Raising Awareness About Cervical Cancer Using Twitter: Content Analysis of the 2015 #SmearForSmear Campaign

BACKGROUND Cervical cancer is the second most common cancer among women under 45 years of age. To deal with the decrease of smear test coverage in the United Kingdom, a Twitter campaign called #SmearForSmear has been launched in 2015 for the European Cervical Cancer Prevention Week. Its aim was to encourage women to take a selfie showing their lipstick going over the edge and post it on Twitter with a raising awareness message promoting cervical cancer screening. The estimated audience was 500 million people. Other public health campaigns have been launched on social media such as Movember to encourage participation and self-engagement. Their result was unsatisfactory as their aim had been diluted to become mainly a social buzz. OBJECTIVE The objectives of this study were to identify the tweets delivering a raising awareness message promoting cervical cancer screening (sensitizing tweets) and to understand the characteristics of Twitter users posting about this campaign. METHODS We conducted a 3-step content analysis of the English tweets tagged #SmearForSmear posted on Twitter for the 2015 European Cervical Cancer Prevention Week. Data were collected using the Twitter application programming interface. Their extraction was based on an analysis grid generated by 2 independent researchers using a thematic analysis, validated by a strong Cohen kappa coefficient. A total of 7 themes were coded for sensitizing tweets and 14 for Twitter users' status. Verbatims were thematically and then statistically analyzed. RESULTS A total of 3019 tweets were collected and 1881 were analyzed. Moreover, 69.96% of tweets had been posted by people living in the United Kingdom. A total of 57.36% of users were women, and sex was unknown in 35.99% of cases. In addition, 54.44% of the users had posted at least one selfie with smeared lipstick. Furthermore, 32.32% of tweets were sensitizing. Independent factors associated with posting sensitizing tweets were women who experienced an abnormal smear test (OR [odds ratio] 13.456, 95% CI 3.101-58.378, P<.001), female gender (OR 3.752, 95% CI 2.133-6.598, P<.001), and people who live in the United Kingdom (OR 2.097, 95% CI 1.447-3.038, P<.001). Nonsensitizing tweets were statistically more posted by a nonhealth or nonmedia company (OR 0.558, 95% CI 0.383-0.814, P<.001). CONCLUSIONS This study demonstrates that the success of a public health campaign using a social media platform depends on its ability to get its targets involved. It also suggests the need to use social marketing to help its dissemination. The clinical impact of this Twitter campaign to increase cervical cancer screening is yet to be evaluated.