In this way, they can help reach and be understood by a majority of the population, promoting solidarity and reducing stigmatisation of risk groups. When new infectious diseases break out, visuals can help risk-reducing messages stand out in the seas of information on social media. Ultimately, their ability to affect viewers renders them powerful tools to foster public adoption of health officials’ recommendations. Moreover, visuals can prompt action by their persuasive and emotional impact, with colour hues affecting an individual’s psychological reactance to health recommendations. Visuals can also help to engage ‘hard to reach’ audiences, such as those with low literacy levels, thereby promoting social equity as an ethical imperative of public health. In doing so, they then foster autonomy by enabling viewers to make their own health decisions and facilitating shared-medical decisions and behaviour change. Graphics (when accurate and truthful) can improve public understanding of qualitative and quantitative health risk information. In online environments, such as Twitter, visuality can help to communicate health and risk messages. Among the array of social media platforms, Twitter has played a prominent role by allowing everyone, from public officials to citizens, to easily share and consume visual and multimedia infection prevention and control messages. From health officials and pop-stars co-producing YouTube videos to animals explaining health measures on TikTok, health risk communication has become fully submerged in the image-driven, de-centralised, peer-to-peer, cross-cultural melting pot of social media. In the wake of the pandemic, amid toilet-paper buying frenzies, government-ordered city shutdowns, and requests from mayors that citizens stay home, visual health risk messages have proliferated online. The coronavirus pandemic has offered public health professionals a real-world case study on visual risk communication through social media platforms like Twitter. More research is needed to understand the implications of framing and its impact on public perceptions and behaviours. However, that more tweets used the emotive medium of photographs often combined with health loss framing raises concerns about persuasive tactics. Further, our findings on the visual characteristic of the most retweeted tweets highlight factors that health and government organisations should consider when creating visual health messages for Twitter. The results underscore the value of engaging individuals, particularly influencers, as advocates to spread health risk messages and promote solidarity. Our findings can inform the didactics of future crisis communication. Although more tweets used health loss framing, health gain messages spread more. 78.1% of Tweets contained 1–2 preventative messages, whereby ‘stay home’ and ‘wear a mask’ frequented most. Messages used mostly photographs and images were found to be rich with information. At the start, most retweeted preventative messages came from the media and health and government institutions, but overall, personal accounts with many followers (51.3%) predominated, and their tweets had the highest spread (10.0%, i.e., retweet count divided by followers). Our results show communication dynamics changed over the course of the pandemic. Following a retrospective approach, we then performed a qualitative content analysis of the 616 tweets meeting inclusion criteria. For inclusion, tweets had to have visuals, be in English, come from verified accounts, and contain one of the keywords ‘covid19’, ‘coronavirus’, ‘corona’, or ‘covid’. We sourced Twitter’s 500 most retweeted Covid-19 messages for each month from January–October 2020 using Crowdbreaks. To address this gap in the literature, this study’s objective was to determine how visual risk communication was used on Twitter to promote the World Health Organisations (WHO) recommended preventative behaviours and how this communication changed over time. Yet to date, only little is known about what characterizes visual risk communication during the Covid-19 pandemic. Consequently, visuality and social media platforms like Twitter have come to play a vital role in disseminating prevention messages widely. The Covid-19 pandemic is characterized by uncertainty and constant change, forcing governments and health authorities to ramp up risk communication efforts.
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