key: cord-0932238-7b0imkjd
authors: de las Heras-Pedrosa, Carlos; Jambrino-Maldonado, Carmen; Rando-Cueto, Dolores; Iglesias-Sánchez, Patricia P.
title: COVID-19 Study on Scientific Articles in Health Communication: A Science Mapping Analysis in Web of Science
date: 2022-02-02
journal: Int J Environ Res Public Health
DOI: 10.3390/ijerph19031705
sha: 5a8a905f0ec301dbafda196316531d221571ac91
doc_id: 932238
cord_uid: 7b0imkjd

The COVID-19 pandemic continues to cause a collapse in the health systems and econo-mies of many countries around the world, after 2 years of struggle and with the number of cases still growing exponentially. Health communication has become as essential and necessary for control of the pandemic as epidemiology. This bibliometric analysis identifies existing contributions, jointly studying health communication and the pandemic in scientific journals indexed. A systematic search of the Web of Science was performed, using keywords related to COVID-19 and health communication. Data extracted included the type of study, journal, number of citations, number of authors, country of publication, and study content. As the number of scientific investigations has grown, it is necessary to delve into the areas in which the most impactful publications have been generated. The results show that the scientific community has been quick to react by generating an extraordinary volume of publications. This review provides a comprehensive mapping of contributions to date, showing how research approaches have evolved in parallel with the pandemic. In 2020, concepts related to mental health, mass communication, misinformation and communication risk were more used. In 2021, vaccination, infodemic, risk perception, social distancing and telemedicine were the most prevalent keywords. By highlighting the main topics, authors, manuscripts and journals since the origin of COVID-19, the authors hope to disseminate information that can help researchers to identify subsisting knowledge gaps and a number of future research opportunities.

Almost 2 years after the onset of the COVID-19 pandemic, the whole world is experiencing uncertainty. The current crisis caused by COVID-19 is taking place in a context that is unprecedented for society. In this globalised world, the transit of people between countries, the development and use of Information and Communication Technologies (ICT) [1] [2] [3] [4] [5] and the interconnection between economies or the flow of goods, capital and ideas [6] are fully established. This environment facilitates the transmission of the coronavirus or each of its new variants such as Delta or Omicron. Depending on the country, up to six waves can be counted that have left behind thousands of infected and dead people, and where vaccines are considered by governments to be the great saviours [7] . It is in these situations of uncertainty, insecurity or even disbelief on the part of the population where communication and especially health communication and risk communication become essential tools for managing public health [3, 4, 8, 9] .

Thus, the World Health Organisation (WHO) [10] has highlighted communication as one of the biggest challenges and has identified risk communication as one of the core 1.

To find out the volume of articles published on COVID-19 and health communication indexed in the WOS database during the pandemic.

To identify the main countries, universities, authors and scientific journals publishing research on health communication during this period. 3 .

To detect the most relevant approaches, methods and lines of research on COVID-19 and health communication. 4 .

To visually represent the degree of international scientific collaboration and thus serve as a starting point for future research in the area.

For the bibliometric study, the Web of Science (WoS) database was used as a first source of information, from which scientific articles were selected in journals indexed in the categories of Social Sciences Citation Index (SSCI) and Science Citation Index Expanded (SCI-Expanded) that in the period 2020-2021 have dealt with the subject related to: COVID-19 or coronavirus and 'health communication'. We also obtained manuscripts that referred to the terms COVID-19 or coronavirus and also to COVID-19 or coronavirus by adding the term 'health'. These two searches have often served to focus the study.

The inclusion and selection criteria, as well as the indices that were applied in the process of searching for publications in WoS, are summarised in Table 1 . The different results obtained depending on each of the different searches carried out are shown, with the research objectives being refined as more specific results were obtained in order to deepen the analysis of the articles on COVID-19 or coronavirus and 'health communication' as the object of the present study. The methodological design as well as the resources employed are based on the systematic review of the scientific literature on bibliometric analysis, as well as the scientometric and visual tools and indicators developed by Chen [27] . In turn, the research follows the approach given by Sánchez-Núñez, De las Heras-Pedrosa and Peláez [28] , in their scientific mapping analysis for the computational analysis (of the number, increase and typology of scientific production, according to authors, scientific journals, keywords, institutions) and manual analysis of the information extracted from the research publications to determine the predominant treatment in the scientific literature on health communication in coronavirus, related thematic trends in this field, as well as possible areas of scientific application.

Based on the results obtained in WoS, VOSviewer and CitNetExplorer software were used for the analysis of scientific production. The first tool was used to study bibliometric performance indicators and identify citation patterns (countries/regions, authors, organisations, publications and academic journals). Configuration of the VOSviewer analysis [29] was as follows:

(1) Unit of analysis: Authors, Academic Journals, Organizations, Countries/Regions; (2) Type of network: Citation analysis;

(3) Cluster network design: Network visualization and density visualization.

Therefore, bibliometric networks are analysed to extract information about co-authorship, co-citation, citation networks and keyword co-occurrence in scientific publications [29, 30] . CitNetExplorer was used to visualise and analyse the citation networks of selected scientific articles, highlighting the relationship between groups of publications [31] .

According to the scientific cartography obtained and the scientometric indicators calculated with the computational analysis of the data, the results shown in this section are obtained.

After the first search (Table 1) , more than half of the articles on coronavirus found (63.38%) correspond to scientific publications in 2021. When the terms 'health' or 'health communication' are added to 'coronavirus' in 2021, the number of articles identified is 63.70% and 57.63%, respectively.

On the citation report under study (Table 2 ), a total of 1505 citations were obtained. Logically, this figure differs greatly from year to year. In 2020 the number of citations was 184, while in 2021 this figure already amounted to 1309. The average number of citations per article is 5.74 and the H-index is 20. (Table 3) .

Researchers from all over the world in the field of health have chosen these journals which, as can be seen in Table 3 , except for the Journal of Medical Virology, are all indexed in the first or second quartile of the Journal Citation Report (JCR) for the year 2020: 10 in JCR Q1 and 9 in JCR Q2. Therefore, we can consider them the best journals in the world in the field of health.

This ranking of the journals with the highest number of published articles has as common characteristics in that they are open access and dedicated to publishing high-quality research in the areas of science or social sciences. Moreover, they are online publications, which means that their papers can be published, read and analysed quickly by the scientific community.

At this time of pandemic where the coronavirus has required the efforts of all researchers in the world to understand its implications in record time in order to safeguard the health of the world's citizens, it is essential to have journals that are rigorous in their peer reviews but also very agile in their publication.

In the case of the search on COVID-19 and health communication, the ranking of the 20 journals with the highest number of contributions on this topic is as shown in Table 4 . The aim is to associate the manuscripts with this term in order to detect only those articles that refer solely and exclusively to health communication in COVID-19 times. The term 'Health Communication' was searched for in the entire text and not only in keywords or manuscript title, obtaining a total of 262 manuscripts. The inclusion of communication aspects shows that many of the journals, especially the Journal of Health Communication and Health Communication, are indexed in JCR Social Science (Table 4 ). Related to the citations, the first position is occupied by Health Communication with 383 citations followed by International Journal of Environmental Research and Public Health (IJERPH) with 202 citations. In the case of the top two journals in the ranking, their titles coincide with the search term of this research. Although this is not the case for IJERPH, this journal is clearly divided into sections where there used to be a section called 'Health Communication' clearly identifying 'the use of communication as a strategy to promote health and prevent disease' [32] . They have now included the term Informatic in this section. It is now called 'Health Communication and Informatics'.

The analysis of authors made it possible to identify the most prolific publications in terms of scientific diffusion. Based on the volume of publications in which the concept of 'Health Communication' accompanies the concept of COVID-19 or coronavirus, the authors listed in Table 5 are those who have generated the greatest scientific output in 2020 and 2021. On this occasion, those authors whose production was equal to or greater than three articles were selected. Public health 

In the studies by country, the USA stands out, doubling its publications with respect to the rest of the countries and regions of the world, followed by China.

In this analysis, a study has been carried out for each of the variables. Thus, firstly, the ranking of the 25 countries that have published the most on COVID-19 is shown ( Figure 1 ). The USA and China are followed by the UK, Italy, Canada, Australia and Spain.

It can be seen that countries with a strong pressure of coronavirus in their territories, researchers have carried out a very important scientific production. Table 6 shows the COVID-19 or Coronavirus and Health search terms for the countries, number of manuscripts and citations for each of them. The four most scientifically productive countries remain the same: USA, China, UK and Italy.

The European Union has been one of the most affected by the different waves of contagion and has defined some common strategies to face the pandemic, such as vaccines or the COVID-19 passport. Although it is understood that the best way to see scientific production is broken down, if all the scientific production of the European Union were to be combined, the number of publications would amount to 10,081 manuscripts, placing it in first place. It should be noted that since Brexit, the United Kingdom is no longer counted within the European Union. In the case of the United Kingdom, WoS breaks down the data into England with 3270 and Scotland with 444 papers. Table 7 shows the data subject to the COVID-19 and 'Health Communication' study. Once again, the same four countries repeat in the ranking in the field of Health Communication, although in this case Spain is in fifth place. In the European Union as a whole, 56 manuscripts were published in this ranking of 25 countries. 

Focusing again on the object of study for COVID-19 and Health Commnication, Table 8 presents a ranking of the most influential international affiliations through reference universities together with indicators of registrations and the percentage that these represent in the total sum of articles analysed. In addition, following the classification of Sánchez-Núñez, de las Heras-Pedrosa and Peláez [28] , two global university ranking indicators are added for the year 2021 QS World University Rankings and Academic Ranking of World Universities (ARWU) that allow measuring the relative position in which the most influential institutions are located. Figure 2 allows us to distinguish the networks of the most influential academic institutions as a result of their citations. The university networks are grouped into clusters. An important cluster can be observed in Chinese institutions and another in United States universities. This is followed by the cluster of British universities. In the case of the European Union, the clusters are subdivided according to their importance in the universities of Italy, France and Spain, and unified in another cluster for the rest of Europe.

The 

From the five general thematic areas in which the different manuscripts registered in WoS are classified (Arts and Humanities, Life Sciences, Biomedicine, Physical Sciences, Social Sciences and Technology), other thematic subcategories are derived.

The main areas of research are reflected in Figure 3 . Among those areas of knowledge that have more than 3000 papers are: 'Public Environmental Occupational Health' covers the largest number of records, followed by the fields related to: 'General Internal Medicine', 'Environmental Sciences Ecology', 'Science Technology Other Topics' ''and 'Environmental Sciences Ecology'.

In the articles selected after searching for articles in which 'Health Communication' appeared next to the concept COVID-19 or Coronavirus', the 10 research areas in which the highest number is assigned are: 'Public Environmental Occupational Health' (30.01% of the total); 'Communication' (28.57%); 'Health Policy Services' (15.41%); 'Health Care Sciences Services' (13.91%); 'Information Science Library Science' (12.78%); 'Environmental Sciences' (8.65%); 'Medical Informatics' (7.90%); 'Medicine General Internal' (4.14%); 'Psychology Multidisciplinary' (3.76%); 'Multidisciplinary Sciences (3.39%) (Figure 4) . Comparing the data of the two cartographic maps (COVID-19 and Health) and (COVID-19 and Health Communication) (Figures 3 and 4) , it can be seen that the topics of 'Public Environmental Occupational Health'; 'Health Care Sciences Services'; 'Environmental Sciences'; 'Medicine General Internal'; and 'Psychology' are repeated.

The most frequently repeated words in the analysed articles are represented visually. The graphs displayed after the analysis carried out with the VOSViewer tool also provide information on the terms that form fields or clusters of words that appear related in the same publication.

With a minimum number of occurrences of a keyword of one, following the same methodological process, from the most general to the most specific analysis, the map of cowords has been determined after searching in WoS for the terms COVID-19 or coronavirus. Thus, Figure 5 is obtained, in which, together with the predominant and most strongly related nuclei grouped under the nomenclature of COVID-19 and coronavirus, other outstanding semantic fields appear, such as those related to Mental Health, Public Health, Symptomatology and Treatments and Media, among other clusters of lesser relevance, but closely related to each other. Figure 5 shows that the most important clusters-because they include the terms with the highest prevalence in the published articles and the strongest interrelation with other words or groups of words-are, in descending order, the following: Cluster 1, with the word 'covid' heading this group, which shares a core with terms such as 'pandemic', 'telemedicine', 'social distancy' or 'resilience'; Cluster 8, with the term 'sars coronavirus' as predominant, together with 'diagnostic', 'rt-pcr' 'antibody' or 'serology'; Cluster 6, in which the term 'coronavirus' is followed by 'receptor', 'hydroxy chloroquine', 'molecular docking' or 'spike protein'.

Of these three clusters, the strength of the relationship they maintain with other clusters and these clusters with each other stands out, such as:

Cluster 3, with related terms: 'mental health', 'anxiety', 'depression', 'lockdown', 'stress', 'quarantine', 'psychological impact' or 'healthcare workers'; Cluster 2, related to symptomatology: 'mortality', 'pneumonia', 'inflammation', 'risk factor', 'pneumonia', 'prognosis', 'diabetes', 'pregnancy', 'infection'.

Cluster 4 is noteworthy for dealing specifically with aspects related to the field of study in question. In this cluster, 'public health' stands out above the terms of the group in which it is related, followed by the words 'social media', 'vaccine' and 'vaccination', 'china', 'prevention', 'knowledge', 'attitude', 'survey', 'risk communication', 'misinformation', 'disinformation' and 'conspiracy theories', 'network analysis', 'infodemiology' or 'fake news'.

In terms of content, when analysing the keyword analysis by year with VOSviewer in those articles dealing with COVID-19 and Health Communication, there are similarities and differences in the predominant subject matter in one year or another, both in terms of the number of publications and the citations they have received.

The most recurrent terms are those repeated in the articles published in 2020 and 2021, especially those related to the names with which the pathology is designated and directly related: pandemic, coronavirus, COVID-19, SARS or Public Health. What has been also found in both years are those referring to preventive measures: Behavior and Planned Behavior. Others, such as Health Communication or Mass Communication, change from one year to another in the order of prevalence. Thus, in the year 2020, articles on the media were more widely disseminated than those on health communication, although health communication gained prominence in scientific publications on the subject under study.

Terms disappeared from the selected publications and others emerged over the months. In 2020, concepts related to Mental Health were more common: Anxiety, Awareness, Fatalism. In 2021, these were Vaccination, Risk Perception, Social Distancing, Health Promotion, or Telemedicine, which were not among the most prevalent keywords in the articles selected in 2020. From the terms Misinformation, Communication Crisis or Communication Risk in 2020, they changed in 2021 to the concepts of Infodemic, Conspiracy or Risk Perception, which denotes a difference in how information is received by society, depending on the time period (Figures 6 and 7) .

The cluster analysis for the two years, jointly, is performed on 877 keywords highlighted by the authors. Thus, 44 different clusters are distinguished (Table A1 ) (Figure 8 ).

In this case, the main words at the top of the clusters that encompass terms with the highest prevalence in the published articles and that have a closer relationship with other terms are: The main clusters cited are closely related to each other and to other groups of terms, among whose most prominent keywords are: 'fear appeal', 'risk perception', 'perception', 'behavior', 'attitudes', 'self-efficacy', 'risk perception', 'perception', 'behavior', 'attitudes', 'self-efficacy', 'self-efficacy' and 'knowledge'. 

The analysis of the 25 most cited articles on coronavirus and health communication provides information on the topics that have had the greatest influence on the scientific community (Table 9 ). The effects of social media use on preventive behaviours during infectious disease outbreaks: the mediating role of self-relevant emotions and public risk perception Journal of Community Health 2020 13 The article entitled: "Considering emotion in COVID-19 vaccine communication: addressing vaccine hesitancy and fostering vaccine confidence" [57] is the one with the highest number of citations, 98. In this article, the authors present a battery of reasons why the United States population may be reluctant to be vaccinated against COVID-19. They propose, in turn, communication strategies based on the dissemination of scientific evidence of the efficacy of vaccines to promote greater confidence in them, as well as on the analysis of emotions, as an element to be taken into account in the construction of the message.

Two other articles have more than 50 citations during the years analysed:

-"The effects of social media use on preventive behaviors during infectious disease outbreak: the mediating role of self-relevant emotions and public risk perception" [58] .

The relationship between what is communicated through social networks and the public's perception of risk and preventive behaviors during infectious disease outbreaks is the topic developed by the authors of this article. In their findings, they highlight how two emotions, such as fear and anger, as well as the public's perception of risk are positively related to social networks. The research also shows how the use of these communication channels can significantly increase preventive actions against the aforementioned pathologies; -'Health communication through news media during the early stage of the COVID-19 outbreak in China: digital topic modeling approach' [59] . With China as the setting, in this article the authors study the relevance of mass media in health communication during an early stage of the coronavirus. The analysis of the subject matter of the published news and their publication dynamics during this period provided findings such as the delay of media news reports in China with respect to the development of the pandemic.

In the word cloud, Figure 9 , in addition to the terms 'communication', 'covid', 'health, 'public', 'social' and 'vaccine', directly related to the subject of this work, other terms stand out that indicate aspects of what the scientific community is researching in this field: 'social behaviors', 'crisis', 'emotions', 'social distance', 'information', 'behavior', 'media', 'perception', 'political communication', 'prevention', 'sources', 'social distance' and 'risk roles', among others. 

This research presents the current status and trends of COVID-19 research and health communication. Although the scientific community has shown an unprecedented effort in generating a large number of studies to solve the problem, there is a need for a global characterisation in the different areas, given the existing multidisciplinarity [78] .

Although there are several bibliometric studies on COVID-19 and Health [79, 80] , socioeconomic [81] , Communication [82] and Tourism [83] are identified as other additional factors. However, this would be one of the first bibliometric analyses addressing health communication at the time of COVID-19 by identifying in WoS the most productive authors, reference articles, universities, countries and research topics. As for the focus of study in the analysed works, a change of topic is observed in parallel to the evolution of the pandemic.

The results of the bibliometric analysis also indicate that there is a relative concentration of the most influential papers among a certain number of researchers, in contrast to the study in the field of health by ElHawary et al. [79] . In agreement with Torres Salinas [84] , it is found that most of the articles are open access, which has led to a wide and rapid dissemination of contributions and, as the field continues to mature, numerous authors joining this line of research. It should also be noted that the number of citations is on the rise, demonstrating the current importance of the relationship under analysis.

The analysis of the geographical dispersion of the publications showed that the USA and China are the countries that contribute the highest number of papers, coinciding with other studies [79] . The results reveal the breadth of methodologies and disciplines used, even among the most prolific scholars, exemplifying the interdisciplinarity of health communication research.

COVID-19 has caused possibly the largest concentration of scientific resources, without precedent. Despite the existence of a multitude of resources, such as repositories and their important contribution, journals are the core of scientific production.

One of the debates at the beginning of this research was the use of the WoS or Scopus databases of bibliographic references and citations of periodicals. Both include prestigious journals and rigorous peer review, although it is true that normally the journals that are in WoS in its Social Sciences Citation Index (SSCI) and Science Citation Index Expanded (SCI-Expanded) databases are included in Scopus. Other WoS databases, such as Emerging Sources Citation Index, were not studied in the search for top-level references. For this reason, it was decided to use only the main scientific database, WoS.

On the other hand, the search term and the use of the field tag with the topic TS= 'health communication' should also be noted. Although other terms such as information, social media or public relations would have provided more results, the main health journals specialised in communication choose this denomination even for the title of their publication. This is the case of Health Communication or Journal of Health Communication, both of which are indexed in Journal Citation Reports (JCR) in Q2. Moreover, other health journals such as the International Journal of Environmental Research and Public Health are indexed in JCR in Q1 (social sciences) with a section called health communication. Hence, given that the main health journals determine the term 'health communication' as their main topic, this was chosen as the main topic for the selection of articles.

It was decided to carry out this research at a time when vaccines were already giving results and infections were at level 0, according to the European classification. However, it is true that a new variant of SARS-CoV-2, called Omicron, detected in November 2021, is causing a new wave of infections at the time of writing. The effects of the pandemic, according to the scientific director of Pfizer, Mikael Dolsten, will last until 2024 [85] . Therefore, the research on health communication and COVID-19 is not completed.

Finally, it should be noted that the results obtained also suggest future lines of research. It has been found that research on the impact of the crisis has focused mainly on the areas of 'Public Environmental Occupational Health', 'Communication' and 'Health Policy Services'. Therefore, it would be interesting to address new areas of study to expand on the results obtained. For example, the impact of health communication in growing economies and in different target groups remains to be studied. The current analysis shows a concentration of contributions in a certain number of countries, so it would be necessary to broaden it and offer a global point of view.

Interest in scientific research in the field of health communication and COVID-19 is growing exponentially and the expected trend is that it will continue to increase. It should be noted that most of the publications that have faced the pandemic scenario have implemented open access policies to share their resources, which has contributed to the rapid diffusion of scientific information.

In general, there is also a significant difference between the articles published in 2020 and those disseminated the following year. The scientific literature is in line with the spread of the coronavirus worldwide and the communicative actions that accompany it. Terms such as fear, anxiety, mental health, awareness, resilience or lockdown in 2020 change in 2021 to behavior, vaccination, risk perception, social distance health promotion, or telemedicine. That said, it is true that some terms such as uncertainty are maintained over time, despite the fact that the role of health communication is to avoid precisely this feeling.

The information obtained from the analysis of authorship includes the references in the research with the greatest impact in the academic journals indexed in the WoS database analysed. The COVID-19 crisis was the first pandemic to be transmitted in real time. One of the great challenges has been to combat disinformation and fake news. It is therefore necessary for governments and health institutions to design clear communication strategies that are adapted to the different stages of the pandemic to avoid uncertainty, confusion or denial among the population. The lack of such strategies could lead to the failure of a correct public health policy. 

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