Introduction

Media channels adopted for public health communication in Ghana have established that most Ghanaians prefer the more traditional, less mass-oriented channels of communication, this study supports a different investigation carried out to establish the significance of traditional media as an essential medium of communication (^{Kwame, 2021}; ^{Preko, & Boateng, 2020}). Traditional media can be described as media that utilize communication channels that are already established to facilitate the discussion of pertinent issues, such as general health education. Because this communication form is integrated within the culture of a given community, ^{Bannor, et al. (2017}); ^{Ansu-Kyeremeh et al. (2016}) argue that it enhances not only the audiences’ beliefs but also their trust in the media of communication, thereby increasing the possibility of media’s effectiveness.

Varied studies were carried out to help establish the most effective communication media to reach the people of Ghana in times of public health emergencies via social media platforms. A study conducted by ^{Bannor et al. (2017}) investigated how social media utilization to carry out public information collection on vitamin treatment for pregnant women within Ghanaian villages, a great part of the outcomes of the study established those social media platforms are very effective for communicating with rural dwellers of Ghana. Another study by ^{Ansu-Kyeremeh et al. (2016}), established that radio stations were the most effective channel of communication for communicating public health information in Ghana. Besides, the radio, posters, and social marketing strategies like billboards and public places announcements (like in churches, mosques, and markets) were also popular and could act as effective media for public health communication as compared to televisions, newspapers, movies, videos, healthcare personnel, and community groups.

However, since the emergence of the COVID-19 pandemic in Ghana, the utilization of social media such as WhatsApp, Facebook, Twitter, YouTube, blogs, and wikis to facilitate health communication, public healthcare information collection, dissemination, and health promotions has progressively increased since the emergence of the for COVID-19 global public health emergency (^{Aryeetey et al., 2020}). This increase has been partly attributed to the ability of social media to eradicate physical barriers that have traditionally hampered access to essential healthcare support (Aryeetey et al., 2020). ^{Bannor et al. (2017}) state that social media use hosts various opportunities for users to share strategic health-related information on popularly-used social media platforms, including WhatsApp, Facebook, Twitter, YouTube, blogs, and wikis through different methods that may include texts, images, and short videos. Moreover, the latest analytic developments have improved the capability of health researchers and other health experts to not only compute and analyze metrics that assess the social media implementation process but also any other health-related effects and outcomes related to its application in managing a pandemic like COVID-19.

Consequently, new collaborative methods of evaluation are being used to enhance social media integration within health-related emergencies. Health professionals need to establish what the general public is commenting on most on the various social media platforms and subsequently align their messages to the audiences’ needs (^{Demuyakor, 2020}; ^{Khamis, & Geng, 2021}). Again, ^{Bannor et al. (2017}) also argue that an engagement with the community and its major influencers improves the credibility of health organizations, and health professionals, besides being an important means of establishing a mutually helpful relationship that may extend beyond the social media realm. Bannor et al. (2017) add that the most favorable action that public health institutions in Ghana need to take is to continue stimulating and engaging in conversation with social media users as well as influencers.

Past studies have confirmed the significance of utilizing social media, effective integrations, and employing the appropriate use of communication media during public health communication (^Owusu,2020). The effective integration, the use of appropriate communication media, and direct contact are undoubtedly effective as far as Ghanaian public health communication strategies are concerned. Many researchers have conducted studies on the effectiveness of social media for public health communication during the peak of the COVID-19 pandemic. The key findings from these past studies raised key issues such as internet penetration rates, limited access to digital information on health, low usage or bad perceptions of social media platforms, and issues of misinformation and disinformation as the central issues on social media used in health communication. There is however limited literature on the actual effectiveness of these social media platforms for COVID-19-related information collection and dissemination in less-studied developing countries, especially Ghana. Therefore, the effectiveness of social media could be different from the findings of the earlier studies due to the digital divide difference. In developing countries like Ghana, where the application of social media in healthcare delivery is limited. The main objective of this study investigate the effectiveness of social media use for health information collection and dissemination during the peak of the COVID-19 pandemic in Ghana.

2. Literature Review

3. Materials and Methods

3.2. Data Analysis

A total of 27 respondents were sampled through purposive, and interviews, making the response rate exactly 90% (27/30) of the study's targeted population. The justification for adopting purposive sampling is to allow the researchers to have much insight into the effectiveness of social media used in crisis communication from a specific perspective of health information collection and dissemination in the context of social media use during the COVID-19 pandemic in Ghana. Since this study is about social media for public health communication, researchers used purposive sampling to select frontline health professionals and public relations officers who use social media for collecting health information and dissemination. The discussions were held with the health professionals and public relations officers with the help of self-made semi-structured questions which were given to respondents who agreed to take part in the interview before the agreed date. The collected data were coded and thereafter analyzed using the four-step coding manual approach proposed by ^{Saldaña (2013}). The final responses were analyzed using the qualitative condensed themes of the interview questions proposed by ^{Tong, et al. (2007}); ^{Creswell (2013}).

The condensed thematic analysis was chosen for this interview because it provided a systematic way of organizing, analyzing, and describing the data sets. From the foregone, empirical, basis, the researchers adopted in-depth interviews to solicit views of the heads of departments of the Ghana Health Service at the regional and district directorates on the effectiveness of social media for COVID-19 collection, and dissemination in Ghana. The interviews offered the opportunity for the researchers to validate the opinions of frontline health workers and the health seekers at large on the subject matter. The thematic analysis of the in-depth interviews was also done to fill in the gap on the inadequate knowledge of the researchers on a certain phenomenon, like what is currently under study, ^{Creswell (2013}) proposed the application of qualitative or inductive research to investigate the unknown. According to ^{Kyngäs (2020}), the qualitative approach is employed to examine the theories, concepts, and practices from a different perspective, than what the researchers already know about the subject matter.

For the analysis of the qualitative data, the condensed thematic analysis technique was used for the identification of themes from the data, to find out the semantic meaning of the coded sentences. The condensed thematic analysis also allowed the researchers to conduct an analysis based on relevant and common themes from the coded data (^{Creswell, 2015}). First, for the thematic analysis, all the data is read so many times to enable the researchers to be familiar with the common themes. Secondly, the initial codes were generated for consideration based on research questions. After the generation of initial codes, certain common themes are searched out in the whole data. The themes are read again re-grouped or divided. After grouping the sub-themes, the researchers distributed these themes into major, and minor themes to produce the report. For the final analysis, all 27 responses were condensed or consolidated and analyzed for further reporting based on or under the themes of the interview questions. The condensed thematic analysis also guides the researchers to identify the patterns of themes in the interview data for analysis and interpretation (^{Creswell, 2015}). The final reporting of the findings was done using what ^{Tong, et al., (2007}) described as the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Table 2 depicts the demographic characteristics of participants.

Table 2 Demographic Characteristics of Respondents 

4. Findings

The researchers interviewed 27 participants such as regional public relations officers, district officers of public relations services, COVID-19 team leaders/contact tracers, and regional public health officers of the Ghana Health Service who agreed to take part in the study. Responses/views of the 27 interviewees on the subject matter are presented in thematic analysis (condensed thematic form);

RQ1: Predominantly Social media platforms for the collection and dissemination of COVID-19-related information

This research question intends to solicit responses from the participants on the predominant social media platform for the effective collection and dissemination of COVID-19-related information. The discussion with the heads of departments revealed that most of the heads used WhatsApp, Facebook, YouTube Twitter(X), blogs, and wikis. From the responses, 17 heads of departments indicated using WhatsApp, and Facebook with one of the above-listed social media types. Below are some condensed responses, and remarks from 17 respondents on the above question;

(...) I believe strongly that, social media platforms in health have significantly influenced positively our attempts to protect the general public against the COVID-19 pandemic(...) Through social media platforms such as WhatsApp, Facebook, Twitter(X), and YouTube, we have been carrying out massive awareness aimed at improving citizens' behavior change (...). The public health information collection and dissemination via social media has given the general public a much-needed understanding of the effects of COVID-19, thereby enhancing public compliance with COVID-19 prevention interventions(...).

(...) For us, WhatsApp and Facebook alone are okay for us to carry our information collection, and dissemination (...) but sometimes when the need arises, we use other social media types like Twitter(X) (...) WhatsApp and Facebook have more audience and a greater number of our target population in Ghana, especially the youth, either in a rural or the urban area all have WhatsApp and Facebook accounts (...).

In addition, 5 respondents reported using, Twitter(X) either alone or with other social media types. Moreover, 3 respondents said;

(...) We use YouTube for collection and dissemination of COVID-19-related information in their respective districts as well as the region (...)

Lastly, 1 respondent indicated using:

(...) As for me, I prefer blogs, and wikis (...) which aid me in the collection and dissemination of COVID-19-related information with staff, and the general public on COVID-19 (...).

RQ2: Social media content type used to disseminate COVID-19-related information

22 out of 27 of the respondents responded to the research question on the contents of COVID-19 shared on the official social media accounts of hospitals in Ghana. According to the responses from the interviews, the respondents alluded to the fact that the digital content type for COVID-19 information on the official accounts of hospitals is considered valuable for the public: Below are some condensed remarks from the respondents;

(...) About 80% of the content of their social media content types are text ie. such as news releases & blog posts, videos, photos, digital flyers, and podcasts. These content types are aimed at educating online audiences on treatment options for COVID-19, knowledge on COVID-19 prevention, awareness of COVID-19 symptoms, knowledge of COVID-19 transmission routes, knowledge of at-risk people, new infections, geographical spread, educational messages to the general public and target groups on the prevention of COVID-19 (...)

Also, our information center on COVID-19 prevention protocols (...) example is the wearing nose mask, physical distancing among others… (...) other educational information collected and disseminated include mode of transmission, causes, signs, and symptoms, prevention, and updates of the infection; causes of COVID-19, and treatments compliance (...)

(...)Social media platforms and accounts of the various health institutions and hospitals are used to disseminate information on COVID-19 Vaccines(...) Some of the information and questions we post include, whether the citizens were ready or willing to take the COVID-19 vaccine (...) (...) Several followers of our social media accounts of health institutions, are made up of different age groups, though some say they would take the vaccine immediately, others said they were not willing to take the vaccine (...) (...) the feedback from our social media platforms indicates that most of the old-age respondents confirmed that they would be able to accept the vaccine but would only do so after some further scientific evidence on the safety and efficacy of the vaccine (...)

(...)content of COVID-19-related information collected and shared information on using contact tracing apps is posted on our social media accounts (...) they were inquired about the GH COVID-19 Tracker app. More health professionals were aware of the GH COVID-19 Tracker app than were aware of the other apps which were not made specifically for Ghana(...) Still, others thought that Ghana-wide app would be better compared to a world-specific one(...) through social media information collection, several health professionals felt that the contact tracing app was better to prevent the spread of the virus and according to them, it would be helpful to be aware of those who were exposed both for themselves and others(...). It is also assumed that younger people were better placed to benefit due to their nature of going out more compared to elder people (...)

In addition to the above, heads of departments of the Ghana Health Service interviewed for this study indicated that:

(...) Social media is used to circulate COVID-19 preventive messages, among them including wearing facemasks, hand washing, and social distancing. Other contents of messages shared by the heads of departments comprised dissemination of COVID-19 control messages such as causes, symptoms, early detection, and treatments (...)

(...)using social media to circulate information on the extent of infection and spread of COVID-19 cases in their localities (...)

Some of the public health officers further remarked;

(...) For us in this hospital, social media especially Facebook and WhatsApp have greatly helped us to educate our people on the need to use nose masks to avoid contracting COVID-19 (...) (...) Social media has helped us a lot to reduce COVID-19 cases in this hospital (...).

RQ3: Positive impact of social media for COVID-19 information collection and dissemination

This question aimed to solicit the views of respondents of various health institutions on the positive impact of using social media for COVID-19 public health information collection, and dissemination in Ghana. The thematic condensed responses from all 27 heads of departments acknowledged that all health facilities in Ghana still use social media to conduct massive information collection at the peak of the COVID-19 pandemic has significantly increased the volume of public health information collection, and dissemination by health professionals. Below are some condensed remarks from the respondents;

“(...) the use of social media had a very positive impact on COVID-19 related information collection, ad dissemination in varied ways (...) Before COVID-19 budgetary allocations from the Central Government for health information collection, and dissemination was very low (...) however, since mid-2020, the surge in COVID-19 cases in Ghana has resulted in the Government has increased funding support for public health information collection on COVID-19(...)

(...) As a result of the high death rates and infectious nature of COVID-19, the government has instructed health facilities to increase their public health awareness and give up-to-date information on COVID-19(...) these directives have resulted in some health institutions increasing their information collection, and dissemination strategies through the use of the varied social media platforms like WhatsApp, Facebook, Twitter(X), YouTube, blogs, and wikis (...).

(...) the directives have in one way or the other increased COVID-19-related information collection, and dissemination, especially on social media platforms (...) we strongly believe that the increased funding support from the central has greatly the low mortality rates during the peak of the COVID-19 pandemic (...).

RQ4: The potential risks of using social media platforms for COVID-19-related information collection, and dissemination

On the potential risks of using social media in public health information collection, and dissemination on COVID-19 control in Ghana responses were solicited from the heads of the Department of Ghana Health Service. According to the condensed responses from the interactions, 20 out of 27 heads of departments of Ghana Health Service indicated the key and common limitations of applying social media for public health information collection, and dissemination. Some of the common limitations are summarized below;

(...) poor network/connectivity internet, followed by validity and reliability of data/information, high internet data cost, language barrier, high cost of smartphones, unreliable power supply(electricity), and inadequate knowledge by health seekers/general public on the use of social media (low media literacy) (...).

Further observations are made by the heads of departments on the limitation of social media for COVID-19 public health communication;

(...) For some of us in the health department, one of the key limitations of social media for public health information collection, and dissemination on COVID-19 relates to the digital divide with the Ghanaian population (...) various groups of people within the population are disadvantaged as a result of illiteracy, language and other related barriers that prevent them to have full access to the public health information shared on social media platforms…”

“…fake news in the form of misinformation and disinformation limit how we use social media to conduct health information collection (...) people distort most of the credible health-related information posted on social media (...).

Notwithstanding the tremendous roles of social media in public health information collection, the application of social media platforms in information collection by health professionals, and health institutions is still bedeviled with some great setbacks;

(...) The key challenges identified in this study include; difficulties in ensuring compliance, misinformation management, and the issues of privacy (...) Social media as the preferred national (Ghana) communication platform has introduced great risks to users and is the main source for creating health-related fake news content as well as distribution (...).

(...) In my opinion, another challenge identified for the application of social media platforms for information collection in this study is the exclusion of a critical subgroup of our population from having first-time health news(...)These subgroups include; aged, physically challenged, people with cognitive disabilities, elderly, and people with low media literacy skills(...) these groups are considered as the most vulnerable groups; hence they should be the first to benefit from any health communication interventions(...).

Another risk reported in this study by the heads of the departments of various health institutions about using social media for public health information collection is the too much involvement of politicians in matters of public health on social media. The following are some remarks from the heads of departments;

(...) The public health communication error committed by politicians in Ghana is the reason I have always maintained that public health communication on social media should be done by health professionals and not communicators of political parties who do not know medicine and public health (...). (...) It is with the Mandate of the Public Health Act that The Director-General of the Ghana Health Service, the Public Health Director, the Director in charge of Immunization, and the Ministry of Health are pushing for the vaccines to reach every nook and cranny of this country…"(...) A recent post one politician social media which I feel inappropriate is “no one can force anyone to take a COVID-19 vaccine (...).

(...) If we go and read the Public Health Act of Ghana! The Minister for Health and his deputies (Even though I can say on authority that of their limited knowledge in Health, they have not read the act themselves, hence their inability to come out forcefully to allay the fears of the public and to rally support with the help of social and mainstream media influencers for a vaccination drive) is empowered to declare a vaccine mandate to protect the citizenry (...).

(...) COVID-19 and other public health communication on social media must be handled by health professionals (...) Again, China adopted this strategy of health professionals leading communication on COVID-19 information collection and have succeeded in reducing COVID-19 spread in mainland China(...)The enhanced surveillance we are undertaking, the Gene Sequencing, and how we are rolling out the COVID-19 vaccination(...) We cannot continue to overshadow the great work of the health personnel who remain in the background almost forever while we ride on the back of their work for political gains(...) Let's make their work known, appreciate their progress and reward their efforts(...).

From the interviews (14) heads of departments of the Ghana Health Service reported the following limitations as major setbacks in the application of social media for public health communication:

(...) It is clear that language usually used on social media platforms must be localized to encourage the majority of the general public to derive the full benefit thereof from social media (...).

(...) One of the notable critiques of social media for public health information collection is the way the public health regulations or information are reported (...) the nature in which the regulations and measures that were put in place were conflicting (...) some respondents were saying they do not make sense(...) for instance, some of the respondents pointed out that some of the messages that were being shared with the public were not consistent, for example when they suggested that physical distancing should be two meters at one point, but in other instances, it is 1.5 meters(...) there are also instances where institutions such as public schools and transit have no guidelines about social distancing (...) some respondents also felt that it was important that resources are availed to help in the implementation of public health measures, for instance, the provision of free masks, funding to support distancing in schools (...).

(...) we believe the challenge of applying social media for public health communication is the inability of public health campaigners or implementers to control the kind of COVID-19 information shared by members of the online community

(...) This overabundant and uncontrolled information on social media leads to fake news, this disinformation, and misinformation...” “…the security and authenticity of data/information collected on COVID-19 is the highest risk associated with social media (...)

(...) breach of privacy/ethical issues, attacked by hackers, and insults by the general public, respectively, as the risk associated with the use of social media to collect data/information on COVID-19(...).

5. Discussion

The in-depth interviews with the frontline health professionals, and public relations officers revealed that most of the respondents used at least one of the social media types such as WhatsApp, Facebook Twitter(X), and YouTube. In responding to the first research question on the most predominant social media platform for COVID-19 information collection, and dissemination, 17 out of 27 respondents, (regional public relations officers, district public relations officers, and regional public health officers), identified varied social media platforms are used. In terms of ranking, the findings showed that WhatsApp was the first choice social media platform for the collection and dissemination of COVID-19-related information, closely followed by Facebook. This trend from this qualitative analysis followed a relatively similar fashion to the views of the COVID-19 team leaders/contact tracers except for blogs, YouTube, and X (Twitter) which were included in the list by the respondents. These findings pinpoint that frontline health professionals, and public relations officers were all aware of social media types for COVID-19 mostly public health communication delivery. In addition, these findings suggest that the application of qualitative study enabled the researchers to obtain as much as possible data/information on the effectiveness of social media for COVID-19-related information collection and dissemination. These findings suggest that social media was predominantly used for COVID-19 public health communication efforts and in line with previous studies by ^{Funget al., (2015}); ^{Marmot et al., (2020}); ^{Wittbold et al., (2020}); ^{Zhu et al., (2020}).

In response to the social media content type used to share COVID-19 related- information on the official digital accounts of hospitals, 24 respondents indicated that they use social media platforms such as text (such as news releases & blog posts), videos, photos, digital flyers, and podcasts were used for sending educational messages on COVID-19 to the general public and online audience. The interviewees indicated that the choice of these types of digital content is used to educate online audiences on the mode of transmission, causes, signs, and symptoms, prevention, and updates of the infection; causes of COVID-19, signs and symptoms, prevention, treatments, and to keep the COVID-19 protocol. While, 3 respondents mentioned that, they use varied social media content types primarily for public compliance and treatment of COVID-19. These findings are in line with earlier studies conducted by ^{Antwi-Boasiako, and Nyarkoh, (2020}); ^{Bannor, et al., (2017}) who investigated the effectiveness of social media for communicating health messages in Ghana. that they use social media.

On the positive impact of social media on COVID-19 information collection and dissemination the findings show that social media for public health communication, is very relevant for health education and promotion, surveillance, enhancing public awareness, reducing pandemic transmission, and prevention during the COVID-19 pandemic. The findings further acknowledged that in a developing country such as Ghana, where the healthcare systems are not so developed and lack the financial resources to carry out large face-to-face public health information collection, the application of social media platforms in times of public health emergencies is highly recommended. Again, the above findings are supported by an earlier study by ^{Statucki et al. (2020}) who have acknowledged that social media and other digital technologies like WhatsApp, Facebook, Twitter(X), YouTube, and blogs, indeed have great potential as far as transforming general communication health awareness, and education are concerned.

Furthermore, research question four of the study investigated the potential risks of using social media in public health information collection and dissemination during the COVID-19 pandemic. There were 27 frontline health professionals, and public relations officers of the Ghana Health Service and sample hospitals classified as focus group participants which emphasized the application of social media in public health communication, with emphasis on COVID-19. These factors were looked into and they included wearing face masks, keeping social distance, staying away especially when one is ill, keeping away from high-risk places such as bars, making use of contact tracing apps, and ensuring that vaccine is taken. Four additional themes were identified. They include the significance of putting up with public health protocol, critique of messaging, and some of the suggestions meant to improve the aspect of messaging. Masking and keeping social distance were mostly identified as more important compared to contact tracing apps as a way of minimizing transmission of coronavirus. On the other hand, wearing masks was perceived as the easiest way to comply with the measures. The respondents insisted that there was confusion in messaging and most cases, very unclear. Several barriers to adherence to using social media for public health communication protocol were identified, for instance, the conflicting public health messaging. There is a need to carefully frame health messages that are meant for the public. This can be achieved through understanding the needs of different audiences on social media. The findings from this study are in line with previous studies by ^{Malecki, Keating, & Safdar (2021}); ^{Bannor, et al. (2017}); ^{Khamis, & Geng (2021}) who observed that the use of social media in health delivery comes with some potential risks like compliance, privacy issues, and the digital divide. With these in mind, the study sought to ask for country-specific potential risks from the viewpoint of the frontline health professionals, and public relations officers of the Ghana Health Service.

6. Conclusion

The general public health requirements also need to be well articulated for easy consumption by the targeted groups. The respondents also recommended conscious efforts to educate all segments of the citizens, especially those who use social media platforms. This would be a significant foundational move towards improving adherence to public health protocol. By doing this, the understanding of the characteristics, attitudes as well and behavior of the public would be improved. The next step is to use the information to come up with a public health messaging system that is aimed at encouraging change of behavior as far as the observance of COVID-19 protocols to curb the spread of the virus is concerned. The respondents gave several suggestions on how to use social media for health information collection to change the behavior of mitigating COVID-19, as well as ways to enhance communication in and when frontline health institutions so that the measures put in place can be effective. It was important that messaging is improved through reframing in three different ways. Social media for public health information collection and dissemination should be framed in such a way that it protects others and not yourself, giving more scientific rationale, and highlighting the significance of the behaviors so that society can come back to normal. The participants also pointed out that, the tailored messaging strategies need to target specific population segments, for instance, the young.