Patterns and conversational structure of knowledge sharing on Ebola virus disease among healthcare practitioners: Observations from a pilot study

Abstract

This pilot study was designed to determine the conversational structure on Ebola Virus Disease (EVD), pattern of knowledge sharing and knowledge sharing behaviour of healthcare practitioners (HCP) on Medscape online network. The study was guided by Conversation Theory, and deployed a retrospective document/content analysis research design. Ninety-two comments from healthcare practitioners including 16 EVD newsposts out of 37 EVD news were randomly extracted from the network between 2014 and 2018. Extracted data were analysed using NVivo and Microsoft Excel applications. An EVD knowledge taxonomy was developed from the content mapping of EVD topics posted on the network. Results from the pilot study revealed that news on EVD were mostly on EVD outbreak management at the peak period of EVD outbreak in 2014. Also, the HCPs mostly engaged in knowledge sharing on issues relating to EVD risk. Findings revealed that the entire (37) newsposts were of interest to HCPs and they responded to 16 newsposts. There were three active and influential HCPs on the network. The novelty of this study stems from its focus on conversation patterns of HCP on online knowledge sharing using the variables of Conversation theory to examine their knowledge sharing behaviours. The outcome of the study could serve as a model for other studies on other trending viral diseases such as Coronavirus, Lassa Fever, Monkey pox, etc. This study thus recommends replicate analysis in the main study with a larger data set with further findings using network analysis and other statistical tools to examine the conversational structure on EVD and pattern of knowledge sharing among the HCPs.

Keywords

Conversational structure Ebola virus disease healthcare practitioners knowledge sharing Medscape network

Introduction

Ebola Virus Disease (EVD), a devastating acute viral illness caused by the Ebola virus, is one of the most devastating viral diseases of this century (WHO Ebola et al., 2015). Fruit bats are the natural reservoir of EVD transmission. The virus is transmitted to humans through contact with blood, bodily fluids or secretions of infected persons or wild animals (WHO Ebola et al., 2015). Ebola is so contagious and virulent that when contracted, it goes directly to the bloodstream then quickly to the organs, shutting them down if immediate medications are not given and eventually kills the victim within 10 days. The symptoms of EVD which often begin after about 21 days include fever, muscle pain, headache, sore throat, vomiting, diarrhoea, rashes, bleeding gums, impaired kidney and liver function as well as a low white blood cell, platelet counts and elevated liver enzymes.

The earliest strain was diagnosed in Germany and Serbia in 1967 and United States in 1982 (Adjemian et al., 2011; Amman et al., 2012; Olival and Hayman, 2014). The most lethal EVD strains originated and spread in 1976 specifically in the countries of Sudan and Zaire in Africa. This was followed by a less severe strain in the United States in 1989, Cote d’Ivoire in 1994, Democratic Republic of Congo in 2018. However, the most lethal outbreak occurred in Liberia, Sierra Leone, Guinea, Republic of Congo, Nigeria, Mali and Spain including the United States in 2014/2015 (Stein, 2015; WHO Ebola et al., 2015). In West Africa alone, more than 28,600 persons were infected with the virus during the 2014/2015 EVD outbreaks (Centres for Disease Control and Prevention (CDCP), 2016).

The spread and morbidity risks associated with outbreak of EVD is higher compared to other emerging diseases and epidemics such as Avian Influenza, Severe Acute Respiratory Syndrome (SARS), Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), WHO Ebola et al. (2015). However, the episodic nature of EVD occurrence, coupled with its highly infective and fast morbidity rates largely constrains research on the disease (Alexander et al., 2015). Due to its high infective and fast morbidity rates, a body of knowledge, research and expertise on the disease are constrained (Campbell and Miranda-Morel, 2017; Roache et al., 2014). EVD is a global issue with potential rapid pandemic growth with the massive migration of humans crossing borders (Omoleke et al., 2016). Increase in global human flow across borders requires instant connectedness among healthcare practitioners to contain and manage all diseases particularly virulent strains unfamiliar to communities. This requires healthcare practitioners to be empowered to manage diseases such as EVD that were hitherto strange to their communities. This is achievable through knowledge sharing among healthcare practitioners in formal and informal settings (Campbell and Miranda-Morel, 2017).

Knowledge is created and exchanged through interaction and spontaneous exchange among two or more people, otherwise known as conversation. Conversation as a subject, intersperses sociology where it is viewed from the perspective of human interaction (Wong and Waring, 2020); in communication studies, conversation describes a process of knowledge sharing (Wong and Waring, 2020) while cyberneticians consider exchange of signals among humans and machines or among machines as a form of conversation (Weiner, 1948). Conversation is thought to basically happen informally and symmetrically for the purposes of either establishing and maintaining social ties. According to Wong and Waring (2020), formalised conversation is a form of knowledge sharing among individuals or groups with a target of meeting an information need or goal. In this study, conversational knowledge sharing is conceptualised as a form of seeking for consensus about a matter on a particular concept such as EVD. Ideas or information derived during conversation are dependent on the inference made by the participants from the conversation which determines the outcome of the knowledge being shared.

According to Panahi (2014), knowledge sharing is an act of communicating knowledge among individuals, groups or organisations. It is an interaction culture that involves the exchange of what one knows and wishes to share, and exchange of experiences and skills (Rauniar et al., 2019). Olatokun and Elueze (2012) opined that knowledge sharing is an act of making knowledge available to others within the organisation. Haeussler et al. (2014) stated that knowledge sharing encompasses a wide range of behaviours which result in the exchange of knowledge from one person to another. In this study, knowledge sharing is conceptualised as an act of communicating knowledge among group of educated and skilled individuals, such as healthcare practitioners, with a defined objective.

Research findings that exposed the significance of generating substantial data from knowledge sharing among healthcare practitioners on issues relating to EVD across borders such as Roache et al. (2014), Omoleke et al. (2016), Campbell and Miranda-Morel (2017) have rarely provided substantial management strategies about the disease and sensitisation of the masses. Research such as Stewart and Abidi (2012) has shown evidence of heavy reliance of healthcare practitioners on technology. However, most of these studies rarely examined conversational structures of healthcare practitioners on the network environment. In addition, studies have rarely examined the knowledge sharing context and the culture of collaboration existing among HCP to infer their online knowledge sharing behaviour using social network tools. Many studies have revealed the role of social network tools in varieties of health-related areas such as maternity care, cancer, diabetes, infertility, binge eating disorder, social phobia and depression (Owen et al., 2010). Brewer and Piper (2016) showed that cancer patients and companions found blogging activity to be most helpful for emotion and knowledge sharing, followed by problem-solving and prevention and care. Their findings indicated that blogs function primarily as tools for emotion management and knowledge sharing rather than tools for problem-solving or prevention and care. In addition, cancer patients and their companions reported that they gain knowledge through their blogging activities and found the knowledge to be satisfactory. This corresponds with other studies on online knowledge sharing which highlight that effective online knowledge sharing is dependent on the ability of the participants to critically interpret post, respond to post and conversations on the network.

On the contrary, McLeod et al. (2010) compared online journal clubs to face-to-face journal clubs in teaching critical appraisal skills. Finding showed a low participation rate on online journal clubs compared to face-to-face journal club since there was no explicit inducement to participate on online journal club. The rate of participation among members in a virtual community declines when there is no explicit inducement to participate and an intrinsic desire to engage in knowledge sharing.

Therefore, it is vital to find out how online forums are used in everyday contexts to enhance knowledge sharing in health-related area. Thus, the most intriguing question that motivated this pilot study was how can knowledge sharing behaviour of healthcare practitioners in an online forum be determined? Healthcare practitioners in this study include professionals that provide preventive, curative, promotional or rehabilitative healthcare services and advise/information in a systematic way to people, families or communities like the medical doctors, nurses, pharmacists, lab technicians, etc.

This study therefore adopted Conversation Theory (CT), developed by Pask (1976), to make inferences on the behavioural aspects of healthcare practitioners during knowledge sharing. The fundamental idea of CT is the interaction that exists among living organisms and machine on a subject matter (Pask, 1976). Hence the elements of CT used to drive this study are the concept, conversation itself and participants.

The concepts or ideas are exemplified by the number of topics or themes in a conversation. They represent the actual encounter in the course of knowledge sharing from a professional perspective. They also indicate the depth of attention given to the problems addressed, the actual content being shared and participants’ commitment to discussions. In this study, the concepts were captured as the nature of EVD newsposts among healthcare practitioners on the Medscape network. The conversation is the comment of the participants, it exemplifies the rate at which the participants respond to the topic of discussion and include the contents of the comments itself (measured using the content analysis) and the rate of responses (measured using response analysis). The participants consist of individuals engaged in the conversation.

Many studies have been carried out on the experimental aspect of CT. But there was insufficiency in the deployment of statistical reasoning by the majority of these studies to decipher the interrelationships among CT variables extractible from conversations and show how conversations facilitated by machines explain knowledge sharing among healthcare practitioners. This pilot study was thus designed to determine the conversational structure of the Ebola Virus Disease (EVD) including the pattern of knowledge sharing and knowledge sharing behaviour of healthcare practitioners on Medscape online network with the aim of answering the following questions:

What were the nature of EVD newsposts and conversations among healthcare practitioners on the Medscape network?

What were the rate of comments, nature of comments and type of comments of EVD knowledge sharing among healthcare practitioners on the Medscape network?

How were the professions of healthcare practitioners represented in the EVD conversation on the Medscape network?

The remaining part of this paper was organised as follows: the details of the study’s materials and methods were presented in the next section followed by the results and discussion. Conclusions and suggestions for further studies finalised the paper.

Materials and methods

In this pilot study, a retrospective document/content analysis design was adopted. The survey was cross sectional featuring both quantitative and qualitative data collection and analysis methods. The qualitative aspect pertained to the use of content analysis to identify and extract knowledge elements in the conversations among HCP while the quantitative aspect utilised communication analysis methods and tools to determine the characteristics and patterns of knowledge sharing among the HCP on the Medscape online network.

The rationale behind the adoption of Medscape network as the platform for the data collection was because it offers the latest medical news with expert perspectives and advice. It also offers essential point-of-care; disease and drug information including a drug database (Medscape Drug Reference or MDR) and drug interaction checker. In addition, the Medscape network offers Medscape Journal of Medicine, a medical journal published exclusively on the Web. The Medscape network is available free of charge for healthcare practitioners and consumers alike. Registration is required for membership. Posts on EVD news and the comments are made strictly by the HCP on the platform.

The study’s methological approach began with searching for EVD newsposts on the Medscape network. The data were selected across the years in order to have a representative dataset across the study period (2014–2018). Thirty-seven EVD newsposts featuring: EVD news content, EVD news topics/concepts posted, EVD news posters, dates of post, names of participants, participant’s area of speciality, participant’s contributions (comments), date of contribution, number of threads, number of isolates and number of likes were extracted from each EVD newsposts.

The next stage involved determining the EVD newsposts that were responded to and those not responded to by the HCPs. Out of 37 newsposts on EVD, only 16 (43.2%) were responded to by the healthcare practitioners while 21 (56.8%) were not responded to. The EVD newsposts that were responded to by the HCPs formed the EVD topics of discussion for knowledge sharing among HCPs on the network.

The third stage involved determining the number of HCPs who engaged in EVD knowledge sharing on the network. There were 86 healthcare practitioners who engaged in EVD knowledge sharing on the network. Out of the 86 HCPs, 82 (95.3%) responded to at least one newspost. The total number of conversations made on the entire newsposts by the HCP was 91 conversations.

Data were analysed using both NVivo software and Microsoft Excel. The qualitative textual data collected for answering research questions 1 and 2 were analysed using NVivo software tool. Both MS Excel software and NVivo were deployed to analyse the structured quantitative data collected on research question three. The next section presents the results in line with the research questions (RQ).

Results

RQ 1. What were the nature of EVD newsposts and conversations among healthcare practitioners on the Medscape network?

There were 16 EVD newsposts responded to by the HCPs across the study period (2014–2018). However, in the year 2018, no newspost was responded to. The categorisation of EVD news contents and topics were used to build an initial EVD knowledge taxonomy as shown in Figure 1 below. The EVD knowledge taxonomy was used as a framework for addressing this research question and other research questions.

Figure 1.

EVD knowledge sharing taxonomy on the Medscape network.

The newsposts responded to were categorised and mapped into 11 minor themes along with their sub-themes (Figure 1). These minor themes were further grouped into six major themes, which are: EVD Outbreak Management, EVD risk, EVD Transmission, EVD Treatment, EVD Resources/Education, Out of scope. The theme ‘Out of scope’ was also captured as ‘others’ to examine if there were other health related issues that were posted on the EVD platform. Derived themes from EVD news content and topics were first agglutinated to form a compound word without changing their form to ensure proper data handling and analyses using NVivo software. The agglutinated words (themes) evdoutbreakmanagement, evdrisk, evdtransmission, evdtreatment, evdresourceseducation, outofscope were then subjected to a word frequency query. Below are some of the EVD newsposts categorised into themes.

EVD Outbreak Management captures news on Management of EVD outbreak that were on the platform. For instance, ‘West African Nations Scramble to Contain Ebola Threat’.

EVD Treatment includes newsposts relating to treatment of EVD on the platform. Example includes ‘Experimental Ebola Drugs Should Be Tried in Africa, Disease Expert Says’.

EVD Risk are newsposts on the risk associated with EVD outbreak on the platform. For instance, ‘As Ebola Stalks West Africa, Medics Fight Mistrust, Hostility’.

EVD Transmission captures news on transmission of EVD that were posted on the platform. Example includes ‘Sierra Leone’s Chief Ebola Doctor Contracts the Virus’.

Out of scope are news that are not related to EVD that were posted on the platform.

For instance, ‘First Zika Virus Case in Continental United States Confirmed in Texas’.

The nature of newsposts on EVD among healthcare practitioners on the network was shown in Figure 2.

Figure 2.

Nature of newsposts on EVD among healthcare practitioners on the network.

Results showed that during the early period of EVD outbreak in 2014, news on EVD mostly addressed issues about EVD outbreak management which were mostly on local management (in different countries). In the mid and late periods of EVD outbreak in 2015–2017, news on EVD addressed issues on other health related case such as ‘Zika Virus’ which may have similar symptoms as EVD. This showed that at the earlier stage of the outbreak, the newsposts majorly focussed on EVD issues due to the intensive global tension which arose from the threat of the virus during the period of outbreak although issues on EVD outbreak management had the greatest number of posts compared with other EVD themes in 2014. But there was a decrease in 2015–2017 on the threats of EVD outbreak on the masses, thus, giving chance for other health related cases to be addressed on the network. This change was as a result of the positive alerts received from the medical agencies at later stage of the outbreak. These alerts include chances of survivals of EVD, management strategies as well as possible intervention plans that were drawn during the last stage of the outbreak.

In addition, the HCPs made about 91 conversations on 16 EVD news topics on the network. Each conversation was initially categorised and mapped into 11 minor themes (Figure 1). The minor themes were grouped into six major themes: EVD outbreak management, EVD risk, EVD Transmission, EVD Treatment, EVD Resources/Education, Out of scope. Each conversation was tagged with the agglutinated version of the labels for its adjudged taxonomy with the main and minor themes, that is evdoutbreakmanagement, evdrisk, evdtransmission, evdtreatment, evdresourceseducation, outofscope.

The results are summarised below.

(I) EVD Outbreak Management

(a) EVD Management (Local Management)

Example:

‘We have not yet identified any case of Ebola in Liberia. We are still observing those cases reported at the border of Guinea with Liberia’.

(b) EVD Sensitisation/Alert (Negative sensitisation/Alert)

Example:

‘If it’s not airborne, how did the 5 other people in the taxi contract the virus? One would assume that her fellow taxi passengers would not have had any direct contact with her bodily fluids. I feel like we’re not getting the whole story here, and that’s a little frightening’.

(II) EVD Resource/Education

(a) EVD Research

Example:

‘Research posted here, http://TinyURL.com/StopEbola, done by the US Department of Defense and declassified in 2009 shows clearly that Nano Silver 10 PPM (which is NOT colloidal or ionic silver) inactivates Ebola virus. Nano Silver is a non-toxic substance which every member of the community can safely take. For my Protocol on its use enter email at www.NaturalSolutionsFoundation.com’.

(b) EVD help

Example:

‘How will the POTUS FY 2015 45 mil impact on the actual epidemic? What are the immediate and long term priorities?’

(III) EVD Risk

(a) EVD Threats

Example:

‘Not only is this Ebola epidemic different in scope and quality than any that have occurred before, but in Liberia and the other countries we seem to be witnessing beginning of a breakdown in basic health care systems. The worst example of this occurred last week in Liberia when the medical staff of Redemption Hospital in New Krutown, Monrovia walked out after the death of a nurse because of their fear of Ebola, (http://allafrica.com/stories/201406200896.html). This case also highlights the fact that it is the frontline healthcare workers who place themselves in the greatest risk and in fact we know that many health care workers have succumbed to the disease in Guinea, Sierra Leone and Liberia. . .’

(b) EVD Effect

Example:

‘Ebola continues to claim the lives of Health Care Workers (HCW) in the affected areas. Having standard guidelines developed to use as default guidance in providing resuscitative intervention for Ebola patients is necessary, to protect the (HCW). I welcome the idea’.

(IV) EVD Treatment

Example:

‘What will it take to get those drugs or vaccines to Liberia and what are the drugs?’

(V) EVD Transmission

Example:

‘Hmmmm,i hope it doesn’t get to Nigeria’.

(VI) Out of scope (other health related issues)

Example:

‘Removing tires and flower pots is just plain silly. We have drainage ditches, ponds and bayous all over the Houston greater metro area as well as in most of south Texas where is rains more than in Seattle. Spraying for mosquitoes is expensive, infrequently done and probably not very effective without also killing the beneficial insects needed for pollination. If this is a real public health problem, why aren’t we working on a vaccine?’

In summary, during the early period of the outbreak, EVD news were mostly on EVD outbreak management specifically local management of EVD across countries while the conversation of HCP during this early period were mostly on EVD risk specifically on EVD threats, effect and casualties. However at the later stage of the outbreak, EVD news centred on sensitisation and alert messages as well as other health related news. The positive alert messages and sensitisation were posted by the medical agencies at later stage of the outbreak which gave more chance for the HCPs to engage on conversation on ideas to sensitise their colleagues while enhancing their clinical expertise and developing more insights about the disease.

RQ 2: What were the rate of comments, nature of comments and type of comments of EVD knowledge sharing among healthcare practitioners on the Medscape network?

This was measured to examine the frequency and content of EVD knowledge sharing among healthcare practitioners on the network. To achieve this, conversations of HCPs were categorised with respect to EVD knowledge sharing taxonomy (themes) developed. These themes were queried across the years of the study period.

In this pilot study, the result (Figure 3) showed that out of the 91 responses of the HCP that were categorised into six major themes of the EVD topic taxonomy, the theme evdoutbreakmanagement occurred 19 times (38.78%) in 2014 and once (3.57%) in 2015, while evdrisk occurred 17 times (34.69%) in 2014, eight times (28.57%) in 2015 and only once (100%) in 2018, whereas evdresourceeducation occurred eight times (16.33%) in 2014, while evdtransmission occurred two times (4.08%) in 2014 and outofscope occurred two times (4.08%) in 2014, 19 times (67.86%) in 2015, 11 times (100%) in 2016 and two times (100%) in 2017, evdtreatment appeared once (2.04%) in 2014. The rate of comments, nature of comments and type of comments of EVD knowledge sharing among healthcare practitioners were shown in Figure 3 below.

Figure 3.

Major themes on the content of EVD knowledge sharing among healthcare practitioners.

Figure 3 showed that the HCPs mostly engaged in knowledge sharing on EVD outbreak management and EVD risk at the peak of EVD outbreak in 2014. The HCPs also engaged in knowledge sharing on EVD resources and education, EVD transmission, EVD treatment and other health related issues. At the mid period (2016) of EVD outbreak, issues on EVD were rarely or not addressed but at the final stage (2017 and 2018), issues such as EVD risk, treatment and other health related issues were addressed by the HCPs on the network.

However, the result in Table 1 showed that the minor theme evdeffect occurred most at nine times (19.15%) in 2014 and eight times (88.89%) in 2015, followed by evdsensitisationalert nine times (19.15%) in 2014, evdhelp occurred seven times (14.89%) in 2014 and only once (100%) in 2018, evdmanagement occurred four times (8.51%) in 2014 and once (11.11%) in 2015 while each of evdexperimentaltreatment, evdpreventivemeasures and evdresearch occurred only once (2.13%) in 2015.

Table 1.

Word count of the minor themes on the content of EVD knowledge sharing among healthcare practitioners.

Word	Length	2014 Count (weighted percentage in parenthesis)	2015 Count (weighted percentage in parenthesis)	2018 Count (weighted percentage in parenthesis)
evdeffect	9	9 (19.15)	8 (88.89)
evdsensitisationalert	21	9 (19.15)
evdhelp	7	7 (14.89)		1 (100)
evdintervention	15	5 (10.64)
evdcasualties	13	4 (8.51)
evdmanagement	13	4 (8.51)	1 (11.11)
evdthreats	10	4 (8.51)
evdspread	9	2 (4.26)
evdexperimentaltreatment	24	1 (2.13)
evdpreventivemeasures	21	1 (2.13)
evdresearch	11	1 (2.13)

The result showed that the HCPs mostly engaged in knowledge sharing on effect of EVD outbreak and sensitisation of EVD at the peak of EVD outbreak especially in 2014, as well as, other issues on EVD help, EVD intervention, EVD casualties recorded, management of EVD outbreak, threats, spread, treatment of EVD, preventive measures as well as research on EVD. However, effect of EVD outbreak and management of EVD outbreak were addressed in the year 2015. At the mid period (2016) of EVD outbreak, issues on EVD were rarely or not addressed among the HCP on the network. However, at the final stage (2017 and 2018), only issues on EVD help was addressed among the HCPs who engaged in knowledge sharing on the network.

In addition, the result in Table 2 showed that positivealert occurred most at seven times (38.89%) in 2014 followed by medicalagencies four times (22.22%) in 2014, localmanagement occurred three times (16.67%) in 2014, negativealert occurred two times (11.11%) in 2014, and globalmanagement occurred once both in 2014 and 2015 while individualintervention occurred once (5.56%) in 2014.

Table 2.

Word count of the sub-themes on the content of EVD knowledge sharing among healthcare practitioners.

Word	Length	2014 Count (weighted percentage in parenthesis)	2015 Count (weighted percentage in parenthesis)
positivealert	13	7 (38.89)
medicalagencies	15	4 (22.22)
localmanagement	15	3 (16.67)
negativealert	13	2 (11.11)
globalmanagement	16	1 (5.56)	1 (100)
individualintervention	22	1 (5.56)

The result showed that in 2014, the HCPs mostly engaged in knowledge sharing on positive alert and sensitisation of the masses on EVD outbreak and intervention from medical agencies and individuals. The result also showed that the HCPs engaged in knowledge sharing on negative alert and sensitisation of the masses, global management of the outbreak. In the year 2015, the HCPs also addressed issues on global management of EVD outbreak However, at the mid period (2016) and final period (2017 and 2018) of EVD outbreak, issues on sub EVD themes were rarely or not addressed among the HCPs on the network.

These results indicated that there was a high conversation frequency among HCPs on the network at the peak period of EVD outbreak in 2014 followed later by a decline at the off-peak of EVD outbreak. This means a high interaction tie among HCPs on the network especially at the peak period. This showed that the HCPs were willing and ready to engage in EVD knowledge sharing on the network.

RQ 3: How were the professions of healthcare practitioners represented in the EVD conversation on the Medscape network?

This research question was out to examine how the HCPs engaged in EVD conversation across their professions. To achieve this, the professions of HCPs who made conversations on each EVD newspost were analysed. Also, the HCPs who originated conversation on each newspost were identified and counted.

Table 3 showed the professions of HCPs who responded to EVD newsposts indicating that medical doctors accounted for about 60.4% (55) conversations on the entire EVD newsposts. Nurses accounted for about 20.9% (19) conversations followed by ‘other’ professions of HCP with about 11% (10) conversations, while Medical students and Health/Business administrators accounted for two (2.2%) conversations each. The conversations of pharmacists, nursing students and psychologists were the least on the network accounting for one (1.1%) conversation each on the network.

Table 3.

Representation of professions of HCPs on EVD conversation.

Word	Length	Count	Weighted percentage (%)
Doctor	6	55	60.4
Nurse	5	19	20.9
Others	6	10	10.99
Health business administrator	27	2	2.20
Medical student	14	2	2.20
Nursing student	14	1	1.10
Pharmacist	10	1	1.10
Psychologist	12	1	1.10

The result showed that doctors and nurses made the highest number of conversations on the network and were the most active contributing professionals on the network. Hence, doctors, having made the highest contributions, were relied on for knowledge seeking on EVD on the network.

In addition, the originator’s responses across the professions of HCP were not uniformly distributed. Result showed that for each post, the HCP from the originator’s profession responded to the post but were, most of the times, not the top contributor in terms of number of posts responded to by other originator’s profession (Table 4).

Table 4.

Inter-occupational communication in terms of number of newsposts.

	Doctor (%)	Nurse (%)	Pharmacist (%)	Nursing student (%)	Medical student (%)	Psychologist (%)	Health/Bus. Admin. (%)	Others (%)
Doctor (8)	8 (100)	5 (38.5)	2 (15.4)	1 (7.7)	1 (7.7)	1 (7.7)	3 (23.1)	4 (30.8)
Nurse (5)	1 (25)	5 (100)						1 (25)
Others (3)	1 (33.3)	1 (33.3)						3 (100)

The result of the inter-occupational communication across the professions of HCP indicated that the HCPs responded to EVD newsposts irrespective of the profession of the conversation-originators of the post (Table 4). The finding showed that the HCP engaged in EVD knowledge sharing regardless of the profession of HCP who originated the knowledge sharing.

Discussion

Online knowledge sharing enabled collaboration and effective interactions among healthcare practitioners on EVD issues on the Medscape online network. The overall result showed that the HCPs interacted effectively among themselves while interpreting and responding to posts. This finding was in line with the major findings in the previous studies such as Eysenbach et al. (2004) which highlighted that effectiveness of online knowledge sharing was dependent on the ability of the participants to critically interpret post, respond to post and conversations on the network. The major findings were derived from answers to the research questions as discussed below,

The nature of newsposts on EVD among healthcare practitioners indicated that during the early period of the outbreak in 2014, news on EVD majorly focussed on EVD issues. This was due to the intensive global tension which arose from the threat of the virus during the period of outbreak. These posts mostly addressed issues about outbreak management especially on local management across the affected countries such as Nigeria, Senegal, Liberia etc. However, in the mid and late periods of the outbreak in 2015–2018, there were reports on survivals of EVD on the platform. Also, possible management strategies and intervention plans were drawn during the last stage of the outbreak. As a result, newsposts on EVD declined during these periods unlike in the early stage. This gave room for other Ebola related viruses such as Zika Virus to be addressed on the platform since they have similar symptoms with EVD.

It was no gainsaying that the network comprises trending issues on EVD that captured the interest of HCPs who engaged in knowledge sharing on the network. The study also showed that the span of EVD content shared among HCP was high. High conversation trend indicated that the HCPs paid close attention to ideas made on EVD by their colleagues while sharing their knowledge and discussing their clinical experiences on the network. The high conversation trend suggested that the HCPs were willing and committed to share their knowledge on EVD issues. It also depicted a strong interconnectedness among the participants. According to Mukherjee, knowledge sharing among professional on the network should be characterised with a sense of communal commitment and interactions, willingness and a shared practice which the members strive to achieve. The type of interconnectedness has a theoretical backing of the Conversation theory (CT) adopted in this study as observed among the HCPs on the network. This was a positive one as it was necessary to provide solutions to a wider range of health challenges.

The study identified three active and two influential HCPs on the network. The active HCPs were characterised by minimum of two comments. These active HCPs consist of two doctors and a nurse. It was no gainsaying that these two professions had greater chance to control the flow of knowledge within the network. The most active HCP was a doctor who responded to four EVD newsposts and made four comments. The most influential HCP initiated collaboration once on EVD newspost and responded to four EVD newsposts with four comments on the network. The implication of this result was that these active and influential HCPs controlled the flow of knowledge within the network. They also had greater power on the knowledge shared among HCPs on the network. This finding conformed to that from a previous study on online knowledge sharing among medical practitioners. According to Stewart and Abidi (2012), active and influential medical practitioners have control over the flow of knowledge.

The occurrence rate of EVD conversations across the profession of HCP who engaged in knowledge sharing about EVD on the network showed a predominance of doctors on knowledge sharing on the network. Also noted were the participation of other health professionals on the network. These health professionals include nurses, pharmacists, dentists, health/business administrators, psychologists, medical and nursing students. These health professionals relatively participated on EVD knowledge sharing on the network. It was important to note that the profession of originators of EVD knowledge sharing did not influence the participation behaviour of HCPs on the network. This was because the participation behaviour of HCPs on the network was driven by individual engagement on EVD knowledge sharing rather than professional engagement on EVD knowledge sharing. The findings aligned with previous studies on online knowledge sharing; it showed that HCPs were self-motivated when participating with colleagues on online knowledge sharing regardless of their profession. This was in line with the findings of Stewart and Abidi (2012) which showed no difference in the participation rates of practitioners on the network and their profession.

It was of interest to recognise the contributions of many young professionals (medical and nursing students) on the network. Their participation demonstrated that they were passionate for knowledge seeking on EVD and can promote more contributions from experts and enhance connectivity on the network. It was important to note the low contributions of the moderators of the network on EVD knowledge sharing. Regardless, the active engagement of the moderators and facilitators of networks promote knowledge sharing on the network (Stewart and Abidi, 2012). The moderators’ engagement on knowledge sharing on the network could motivate the HCPs to engage in EVD knowledge sharing on the network. The participatory behaviour across the professions of HCP on the network was promising. Progress such as this provides a positive attitude in the HCP community. This also promotes regular online knowledge sharing to develop the best practices with respect to intellectual capital development in the medical fields. In addition, given the complexity in finding a cure of EVD, HCPs require instant and constant updated and emergency consultation/conversation to handle outbreaks as they occur. This was a positive finding among HCP who engaged in knowledge sharing about EVD in this study.

Health professionals identified on the network include doctors, nurses, pharmacists, dentists, health/business administrators, psychologists, medical students, nursing students and other HCP. Despite the predominance of doctors on the network, there was uniformity in the number of conversations originated by HCP from each profession and the number of conversations generated from each profession on the network. The finding showed a strong interaction across professions of HCP on the network. This finding agreed with those from previous work of Stewart and Abidi (2012) which depict a significant interaction across professions of HCPs online discussion forum.

This study was an exercise to continuously improve knowledge sharing with instant access to life-saving data and preventing the reoccurrence of devastating and possibly epidemic diseases such as the Ebola virus disease. This corresponds to the National Healthcare Bill (NHB) of the Federal Government of Nigeria of mandatory establishment of health forum to facilitate interaction, communication, collaboration and knowledge sharing on National Health issues among concerned bodies in order to improve the quality of patient care and reduce the overall costs of healthcare in the society (National Healthcare Bill, 2014).

This study has contributed to the research tradition of knowledge sharing and continuous advancements by providing a global awareness and use of strategies to take preventive measures on pandemic outbreak. Specific findings in the study had useful implications in the theory and application of knowledge sharing on health and illness. The data on EVD evidence found on Medscape online network implied that the platform is a knowledge repository/database. This online platform is beneficial to both HCPs and masses to acquire cross-border knowledge on EVD and other health issues. The Medscape online network enables both registered and non-registered members to pose queries or find updates of related health issues such as EVD. For a fully operating information society in the medical field, online media is a major tool to deploy (Stewart and Abidi, 2012). This tool enhances knowledge sharing and communication of not only EVD but other health-related issues. This implied that online communication enhances formalised knowledge sharing on EVD in health care professions.

Conclusion

The study examined the nature of newsposts on EVD among healthcare practitioners on the Medscape network. It was found that during the early period of the outbreak in 2014, news on EVD majorly focussed on EVD issues which mostly addressed issues about outbreak management especially on local management across the affected countries. In addition to these findings, the newsposts generated bulk of useful information on EVD which can strengthen global health systems and empower HCPs in addressing health challenges whenever there is an outbreak. Majority of the news on EVD that were posted on the network were incidence of EVD outbreak in Africa showing that the epidemic was common in Africa.

Online knowledge sharing by the healthcare practitioners focussed mainly on Ebola virus disease management and risks, and were mostly relevant to the posted topics. Health agencies at national and global levels should recognise knowledge sharing among healthcare practitioners on social media networks as important sources of information on Ebola virus disease and other emerging diseases.

Limitations of the study

A major challenge and limitation to this study was the limited access to contacts of HCPs who made conversations to EVD newspost on the network. Details such as email address, institution affiliation and the country of registered HCPs on Medscape network could not be retrieved. As a result, further findings on qualitative analysis were not carried out to evaluate the effectiveness of the forum by conducting an interview on the HCP. This could be of interest to the administrators of the network and other agencies such as WHO towards alleviating the global spread of EVD. In addition, if the contacts of the active and influential HCPs on the network were identified, the masses could seek information about EVD from them in the case of any future outbreak. This would enhance the health knowledge and engagement of healthcare practitioners with the masses and reduce the spread and effect of misguided information during outbreaks.

Ethics

This piece of work is for academic purposes only. Due to data privacy, information obtained from healthcare practitioners on Medscape network were treated with a high level of confidentiality. Other ethical issues such as plagiarism, fabrication and falsification of data and result were also taken into consideration. These include ethical issues which emanate as a result of improper citations and referencing of articles, misrepresentation of data and results, as well as manipulation of data and result were taken into consideration. The materials used in carrying out this study were cited and referenced accordingly. The data retrieved were analysed accurately to address the research questions of the study. No effort was made to misrepresent or manipulate the result obtained from the analysis of this study.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iDs

Ebelechukwu Gloria Igwe

Wole Michael Olatokun

Author biographies

Ebelechukwu Gloria Igwe is a fresh PhD graduate from Department of Data and Information Science (DDIS), University of Ibadan, Nigeria. She has many publications to her credit on studies relating to Knowledge management; Information and Communications Technology (ICT); Information Behaviour. She is also a multidisciplinary fellow with studies on ICT and Agriculture, Cybernetics, Network analysis, Natural Language Processing (NLP), Climate change and Agriculture, Knowledge sharing and Health; Gender studies and Academic productivity; Information sharing and Safety.

Wole Michael Olatokun is a Professor of Information Science at the Department of Data and Information Science (DDIS), University of Ibadan. He has vast knowledge in teaching and research and has published extensively in the areas of National ICT policy issues, Social Informatics, e-Governance, Knowledge Management, Computer and Society, Information Systems (Business Informatics) and Indigenous Knowledge. He is a honourary Professor at the University of Johannesburg and Information Studies Programme, University of Kwazulu-Natal, South Africa.

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