Use Patterns and Challenges of the Social Media Platform X Among Physiotherapists in Saudi Arabia: Cross-Sectional Study

Introduction

Social media has transformed the way in which health care professionals engage in continuous learning, networking, and professional development [1]. Among the numerous social media platforms, X (formerly known as Twitter) serves as a prominent platform for discussions concerning evidence-based practice, clinical decision-making, and new research findings among physiotherapists. As health care disciplines become more digitally integrated, X and analogous platforms facilitate real-time knowledge exchange and professional dialogue [2,3]. Within the scope of digital professionalism, health care professionals are encouraged to engage in ethical, effective, and respectful online communication. When such professionalism is present, digital platforms such as X can promote professional participation, collaboration, and knowledge sharing. Online learning frameworks, particularly those presented by Anderson [4] and Garrison et al [5], underscore the significance of social presence, cognitive presence, and teaching presence in establishing a successful online learning environment. Therefore, platforms such as X can function as venues for professional learning via interaction and discussion. Furthermore, health communication theories such as the social cognitive theory [6] emphasize how individuals’ behaviors are influenced by observing others, particularly within online communities. Accordingly, health care professionals may adopt best practices and engage in evidence-based discussions through X.

While X provides opportunities for information dissemination and online learning, challenges such as content reliability, engagement barriers, and ethical concerns remain understudied, particularly in the context of physiotherapy practice in Saudi Arabia [1,7,8]. Saudi Arabia has one of the highest social media penetration rates worldwide [9-11], making it a fertile ground for exploring how digital platforms influence professional development among physiotherapists. Previous studies have examined the application of social media in health care [1,7,8]. However, research on the engagement patterns, challenges, and perceived benefits of X within the physiotherapy community remains limited [1,12,13]. Addressing this gap can provide insights into how physiotherapists use X for knowledge acquisition, professional networking, and overcoming practice-related challenges. Therefore, this study aimed to (1) assess the professional use of X among physiotherapists in Saudi Arabia (prevalence of active accounts, time spent on use, interaction level, and primary purpose of engagement) and (2) identify the challenges and motivations concerning physiotherapy-focused debates on X.

Methods

Design and Setting

This cross-sectional study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Checklist for Reporting of Survey Studies (CROSS), and Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines to enhance methodological rigor, survey transparency, and reporting completeness. Data were collected via an online survey conducted among licensed physiotherapists practicing across various health care settings. Furthermore, we adhered to established research guidelines to ensure validity and reliability.

Participants and Recruitment

This study targeted licensed physiotherapists who were registered with the Saudi Commission for Health Specialties (SCFHS) and were actively working in Saudi Arabia. Physiotherapy students, interns, and professionals without an active SCFHS registration were excluded. Using convenience sampling, we distributed participation invitations within physiotherapy-focused professional groups on social media platforms such as WhatsApp, Telegram, and X. The invitation stated the following: “Licensed physiotherapists in Saudi Arabia are invited to participate in a voluntary and anonymous survey examining physiotherapists’ use of X for professional development.” This wording was consistent across all channels used for dissemination. Additionally, the invitation described the study’s purpose and eligibility criteria.

Survey Instrument

A structured questionnaire was developed based on a comprehensive review of relevant literature and prior studies investigating social media engagement in health care [8,12-18]. This review provided the initial pool of survey items covering use patterns, interaction behaviors, and challenges and motivations related to engagement on X. Consequently, the questionnaire comprised 4 main sections.

Through 6 items, the first section collected demographic information (age, sex, years of experience, highest level of education, and workplace setting [government hospital, private clinic, private hospital, or academic institution]) and whether the respondent had an active account on X. The second section comprised 3 items and collected data on social media use and interaction: frequency of use, time spent on X, preferred content type (eg, debates, knowledge sharing, mentorship, and training), and pattern of engagement. The third section consisted of 5 items and collected data on challenges and concerns regarding engaging in physiotherapy-related debates on X, such as time constraints, information credibility, communication barriers, and conflicts of interest. The final section comprised 5 items and explored the motivations for and perceived benefits of following physiotherapy-related debates on X.

The questionnaire included a combination of multiple-choice questions and Likert-scale items. We conducted a pilot test among 10 to 15 licensed physiotherapists to assess clarity, comprehension, flow, and item relevance. On the basis of their feedback on phrasing, ease of completion, and the appropriateness of the response options, we refined several items for clarity, removed ambiguous statements, and reordered questions for readability and coherence. The final version demonstrated satisfactory internal consistency (Cronbach α=0.87), ensuring reliability and content validity before full deployment.

Data Collection

The survey was conducted on SurveyMonkey (SurveyMonkey Inc) from January 5, 2024, to February 10, 2024. The participants were required to provide informed consent before starting the survey. The survey spanned 5 pages, which included the consent page, demographic items, use questions, and challenge- and motivation-related items. The estimated completion time was 10 to 15 minutes. To ensure data quality and prevent duplicate responses, we activated SurveyMonkey’s built-in “Prevent multiple submissions” feature (cookie based) and enabled IP address tracking and time stamp checks. The IP addresses were automatically collected by the platform for quality control but were not analyzed, linked to individual responses, or included in the exported dataset.

Data Analysis

Descriptive statistics (frequencies and percentages) were used to summarize participant characteristics and patterns of professional use of X. Next, we examined the association between demographic characteristics and use patterns using chi-square tests. Because the variables in this study were primarily categorical, no t tests or ANOVA were conducted. Missing data were assessed to determine the underlying mechanism, and patterns suggested that data were missing completely at random as there was no systematic association between missingness and participant characteristics. Therefore, pairwise (available-case) deletion was used to handle missing values rather than imputation. Subsequently, inferential analyses were performed to explore associations between physiotherapists’ demographic characteristics and their professional use of X. Statistical significance was set at P<.05, and all analyses were conducted using SPSS Statistics (version 28; IBM Corp).

Ethical Considerations

This study complied with the principles outlined in the Declaration of Helsinki. Ethics approval was obtained from the King Saud Medical City Institutional Review Board (H-01-R-053). Participation was entirely voluntary, and informed consent was obtained electronically before the start of the survey. To ensure privacy and confidentiality, responses were anonymized before analysis. SurveyMonkey automatically collected IP addresses for quality control; however, these addresses were not analyzed, linked to responses, or included in the exported dataset. Participants did not receive any financial or nonfinancial compensation for taking part.

Results

Characteristics of the Participants

A total of 193 individuals accessed the survey. However, of these 193 individuals, 1 (0.5%) refused to participate, and 4 (2.1%) were not SCFHS-registered physiotherapists practicing in Saudi Arabia. After excluding these individuals, 97.4% (188/193) of the responses were used for data analysis (response rate consistent with the CROSS guidelines). Most participants were female (109/188, 58.0%) and in the 31- to 40-year age group (79/188, 42.0%). Regarding work experience, 38.8% (73/188) of the participants reported 11 or more years of experience, 36.7% (69/188) reported 0 to 5 years, and 24.5% (46/188) reported 6 to 10 years. Most participants held a bachelor’s degree (132/188, 70.2%), followed by a master’s degree (43/188, 22.9%) and a PhD (13/188, 6.9%). Most of the participants (113/188, 60.1%) worked in governmental hospitals, whereas 16.5% (31/188) worked in private clinics, 13.3% (25/188) worked in private hospitals, and 10.1% (19/188) worked in academic institutions. Furthermore, most participants (143/188, 76.1%) reported having an active account on X (Table 1).

Patterns of Professional Use of X Among Physiotherapists in Saudi Arabia

Regarding the time spent per week following or viewing professional physiotherapy-related posts, 32.9% (47/143) of the participants spent 4 to 6 hours, 27.3% (39/143) spent less than an hour, and 25.9% (37/143) spent 1 to 3 hours. Regarding the extent of interaction with physiotherapy-related debates, 35.7% (51/143), 27.3% (39/143), and 18.2% (26/143) of the participants interacted occasionally, rarely, and frequently, respectively. Furthermore, the participants predominantly interacted with knowledge sharing–related (102/143, 72.3%), training- or workshop-related (94/143, 66.7%), or debate-related (37/143, 26.2%) posts (Table 2).

Association Between Demographic Characteristics and Use Patterns

Demographic Characteristics and Time Spent on the Platform

The chi-square tests revealed that the time spent following or viewing professional physiotherapy-related posts was significantly associated with sex (χ²₄=18.8; P=.001) and workplace setting (χ²₁₂=24.2; P=.02). In contrast, the time spent was not significantly associated with the highest level of education (P=.13), as shown in Table 3.

Demographic Characteristics and Extent of Interaction

The extent of interaction (eg, liking, sharing, and commenting) was significantly associated with workplace setting (χ²₁₂=27.7; P=.006). However, it was not significantly associated with sex (χ²₄=7.7; P=.10) or highest level of education (χ²₈=7.1; P=.52; Table 3).

Challenges and Concerns Regarding Engaging in Physiotherapy-Related Debates on X

Among the respondents, 49.0% (70/143) agreed or strongly agreed that they had encountered challenges or negative experiences, with 31.5% (45/143) remaining neutral on this issue. Lack of time was also a significant concern, with 40.6% (58/143) agreeing or strongly agreeing that it affected their interaction with physiotherapy-related debates, although a third of the respondents (48/143, 33.6%) disagreed or strongly disagreed. Finding relevant and reliable information was another challenge, with 52.4% (75/143) of the respondents agreeing or strongly agreeing that they experienced this issue, whereas 36.4% (52/143) remained neutral. Communicating ideas effectively was problematic for 48.3% (69/143) of the respondents, whereas 51.7% (74/143) reported experiencing conflicts of interest related to their personal or professional involvement (Table 4).

Motivations for and Perceived Benefits of Following Physiotherapy-Related Debates on X

As shown in Table 5, a significant proportion of physiotherapists (60%‐70%) saw value in engaging with debates on X as it allowed them to stay informed about new research; catered to their personal interests; and provided potential benefits for the wider physiotherapy community in terms of knowledge sharing, collaboration, and critical thinking. Among the respondents, 39.2% (56/143) agreed and 21.0% (30/143) strongly agreed that they engaged in physiotherapy-related debates because it offered them the opportunity to keep up with new and emerging research. Meanwhile, 39.2% (56/143) agreed and 23.8% (34/143) strongly agreed that they were motivated by their personal interest in the topics being discussed. Similarly, 42.0% (60/143) agreed and 26.6% (38/143) strongly agreed that the debates could facilitate knowledge sharing, collaboration, and networking among the physiotherapist community. Furthermore, 42.7% (61/143) agreed and 25.2% (36/143) strongly agreed that the debates could promote critical thinking and reflection on current practices. A total of 29.4% (42/143) to 33.6% (48/143) of the respondents remained neutral on these issues.

Discussion

Principal Findings

The findings of this study align with those of previous research indicating that social media platforms, particularly X, serve as valuable tools for professional development and knowledge sharing among health care professionals [12,13]. Similar to prior studies, this study found that physiotherapists in Saudi Arabia actively use X for knowledge acquisition and training opportunities [17,18]. However, as this cross-sectional survey–based study collected self-reported data, the associations should be interpreted with caution, and causal inferences cannot be drawn about practice changes. The high engagement rate suggests that X is widely accepted as an informal learning tool and it may complement traditional educational methods in physiotherapy [16].

However, this study also highlighted significant challenges associated with the use of social media for professional development. Concerns about information credibility and time constraints were commonly reported, mirroring the findings of studies involving other health care professionals [14,15]. Moreover, previous studies have reported that the difficulty in distinguishing between evidence-based content and misinformation hinders effective engagement on health care–related social media channels [19]. Addressing these concerns through improved content curation and institutional guidelines may enhance the usability of X as a source of professional development. Furthermore, recent studies, particularly those in the health care field, have reported concerns about unprofessional behavior on social media. Vukušić Rukavina et al [20] emphasized the importance of defining and addressing unprofessional behaviors online to ensure that health care professionals maintain ethical standards in digital spaces.

Similar to our findings, Alasfour et al [1] reported that, while X positively affects physiotherapists’ professional development, a substantial portion of users remain passive consumers rather than active participants in discussions. In this study, demographic variables such as sex and workplace setting strongly influenced the time spent on the platform. This finding aligns with those of other research suggesting that personal motivation or digital literacy may play a larger role in determining platform use patterns, which reflects global trends in health care professionals’ social media engagement [7,21]. Future efforts should increase active participation through strategies such as structured online discussions, mentorship programs, and incentives for contribution. Social media presents not only benefits but also potential risks for health care professionals. Vukušić Rukavina et al [22] reviewed the dangers and benefits of social media use, stressing the potential for professional growth and networking while cautioning against the risk of diminished professionalism if used improperly. These findings underscore the necessity of establishing professional guidelines and enhancing digital literacy to maximize the advantages of online engagement while safeguarding against its potential pitfalls.

The recommendations in this study align with those of previous research advocating for clearer professional guidelines on social media use for physiotherapy professional growth [12,13]. Establishing best practices and offering professional training on effective digital communication can further enhance the platform’s role in facilitating continuous learning and professional networking. Overall, the findings reinforce the importance of social media as an emerging tool for physiotherapy education while emphasizing the need for addressing engagement barriers to maximize its potential.

Limitations

This study has several limitations. First, the use of convenience sampling may have introduced selection bias and limited generalizability. Because recruitment was conducted through physiotherapy-focused social media groups, the sample likely overrepresented physiotherapists already active on social media platforms. Consequently, the findings may not fully reflect the behaviors and perspectives of all SCFHS-registered physiotherapists, particularly those who are less digitally engaged or not present in such online communities. Second, the reliance on self-reported data may have led to recall or social desirability bias. Third, while inferential tests were conducted, the study’s design was descriptive. Therefore, these analyses should be interpreted with caution. Future studies should use probability sampling or mixed methods approaches.

Conclusions

There is a high prevalence of active X accounts among SCFHS-registered licensed physiotherapists. With 1 to 6 hours a week spent on the platform, they exhibited high levels of engagement with physiotherapy-related debates on X. While the platform offers substantial benefits, it also presents challenges that must be addressed to maximize its potential as a professional tool. By understanding and addressing these challenges, X can become an effective resource for physiotherapists, contributing to their ongoing development and improving patient care outcomes.