To hashtag or not to hashtag: what is the engagement?

Tamalette Loha, Lynda Changb, Elaine Wilsonc, and Robert Pooled

  • aComplete HealthVizion, Chicago, IL, USA
  • bComplete HealthVizion, Glasgow, UK
  • cMcCann Health Medical Communications, Macclesfield, UK
  • dComplete HealthVizion, Macclesfield, UK


Consistent indexing/tagging should make content more discoverable and enhance engagement. Increased engagement has been reported for use of Twitter hashtags, including in health settings.1 Our objective was to study this relationship in the setting of publication-related tweets to understand how to optimize engagement with journal publications using this channel.

Research design and methods

Representative journals were selected from three disease areas. Using PubMed® and Altmetric’s Bookmarklet, we identified the first 20 articles from each journal starting May 1, 2017 (to allow indexing time) with ≥1 English language tweets. We determined original tweets, retweets, and use of hashtags.


The journals The Oncologist, Heart, and Gastroenterology were selected (N=60 articles). There were 623 overall tweets (140, 332, and 151 for each journal, respectively), with 255 original tweets and 363 retweets (mean 1.4 retweets per original tweet). Among the 255 original tweets, 89 used hashtags (35%). Of the 173 total hashtag instances, 53% matched tags from the Symplur Healthcare Hashtag Project.

For the journal-originated tweets (n=31), seven used hashtags; the mean number of retweets was 6.4 and 7.1 for those with and without hashtags, respectively. For the non-journal tweets (n=224), 82 used hashtags; the mean number of retweets was 1.0 and 0.5 for those with and without hashtags, respectively.


In our data, hashtags did not have a consistent impact on engagement with tweets relating to specific publications. However, tweets from the originating journal had a higher number of retweets than those from other sources, irrespective of hashtag usage. There are opportunities to improve the consistency of tagging in Twitter communications on publications.


1. Saxton GD, Niyirora JN, Guo C, Waters RD. #AdvocatingForChange: The Strategic Use of Hashtags in Social Media Advocacy. Advances in Social Work 2015; 16: 154-169