**6. Conclusions**

Applying the combination of topic modeling and user network analysis, we were able to detect two main types of user communities with specific types of concerns and topic discussions and define different narratives employed by influencers.

The findings of this study provided a detailed example of the implications for healthcare organizations when detecting, understanding, and defining topic discussions and communicative functions available on Twitter. We thus provided an overview of the valuable opportunity to identify appropriate user audiences and share what might be suitable content to engage and interact them, going beyond word frequency, hashtag counts, and online community detection. The importance of considering public health issues involves the complexity embedded in any kind of low-prevalence/rare disease where the low number of patients makes it hard to obtain valuable information, increasing public awareness, and impact on health behavior.

Future research should consider the geographical location and related characteristics of health communication strategies to provide insights able to implement health information dissemination for health practitioners and policymakers.

This type of research can fill the knowledge gap between clinical epistemological uncertainty and patient experiential knowledge when dealing with lupus. We believe that the proposed approach may have a significant role in public health, applying such research indicators and methodologies to aid decision-makers in designing interventions and effective communication strategies.

**Author Contributions:** Conceptualization, S.P.; methodology, S.P. and V.L.; software, S.P. and G.A.; formal analysis, S.P., V.L., G.A., and G.T.; writing—original draft preparation, S.P., V.L., M.M., and G.T.; writing—review and editing, S.P., V.L., G.A., M.M., and G.T.; supervision, M.M. and G.T.; All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** We would like to acknowledge Peter Morley, Paul Howard at LUPUS UK, Rachael Lowe at Physiopedia, and John Hibbs at the Hibbs Lupus Trust for their support and consent in sharing their Twitter account name. Their efforts add tangible value to increasing the awareness for Lupus. We would like to thank the Data Protection Officer and legal-ethical advisor of Scuola Superiore Sant'Anna for providing advice on how to collect and manage data in compliance with current privacy legislation. Furthermore, we would like to extend our gratitude to Simone Ticciati for helping us draft the manuscript.

**Conflicts of Interest:** The authors declare no conflict of interest.
