Atlantic Journal of Communication

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#Ebola: Tweeting and Pinning an Epidemic

Jeanine P.D. Guidry, Shana L. Meganck, Paul B. Perrin, Marcus Messner,

Alessandro Lovari & Kellie E. Carlyle

To cite this article: Jeanine P.D. Guidry, Shana L. Meganck, Paul B. Perrin, Marcus Messner,
Alessandro Lovari & Kellie E. Carlyle (2020): #Ebola: Tweeting and Pinning an Epidemic, Atlantic
Journal of Communication, DOI: 10.1080/15456870.2019.1707202

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Published online: 16 Feb 2020.

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ATLANTIC JOURNAL OF COMMUNICATION
https://doi.org/10.1080/15456870.2019.1707202

#Ebola: Tweeting and Pinning an Epidemic

Jeanine P.D. Guidrya, Shana L. Meganckb, Paul B. Perrinc, Marcus Messnera,
Alessandro Lovari d, and Kellie E. Carlylee
a
Robertson School of Media and Culture, Virginia Commonwealth University, Richmond, USA; bSchool of Communication
Studies, James Madison University, Harrisonburg, United States; cDepartment of Psychology, Virginia Commonwealth
University, Richmond, USA; dDepartment of Political and Social Science, University of Cagliari, Cagliari, Italy; eDepartment
of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA

ABSTRACT
The Ebola outbreak that started in 2014 had infected 28,652 people and taken
more than 11,325 lives by spring 2016. Along with this infectious disease
pandemic, a pandemic of fear surfaced, especially on social media platforms.
Yet little is known about the types of communications, the larger ecological
context, and the associated risk perception factors that were present in the
social media discussion. This study focused on the social media platforms
Twitter and Pinterest and analyzed tweets and pins through the lens of a risk
communication theory, the Risk Perception Model, as well as a health behavior
theory, the Health Belief Model. Large differences were found in the presence
of risk perception variables and health behavior variables between the two
platforms, and recommendations for public health practitioners to address
fear, anger, and attitudinal biases related to Ebola are included.

Introduction
Despite the progress in finding a cure and developing a vaccine, Ebola still is a severe threat to public
health. Indeed, a new outbreak was declared in the Democratic Republic of the Congo, leading to
a total of 1934 deaths out of 2877 cases as of August 15, 2019. Thus, since we are “all a plane ride
away from a chain of lethal transmission” (Ungar, 2001, p. 44), and we live in an interconnected
society characterized by a hybrid media system where social media play a crucial role in spreading
information, it is paramount to learn from what happened during previous Ebola pandemics in
terms of digital communication flow on the social web.
The Ebola outbreak that started in 2014 is the most severe of its kind in history: by spring 2016,
a total of 28,652 cases had been reported and 11,325 deaths had been confirmed (CDC, 2016) – it
was the largest and most complex Ebola outbreak since the virus was discovered in 1976 (WHO,
2019). Social media and mobile technologies play an increasingly important role in health commu-
nication (Moorhead et al., 2013; Rideout & Fox, 2018); however, not much is known about the
content of online social media discussions around the Ebola outbreaks. In the past, social media
platforms have become a discussion forum for the public’s concerns and fears about diseases and
other health issues, often spreading panic and misinformation. Due to their global penetration
(WeareSocial, 2018) social media platforms have become channels where people search for health-
related information, as well as communication environments for publics’ concerns and fears about
diseases, often spreading panic and misinformation. For example, panic surrounding the 2009 H1N1
outbreak was fueled by Twitter conversations (Chew & Eysenbach, 2010; Kaplan & Haenlein, 2011),
and messages about vaccines causing autism often appear on social media platforms like Facebook

CONTACT Jeanine P.D. Guidry guidryjd@vcu.edu Robertson School of Media and Culture, Virginia Commonwealth
University, 901 W. Main St., Richmond 23284 USA
© 2020 Taylor & Francis Group, LLC
2 J. P. D. GUIDRY ET AL.

and Pinterest (Guidry, Carlyle, Messner, & Jin, 2015; Kata, 2010). It is therefore crucial to both
contain the Ebola virus as well as the panic and fear that accompany the virus, and much of this
panic and fear has spread on social media.
The goal of this study is to map the information flow about the 2014 Ebola outbreak as it was
expressed on social media, as well as contribute to public health efforts addressing similar pan-
demics. Analyses are based on a health behavior theory (the Health Belief Model) as well as a risk
communication theory (the Risk Perception Model).

Literature review
Infectious disease outbreaks and (social) media
Social media platforms are creating new challenges and opportunities for communications during crises
such as pandemics. Sastry and Lovari (2017) talk about “Epidemic 2.0”, to designate challenges and
opportunities presented by web 2.0 platforms to health communication as a discipline, and particularly
to communication about/of/during epidemics. While social media provide an opportunity for real-time
dialogue and limit the lag in information flow from traditional mass media to individuals as well as
between individuals, they also are prone to the spreading of rumors and unsubstantiated information or
even misinformation. In addition, public health organizations have often been slow to respond to
pandemic and other health concerns on social media platforms (Guidry, Jin, Orr, Messner, &
Meganck, 2017; Li, Vishwanath, & Rao, 2014; Tirkkonen & Luoma-aho, 2011).
In 2003, Severe Acute Respiratory Syndrome (SARS) spread from a province in China to
individuals in 37 countries around the world (Smith, 2006). Muzzatti (2005) concludes that, during
the SARS outbreak, the media actually manufactured certain public health threats, contributing to
public fear and distrust. Hansen (2009) found that the Norwegian media, in spite of the fact that no
cases of SARS were ever diagnosed in Norway during the 2003 outbreak, often compared SARS
explicitly with the Black Death (the plague that killed half of Europe’s population in the mid-
fourteenth century), thereby portraying SARS as an uncontrollable threat that could change the
demography and economy of an entire continent.
Liu and Kim (2011), in a study of both the traditional and social media communications practices
of 13 corporate and government organizations affected by the 2009 H1N1 flu pandemic, found that
while the H1N1 crisis was often listed as the first global crisis situation where social media was
effectively used to respond to crisis concerns, most organizations tended to rely heavily on traditional
media to frame the crisis. A study among Finnish citizens about their perceptions of authorities as
crisis managers during the H1N1 epidemic examined the success of authority interventions on online
discussion forums (Tirkkonen & Luoma-aho, 2011). The high level of trust for authority figures in
general was not extended to the online environment, and the authorities’ interventions on the online
forums aimed at correcting misconceptions seemed to fail (Tirkkonen & Luoma-aho, 2011; Vraga &
Bode, 2018). Finally, a study of 5,395 tweets sent during the 2009 H1N1 outbreak found that H1N1-
related tweets were primarily used to spread information from credible sources. In addition, news
websites were the most often-used sources (23.2%), while government and health agencies were linked
only 1.5% of the time (Chew & Eysenbach, 2010).

Ebola and the media

A study focused on the way the Ebola virus threat was presented in two types of British mass media
outlets after the mid-1990s Ebola outbreaks found that the first Ebola outbreaks in 1976–1977
received relatively little attention from the British public, while the mid-1990s outbreaks received
significant media coverage. Both newspapers and tabloids presented Ebola as a far-removed, almost-
fiction-like illness, and the British population was portrayed as invulnerable to the Ebola virus (Joffe
& Haarhoff, 2002).
 ATLANTIC JOURNAL OF COMMUNICATION 3

A content analysis of three U.S. TV stations’ and nine English-language newspapers’ coverage of the
1995 Ebola Zaire outbreak found that the mention of Ebola in their coverage was accompanied by the
words “killer” or “deadly” (Ungar, 1998). The 1995 outbreak quickly led to countries tightening their
borders, quarantining travelers, and issuing travel advisories. The New York Times’ coverage developed
from the concept of Ebola being a highly contagious disease with a 90% mortality rate on day one to
Ebola being a disease that is much harder to catch than measles or the flu on day two. At the same time,
the Times of London’s coverage shifted from Ebola as an easily spread, airborne disease on day one to
Ebola being relatively difficult to catch on day three (Ungar, 1998).
Sastry and Lovari (2017) provided a narrative analysis of Centers for Disease Control and
Prevention (CDC) and WHO’s official Facebook pages during the 2014 Ebola epidemic, highlighting
the importance for public health organizations to have a clear and credible voice in the social media
realm, characterized by the interaction of organizational messages, users’ digital practices, and mass
media coverage.

Social media, twitter, and pinterest

Social media platforms have changed the way organizations can communicate with their stake-
holders as well as provided new opportunities for stakeholders to engage in direct dialogue with both
organizations and each other (McAllister-Spooner, 2009; Sommerfeldt, Kent, & Taylor, 2012). The
variety of social media platforms available differ in their characteristics and affordances, enabling
certain type of interactions and practices by digital publics (Boyd, 2010).
This study chose two very different social media platforms as its focus: microblogging platform
Twitter and visual bookmarking platform Pinterest. As of early 2018, 24% of U.S. adults were using
Twitter, which was launched in 2006 (Pew Research Center, 2018). Pinterest was launched in March
of 2010 and grew to more than 250 million users by 2018 (Pinterest, 2018), with 29% of all
U.S. adults using the platform (Smith & Andersen, 2018). These platforms were selected for
a number of reasons, including their increasing use for communicating about health-related infor-
mation, different formats (primarily text versus primarily visual) and different demographic profiles.
Health-related social media studies frequently focus on Twitter because it is the most popular social
media platform used for health communication (Pershad, Hangge, Albadawi, & Oklu, 2018). Similar
to Twitter, while Pinterest was not designed to facilitate communication about health issues, studies
have shown that users do utilize the platform for this purpose, and that this use is often characterized
by concerning characteristics such as a high presence of misinformation (Guidry et al., 2015). Visual
platforms such as Pinterest are still under-studied, which is concerning considering the rise of
visually focused social media platforms as well as the proven impact of visuals on message processing
with messages including visuals associated with remembering messages longer and more accurately
(Houts, Doak, Doak, & Loscalzo, 2006; Lipkus, 2007). All social media platforms have different user
bases which alter levels of engagement depending on the content shared. Twitter has an even gender
distribution whereas Pinterest is used more often by women, which added an interesting component
for this study because women are more likely to make health-care decisions for their families (U.S.
Department of Labor, 2013; West, 2019). While these platforms cannot be easily compared because
of their differences, both Twitter and Pinterest are being used to share and communicate about
health-related information highlighting the need to better understand how members of the public
are talking about and responding to health-focused messages on these platforms.

Ebola-related information online

People increasingly search for health information on the Internet, and the information they find
often influences medical decisions they make (Kata, 2010). It is therefore crucial to understand what
health-related information is available online. While timely and accurate health information is
definitely present online, misinformation and rumors seem to be equally so. For example, Internet
4 J. P. D. GUIDRY ET AL.

searches tend to lead to public health versus anti-vaccination websites with about equal likelihood –
which means that anti-vaccination information is often as easily available as reliable scientific
evidence (Betsch et al., 2012). Or, as vaccine researchers Poland and colleagues state, “All ideas
are given equal credence regardless of expertise” (Poland, Jacobson, & Ovsyannikova, 2009). While
the Centers for Disease Control and Prevention (CDC) less than three hours after confirming the
first Ebola case in Dallas sent a much-retweeted tweet featuring detailed information on how Ebola
can and cannot be contracted, thousands of other users shared half-truths, rumors, and conspiracy
theories (Firger, 2014; Luckerson, 2014). On August 10, 2014, Yahoo’s Twitter account was hacked
and posted a tweet to its 1.3 million followers that 145 people were infected with the Ebola virus
since “doctors carrying the disease were flown in from Africa” (Blair, 2014). The Department of
Public Health in Iowa had to issue a statement dismissing rumors that Ebola had arrived in their
state (Sarmah, 2014).
Prominent content themes related to Ebola and broadcast via traditional and digital media
include topics like Ebola symptoms, preventative measures targeted toward Ebola, misinformation
like the virus being airborne and patients being contagious before they are symptomatic, the issue of
closing the borders to protect nations and their citizens from the Ebola virus, and the issue of
mandatory quarantine for travelers originating from countries with current Ebola outbreaks (Blair,
2014). This, combined with the gravitas of the disease and the observed panic surrounding Ebola in
the Western world, led to this study’s first research question:

RQ1: How do members of the public talk about Ebola on Twitter and Pinterest?

The potential for interactivity is one of the social media’s greatest contributions to the commu-
nications field, even though that promise does not always become a reality (Alhabash & Mcalister,
2014; Bortree & Seltzer, 2009; Lovejoy, Waters, & Saxton, 2012). Virality – how many times a post is
shared, liked, and commented on – can both be seen as an outcome measure as well as a message
feature (Yuan & Alhabash, 2014). The greater the virality of the post (the more it has been retweeted,
favorited, repinned, liked, and received comments), the greater the tone and magnitude of the post
that others on these platforms will perceive (Yuan & Alhabash, 2014). It is therefore important to
determine the virality of the posts in this study:

RQ2: How do members of the public respond to tweets and pins about Ebola?

Risk communication theory

The successful resolution of any type of health crisis depends at least in part on effective communication.
At the same time, these types of situations often create substantial barriers to effective communication
and evoke strong negative emotions such as fear, distrust, and anger (Covello, Peters, Wojtecki, & Hyde,
2001). When the communications environment becomes emotionally charged, the rules for effective
communications change. The Risk Perception Model is a risk communication theory that focuses on
how risks are perceived, based on the following factors: (a) risks that evoke fear, terror, or anxiety will be
perceived as greater than risks that do not; (b) risks associated with institutions or organizations that are
lacking in credibility and trust are perceived as greater than risks associated with trustworthy entities; and
(c) risks that produce fatalities or have irreversible, catastrophic consequences are perceived as greater
than risks that have less catastrophic effect potential (Covello et al., 2001). When a serious threat is
perceived, people’s ability to process information is significantly impaired. In addition, these types of
risks are often accompanied by so-called mental noise, which in turn can affect one’s ability to engage in
rational discourse (Cairns, de Andrade, & MacDonald, 2013; Covello et al., 2001). It is important to
determine the presence of certain risk perception factors in Ebola-focused social media posts, and how
social media users respond to these posts. This study’s third and fourth research questions, therefore, are:
 ATLANTIC JOURNAL OF COMMUNICATION 5

RQ3: To what extent do Ebola-focused tweets and pins contain risk perception variables?

RQ4: How do members of the public respond to tweets and pins about Ebola and risk
perception variables?

Health behavior theories

The Health Belief Model (HBM) is one of the most common theories used to study and explain
health-related behavior (Janz & Becker, 1984; Rosenstock, 1974). The HBM’s main constructs, as
applied to Ebola, are perceived susceptibility (what is the likelihood of contracting Ebola), perceived
severity (how serious is Ebola, if contracted), perceived benefits (how effective are available treat-
ment and preventative measures in protecting against Ebola), perceived barriers (what are the
perceived barriers to Ebola treatment and preventative measures), and self-efficacy (belief that people
can successfully take the steps to protect themselves from Ebola) (Champion & Skinner, 2008). The
HBM is widely used when studying how health beliefs relate to health-related actions. A study in
Hong Kong, for example, showed that perceived barriers to the seasonal flu vaccine among pregnant
women were strongly associated with failure to vaccinate, while perceived benefits of vaccination and
perceived susceptibility to the flu were positively associated with getting the vaccine (Yuet Sheung
Yuen et al., 2013). Another study, consisting of a review of studies focused on adolescents’ percep-
tions of addiction and health risks associated with cigarette smoking, found that adolescents
regarded perceived barriers to quitting smoking as more relevant than the benefits of quitting,
with this balance changing when they decided to attempt to stop smoking (Mantler, 2013). Based on
this literature the current study’s final two research questions are:

RQ5: To what extent do Ebola-focused tweets convey information related to the five main
constructs of the Health Belief Model?

RQ6: How do members of the public respond to tweets and pins about Ebola and the five
main constructs of the Health Belief Model?

Method
This study analyzed information related to the recent Ebola outbreak on Twitter and Pinterest, two
popular social media platforms. In a quantitative content analysis, 700 Pinterest posts (hereafter referred
to as “pins”) were identified on October 15–16, 2014 by choosing every fifth applicable pin for analysis.
Drawing upon existing literature, this study identified two hashtags/keywords to select the tweets and
pins for the sample: #Ebola/Ebola and #EbolaOutbreak/EbolaOutbreak (Joffe & Haarhoff, 2002).
To generate a matching sample from Twitter, 700 Twitter posts (hereafter referred to as “tweets”)
were randomly selected from a larger sample of tweets. This larger sample of tweets (199,316) was
collected in the second two weeks of October of 2014 using Netlytic.org, a cloud-based text and
social networks analyzer that can use the public Twitter API to collect tweets.
Coding protocols for tweets and pins were developed, tested, and implemented. Each tweet was coded
for the timeframe of the tweet, the handle of the Twitter user, whether a tweet was retweeted and how
many times, whether a tweet was favorited and how many times, and whether the tweet included
a hyperlink and, if so, the type of website it is linked to. Each pin was coded for the timeframe of the post,
the handle of the pinner who posted, whether the pin was an original post or a repin, whether a pin was
repinned and the number of repins, whether a pin was liked and number of likes, whether a pin received
comments and number of comments, whether the pin linked to another website and, if so, what type of
website. In addition, all posts were coded for the presence of seven health behavior model variables
(perceived severity, perceived susceptibility, perceived benefits of Ebola prevention, perceived benefits of
6 J. P. D. GUIDRY ET AL.

Ebola treatment, perceived barriers to Ebola prevention, perceived barriers to Ebola treatment, and self-
efficacy), and five risk perception variables (fear, danger, untrustworthy entities, identifiable victim, and
dreaded outcome). Finally, all tweets and pins were coded for 13 Ebola-specific variables: news about
Ebola, Ebola symptoms, the spread of Ebola, Ebola being contagious, preventative measures against
Ebola, Ebola being deadly, misinformation (Ebola is airborne, Ebola patients are contagious before they
are symptomatic, and other types of Ebola-related misinformation), closing borders, mandatory quar-
antine, reassurance, and Ebola vaccine.
Two coders were trained to establish intercoder reliability. The first coder coded all of the Twitter
posts (n = 700) and all the Pinterest posts (n = 700), while the second coder coded 10% of both the
Twitter posts (n = 70) and the Pinterest posts (n = 70) for the subjective study variables. After pre-
testing and subsequent changes to the coding protocol, intercoder reliability was assessed with the
ReCal statistical program using Scott’s Pi (Scott, 1955), which was on average 0.83, with no
coefficients under 0.70. The coefficients were all considered to be reliable.

Statistical analyses
Frequencies were gathered for all variables in the study. Mann–Whitney U tests were used to check
for differences between Twitter and Pinterest engagement between posts with versus without a series
of dichotomous variables. Distributions of the engagement frequencies for all variables were eval-
uated and determined to be similar based on visual inspection of a box plot. Finally, Chi-Square tests
were used to compare Twitter and Pinterest for presence of dichotomous variables.

Results
The first research question asked how members of the public discussed Ebola on Twitter and
Pinterest. Chi-Square tests for association were conducted between the type of platform and general
Ebola variables. The majority of the general Ebola information variables were mentioned signifi-
cantly more frequently on Pinterest than on Twitter. Significant associations were present between
type of platform and mention of the spread of Ebola, Ebola being contagious, prevention, mis-
information related to Ebola (airborne virus, disease contagious without symptoms, and other types
of misinformation), closing borders, mandatory quarantine, mention of the cause of Ebola, decep-
tion by medical authorities, worry about Ebola, mention of a future Ebola vaccine, experimental
treatment, and doubt about containment. All these were more frequently present on Pinterest
compared to Twitter. In addition, significant associations were present between the type of platform
and mention of a joke or parody related to Ebola, prejudice toward Africa, comparing Ebola to
another disease, and messages containing a direct quote. These four variables were more frequently
present on Twitter compared to Pinterest (see Tables 1 and 2).
Research question two asked how members of the public respond to tweets and pins about Ebola.
Retweeting was the most used form of interaction: 57.9% (n = 463) of the tweets in this sample were
retweeted at least once, while 42.1% (n = 337) were not. “Liking” was less popular: 38.9% (n = 272) of
the tweets were liked at least once, while 61.1% (n = 428) were not. The mean number of retweets for
the tweets in this sample was 184.92, while the mean number of likes was much lower at 0.15.
However, like the majority of social media engagement variables, the tweets and pins in this sample
were not normally distributed, and using the median is a more appropriate measure of central
tendency. The median number of retweets was 3.00, and the median number of likes was .00. The
range for retweets was 0–10,134, and the range for likes was 0–19.
Of all the tweets in this sample, 76% (n = 608) contained at least one mention, while 24% (n = 192) did
not; 11.1% (n = 89) used a direct reply, while 88.9% (n = 711) did not. Finally, 57.5% (n = 460) of all
tweets included a link to an external website, while 42.5% (n = 340) did not.
Repinning was the most used form of interaction: 73.0% (n = 511) of the pins in this sample were
repinned at least once, while 27.0% (n = 189) were not. “Liking” was less popular with 38.9% (n = 272) of
 ATLANTIC JOURNAL OF COMMUNICATION 7

Table 1. Ebola descriptive variables on Twitter and Pinterest.

Variable Present in tweets (N = 700) Present in pins (N = 700)
Ebola news 90.7% (n = 635) 88.9% (n = 622)
Ebola symptoms 13.9% (n = 97) 16.7% (n = 117)
Spread of Ebola 29.3% (n = 205) 46.6% (n = 326)
Ebola being contagious 29.3% (n = 205) 39.4% (n = 276)
Preventative measures 27.1% (n = 190) 53.1% (n = 372)
Ebola being deadly 30.0% (n = 210) 54.9% (n = 384)
Misinformation: airborne 2.0% (n = 14) 9.3% (n = 65)
Misinformation: contagious without symptoms 1.0% (n = 7) 3.3% (n = 23)
Misinformation: other 3.4% (n = 24) 13.3% (n = 93)
Closing borders 6.3% (n = 44) 20.3% (n = 142)
Mandatory quarantine 4.7% (n = 33) 15.1% (n = 106)
Reassurance 7.9% (n = 55) 6.1% (n = 43)
Ebola vaccine 1.1% (n = 8) 9.0% (n = 63)
Prejudice toward Africa 4.1% (n = 29) .7% (n = 5)
Joke/parody 8.9% (n = 62) 5.3% (n = 37)

the pins receiving at least one “like,” while 61.1% (n = 428) did not. Only 7.3% (n = 51) of the pins
attracted at least one comment, while 92.7% (n = 649) did not. The mean number of repins was 14.96; the
mean number of likes was 2.38, and the mean numbers of comments was 1.92. The median number of
repins was 2.00, the median number of likes and comments were both .00. The range of repin frequency
was 0–721, the range of like frequency was 0–151, and the range for comments was 0–15. Of all the pins
in the sample, 64.7% (n = 453) were original pins, pins uploaded by the pinner, while 35.2% (n = 247)
were repins, shared content from another Pinterest user. Finally, 96.7% (n = 677) of all pins included
a link to an external website, while 3.3% (n = 23) did not.
Mann–Whitney U tests showed that on Twitter, the presence of a comparison with another
disease, mention of a future Ebola vaccine, mention of incompetence of authorities in handling
Ebola, and reassurance about Ebola were associated with an increase in median retweet frequency,
but mention of Ebola symptoms and worry about Ebola were associated with a decrease in median
retweet frequency (see Table 3). On Pinterest, the presence of Ebola symptoms was associated with
an increase in median like frequency, while Ebola being contagious, Ebola prevention, and
deception by authorities were associated with an increase in median repin frequency.
Mentioning closing borders and worry about Ebola were associated with a decrease in median
repin frequency (see Table 4).
Research question three asked to what extent Ebola-focused tweets and pins contained risk
perception variables. Chi-Square tests for association were conducted between the type of platform
and Ebola risk perception variables. Significant associations were present between the type of
platform and mention of the involuntary nature of Ebola, fear of Ebola, the danger of Ebola, dreaded
outcomes of Ebola, deadly nature of Ebola, and mention of untrustworthy entities related to Ebola
(e.g., mention of government conspiracies in handling Ebola). All these were more frequently
present on Pinterest compared to Twitter (see Tables 5 and 6).
The fourth research question asked how members of the public respond to tweets and pins about
Ebola and risk perception factors. Mann–Whitney U tests showed that on Twitter, the presence of
a mention of an identifiable victim was associated with an increase in median retweet frequency, but
mention of fear, danger, and dreaded, adverse outcomes were associated with a decrease in median
retweet frequency (see Table 3). On Pinterest, the mention of danger was associated with an increase
in median repin frequency, while the mention of fear, dreaded, adverse outcomes, and untrustworthy
entities were associated with a decrease in median repin frequency (see Table 4).
Research question five asked to what extent Ebola-focused tweets and pins convey information
related to the five main constructs of the Health Belief Model. A complete list of variables and
percentages can be found in Table 7, but the most striking result is two-fold: 75.1% of pins addressed
the issue of perceived susceptibility to Ebola while only 44.3% of tweets did, and 78.1% of pins
mentioned the perceived severity of the Ebola virus while only 47.6% of tweets did.
8 J. P. D. GUIDRY ET AL.

Table 2. Chi-Square comparisons of Pinterest and Twitter.

Variable Response Frequency Twitter Pinterest χ2 df p-Value
Joke/Parody Yes Observed 67* 37 9.348 1 .002
Expected 52.0 52.0
No Observed 633 663
Expected 648.0 648.0
Africa prejudice Yes Observed 30* 5 18.315 1 <.001
Expected 17.5 17.5
No Observed 670 695
Expected 682.5 682.5
Spread of Ebola Yes Observed 171 326* 74.946 1 <.001
Expected 248.5 248.5
No Observed 529 374
Expected 451.5 451.5
Contagious Yes Observed 202 276* 17.395 1 <.001
Expected 239.0 239.0
No Observed 498 424
Expected 461.0 461.0
Prevention Yes Observed 195 372* 92.864 1 <.001
Expected 283.5 283.5
No Observed 505 238
Expected 416.5 416.5
Ebola deadly Yes Observed 202 384* 97.218 1 <.001
Expected 293.0 293.0
No Observed 498 316
Expected 407.0 407.0
Misinformation: Ebola airborne Yes Observed 15 65* 33.144 1 <.001
Expected 40.0 40.0
No Observed 685 635
Expected 660.0 660.0
Misinformation: contagious w/o symptoms Yes Observed 6 23* 10.176 1 .001
Expected 14.5 14.5
No Observed 694 677
Expected 685.5 685.5
Ebola symptoms Yes Observed 89 117* 4.462 1 .035
Expected 103.0 103.0
No Observed 611 583
Expected 597.0 597.0
Closing borders Yes Observed 42 142* 62.572 1 <.001
Expected 92.0 92.0
No Observed 658 558
Expected 608.0 608.0
Mandatory quarantine Yes Observed 42 106* 30.947 1 <.001
Expected 74.0 74.0
No Observed 658 594
Expected 626.0 626.0
Comparison with other disease Yes Observed 47* 28 5.086 1 .024
Expected 37.5 37.5
No Observed 653 672
Expected 662.5 662.5
Cause of Ebola Yes Observed 170 268* 31.910 1 <.001
Expected 219.0 219.0
No Observed 530 432
Expected 481.0 481.0
Medical authority deception Yes Observed 12 107* 54.643 1 <.001
Expected 49.8 69.2
No Observed 491 593
Expected 453.2 630.8
Worry Yes Observed 174 567* 442.802 1 <.001
Expected 370.5 370.5
No Observed 526 133
Expected 329.5 329.5
Direct quote Yes Observed 35* 5 23.162 1 <.001
Expected 20.0 20.0
No Observed 665 695
Expected 680.0 680.0
(Continued )
 ATLANTIC JOURNAL OF COMMUNICATION 9

Table 2. (Continued).
Variable Response Frequency Twitter Pinterest χ2 df p-Value
Ebola vaccine Yes Observed 18 63* 26.535 1 <.001
Expected 40.5 40.5
No Observed 682 637
Expected 659.5 659.5
Experimental treatment** Yes Observed 3 25* 17.638 1 <.001
Expected 14.0 14.0
No Observed 697 675
Expected 686.0 686.0
Doubt about containment Yes Observed 32 80* 22.360 1 <.001
Expected 56.0 56.0
No Observed 668 620
Expected 644.0 644.0
*Significant at p < .05; **Using Fisher’s Exact Test.

Table 3. Dichotomous independent variables and median engagement on Twitter.

Engagement variable Variable Mdn present Mdn absent U Z p-Value
Retweets Ebola symptoms .00 3.00 21,719.500 −3.137 .002
Retweets Compare with other disease 36.00 2.00 20,894.000 4.236 <.001
Retweets Worry 1.00 3.00 37,624.000 −3.598 <.001
Retweets Reassurance 11.00 2.00 23,921.500 2.786 .005
Retweets Ebola vaccine 2611.50 2.00 10,445.500 5.200 <.001
Retweets Incompetence of authorities 6.00 2.00 36,722.000 1.977 .048
Retweets Fear 1.00 3.00 27,988.000 −3.662 <.001
Retweets Danger 1.00 4.00 43,416.000 −4.192 <.001
Retweets Identifiable victim 6.00 2.00 37,008.000 2.259 .024
Retweets Deception by authorities 6.00 2.00 17,298.000 1.995 .046
Retweets Dreaded, adverse outcomes .00 3.00 20,341.500 −4.186 <.001

Table 4. Dichotomous independent variables and median engagement on Pinterest.

Engagement variable Variable Mdn present Mdn absent U Z p-Value
Likes Ebola symptoms 1.00 .00 39,746.000 3.226 .001
Repins Ebola contagious 2.00 1.00 64,864.500 2.470 .014
Repins Closing borders 1.00 2.00 34,866.500 −2.245 .025
Repins Worry 1.00 2.00 32,872.000 −2.341 .019
Repins Ebola prevention 3.00 1.00 45,503.500 3.322 .001
Repins Deception by authorities 1.0 .00 52,279.500 −2.808 .005
Repins Fear 1.00 2.00 38,743.000 −3.297 .001
Repins Danger 1.00 .00 36,729.500 −2.352 .019
Repins Untrustworthiness 1.00 2.00 51,490.500 −3.599 <.001
Repins Dreaded outcomes 1.00 2.00 53,095.000 −2.959 .003
Repins Self-efficacy 3.00 1.00 20,701.000 3.959 <.001
Likes Self-efficacy 1.00 .00 20,047.000 4.863 <.001
Repins Benefits prevention 4.00 1.00 19,387.500 4.574 <.001
Likes Benefits prevention 1.00 .00 20,670.500 4.276 <.001

Table 5. Risk perception variables on Twitter and Pinterest.

Variable Present in tweets (N = 700) Present in pins (N = 700)
Negative emotion 30.7% (n = 215) 80.9% (n = 566)
Fear 17.4% (n = 122) 74.7% (n = 523)
Danger 32.4% (n = 227) 81.4% (n = 570)
Irreversible harm, dread 13.0% (n = 91) 54.0% (n = 378)
Deception by authorities 6.4% (n = 45) 41.7% (n = 292)
Incompetence by authorities 16.0% (n = 112) 18.7% (n = 131)
Identifiable victim 15.9% (n = 111) 17.1% (n = 120)
Untrustworthy organization/institute 15.7% (n = 110) 53.6% (n = 375)
10 J. P. D. GUIDRY ET AL.

Table 6. Chi-Square comparisons of risk perception variables on Twitter and Pinterest.

Variable Response Frequency Twitter Pinterest χ2 df p-Value
Involuntary nature Yes Observed 14 35* 9.326 1 .002
Expected 24.5 22.9
No Observed 686 665
Expected 675.5 677.1
Ebola deadly Yes Observed 202 384* 97.218 1 <.001
Expected 293.0 290.3
No Observed 498 316
Expected 407.0 409.7
Fear Yes Observed 122 523* 462.285 1 <.001
Expected 322.5 315.5
No Observed 578 177
Expected 377.5 384.5
Danger Yes Observed 227 547* 295.878 1 <.001
Expected 387.0 382.2
No Observed 473 153
Expected 313.0 317.8
Dreaded, adverse outcome Yes Observed 91 378* 264.101 1 <.001
Expected 234.5 228.2
No Observed 609 322
Expected 465.5 471.8
Associate with untrustworthy entities Yes Observed 110 375* 221.542 1 <.001
Expected 242.5 231.5
No Observed 590 325
Expected 457.5 468.5

Table 7. Health belief model constructs on Twitter and Pinterest.

Variable Present in tweets (N = 700) Present in pins (N = 700)
Perceived benefits treatment 7.0% (n = 49) 4.9% (n = 34)
Perceived benefits prevention 10.6% (n = 74) 13.9% (n = 97)
Perceived benefits treatment 2.4% (n = 17) 4.0% (n = 28)
Perceived benefits prevention 5.3% (n = 37) 6.6% (n = 46)
Perceived susceptibility 44.3% (n = 310) 75.1% (n = 526)
Perceived severity 47.6% (n = 333) 78.1% (n = 547)
Self-efficacy 2.6% (n = 18) 13.0% (n = 91)

Chi-Square tests were conducted between the type of platform and health behavior theory
variables related to Ebola. All expected cell frequencies were greater than five. Significant associa-
tions were present between the type of platform and mention of perceived susceptibility to Ebola,
perceived severity of Ebola, and self-efficacy in carrying out Ebola preventive actions. All these were
more frequently present on Pinterest compared to Twitter (see Table 8).
The final research question asked how members of the public respond to tweets and pins about
Ebola and the five main constructs of the Health Belief Model. Mann–Whitney U tests showed that
on Pinterest, mentioning perceived benefits of Ebola prevention and self-efficacy were both asso-
ciated with an increase in median repin and like frequency (see Table 4). No engagement differences
regarding HBM constructs were present on Twitter.

Discussion & conclusion

The goal of this study was to analyze the discussion about the 2014–2016 Ebola outbreak on the
social media platforms Twitter and Pinterest in order to gain an understanding of how members of
the public are talking about responding to messages related to Ebola. Two quantitative analyses, one
of 800 tweets and one of 700 pins, showed that, overall, Pinterest contained more Ebola-focused
messages than Twitter. One possible explanation for this result is user demographics. Over 80% of all
Pinterest users are women, and it is known from previous research that women are more likely to
 ATLANTIC JOURNAL OF COMMUNICATION 11

Table 8. Chi-Square comparisons of health belief model constructs on Twitter and Pinterest.
Variable Response Frequency Twitter Pinterest χ2 df p-Value
Susceptibility Present Observed 329 552* 152.263 1 <.001
Expected 440.5 440.5
Absent Observed 371 148
Expected 259.5 259.5
Severity Present Observed 338 556* 147.080 1 <.001
Expected 447.0 447.0
Absent Observed 362 144
Expected 253.0 253.0
Self-efficacy Present Observed 18 91* 53.018 1 <.001
Expected 54.5 51.3
Absent Observed 682 609
Expected 645.5 648.7

make health-care decisions (U.S. Department of Labor, 2013); therefore, we have reason to believe
that they are more likely to be concerned about the specifics of health issues, such as symptoms and
potential life-threatening outcomes.
Overall engagement on both Twitter and Pinterest was low. However, there were a few interesting
differences between the types of messages that elicit increasing engagement and those that do not.
Both on Twitter and on Pinterest, it seems that messages that likely evoke fear in some way (the
deadly nature of Ebola, worry about Ebola, fear of Ebola, adverse outcomes of Ebola) decreased
engagement on both platforms. However, HBM constructs that promote being able to prevent Ebola
(benefits and self-efficacy) resulted in increased engagement on Pinterest.
Additionally, there was a dramatic difference in the presence of risk perception variables between
the two platforms, with Pinterest having significantly more messages that display fear, danger,
untrustworthy institutions, the involuntary nature of Ebola, dreaded outcomes, and the deadly
nature of Ebola. The higher presence of these risk perception variables on Pinterest means it may
be more difficult to change pinners’ minds about the misinformation and rumors related to the
Ebola virus. In addition, the lack of expressed trust in authorities and government entities on
Pinterest may mean that messages from public health practitioners may not be as effective in the
population that uses this platform. An interesting result, however, was the lack of engagement with
pins and tweets displaying risk perception variables, which may mean that while messages of fear
and danger are plentiful on Twitter and messages of mistrust are common on Pinterest, they may
not spread as quickly as messages without these characteristics on the respective platforms.
In closing, there are several recommendations for the field of public health that can be derived from
this study. First and foremost, discussions and messages of fear and danger related to Ebola are taking
place on Twitter and Pinterest. Public health practitioners should consider the use of social media
interventions to target these audiences at the place they are already spending their time, which may help
the message reach its desired goal. Secondly, while many public health institutions have adopted Twitter,
few currently use Pinterest, perhaps due to the platform’s reputation for decorating tips and wedding
planning boards. Considering the dramatic presence of Ebola risk perception factors present in the pins
of this study, Pinterest should be considered a valid health communication platform. Third, not all social
media platforms are created equal. Possible interventions should be tailored differently for Twitter and
for Pinterest, reflecting the different concerns present on these platforms.
Finally, there are a number of limitations and future considerations to this study. We are
increasingly going online to find health information, share health experiences and connect with
health providers (Rideout & Fox, 2018), so communication practitioners and scholars need to
continue working to understand how social media and other online tools can best be used to
share and receive health-related information. This paper is a starting point but there are still several
avenues left to explore. First, Pinterest does not list its pins chronologically and does not list an exact
time stamp for each pin. This makes using a more conventionally used content analysis sampling
method, like a constructed two-week time period, virtually impossible. The lack of previous Pinterest
12 J. P. D. GUIDRY ET AL.

studies means few examples are available. Future studies will likely devise better ways to sample
Pinterest content. Secondly, this study only focused on the messages posted by the public. Future
studies should also consider the messages sent by public health organizations, and contrast those
with messages from the public. Third, while this study focused on Twitter and Pinterest, future
studies in this field should consider Facebook and Instagram to study the same topic and build
a more robust field of literature regarding the discussion of Ebola on social media platforms. Future
research should also discuss the source relationship between traditional news media and social media
in health crisis as traditional news media often amplify the reach of social media posts through the
use of them as sources. In this context, the topics of opinion leadership in the digital space as well as
the credibility of digital sources should also be examined. Unfortunately, Ebola and infectious
diseases like it will not disappear any time soon, and there is much that is not known yet in this
emerging field of social media health communications, especially as it applies to infectious disease
communications.

Disclosure statement
No potential conflict of interest was reported by the authors.

ORCID
Alessandro Lovari http://orcid.org/0000-0002-5877-467X

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