INTRODUCTION

The SARS-CoV-2 pandemic was first identified in Wuhan, China, in December 2019. Since then, a total of 271,340,834 infected and 5,332,521 deaths have been identified, reported by 222 countries as of 14 December 2021 (Worldometer, 2021). The World Health Organization (WHO) declared this disease a pandemic on 11 March 2020 (WHO, 2020), since then, the health crisis has not ceased to highlight public commitment and governmental response capacity at the international level (Liao et al., 2020).

The world is experiencing an unprecedented situation that breaks with the communication management models of previous crises (Xifra, 2020). Against this backdrop, it is necessary for the parties involved to develop specific communication actions to disseminate reliable information and curb the spread of medical misinformation that has been spread about COVID-19 (Kouzy et al., 2020).

In this regard, the Spanish government has been an active player since the beginning of the pandemic, continuously updating relevant information on its websites and holding numerous press conferences or giving interviews to decision-makers in national and international media (Castillo-Esparcia, Fernández-Souto, & Puentes-Rivera, 2020).

Developing effective communication strategies in health crisis situations becomes essential. In this way, it is possible to adopt certain desired behaviours, such as social distancing and good hygiene habits, which are essential in pandemics such as the one caused by COVID-19. Transparent and consistent communication in the face of uncertainty is essential to maintain public trust (Holmes, 2008; Vaughan & Tinker, 2009). Traditionally, governments and health authorities used their websites, the media, the press and television as the main tools for disseminating news and information. The emergence of social networking sites such as Facebook and Twitter presents a new scenario...

Social media has added a new plane to broaden the view of crises. Managers are very sensitive to the fact that crisis threats, especially those that damage reputations, can emerge and grow rapidly online (...). There is a growing need to monitor social media and decide how to integrate it into crisis responses. (Coombs, 2015 p. 15).

OBJECTIVES

In the midst of the uncertainty generated by a health threat such as the health crisis caused by COVID-19, society demands more truthful information. In such situations, public institutions run the risk of losing centralised control of communication if they do not act quickly in the face of public opinion, trying to combat falsehoods and misinformation (Glik, 2007; Vaughan & Tinker, 2009).

Societal misinformation could lead to undesirable behaviour in emergency situations such as that caused by the coronavirus (Raamkumar et al., 2020). Therefore, it is interesting to know how health-related public institutions reacted on their official accounts and how the public perceived this reaction. This will allow public health organisations to observe how society behaves in times of pandemics.

Therefore, this research aims to characterise the use of Facebook by ministries of health in Europe's most populous countries during 2020 and to understand the behaviour of their online communities. This year includes the onset and development of the pandemic caused by COVID-19, which will make it possible to observe the evolution of these accounts over a sufficiently long period of time. To this end, four objectives related to the use of Facebook by the official bodies responsible for health in each country during the pandemic are proposed:

• Objective 1 (O1): To determine the evolution and temporality of the publications of the official Facebook pages of the Ministries of Health of the main European countries.

• Objective 2 (O2): To analyse the evolution of the following of the official Facebook pages of the Ministries of Health of the main European countries, in relation to the number of inhabitants of each country.

• Objective 3 (O3): To observe how the inhabitants of each country have responded to the publications made by the official Facebook pages of the Ministries of Health of the main European countries in terms of interaction.

• Objective 4 (O4): To make a comparison of the similarities and differences between the main European countries in terms of the relationship with their inhabitants in communicating about health through Facebook.

METHODOLOGY

This study focuses on the communication activity of the official bodies in charge of managing the health of each country within the European Union. Although there are several studies that deal with the phenomenon of communication during the pandemic caused by COVID-19 (Masip et al., 2020; Moreno, Lara, & Navarro, 2020; Xifra, 2020), there are few initiatives that study and compare the communication activity of different official bodies in such a specific context. These include the study by CCastillo-Esparcia et al. (2020) on the communication strategies of the Spanish government during the pandemic, the study by PochButler, Martínez, and B (2021) who analysed the Twitter accounts of the Spanish government and the Spanish Ministry of Health or, outside Spain,Raamkumar et al. (2020) who analysed the public health authorities' outreach efforts and public response on Facebook in Singapore, the United States and England.

Following this last line, the selection of the countries with the largest number of inhabitants in the European Union allows us to compare the relevance of official communication on health, both in terms of economic and social power. According to Statista data (2021), these countries are, in order from the largest to the smallest, Germany, France, Italy, Spain, Poland, Romania, the Netherlands, Belgium, the Czech Republic and Greece.

Based on this approach, this study carries out an in-depth descriptive analysis of the presence, activity and impact of the official Facebook pages of the ministries of health of the 10 most populated countries in the European Union from a quantitative perspective. In this sense, the research will make it possible to assess the impact of the messages issued by these institutions, as well as their repercussion among the inhabitants of each country, with the aim of contributing to professional practice and to the benefit of society as a whole.

The study sample is made up of the publications made by the official Facebook accounts of the health ministries of the 10 most populated countries of the European Union from 1 January to 31 December 2020. Thus, after excluding the Netherlands because it does not have an official Facebook page for its health ministry, the sample is made up of the nine countries presented in Table 1.

Source: own elaboration

CrowdTangle was used to obtain the data. This is a public information tool, belonging to the Meta group and integrated within the Facebook ecosystem, which facilitates the monitoring and quantitative analysis of content published on social networks. It also allows the extraction of these publications and their metadata, generating a file in CSV format (comma-separated values) that can be opened and viewed using programmes such as Microsoft Excel.

Thus, through CrowdTangle, the following analysis variables have been downloaded from Facebook for all publications:

• Name of the page.

• Followers at the time of publication.

• Date and time of publication.

• Text accompanying the post.

• Type of post.

• Number of "likes" of the post at the time it was made.

• Number of comments on the post at the time it was made.

• Number of times the post was shared at the current time.

• Number of reactions ("Haha", "Wow", "Care", "Angry", "Sad" and "Love") to the post at the current time.

The research was carried out using the technique of content analysis with a quantitative approach. By cross-referencing the variables listed above and observing the differences or similarities between each country, the aim is to respond to the previously stated objectives.

RESULTS

This section presents the results of the research in three large blocks that analyse. Firstly, the total volume of publications, then the response of users measured through interaction and, finally, the overall evolution in terms of followers in relation to the number of inhabitants in each country.

Analysis of the volume of publications

A temporal X-ray of the publications made throughout 2020 shows that in March and April 2020 the number of posts on Facebook increased considerably, reaching a fourfold increase in March compared to January (Figure 1).

This increase in posts decreases again in the period after May, stabilising during the remaining months of 2020. The most notable case is that of Greece, which starts the year with 27 publications in January, reaching 375 in March (Table 2). A general increase in the volume of publications can be seen in the countries in the sample, with an average of less than 40 publications in January and an average of 181 in March, which is the month in which they reach their maximum value, as shown in Table 2.

Table 2: Volume of publications by country

	Germany	Belgium	Spain	France	Greece	Italy	Polond	Czech Republic	Romania
January	8	9	23	112	27	24	31	103	19
February	24	54	81	99	102	24	60	162	18
March	91	95	198	182	375	91	113	248	236
April	96	82	169	120	292	92	170	278	195
May	78	74	108	96	252	74	141	363	166
June	56	28	68	95	249	17	144	208	77
July	50	35	64	71	231	16	87	145	63
August	38	28	66	65	226	19	76	141	53
September	42	26	60	119	219	15	89	111	59
October	54	32	70	93	264	22	98	101	71
November	53	44	79	100	295	34	105	139	68
December	71	40	80	108	306	15	99	77	68

Source: own elaboration

Source: own elaboration

Analysis of the level of interaction

In terms of interaction levels, there are small differences compared to what was previously observed in the volume of posts. The highest levels of interaction are obtained in the first part of the year, where in the months of January, February and March the average interaction of Facebook posts is 1.03, 1.27 and 1.02, respectively (Table 3). These first three months of the year show levels more than twice as high as the last ones, which would obtain levels of 0.45, 0.34 and 0.28 in the months of October, November and December, as shown in Table 3.

At the individual level, it can be seen that all countries obtain their peak interaction during the first 4 months of the year, except in the case of France, which receives its maximum interaction level in May (Figure 2).

For practical purposes, it has been observed that there is a high positive correlation between the average number of publications per month and the average number of interactions (r=0.59).

Figure 2. Evolution of the level of interaction

Source: own elaboration

Table 3: Average interaction per follower for each country

	Germany	Belgium	Spain	France	Greece	Italy	Polond	Czech Republic	Romania
January	2,18	3,45	0,02	0,16	1,58	0,41	0,73	0,22	0,49
February	2,28	2,75	0,74	0,19	1,42	1,83	0,12	0,22	1,92
March	0,13	2,87	0,77	0,22	0,27	2,32	0,96	0,88	0,75
April	0,89	0,74	0,46	0,38	0,27	2,33	1,59	0,78	0,42
May	0,77	0,43	0,57	0,83	0,17	2,25	1,38	0,72	0,44
June	0,86	0,56	0,43	0,12	0,13	0,54	0,47	0,02	0,43
July	0,76	0,61	0,37	0,32	0,07	1,65	0,53	0,21	0,63
August	0,83	0,64	0,66	0,28	0,21	0,76	0,58	0,14	0,36
September	0,59	0,45	0,41	0,22	0,27	0,52	0,41	0,21	0,22
October	0,53	0,51	0,56	0,41	0,42	0,85	0,27	0,17	0,32
November	0,45	0,67	0,33	0,27	0,27	0,36	0,27	0,08	0,33
December	0,47	0,37	0,32	0,06	0,16	0,28	0,42	0,12	0,28

Source: own elaboration

CONCLUSIONS

Public institutions have a significant responsibility in the management of public health crises and effective communication is necessary to better cope with health emergencies that may arise. This means that they must be able to carry out risk communication to improve citizens' response during health crises (Coombs, 2020).

With regard to the first objective set out in this research (O1), it has been found that the volume of messages posted increases according to the timeline of the health emergency. The Facebook pages of European health ministries went from posting an average of 39.56 posts in January to 181 in March, the peak of COVID-19 in Europe. These results are consistent with those presented by Kim and Kreps (2020), who consider it crucial to use direct communication channels with citizens to avoid confusion, fear or misunderstanding during the pandemic.

This increase in communication activity by ministries of health on Facebook has led to considerable growth in their communities. This study shows the reaction of citizens in seeking and following official information about a health emergency, an aspect already noted by other research such as (Lwin et al., 2018). Observing increases in the number of followers ranging from 846.16%, in the case of Spain, to 15,524.48%, in Poland, shows the interest that the pandemic has aroused in citizens, leading them to follow the information published by official sources, corresponding to their health institutions, thus responding to what was stated in the second objective of the research (O2).

Regarding the interaction and participation of citizens in the messages published on Facebook, the importance of temporality has been verified. With regard to the third objective (O3), it can be seen that the months of January, February and March, i.e. the beginning of the pandemic, are the period of greatest interaction. This could be due to the fact that in the initial periods of the crisis citizens are more interested in participating in this official communication, although a certain positive correlation has also been observed between the average number of publications and the number of interactions (r=0.59), which could mean that citizens participate more because they have more information.

With regard to the similarities and differences in the quantitative data on Facebook communication in the Ministries of Health of the most populated countries of the European Union (O4), small differences were observed that may be due to the intrinsic characteristics of the countries themselves. These disparities could also be due to the different stages of penetration of the coronavirus in each of the countries, which have taken different measures at different times. Overall, however, there are many quantitative similarities that may reflect the penetration of the crisis at similar times and in similar dimensions.

These results show the relevance of the use of social networks in European countries and their potential as information dissemination tools during health crises. Therefore, the mere observation of the efforts already being made by some organisations in this field, as well as the comparison of their activity with entities in other countries, is valuable for opening up new avenues of research. Although this is a preliminary study that only delves into quantitative aspects, so future research is needed to corroborate these results, it has been observed that these institutions have been able to offer a greater volume of content on social networks, which has fostered growth in the volume and participation of the audience.

Among the limitations of this research is the fact that it only analysed the social network Facebook. Health authorities may have used other platforms such as Twitter, Instagram or Youtube to disseminate public health information to their citizens. In addition, these institutions continue to use traditional media to convey informative messages, pandemic updates and guidance measures to citizens (Castillo-Esparcia et al., 2020). Therefore, the communication efforts of health authorities on social media are complementary, considering these platforms as an additional resource to provide additional information or to reach people who no longer follow traditional news channels (Raamkumar et al., 2020).

Another limitation of the study lies in the very fact of the communicative analysis of the pandemic caused by COVID-19. The interest of citizens in obtaining information from official sources in times of pandemic (Castillo-Esparcia et al., 2020) has directly influenced both the increase in the volume of posts on Facebook by health authorities and the high growth of their communities. In this sense, it would be of interest to replicate the study by taking another sample year to properly assess this impact.

On the other hand, it is suggested as a future line of research the thematic analysis of the content published on social networks in the field of public health by official bodies. The qualitative study of this aspect could provide a deeper insight into the characterisation of the messages and detect the possible existence of patterns related to the subject matter, format or language. In addition, this would help public institutions to improve their communication on social media in order to provide the most appropriate response to future health crises.

REFERENCES

AUTHOR CONTRIBUTIONS, FUNDING AND ACKNOWLEDGEMENTS

Authors' contributions: Conceptualisation, Abuín-Penas, Javier; methodology, Abuín-Penas, Javier; software, not applicable; validation, Abuín-Penas, Javier; formal analysis, not applicable; research, Abuín-Penas, Javier; memories, not applicable; data curation, Abuín-Penas, Javier; writing, Abuín-Penas, Rocío; -preparation of the original draft, Abuín-Penas, Rocío; writing-revision and editing, Abuín-Penas, Javier; visualisation, Abuín-Penas, Rocío; supervision, Abuín-Penas, Javier; project management, Abuín-Penas, Javier. All authors have read and accepted the published version of the manuscript.