Using social media is one important strategy to communicate research and public health guidelines to the scientific community and general public. Empirical evidence about which communication strategies are effective around breastfeeding messaging is scarce. To fill this gap, we aimed to identify influencers in the largest available Twitter database using social network analysis (n = 10,694 users), inductively analyze tweets, and explore communication strategies, motivations, and challenges via semi-structured interviews. Influencers had diverse backgrounds within and beyond the scientific health community (SHC; 42.7%): 54.7% were from the general public and 3% were companies. SHC contributed to most of the tweets (n = 798 tweets), disseminating guidelines and research findings more frequently than others (p < 0.001). Influencers from the general community mostly tweeted opinions regarding the current state of breastfeeding research and advocacy. Interviewees provided practical strategies (e.g., preferred visuals, tone, and writing style) to achieve personal and societal goals including career opportunities, community support, and improved breastfeeding practices. Complex challenges that need to be addressed were identified. Ideological differences regarding infant feeding may be hampering constructive communication, including differences in influencers' interpretation of the WHO International Code of Marketing of Breast-milk Substitutes and in perspectives regarding which social media interactions encompass conflict of interest.
Keywords: Twitter; breastfeeding; challenges and opportunities; communication strategies; influencers; public health; science communication; social media; social network analysis.