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Analysis of social media data to inform UK cardiovascular health equity strategies

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Summary

This session will be a combination of conversation and slides, with two experienced medical professionals from White Swan. Beth and Lucy will discuss insights from their project exploring health inequalities in the cardiovascular sphere. Using data from social conversations, demographics and Department of Work and Pensions data, they will discuss methods of analysis and findings to help inform healthcare plans and improve care. Participants will be invited to join the conversation and use visuals to support the discussion. With a combination of conversation and practical experience, this session is a valuable opportunity for medical professionals to learn more about health inequalities.

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Description

Analysis of social media data to inform UK cardiovascular health equity strategies

  • High level description of what our methodology and technology can provide above traditional market research.
  • Why we decided to tackle this subject:
  • Cardiovascular diseases are estimated to take 153,000 lives in the UK every year, and 17.9 million lives globally
  • There is a proven disparity in quality of cardiovascular health because of social determinants of health like, sex and gender, and neighbourhood poverty, a root cause of which is inequality and bias.

Presented by Beth Fordham to in a 40 minute bitesize webinar.

Have you watched the LWN in Conversation webinar delivered by Beth Fordham and Lucy Bell? Click to watch it On- Demand:

Unlocking inequalities with social media: Equality in cardiovascular care

All delegates who attend will have the opportunity to receive a certificate of participation for CPD and access to presentation slides on submission of evaluation via MedAll.

You will need to be verified to participate in the chat on webinars and for future access to your certificates and any reflective notes you make in your profile.

Verification is available to healthcare professionals globally, you can find out how by clicking here

This webinars is part of the LWN series provided FREE to increase accessibility to all

At LWN we feel it is important to continue to deliver FREE webinars, especially during the current cost of living crisis and global disasters restricting attendees’ ability to continue their professional development in healthcare and medical education. The trainers volunteer to deliver webinars without payment however there are back-office costs that have to be covered. If you would like to donate towards the costs incurred in providing webinars to help LWN continue to offer free webinars, we would be delighted!

Please visit our LWN Donations page by clicking HERE

About Beth

Beth:

Beth has nearly 20 years’ experience in the digital sector. The early days in SMS marketing led to project managing website builds and smartphone apps, and in 2012 she joined Black Swan Data where she delivered social data insights for clients such as PepsiCo, Disney and GSK.

Having volunteered for White Swan, Black Swan Data’s healthcare charity, since its creation in 2015, she transitioned to a full time role managing day-to-day operations in 2019.

Beth now leads the development of Million Minds (White Swan’s tool to accelerate the path to diagnosis) and also manages the commissioned and volunteer patient insight projects.

Learning objectives

Learning Objectives

  1. Understand the role of data and social media in helping predict trends in consumer behavior
  2. Recognize inequality across geographies when it comes to access to health care
  3. Become familiar with sources for collecting demographic data
  4. Be able to identify and filter out relevant patient conversation from general online conversation
  5. Gain insight into the effects of demographic statistics on healthcare decisions and policies
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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Welcome everybody to another of our learn with nurses session. This one is going to be a slightly different version of like a combination of two of the types that we do. So, some of you might have joined us in the past with our live webinars slides that run and other ones that we run also are as an in conversation. And the guys, Lucy and Beth and White Swan have done a few sessions with us now and we're delighted to have them back. And what we'll be doing is doing that combination. So it'll be a bit more very relaxed altogether in conversation style, but with some slides because they've got some really interesting stuff all around cardiovascular disease and data and social media and inequalities for those people who are watching on demand. You mean we might talk about what's going on in the chat. You won't be able to see that. So what we'll make sure we do is read out the conversation or read out the question and, and, and then we'll be able to have a bit of a discussion about it. Now, Lucy, I've noticed that Beth might have just, oh, and she's on her way back. So, yeah. So the joys of the internet and running things live does mean that sometimes things never quite go to plan, but Beth is on her way back here. So internet and the joy of internet, I'll just invite her to the stage in case she's struggling to get back on. But, er, here we go, Beth is back now whilst we are waiting for Beth to come back. I just so hopefully some of you have joined in with the selfcare summer campaign that we ran together with the self care forum and the National Association for Primary Care. And we've actually got some really exciting stuff coming up around diabetes and oral health. We've already had some live webinars that are available on demand and we're just about to record some of the podcasts. So if you haven't looked into that, now, that's real sort of, um, really sort of front front of thinking of, does diabetes make your gums bad? And does having bad gums make bad, make for diabetes? And what does it do for inflammation in your endothelium? So, we've got Beth back now and I'm going to hand over the reins for a bit and so I'm going to sit here quietly, but I am just going to sort of be in the background. But what I'm going to invite Beth to do is introduce herself and White Swan and I am gonna help sort of say, let's go through about how to share slides and stuff that's there. But hopefully if you got them uploaded Beth or would you like me to upload them? I think that might be why I dropped off as it was trying to do it so I can do the white and I'll, and I'll, and I'll upload them and then I'll be your, I'll be your slide forward, slide back, please. Next slide, please, person. How's that? Ok, thank you very much. Ok, thank you. Yeah. Well, hello everybody. And so I'm the operations director at White Swan. Um We're a registered GK charity that was initially a not for profit offshoot of a commercial organization called Black Swan who used all the social conversation that happens online and reddit um Twitter, etcetera to predict trends in consumer behavior. Um But what we did at Black Swan and where I worked previously is use all of that conversation that happens online from patients. So peer to peer conversation about their symptoms and um diagnosis are all sort of elements of their patient journey, which we know they share about in great depth online and use that to help the CEO of Black Swan's sister get diagnosed with a condition that she'd been undiagnosed with for a long time. So she'd been through lots of misdiagnoses trying to find clues as to what it was that was causing these debilitating symptoms. So she was unable to walk, you know, not able to look after her Children and so on. And long story short, after sort of narrowing down to pockets of conversation that match those that symptoms that she was experiencing. We came up with two candidate conditions that sounded similar to her set of symptoms and we went back to the doctors and they were very open about testing for these and it turned out she had an early onset Parkinson's so something that hadn't been considered before. Um But it was the fact her toe had been curling, which hadn't really come up when she was talking to doctors before that then differentiated between this Parkinson's Dystonia and all these other more generalist conditions with the symptoms that she was having. So the theory was if we could help Julie by using this data, we might be able to help other people both in diagnosis, but also just harnessing all of that insight from patient conversation. So that was when White Swan was created. Um We're now a team of four and about 100 plus volunteers and we've done lots of projects since then. NHS and the BHF gosh, lots of different charities as well helping to answer questions about um people's experience of their health care. So as I say, you know what the symptom experiences were, why they might drop off their treatment program. Um Reticence to take up clinical trials, lots of different things that people talk about between themselves online. And then we use the technology that we have to analyze all of that conversation and find meaning in it, which helps then inform healthcare plans and hopefully improve their care. And so Lucy will talk through some of the details of this project, but some of the data that we get from the online online conversation. So some of the sources has some demographic data tagged to it and we hadn't really used this on any projects before. And so we thought it would be interesting to see what it could do. And so working with a team of volunteers who were interested in this area, we came up with a brief almost for ourselves looking at health inequality. We knew it was a really big topic. We'd talked to quite a few people in the cardio muscular area in particular. Um who he mentioned that they would want to know more about this. So, um as I said, I let Lucy talk about the project, but that's what we've been doing over the past year um with the team of volunteers and, and Lii leading it from the White Swan side. And we're going to talk through a few of the things that we found out today. Hopefully, we have some slides now, we certainly do. Just keep telling me next slide and I'll do it over the first couple. Yes. So there we go. Yeah. Lovely. OK. So, yeah, Beth, been over it briefly. So we decided to that we really wanted to test out this sort of demographic capability. And we want, the main thing we wanted to understand is what can we actually say from the statistics and what can we learn from them and what kind of, what coming forward with these, what kind of strategies coming forward with these findings? Um, and it was an area that we thought that our volunteers would be interested in. Um, and thankfully, they were, um, and were happy to work with us on the project UK to go to the next er Stride MLA. Yes. So we've got a, a brief background here. So what drew us to the cardiovascular sphere? Um Well, from the research that we did when you across geographies, inequality and access to health is still a major concern. Um It's also life expectancy name for mortality is a concern for particularly for minority groups, but there's a disproportionate burden and prevent parental disease, death and disability. And there's also sex and gender differences um that we thought we'd be able to uncover with this type of work. Um And then we have some brief sort of project detail here. So Beth Beth mentioned some sources here. We have um you know, sources that we use. So we started off with boards reviewed on Twitter now called X. So the boards be sites like Reddit or have unlocked or mums net where people go to speak. And overall we collected around 669 2000 social documents just for the UK, which were, you know about all the different cardiovascular conditions that someone could be suffering from. And then from that, we used, used a specialist provider called demographics pro using anonymized sample of data to, to get these demographic statistics and then looked at comparing them with the Department of Work and pensions data to give them like a real, real life grounding. So it's very well, we can go and say about what's going on in the online world, but we actually wanted to see a case what's happening in real life in Alex and what's happening in what's happening online. So if uh if we go to the next side, OK. So on here, you can see just so this is an example, I think we've got about 16 different conditions, 16 to 18 different um like condition areas that we base the project on. So this is just a quick example of the top five and you can see kind of what you, what you'd expect as healthcare professionals to be up here. It's the heart attacks, the cerebrovascular disease, the embolism and thrombosis, the coronary heart disease and the arrhythmia and tachycardia. Um And if you're interested, you can see sort of how this is how those different conditions be tagged. So for example, heart attack could be tagged as heart attack in the data or carcinogenic cardiogenic shock. Um maybe em embolisms and thrombosis could be tagged as blood clot. It could also be tagged as uh deep venous thrombosis and then arrhythmia and tachycardia. Um it could be tachycardia, but it will also be someone saying that they've got palpitations. So that's kind of a brief example on if you were to go online onto a forum and see how people and have a conversation about these things, it would be those type of conversations that included these words that we'd be, be analyzing. And I think just before we get onto the main demographic bit, there's one sort of important point is the data. So people can talk about, of course, heart attacks in a very general way or perhaps even in a jokey way, we didn't find that so much in the UK. It wasn't, the conversation was quite serious, it wasn't jokey, but there'll still be perhaps conversation which isn't particularly relevant to patient populations. So a big part of our job is filtering down that data and making sure that we're talking, we're measuring the experience of patients what they're saying about it and perhaps what other people are saying about their experience. So I think on this side, you can see you've got the total volume, but if you look in the bottom left corner, you've got the patient journey volume and that sort of darker um darker bar on the chart is actually patients talking about their treatments, patients talking about um diagnosis, clinical trials, all of that type of thing and that's what we measure these demographics of. So it's actually conversations about, about experiences of, of care. OK. So if you go to the next slide, um and maybe the next one, actually, we can probably skip the intro one so on to the demographics. So this is the sort of first review of demographics that we show you. And um I think this is a key of interest that we, you know, that we found out about really, we were expecting perhaps some more granular areas to be really, really interesting, but just for male female to be a really interesting area for health professionals. Um You know, that was interesting for us and we could see how we could come up with strategies to improve that. Um So the overall sort of insight for the whole of cardiovascular in the UK for gender was that females are 25% less likely to share cardiovascular experiences, but only 4% are less likely to use Twitter. So if I take you down to this chart that we've got here, you can see you've got um gender split of male and female here. And then in the second column, you've got the total Twitter users in the UK. So this total Twitter user group, but there's not a big split, there's a 4% difference between male and female. Um And if we have a look at the next column and have a look at total UK population we can see that, you know, again, not a huge difference. It's 45 49% male, 51% female. So slightly the other way compared to total Twitter, but nothing particular to comment on. But then when we compare that with online users who discussing this cardiovascular patient journey. So that's the treatment, um their diagnosis experience of the doctors. Um We find that many more, what we understand to be many more men than women are talking about these experiences. So 62% of conversations was from men and then 38% were from female. And of course, if we then look back at the total Twitter users and the to UK population something doesn't quite add up. Um So what we take from this is OK, so how could we improve? Um How could we encourage people to learn about their health? Um A big thing with, particularly with Twitter and now X is that it's a great place, has been a great place for health advocacy. So people can go on charities can go on promote health advocacy, educate people, educate people about their symptoms, that type of thing. Um So we kind of take it from the date. What would we say from this? Produce almost produce some hypotheses and then talk to people like Michaela and other health professionals and say, OK, so what are they seeing? And um you know, does this match their expectation and how would they achieve these sort of strategic, strategic moves. So underneath the findings and actions would be invest in cardiovascular education for and about women, investigate why a few women and talking about cardiovascular care and evaluate how this disparity could be defecting diagnosis rates. So I'm sure that you as healthcare professionals already have an idea exactly what's going on because you, you know, you may talk to patients, it may be a few patients, it may be many patients. But this is we find that this sort of thing is a great opportunity to get big data kind of grounding. And we often find that, you know, these findings will match, almost match what you expect. And they're a great tool to um great tool to prove that maybe things need improving um in different areas. So that's, that's the first sort of gender side with the findings and a bit of background over, you know, how we think this will be used and how we think it, you know, could be useful. I know we spoke last last webinar we did on this. I think Michaela, you spoke a bit about um you know, your expectations around this. I don't know if you want to jump in and yeah, absolutely. So thank you. And I, I get really interested in this and particularly around the women. And we know we know that, you know, traditionally more men, men have more traditional heart attacks than women. But women when they have their heart attacks are less likely to have it diagnosed, they are less likely to have it recognized. In fact, 53% of women presenting with heart attacks have a late diagnosis or, you know, have their symptoms almost ignored. And I can see that in these statistics here, exactly what we're also seeing as well is that women are having less traditional heart problems. So we're seeing more of this sort of microvascular angina. So they're still getting with the chest pains, but not what we count as our traditional a and down to spasms and spontaneous coronary artery dissection. But many women are being dismissed, I would say and being taught to being told to rethink their pain rather than when they're presenting at hospital with chest pain that they really need to consider what they think pain is about. So, which is really unfortunate. So I totally echo everything you're saying there. Um And, and then I was trying to decide, is it a lot or is it not because actually, um but yeah, I think there's a way to go because you'd almost think women are more likely to talk about their health than men. So it almost feels like it's even worse than it is because that 38% is made up of lots of people who are maybe more likely to talk about their health. So, you know, in real life, it's probably, you know, even worse than that. And it does, I think. Remember really nicely. There's a bit, there is a drive, I would say at the moment going on, um, around women and cardiovascular disease and particularly heart health. It's quite big in other countries. There's a lot that's going on in Canada and Australia and in the UK, we have a lot to catch up on. So, yeah. But I think really, really interesting and sad and interesting and sad that the way it is, but, you know, it gives us somewhere to go. There's an interesting point in the chat there about whether it's men that find it easier to talk online than face to face. And I think there could definitely be something in that. Um But again, as you say, Michaela, I think, you know, maybe this is anecdotal, we'd have to look. But from the other projects we've done certainly around cancer and things we often see it's women sharing experiences in the forums on behalf of their husband because their husband doesn't want to engage in talking about it. So I think, yeah, generally speaking, we do see more women talking about health online. Um and also of somebody else. So this pattern is different then to you would see in other health conditions. Yeah, it really does depend on the condition I think because for example, something like prostate cancer, actually, you know, many men do actually go online and find, you know, find communities and educate a lot of education and guidance in forums. Um So I think it really, it is on a, it is on a condition by condition basis. And I think one of the interesting things for the cardiovascular as well that I did take the slide out because it was a bit much to, I thought there was a couple of interesting points, but overall, it wasn't that interesting. Um One of the, one of the biggest sort of board forum sources is actually called Piston Heads. And that is a source, I mean, it's about 2000, 5000 conversations, but it's still one of the biggest sort of sources and men go on there. Um talk about cars and also talk about their health. Yes, this rather complex. So we always see this rather complex landscape of who's talking, where are they talking. Um And it, it's quite difficult to because we know that maybe women would be more likely to go and talk, maybe face to face about it and probably online. But then we find these other findings that say actually for this and for this, it's not quite the case. Yeah, that's very interesting that they and actually that reminds me a bit of the gone fishing program where it's all about the fishing, but actually there's a lot of health discussion around it. So Piston Heads is all about cars, but there's some health discussion around. And I think there's a lot as a clinician, I would say that we can take back from that as well and it just adds to the, to the depth and the challenges that we need to be able to do. Are we on to the next topic? The next, not the next topic, the next finding, shall I, shall I move the slides forward? Yeah, that would be great. Thank you, Michaela. Ok. So now onto um income. So we were, so this is sort of the beginning of this is the first of two slides where we found some quite um to our surprising findings. Um So we found that only 9% of the cardiovascular journey documents on Twitter are from those with a low income. And if I take you through to the table again, you can see we've got the income level. Um So this, I know there's been recent news about housing based housing, price based stuff, but this is actually the traditional kind of 40% low income below 17,000 a year versus anything above anything above that. Um So if you have a look at the bottom 40% income, we can see to Twitter users in the UK. There's actually, you know, quite a high percentage of people from that lower income group who go on sites like Twitter, in this case, 45% for the UK. And then if we have a look at the UK population that drops quite a lot. So it's actually only I say only but comparatively only 18% of users of the population are within that lower income group. And then if we then go and have a look at users discussing the cardiovascular patient journey, we can see that that's even lower than population and much, much lower than, you know, what you'd expect from the usual users of Twitter. And it's only at 9% versus 91% for those above the 17 to 20 income bracket. Um And from this, what we take is, you know, findings insights, um recommendations that could help improve awareness of cardiovascular health within that group. So it would be around targeting low income users in cardiovascular advocacy and education are using local and diverse influence, influencers with access to low income groups so that could be online or in person. So people that know people locally, um people that are connected to the community in some way that they can have, you know, an honest discussion and um you know, and have a discussion that they will listen to and learn something from. And then also there's opportunity here to sort of launch campaigns targeting these groups on Twitter and other social platforms. So if we're seeing what we're seeing on Twitter, that actually this group is quite big on social media, it's, you know, it's the perfect place to, it seems like the perfect place to target them, advertise to them, get them more aware about their health. And I think one of the big things sort of behind this is when we talk to people is, you know, in some cases, it might be on the cardiovascular side that perhaps these people aren't living as long in the low income groups or say that is the case. But social media could be, you know, one of those places where you could be an opportunity to access those people when they're younger, um make them more aware and just be a tool to help. Um Yeah, help improve public health. Wow. So I'm completely flawed by this statistic now. And thank you for sharing. So we know that people from the least deprived areas are four times more likely to die prematurely from cardiovascular disease than those from the most deprived areas. So absolutely vast differences there and what we're seeing is much less people from those lower income groups are actually talking about their cardiovascular journey and that I'm trying to almost get my head round because it's the first time and this is why I didn't want to see any of your stats beforehand because I wanted to see and feel them straight away. And my mind is absolutely now thinking. So why are people not talking about their experiences? Is it because they're not experiencing it? Is it because they're having bad experiences? We know that, you know, health literacy is a massive issue when it comes to people being able to access services, being able to, you know, know how to take the tablets. There's so much that's wrapped up in that. And yet there is um there's this amazing opportunity that is there to be able to engage with um people who are on that with the lower income and the lower socio chemical status. Then this is an absolute gold mine of being able to access somebody. Now, I can see the challenges already in that because actually when you're putting health messages out, you get lots of pushback. It takes a lot, it takes a lot, a lot of resources and time and energy, but it almost feels like that, that this is a, this is a sweet spot almost that could be found on social media in getting those key health messages about. Wow, I know there's some people um who are joining in tonight and I wondered Zoe if you've got any thoughts or comments because Zoe's always amazing, given the most, the most amazing comments. But were you just as surprised Beth and Lucy on, on what came out here? You nodding away be? But I, I think it um like you say, we know that health literacy is a problem. So, you know, that would be an immediate sort of thought as soon as you see these statistics. But the fact there is such a discrepancy, you know, is worrying and yeah, I think it's that one that we'd love to have the time to sort of dig into and um and start to uncover a bit more as part of sort of building a strategy for some kind of public awareness campaign or something. So, um yeah, there'll be more clues in the data to unpick that more, I think. And if you think back to one of the first slides that Lucy showed us and I wrote down here, it's about the different language that was used in the boxes that you had. So you had people that were talking about ventricular septal defects to my heart went really fast. And I think that's a real vast sort of diversity of language that's being used there. I felt my heart getting palpitations wise. So you had all medical terms being used by some people to very sort of what we would say, real layman terms there and that's there. And, and actually a lot of the language seem to be geared towards the more clinical terms, the more medical terms. And that's reflected. And I'm sure in these percentages we're seeing here that it's so many people in that top 60% income that are there talking about the journeys that they have. So have you got anything more for us then Lucy? Shall I I move on? Oh, lovely. Let me just when we're looking at condition specific statistics, we do have that thing where it's probably more biased to people with more education, but actually, overall in cardiovascular care because we've got all the general conversation around um like chest, like heart pain or, you know, chest pain. Um All the layman's terms, it means actually in cardiovascular overall, we're capturing, capturing those, those instances or symptoms where people don't have a name to put them to. Yeah. So this is gonna get good again. Yeah. And this is, this is this, I think we kind of expected to see a disparity but we didn't, it particularly with this, we didn't expect to see such a clear one. Um So on this side, we have a look at. So we saw that people living in areas of the UK with a higher risk of poverty are less likely to share experiences of cardiovascular care. So if we have a look at the table and have a look at um the regions that we have here um in the first column, we have the likelihood to share cardiovascular documents. So this says, ok, so compared to the whole of Twitter, um compared to how many people usually talk on Twitter, how re how um how likely are people going? How likely is it that people talk about cardiovascular care? And what we found was that actually those, so it's Scotland, London, Southeast, northern Ireland, East and South West were likely to talk about, you know, relatively likely to talk about a cardiovascular care. Um But the Yorkshire and Humber, East Midlands, North west, north east West Midlands and Wales were not likely to talk about it. And then we contrasted this with, I don't think we got, we've got two here, but the first is below 40% it's below that 20 17,000 income. And then the next is above that 40%. So we can see if we go to the below 40% that all these people or say all these people within the, all these regions um are less likely to be in the poverty bracket and they are more likely to be talking about their cardiovascular care. If we go back to the first column, and then if we have a look at these, at the bottom in the red, we can see all the, all the regions that are least likely to be talking about their cardiovascular care than if we go to the third column, um are less likely are more likely sorry to be in the lower income bracket. So those are less likely to talk about their cardiovascular health are more likely to be lower income. And that's a sort of direct correlation between um you know, poverty levels across relatively, across regions in the UK, um which we didn't expect to find. Um and we found, so if you go to sort of the findings and actions, we found that the northeast and the Midlands have a sort of a high level of low income households and some of the lowest likelihood to talk about experiences of cardiovascular care and the sort of insight around this would be discover regional and local champions who can advocate to improve care in the low incomes or low likelihood regions. And I think we've got a little note here to say thank you to no nurses and you Michaela because I think we talked to you about the last time, like not without, without slides. I think we just sort of listed things off for you. And you were saying that, you know, in the country where you have your health heroes and the people leading, leading the charge and you could see that reflected in these statistics. Yeah, absolutely. You can. And, and it's, if I look at this now and again, it's, it's quite shocking. I just feel like I'm using the word shocking a lot, but it really is. And you see it's so stark like this and, and then if I put my sort of like thinking forwards hat on, if I was a region, if I was one of the regions of the Yorkshire and, and, and the East Midlands and stuff that this gives us an opportunity then to really focus down. It's not about that. One size fits all messaging, I think now across the country, it really does say, yeah, a regional type messaging and or quite big clustering messaging totally does totally would be, would be worthwhile and do. And I think we do have, as I said, yeah, I did say before about, you know, in London, we are protected in a lot of ways in the southeast that does happen and we do have some, yeah. Amazing. Yeah, those, those clinical champions that are happening around that sort of attract people towards them when they attract other healthcare professionals and services and teams. Yeah, quite, quite, quite stunning and shocking. But actually it's that food for thought and seeing what can we do. And I guess that we know that those disparities are there, But it's about thinking how can data help improve things? I think that's the bit I see, isn't it? So, whilst it's shocking and it's awful, it's how can this data can be used? And I think it's that regional targeting and I think it's also like saying as well, but you know, London don't rest, don't rest on your Laurels. You know, you're, you're not scot free or the northern Ireland, you're not scot free. It's just that your people are talking about it more and that's probably a good thing. Um And, and it's about the other areas. So, yeah. Yeah. Wow. Have you? Is there any more? She says whilst I'm, I'm looking for this, shall I, shall I do the next one? Is there another one? Yes. Yeah, we've got our ages. Ok. Oh, lovely, lovely. Yes. So the way that we um discovered the regions was we put um all the city demographics together and leveled them up into regions because we felt we were more confident in, in, in the size of samples for regions than we, than we were with the cities. Um So for each of the cities, our minimum sample is 20 um which we think relatively or I think relatively between all the cities, that's a fairly healthy sample. Um But of course, for some people that may not be quite the level of data, um they, they'd be looking for. But what we did find was that the key cities in the Midlands are the least likely to share experience of cardiovascular care overall. So we've got the Stoke on Trent Derby Coventry, Northampton. And then we've also got um Swansea in Wales. Um And I think the findings and actions we take from this would be to create city based as you were talking about Michaela with regions really focusing, focusing in on those areas. Um you know, to create strategies to increase awareness and also possibly evaluate local services to identify where additional funding in education will improve care. Now, that's a very easy insight for us to write down. Um But it seems to be from this data, that's what we take and then it helps to get back into what, you know, as you said, what you health care professionals are experiencing. Um Yeah, I think, I think we've got a question, another question from um Zoe. Well, so are there online forums that are in other languages that could be analyzed? So yes, there are, I think not for the UK but for the US, we did include Spanish, but it ended up being very, very small percentage of conversation and the English language world is the biggest, I think are the biggest users of social media. Yeah, I thought that was a good question. If I, and if I think practically about this and the use of you, have you thought of going to these particular letting these cities or towns know, know that this, you know, co actually, if I was working, if I was in public health in derby everything and now how can I use this information? So have you thought about this going forwards, how it's going to be used? I think what we, what we've done is we've beth can talk to this as well. I think what we've done is we've shared it with different partners who've then shared it with their partners and trying to serve the information that way. I know our expertise is in the technology, it's in the data, it's not in online communication, but we wouldn't say we wouldn't be the right people to talk to people. Really. One projects already sprung up from sharing this in, in Birmingham. They're trying to develop a screening program for amyloidosis and they're struggling to get the right people coming forward for that. So having seen this, we're now working on again, another volunteer project for that, looking at some of the barriers to people coming forward for screening and treatment for that. I believe there's a new drug on the horizon and that's going to really help patients with amyloidosis. And so they want to start capturing more of those people and bringing them in and identifying them. So, so yeah, I think that there'll be organic things that spring out of it that people will see this and think, oh, you know, the art of the possible, which is brilliant. Um Yeah, I think it's always our challenge to try and get this out there. And hence we like talking to you and spreading the word. Exactly. And I'm almost thinking and if an area, let's say I pick on Trent thought, right. Let's go to town, let's really do this. And let's say they did lots of targeting, working with local groups and really thinking about how they could make a difference in changing, in getting more people in my head. If more people are talking about it on social, that means they're experiencing it more. They experience those cardiovascular journeys, recognizing that they've gone to hospital, they've had chest pain that, you know, that this has been dealt with rather than sitting at home, not noticing it. Well, not, not, not, you know what I mean? And then we repeated it and stoke on Trent, not that I'm trying to get you to do more, but, you know, in a year's time you did it and stoke and Trent wasn't even top five. You could really see that, you know. So it would be a lovely thing. Anyway, I'm going to move us along to the last one. I think you've got one more, you said, didn't you? And we'll whip along to that one because we're getting close to 22. So, yeah, let's go for it. Ok. Very quickly. Here's ages. So it's what we would expect really over 35 starts to become more aware if we have a look at the chart in the green. And we use this sort of indexing method again to say, OK, so compared to Twitter, generally, how likely are these people, these groups or not likely they are to be talking about um cardiovascular care. So we can see on the chart in green that above 35 is when people start talking about it more and by the time they get to 50 then to 60 the level of conversation is much more significant in those groups. Um I think insights or learnings from this type of thing, it seems obvious at first, but what you can do is look, OK, well, is this what we want? Is this the rate, is this the share of conversations over all of these years or actually, do we want people in their thirties or 25 to 29 to be actually a bit more likely to talk about this? So they, so we know that they are learning early that they need to manage their diet or exercise or lifestyle in general, um, to prevent, help prevent, you know, development of cardiovascular disease. Um, I mean, in some cases it could be, you know, it could be things like early genetics testing. Um, you know, we're seeing lots of different things now and ways that people can prevent. Um, yeah, can, can prevent their health becoming worse later on in life. So, it's kind of looking and going actually what if we want this to change? What do we need to do? Should we be targeting, not just at the older groups, but at the 30 to 30 fours at the 25 to 29 and using that to inform, you know, in the strategy of how you talk to people and that. And that so interestingly this morning, I was doing a session for the primary care cardiovascular society about cardiovascular risk and I was on a joint session with an amazing professor John Dean Field who was talking about the life course and lifetime risk. And, and really, I mean, we both agreed it's never too early to start with prevention. And the best way to enter into your older years is to have healthier, younger years. And so there is something about trying to engage with younger people to and it's harder I know when you think about, well, why should I worry about when I'm 80 because I'm never going to make it there. And that's what you think about when you're 15 or 18, I'm sure that I did. Now, I'm thinking I'd quite like to be healthy at 80 if that's ok. So, but I think there is, maybe there's a way we can use social media to harness that change because we do want, we do want people to be healthier younger because the best way to be healthier older is to be healthier younger. That's the best thing you can do. And it was a bit like, and he was saying, you know, almost like a pension that you invest now ready to reap the benefits. And that's what we should be doing with health. So I totally echo what you're saying there. Lucy about maybe we would like people who are in those sort of 30 age groups or even twenties to start thinking about their longer term health in the same way as we're trying to encourage people to think about their longer term pensions and stuff that's going on, not wanting to keep it, you know, not only to make it topical at all but about money, but, you know, we can't escape from that at the moment. Have I another slide for you or are we um have we got another one? I'll click it. We do have a key finding slide that we can go over. But um it depends on time and if you want to wrap up with something else. Yeah, I think, I think we might be there. So I think I will if that's all right, pause there, we've got. So, um so I just want to say I'm just going to wrap it with my overall thoughts. But Betha, before I do that, I'm gonna ask you if you've got anything you got, you'd like to any, any little pearls of wisdom you'd like to throw away. Um Oh goodness, you've put me on the spot now. But no, yeah. thank you for the opportunity to share this. It's, you know, it won't necessarily be the end of the project. As I say, we are already talking to someone about kind of evolving this in a particular area now. So we will keep in touch and yeah, we would love to come back and share more and, you know, we'll have you back. Absolutely. And if any of the other ones you want to do, we should just do a standing twice a year, something can just drop it in and some of the other stuff because I've started to hear more and more now in different spaces about, you know, social media and what's being said and, and I think starting to really gather speed for people to become more interested in what's being said, not what we think is being said, but actually what is being said, something that's very, very different. So I am going to wrap it up. So thank you to those guys who have watched us live tonight and I thank you for those of you who are going to be watching on demand. And so this is available um, for, and, and, and feel free to share with anybody. Don't forget to do those evaluations for us because they always all really important and that helps to give some feedback. Um, we do have some other sessions available, what we've done with White Song. So, check out those ones as well. And of course, we've got the Amazing White Swan website where there's lots of information. So, er, Bet and Lucy, I'd like to say a really big thank you to you guys for coming back and, yeah, I'm going to click the feedback for people now, for those of you are on demand, you get your feedback at the very end. Otherwise it's a thank you, everybody and we'll see you next time.