Content analysis of metaphors about hypertension and diabetes on twitter: Exploratory mixed-methods study

Abstract

Background: Widespread metaphors contribute to the public's understanding of health. Prior work has characterized the metaphors used to describe cancer and AIDS. Less is known about the metaphors characterizing cardiovascular disease. Objective: The objective of our study was to characterize the metaphors that Twitter users employ in discussing hypertension and diabetes. Methods: We filtered approximately 10 billion tweets for keywords related to diabetes and hypertension. We coded a random subset of 5000 tweets for the presence of metaphor and the type of metaphor employed. Results: Among the 5000 tweets, we identified 797 (15.9%) about hypertension or diabetes that employed metaphors. When discussing the development of heart disease, Twitter users described the disease as a journey (n=202), as transmittable (n=116), as an object (n=49), or as being person-like (n=15). In discussing the experience of these diseases, some Twitter users employed war metaphors (n=101). Other users described the challenge to control their disease (n=34), the disease as an agent (n=58), or their bodies as machines (n=205). Conclusions: Metaphors are used frequently by Twitter users in their discussion of hypertension and diabetes. These metaphors can help to guide communication between patients and providers to improve public health.