Linguistic Variation in NHS Tweets During the COVID-19 Pandemic

Linguistic variation in NHS tweets throughout the first year of the COVID-19 pandemic DAVID BEAUCHAMP. COVENTRY UNIVERSITY. 1 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Background: A quick recap of COVID-19 in the UK COVID-19 broke out in late 2019. By late January 2020, cases were being reported in the UK. On 20th March 2020, the closure of many businesses was ordered. On 23rd March 2020, the country was put into full lockdown, and regular briefings were held from Downing Street to keep the public updated. As the primary institute of health care provision in the United Kingdom, the National Health Service (NHS) has a role both in treatment of illness, and promoting prevention of illness through educating the public on healthy lifestyles (NHS, 2023). The NHS is active on social media, and the @NHSuk account has been present on Twitter/X since November 2007. 2 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Existing research on health and crisis communications: frameworks for best practice Frameworks for best practice of health and crisis communication have been produced by: Atkin and Salmon (2012) Schiavo (2013) (Malecki, Keating & Safdar, 2020) Common features include the need for communications to be: 1. Credible 2. Accessible 3. Informative 4. Engaging 5. Relevant 6. Dialogic 3 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Existing research on health and crisis communications during the COVID- 19 pandemic Research into health communications during the pandemic has explored a number of areas and made a number of findings, including: The preference for concise informational messages over fear-mongering and moralising (McClaughlin et al., 2023). A lack of clarity in language and imagery of Tweets (Jones, Oakey & O Halloran, 2023). Comparison of the social media output of health institutions, praising the NHS (Ireland, 2024). The effects of sentiment polarity on retweets, likes and replies (Yu et al., 2022). 4 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Aims of the research project What are the key linguistic characteristics of NHS Twitter communications, based upon their content, form/style and complexity? To what extent do these characteristics change over the period of the first year of the pandemic, from the beginning of the first wave and lockdown, to the end of the second wave? What differences can be observed between national level Twitter communications and those at regional level in terms of key linguistic characteristics? 5 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Data @NHSuk (UK wide) and @NHSNW (North West Region). Covered the period of 16 March 2020 to 15 March 2021. Divided into 13 months of 4 weeks. Does not include emojis, links, comments, retweets, duplicates or aborted tweets. 6 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Methods Sentiment analysis: Keyness analysis: Tweet complexity: Used sentimentR package to calculate the mean sentiment polarity of tweets by week (Rinker, 2021). Top five key words (lemmas) per month identified in both corpora. Calculated average tweet length by words per month Extracted using the Postman API and a Twitter Developer Account. Words ranked according to difficulty/complexity by Nation s vocabulary lists. Keyness calculated by the Simple Maths method in Sketch Engine (Kilgariff et al., 2014). Extracted between 21 June 2022 and 24 June 2022 via a JSON file. Counted the frequency per month of non-word linguistic features (@ mentions and hashtags). Converted to csv format in R for data cleaning. Minimum frequency of four words was set to avoid proper nouns being too prominent. 28/04/2025 7 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Results: Sentiment analysis Fluctuation in average sentiment of NHSNW tweets by week during the first year of the pandemic Fluctuation in average sentiment of NHSuk tweets by week during the first year of the pandemic 8 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Results: NHSuk Keyness Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 key wellbeing wellbeing handwashing self-isolate covering handwashing covering Wellbeing coronavirus coronavirus hiit breathless handwashing trialed wellbeing Measures nhs distancing self-isolate handwashing clinically newham coronavirus Test and trace anxious worried breathless nhs* supermarket wight nhs Other conditions cope nhs pilates* covering nhs covering understandable Vaccine Health care provision Month 8 Month 9 Month 10 Month 11 Month 12 Month 13 treatable treatable treatable bsl nhs treatable stoptober diarrhoea diarrhoea nhs mers checked unexplained unexplained nhs light-headed emails shan poo flu bloat treatable vaccine nhs pee poo unexplained astrazeneca sars restful 9 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Examples of sentiment and keyness. NHSuk Early period/first wave focus on positive mental and physical wellbeing: "Taking care of your mind as well as your body is really important whilst staying at home Visit EveryMindMatters for practical tips on improving your wellbeing whilst staying at home" (April, 2020. Polarity: 1.15) Routines make children and young people feel safer, so think about how to develop new routines that are interesting and fun. For more tips and advice for look after the mental health of children and young people, visit (April 2020. Polarity: 0.673) More negatively charged period of tweeting about risks, guidelines and safety measures post- first wave: Face coverings are now compulsory on public transport in England. Some people do not need to do this, including children under 11 and people with breathing difficulties. (June, 2020. Polarity: -0.359). Feeling breathless is one of the symptoms of Coronavirus. If you're isolating with symptoms, there are some things you can try that may help. , More info: If you feel breathless and it's getting worse, get medical advice here: (July, 2020. Polarity: -0.211). 10 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Examples of sentiment and keyness. NHSuk Period of heavily tweeting about other medical conditions, particularly cancer: Blood in your poo or pee could be a sign of cancer. It's probably nothing serious, but finding cancer early makes it more treatable. Your NHS is here to see you, safely. (October, 2020. Polarity: -0.449). The last few months shows a focus on vaccine promotion, stressing its scientific integrity: The AstraZeneca/Oxford University COVID-19 vaccine has been approved. The NHS will continue to provide care and support to those who are eligible for COVID-19 vaccination: (December, 2020. Polarity: 1.02). Vaccines are only made available to the public after meeting strict safety and effectiveness criteria. Find out more about why vaccination is safe and important. (December, 2020. Polarity: 0.652). Vaccine development has been underway since early 2020, as soon as the virus began spreading. Knowledge from other vaccines, like SARS and MERS, have been used in developing the COVID-19 vaccines. Read more (January, 2021. Polarity: 0.106). 11 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Results: NHSNW Keyness key Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 sanitiser midwife sanitiser sanitiser handwashing handwashing gp Wellbeing Measures wellbeing nhs nhs sneeze treatable unwell indoors Other conditions nightingale clinically gp nhs covering cervical alert Vaccine soap maternity pharmacy thirsty cervical gp outdoors Healthcare provision gp wellbeing alert clap midwife covering nhs Month 8 Month 9 Month 10 Month 11 Month 12 Month 13 optician* optician flu macclesfield pharmacy-led nhs pronoun nhs gp roll-out aneet jab nhs flu midwife nhs self-isolate gp gp pharmacist nhs gp maternity* vaccination urgent gp pharmacy urgent cervical vaccine 12 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Examples of sentiment and keyness. NHSNW Early period/first wave focus on positive mental and physical wellbeing, yet also has more personal messages, directed to individuals in the community: This is just wonderful If anyone, anywhere, can join in and light up blue to show your support for the NHS and all our amazing staff we would love to see your photos Tag us and add #ThankYouNHS to your message Thank you all for your support (March, 2020. Polarity: 0.547). Maintaining healthy relationships with people you trust is important for your mental wellbeing. Stay in touch with friends and family while you are all Staying at home, by phone, messaging, video calls or social media # StayHome #SaveLives (April, 2020. Polarity: 0.633). Can you help add some colour at #NHS Nightingale Hospital North West? Share your artwork using #NHSNightingaleNW and the team will use them to display at the new hospital (April, 2020. Polarity: 0.353) 13 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Examples of sentiment and keyness. NHSNW This is followed by a period of increased focus on safety measures, restrictions and health care provision information: Most GP practices in the North West are now able to offer their patients the option of a video consultation. Video consultations provide a safe, secure and convenient way for people to access NHS services during the Coronavirus pandemic and beyond. #HelpUsHelpYouNW (May, 2020. Polarity: 0.363) Wash YOUR HANDS MORE OFTEN FOR 20 SECONDS Use soap and water or a hand sanitiser when you:- Get home or into work- Blow your nose, sneeze or cough- Eat or handle food (June, 2020. Polarity: 0.009). With the risks higher for women and people with a cervix under the age of 35, it's essential that you attend your cervical screening as soon as you are eligible. (July, 2020. Polarity: 0.214) 14 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Examples of sentiment and keyness. NHSNW Later in the year, there is also a focus on the provision of the vaccine, however, it tends to be contextualised in less scientific terms, and more in the community-based efforts of provision: Liz Minshull, 49, has been volunteering at Andrew's Pharmacy, Macclesfield, to help with the #CovidVaccine launch As a thank you her colleagues' bought her some gifts as she's having a milestone birthday on Sunday. Happy Birthday Liz! (January, 2021. Polarity: 0.584). Another pharmacy-led vaccination centre has opened in Lancashire at @AFCFylde. Local residents invited for the vaccine will be able to book at this site. @HealthierLSC @lancslpc @FyldeCoastCCGs @GreenLPharmaUK (January, 2021. Polarity: 0). TV star and DJ Craig Charles has had his COVID-19 vaccination and is encouraging others to book their appointment when they are invited Here's what he had to say (February, 2021. Polarity: 0.297). 15 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Use of dialogic features, hashtags and @ mentions: NHSuk 735 hashtags, 136 types. Two phenomena drive this: #EveryMindMatters occurring 187 times, mostly in the early weeks Visit #EveryMindMatters and get your free mental health action plan, and for advice on improving your wellbeing whilst staying at home And #Helpushelpyou, occurring 97 times as part of generic, frequently repeated tweets to encourage people to use NHS services and check symptoms, mostly from September to November 2020: When you think you need A&E, just think 111 first. We will help you right away. And if you need urgent care, we'll book you in to be seen quickly and safely: #HelpUsHelpYou 16 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Use of dialogic features, hashtags and @ mentions: NHSuk @ mentions are far less frequent, with only 74 occurrences across the year. The four most common are @NHSCOVID19App (15), @NHSTestTraceApp (9) and @NHSVolResponder (9), predominantly around the September 2020: The @NHSCOVID19app is now available to the public in England and Wales. Download today from: Apple App Store: (September, 2020. Polarity: 0.175) Also, the @InstructorLive (14), predominatly in the first wave to promote wellbeing: We've teamed up with fitness experts @InstructorLive to bring you some exciting new workout courses 17 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Use of dialogic features, hashtags and @ mentions: NHSNW 817 hashtags, 275 types. NHSNW is notable for an increase towards the end of the period, rather than a falling off. There is more variation in hashtag use, with vaccination being a common theme in the later part of the year: Big thanks to all the volunteers supporting the COVID-19 vaccination programme - we wouldn't have been able to do so well without you #VaccineHeroes #VaccineVolunteers #COVIDVaccine (February, 2021. Polarity: 0.48) So great to have another mass vaccination centre in the North West. The team are working incredibly hard here and across the region #COVID19vaccinationheroes @sthknhs #NHSFamilyhttps 18 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Use of dialogic features, hashtags and @ mentions: NHSNW There is also a spike around the summer as part of the campaign to show appreciation to the NHS: Thank you to every single person in the NW who has helped the NHS in the most difficult period it has ever faced. Thank you to every single key worker. And thank you to the NHS staff that stepped up and controlled the virus. #HEROES #NHS72 #HappyBirthdayNHS (July, 2020. Polarity: 0.248) 19 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Use of dialogic features, hashtags and @ mentions: NHSNW 227 @ mentions combined, consisting of 146 types. They were consistently more common throughout the year than in the NHSuk tweets. Use of @ mentions increased sharply in the final months as a way of promoting the vaccination roll-out: Another pharmacy-led vaccination centre has opened in Lancashire at @AFCFylde. Local residents invited for the vaccine will be able to book at this site. @HealthierLSC @lancslpc @FyldeCoastCCGs @GreenLPharmaUK (January, 2021. Polarity: 0). If you guessed Sir Bobby Charlton, Francis Lee, Sue Johnston and Noddy Holder then well done! All these famous faces have had their COVID-19 vaccination and if you receive an invite, you should too! @SirBobby @suejohnstontv @frannylee7 #COVIDVaccine #VaccineHeroes . (February, 2021. Polarity: 0.128). 20 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

Summary/conclusions The following findings can be observed from the analyses: Both NHSuk and NHSNW Twitter feeds respond to the initial outbreak with a strong focus on positive messages related to physical and mental wellbeing. This is followed in both feeds by a period of more negatively framed warnings and health advice post-first wave. The arrival of the vaccine prompts generally positive content from both twitter accounts, however, while @NHSuk promotes the vaccine in terms of its scientific credentials and safety, @NHSNW focuses more upon the community activity of the vaccine roll-out and its relevance to ordinary people. The community focus of the NHSNW account is also realised through the disproportionate use of dialogic resources such as hashtags and @ mentions, referencing and engaging NHS staff, celebrities and ordinary members of the public. In contrast, the dialogic nature of the NHSuk communications is limited to promotion of the NHS test and trace app and requests for feedback through the website. 21 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.

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Questions? 23 28/04/2025 7TH CORPORA & DISCOURSE INTERNATIONAL CONFERENCE. INNSBRUCK, AUSTRIA.