**4. Results**

Going into detail concerning with the qualitative technique, it is shown a descriptive analysis of the participant in order to present a general view of its make-up and highlight the main relationships between variables and their significance for the population (Table 2).


**Table 2.** Demographic factors.

Both their years of work experience in the health communication sector and their activity in social media validate their extensive knowledge in the field.

Over half of the interviewees, is between 30 and 39 years old, whereas the rest is over 40. All of them were part of the working-age population when social media appeared, according to the mapping of birth with the evolution of social media that Boyd and Ellison made in 2008 [77,78].

The number of years of professional experience is also worthy of attention. Over half of the professionals have worked for over ten years and the rest have worked for between five and ten years. This is significant if it is considered that specializing in the health sector, which since the 90 s has been affected by a "superabundance of information" [79], implies years of professional experience in order to provide quality information.

As it was indicated before three categories were predefined. Table 3 summarily describes the themes obtained of participants.

Regarding RQ1, the experts highlighted that the most important stakeholders for the OMC are their own collegiate members that corresponds to all medical professionals enrolled in their district, with which they maintain regular bidirectional communication. When considering that they should be informed of all the concerns and investigations that are carried out by all health professionals. Followed by public and private hospitals. Patients and their families showed scarce representativity. Finally, society in general and health institutions were the groups with the lowest score (Figure 3). Comparing Figure 3 with the theory of Freeman's stakeholders seen in Figure 2, the only groups that are not represented are the suppliers (pharmaceutical, technological, etc.) and other health's professional (nurses, physiotherapists, etc.).


**Table 3.** Main Themes.

**Figure 3.** Official medical colleges (OMC) relations with their primary stakeholders. The percentage indicates the relationship with each stakeholder. Source: In-house elaboration.

Regarding question RQ2, all official medical colleges participants in this investigation have an organized communication department, in which one to three people work—either specialists in the field and graduates in Journalism and/or Public Relations. In addition, these are organized in a communication network of professional medical colleges, to exchange experiences, and even organize an annual congress to present and share their initiatives. Recently, they have dedicated these

conferences to social media strategies, and they have also worked in the fight against the dissemination of fake health news or crisis communication.

In terms of usability, the recurrent use of social media as an instrument of work exposed in the scientific literature referred to is corroborated in the results obtained in the interviews. The fact that all respondents use social media in their work may reflect the challenge of incorporating social media. Most indicated that their usage times are growing annually. The following table reflects the number of hours/days of social media use to collect or disseminate information (Table 4).


**Table 4.** Use of social media per day (%).

It is important to highlight that, despite the fact that 18.8% of those interviewed consider that social media hinders their work because excessive information published results in intoxication of the content, most of the respondents think that social media make their job easier and lead them to other sources of information (Table 5).

**Table 5.** Usefulness of social media for daily work.


Nevertheless, social media have become a source of information that is relevant or very important for most professionals (Table 6).

> **Table 6.** Social media as an information source in your work.


It was highlighted by respondents that content generated by unofficial sources or by users was not sufficiently rigorous.

With regard to health-related accounts. All of them visit the corporate social media of hospitals and/or health institutions and evaluate their content as relevant (Table 7). None of the respondents considers the content found on hospital or health institutions social media to be "not important at all".

**Table 7.** Importance of the social media related to the health sector.


The participants use social media as a "source of information", which is one of the main aims for using them. In addition, the respondents highlight that this motivation is followed by keeping up with what is happening in their professional field. The aims that follow in the ranking of importance emerging from the interview are "as a source of information for the organization they work for", "as the main content focus", "establishing professional connections", "monitoring competition", "as a source of information as specialized journalist", "verifying information" and "finding stories" (Figure 4).

**Figure 4.** Main aims in the use of social media. Source: In-house elaboration.

In the case of social media as a source of information, the difference between the percentage of Twitter and Facebook users increases, so that Twitter emerges as the top social media chosen by specialized professionals. All of them point out social media as the main channel in the future.

In particular, out of the social media that they use, specialized health professionals in Spain resort most often to Twitter and Facebook (Table 8).



All of the interviewers visit social media that are managed by health institutions, follow by health professionals accounts and researchers. Almost a third of the participants mention patient collectives that also communicate by social media.

In terms of credibility, the most credible accounts are those of health institutions, to which 87.5% refer. They are followed by the accounts of health professionals and researchers in the health sector. If the public and private hospitals are considered separately, the public hospitals accounts enjoy greater credibility than those in the private hospitals. The patient collectives accounts are the least credible. The accounts of citizens expressing themselves on the topic of health and who do not belong to any association do not enjoy any credibility (Table 9).

The argumen<sup>t</sup> that the respondents give for their answers is scientific rigor, which is considered to be greater in the case of health institutions. The communication on these social media is contemplated dependable because it is supported by the institution they represent and the professionalism of is specialists.


**Table 9.** Health-related social media.

It is necessary to point the low level of credibility in public and private hospitals. The professional proposes changes in hospital social media, such as contents that are not biased according to institutional interests, more information about health in general and about health promotion in particular that can be communicated to the citizenship. Another suggestion has been to give a relevant role to the hospital professionals as co-creators of contents.

In their responses, communication professionals of OMC do not coincide in their opinions about how institutions avoid managing communication through social media in the event of a health crisis. It is widely recognized in the literature that social media o ffer immediate circulation of messages and this makes them valuable for such professional communication.

The speed with which information can be spread through social media in emergency situations, catastrophes and socially critical events which are dangerous for public health makes them essential for professionals specializing in health.

With respect to RQ3, the participants think that social media is a useful tool for establishing bidirectional communication with their registered doctors, health institutions, hospitals and patient associations. Likewise, the contents generated in their social media accounts have scientific rigor that is very useful for society.

The professional of OMC defend that unlike the beginning of the decade, when the participation of the o fficial medical colleges in Spain in social media was insignificant, today its activity is remarkable. This can be noticed in the significant increase both in the number of followers of their social media and in the volume of information they generate. The voice of the professionals of these entities in social media acquires special relevance in order to promote accurate information that preserves the quality of life and well-being of citizens.

The interviewees consider that o fficial medical colleges have the capacity and the authority to become the voice for health institutions in their role as o fficial sources in matters of health, using its own social media accounts at times when citizens claim a continuous supply of information.
