fn id="table2fn2"><p><sup>b</sup> Internet user figures obtained from [<xref rid="ref54" ref-type="bibr">54</xref>].</p></fn><fn id="table2fn3"><p><sup>c</sup> Facebook user figures obtained from [<xref rid="ref52" ref-type="bibr">52</xref>].</p></fn><fn id="table2fn4"><p><sup>d</sup> Twitter user figures obtained from [<xref rid="ref55" ref-type="bibr">55</xref>].</p></fn></table-wrap-foot></table-wrap><p>For the microblogging website Twitter, the number of active users in the Arab world reached 3,766,160 individuals as of March 2013, with an estimated 10,832,000 tweets per day. Saudi Arabia has the highest number of active Twitter users in the Arab world, with 1.9 million individuals, which is approximately 50% of the total Twitter users in the Arab region. Approximately 47% and 11% of the total tweets in the Arab world are generated from Saudi Arabia and United Arab Emirates, respectively.</p><p>The video-sharing website YouTube is also a popular media platform in the GCC, particularly in Saudi Arabia. As an update to research conducted by Forbes Middle East, we present data from selected local GCC talk shows on YouTube (<xref ref-type="table" rid="table3">Table 3</xref>). It is clear that these shows attract many viewers, although some shows from Saudi Arabia receive the most attention. This audience would make these shows an excellent platform for delivering awareness messages to a larger number of viewers.</p><table-wrap id="table3" position="float"><label>Table 3</label><caption><p>The popularity of selected YouTube-based shows in the GCC states.</p></caption><table frame="hsides" rules="groups" width="621" border="0" cellpadding="8" cellspacing="0"><col width="88" span="1"></col><col width="56" span="1"></col><col width="74" span="1"></col><col width="67" span="1"></col><col width="65" span="1"></col><col width="84" span="1"></col><col width="75" span="1"></col><thead><tr valign="bottom"><td rowspan="1" colspan="1">Name of show</td><td rowspan="1" colspan="1">Origin</td><td rowspan="1" colspan="1">Launch date</td><td rowspan="1" colspan="1">Episodes<sup>a</sup></td><td rowspan="1" colspan="1">Subscribers<sup>a</sup></td><td rowspan="1" colspan="1">Total views<sup>a</sup></td><td rowspan="1" colspan="1">Average views per episode<sup>a</sup></td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">EyshElly</td><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">Feb 2011</td><td rowspan="1" colspan="1">63</td><td rowspan="1" colspan="1">1,714,699</td><td rowspan="1" colspan="1">197,686,128</td><td rowspan="1" colspan="1">3,137,875</td></tr><tr valign="top"><td rowspan="1" colspan="1">3al6ayer</td><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">Sep 2010</td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">810,119</td><td rowspan="1" colspan="1">61,462,338</td><td rowspan="1" colspan="1">1,365,029</td></tr><tr valign="top"><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">Sep 2010</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">649,465</td><td rowspan="1" colspan="1">72,887,865</td><td rowspan="1" colspan="1">2,208,723</td></tr><tr valign="top"><td rowspan="1" colspan="1">Endam Cinema</td><td rowspan="1" colspan="1">Oman</td><td rowspan="1" colspan="1">Jul 2013</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">215</td><td rowspan="1" colspan="1">50,864</td><td rowspan="1" colspan="1">8477</td></tr><tr valign="top"><td rowspan="1" colspan="1">Balalee6</td><td rowspan="1" colspan="1">United Arab Emirates</td><td rowspan="1" colspan="1">Jun 2012</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">6686</td><td rowspan="1" colspan="1">972,165</td><td rowspan="1" colspan="1">74,781</td></tr><tr valign="top"><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">United Arab Emirates</td><td rowspan="1" colspan="1">May 2012</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">10,133</td><td rowspan="1" colspan="1">954,815</td><td rowspan="1" colspan="1">190,963</td></tr><tr valign="top"><td rowspan="1" colspan="1">shenoya3nitv</td><td rowspan="1" colspan="1">Kuwait</td><td rowspan="1" colspan="1">Jan 2012</td><td rowspan="1" colspan="1">54</td><td rowspan="1" colspan="1">67,477</td><td rowspan="1" colspan="1">8,076,193</td><td rowspan="1" colspan="1">149,559</td></tr><tr valign="top"><td rowspan="1" colspan="1">How to Prevent from Corona</td><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">May 2014</td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">17,759</td><td rowspan="1" colspan="1">2,973,376</td><td rowspan="1" colspan="1">NA</td></tr></tbody></table><table-wrap-foot><fn id="table3fn1"><p><sup>a</sup> The figures were obtained from YouTube channels on November 15, 2013.</p></fn></table-wrap-foot></table-wrap></sec><sec><title>Examples of Saudi Public Health Awareness Messages Delivered Through Social Media Platforms</title><p>Owing to its high profile and popularity among Internet users in the GCC region, YouTube has often been used in Saudi Arabia as a platform to deliver public health–related awareness messages and campaigns (<xref ref-type="table" rid="table4">Table 4</xref>). We have noticed 2 different models for delivering health-related topics on YouTube in Saudi Arabia. One model was noticed in many campaigns that used comedy talk shows with large audience as a platform to deliver the awareness messages. With the help of other social media platforms, such as Facebook and Twitter, these messages have traveled far and wide, attracting a large number of viewers. For example, a Saudi-based comedy show named “Fe2aFala” released an episode about acquired immune deficiency syndrome (AIDS) and this episode attracted over 1 million viewers.</p><table-wrap id="table4" position="float"><label>Table 4</label><caption><p>Health messages delivered through Saudi YouTube-based shows.<sup>a</sup></p></caption><table frame="hsides" rules="groups" width="620" border="0" cellpadding="8" cellspacing="0"><col width="130" span="1"></col><col width="110" span="1"></col><col width="122" span="1"></col><col width="98" span="1"></col><col width="80" span="1"></col><thead><tr valign="top"><td rowspan="1" colspan="1">Show/channel name</td><td rowspan="1" colspan="1">Type</td><td rowspan="1" colspan="1">Awareness about</td><td rowspan="1" colspan="1">Number of viewers</td><td rowspan="1" colspan="1">Channel subscribers</td></tr></thead><tbody><tr valign="bottom"><td rowspan="1" colspan="1">Phosphine</td><td rowspan="1" colspan="1">Special episode</td><td rowspan="1" colspan="1">Phosphine gas</td><td rowspan="1" colspan="1">3,288,241<sup>b</sup></td><td rowspan="1" colspan="1">14,821</td></tr><tr valign="top"><td rowspan="1" colspan="1">Lumink</td><td rowspan="1" colspan="1">Special show</td><td rowspan="1" colspan="1">Health promotion</td><td rowspan="1" colspan="1">2,583,534</td><td rowspan="1" colspan="1">807,561</td></tr><tr valign="top"><td rowspan="1" colspan="1">Telfaz11</td><td rowspan="1" colspan="1">Special episode</td><td rowspan="1" colspan="1">Breast cancer</td><td rowspan="1" colspan="1">1,489,802</td><td rowspan="1" colspan="1">296,563</td></tr><tr valign="top"><td rowspan="1" colspan="1">Fe2aFala</td><td rowspan="1" colspan="1">Special episode</td><td rowspan="1" colspan="1">AIDS</td><td rowspan="1" colspan="1">1,139,948</td><td rowspan="1" colspan="1">351,907</td></tr><tr valign="top"><td rowspan="1" colspan="1">Sen_tube</td><td rowspan="1" colspan="1">Entire show</td><td rowspan="1" colspan="1">Dental care</td><td rowspan="1" colspan="1">1,292,959</td><td rowspan="1" colspan="1">29,373</td></tr><tr valign="top"><td rowspan="1" colspan="1">3almezan</td><td rowspan="1" colspan="1">Entire show</td><td rowspan="1" colspan="1">Obesity and well-being</td><td rowspan="1" colspan="1">1,097,713</td><td rowspan="1" colspan="1">51,746</td></tr><tr valign="top"><td rowspan="1" colspan="1">Hotcoldshow</td><td rowspan="1" colspan="1">Special episode</td><td rowspan="1" colspan="1">Diabetes</td><td rowspan="1" colspan="1">455,485</td><td rowspan="1" colspan="1">81,725</td></tr><tr valign="top"><td rowspan="1" colspan="1">MedScoope</td><td rowspan="1" colspan="1">Entire show</td><td rowspan="1" colspan="1">Health promotion</td><td rowspan="1" colspan="1">88,703</td><td rowspan="1" colspan="1">937</td></tr></tbody></table><table-wrap-foot><fn id="table4fn1"><p><sup>a</sup> The figures were obtained by accessing the YouTube channels on the March 4, 2014.</p></fn><fn id="table4fn2"><p><sup>b</sup> This number of views was achieved within only 3 days of uploading the video on YouTube.</p></fn></table-wrap-foot></table-wrap><p>Another model is to use YouTube as a channel similar to traditional mass media to distribute health awareness messages. For example, in June 2014, the Saudi Arabia Ministry of Health launched an engaging public awareness campaign using YouTube, Twitter, Facebook, educational posters, and health guideline updates to educate the general public and medical communities on the emergence of, and health precautions needed for, MERS-CoV [<xref rid="ref34" ref-type="bibr">34</xref>]. In this example, social media platforms may have been used to create online presence to endorse awareness messages delivered locally on traditional media. It must be noted that the incidence rate of MERS-CoV has declined [<xref rid="ref56" ref-type="bibr">56</xref>] with the multi-faceted intervention, which social media has been a part of.</p><p>Publishing awareness content on social media might allow international distribution and an indefinite exposure period. However, in order to potentiate the effectiveness of a YouTube video, additional advertising strategies must take place. <xref ref-type="table" rid="table4">Table 4</xref> summarizes some of the campaigns that have used YouTube shows to deliver public health awareness in Saudi Arabia and have attracted a high number of views.</p></sec><sec><title>Our Pilot Experience</title><p>Many health care facilities and organizations have started using Twitter as a teaching tool; for example, “tweeting” about specific health problems has been used by major organizations such as the Centers for Disease Control and Prevention (CDC), WHO, the National Cancer Institute (NCI), and the National Institutes of Health (NIH). “Tweets” go out from a sender and are simultaneously received by all members of a group of “followers,” providing a fast, open, and easy way to deliver a particular focused message.</p><p>We used Twitter in our online Arabic-language pilot campaign focusing on superbugs using a hashtag. We delivered short tweets and links to various articles and videos related to superbugs. We also translated multiple non-Arabic research articles and news for our more than 34,000 followers, who were primarily from Saudi Arabia and the surrounding areas. This medium gave us the ability to have a real-time conversation by answering their questions and concerns about the topic. To track our efforts, we regularly reviewed the number of followers, updates, retweets, and “mentions” in Twitter. Many evaluation metrics for Twitter can be collected. We evaluated our Twitter pilot study by analyzing the influence of some of our tweets. We kept track of how many of our “followers” published updates including “retweets” or “at replies” over time. A simple analysis of 147 selected tweets with the Arabic superbug hashtag resulted in approximately 4100 retweets between July and November 2013. This information does not tell us which of the tweets encouraged followers to go on to read the full article or watch the video, but it does give us useful information on general interest levels.</p><p>We created a whiteboard animation with a voiceover video [<xref rid="ref57" ref-type="bibr">57</xref>] that discussed the importance of antibiotics, how superbugs are created, and the spread of superbugs in the GCC. We also discussed possible factors that could contribute to the emergence and spread of superbugs in addition to advice on how to control superbugs as reviewed previously [<xref rid="ref1" ref-type="bibr">1</xref>].</p><p>Interestingly, the number of retweets that we received from our superbugs hashtag correlated with the number of YouTube views that we recorded for our video. The video viewing pattern as determined by YouTube was as expected: there were a large number of views soon after the video was posted and released on Twitter, and there were fewer views from 3 weeks later until the present day. We observed 2 large peaks in viewing rates within the first 2 weeks of the video being released. We believe the first one was due to our successful Twitter activities. We are unclear about what caused the second and largest jump in YouTube views. It is possible that the video was picked up by another group and spread on Twitter again (<xref ref-type="fig" rid="figure1">Figure 1</xref>).</p><p>We also observed sporadic smaller peaks in YouTube views from 3 weeks onward. These numbers suggest that the video was still drawing attention and being shared, most likely on social media, even months after being posted.</p><p>Our viewer retention rate was consistent with what YouTube estimates to be the average retention rate for videos of a similar length—approximately half of the video. This rate suggests that the length of our video—5.5 minutes—is adequate to capture the viewers’ attention.</p><p>Subsequently, we created an infographic video uploaded on YouTube [<xref rid="ref58" ref-type="bibr">58</xref>] that combined a selection of our tweets with visual and audio enhancement. The tweet that featured the video received 152 retweets and 130 favorites, and the video was viewed more than 3000 times in only 2 weeks (<xref ref-type="fig" rid="figure2">Figure 2</xref>).</p><p>The content generated for our pilot campaign was primarily dependent on our existing knowledge of antibiotic misuse in Saudi Arabia and neighboring states as previously reviewed [<xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref14" ref-type="bibr">14</xref>-<xref rid="ref16" ref-type="bibr">16</xref>,<xref rid="ref35" ref-type="bibr">35</xref>-<xref rid="ref37" ref-type="bibr">37</xref>]. We acknowledge the limitations of our pilot campaign resulting from the lack of formative research, its Arabic content, and reliance on social media. In order to achieve prospective behavioral change, it is important to understand the motivation for antibiotic misuse in the general public. Future research should conduct a thorough survey, interviews, and observations to cover the diverse population of the GCC states. This will help us design relevant key messages to be used in future awareness campaigns. The diverse ethnic groups and socioeconomic status of people in the Gulf States should also be considered in future campaigns because more languages and media platforms might need to be used. Relying solely on a social media platform in an awareness campaign might overlook the large population of migrant workers in the GCC who might not have access to social media platforms.</p><fig id="figure1" position="float"><label>Figure 1</label><caption><p>YouTube views over a period of 84 days for the whiteboard animated and voiceover video about superbugs and proper antibiotics use.</p></caption><graphic xlink:href="jmir_v17i10e233_fig1"></graphic></fig><fig id="figure2" position="float"><label>Figure 2</label><caption><p>YouTube views over a period of 20 days for the infographic video.</p></caption><graphic xlink:href="jmir_v17i10e233_fig2"></graphic></fig></sec><sec><title>Conclusion</title><p>Reducing the suboptimal use of antibiotics among the general public and medical community through awareness activities is an important element in national plans to combat rising AMR. However, it is important to create awareness content that is related to the target audience and based on formative research. Social media platforms seem to be a valuable platform for delivering awareness messages. Owing to social media popularity, awareness messages could reach a large number of users and the reach can be tracked. Through our pilot experience we have successfully distributed antibiotics awareness messages through Twitter and YouTube to our target audience in the Gulf counties and Saudi Arabia. The use of social media can also enhance awareness campaigns delivered in traditional media channels. However, it is important to consider the cultural demographic diversity, which could limit the reach of awareness massages, such as the high population of immigrant workers in the GCC who might not have access to these emerging social media platforms. Social media–based messages can also have short life span, which might limit the effect and reach of key awareness messages. Measuring the impact of the social media–based awareness campaigns on the general public’s understanding and behavioral change is a challenge and needs further research.</p></sec></sec></body><back><ack><p>HMZ is academically sponsored by the government of Saudi Arabia to pursue postgraduate studies in the field of clinical microbiology and infectious diseases.</p></ack><fn-group><fn fn-type="conflict"><p>Conflicts of Interest: None declared.</p></fn></fn-group><glossary><title>Abbreviations</title><def-list><def-item><term id="abb1">AIDS</term><def><p>acquired immune deficiency syndrome</p></def></def-item><def-item><term id="abb2">AMR</term><def><p>antimicrobial resistance</p></def></def-item><def-item><term id="abb3">GCC</term><def><p>Gulf Cooperation Council</p></def></def-item><def-item><term id="abb4">ICU</term><def><p>intensive care unit</p></def></def-item><def-item><term id="abb5">NCI</term><def><p>National Cancer Institute</p></def></def-item><def-item><term id="abb6">NIH</term><def><p>National Institutes of Health</p></def></def-item><def-item><term id="abb7">WHO</term><def><p>World Health Organization</p></def></def-item></def-list></glossary><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zowawi</surname><given-names>H</given-names></name><name><surname>Balkhy</surname><given-names>H</given-names></name><name><surname>Walsh</surname><given-names>T</given-names></name><name><surname>Paterson</surname><given-names>D</given-names></name></person-group><article-title>β-Lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula</article-title><source>Clin Microbiol Rev</source><year>2013</year><month>7</month><volume>26</volume><issue>3</issue><fpage>361</fpage><lpage>80</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://cmr.asm.org/cgi/pmidlookup?view=long&pmid=23824364"></ext-link></comment><pub-id pub-id-type="doi">10.1128/CMR.00096-12</pub-id><pub-id pub-id-type="medline">23824364</pub-id><pmc-comment>26/3/361 </pmc-comment>
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<pmc-comment>PMC4402954 </pmc-comment>
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