Upholding dignity during a pandemic via Twitter

Dignity

While it is clear that dignity and human rights are closely associated, it is essential to consider that dignity encompasses how a person feels (their self-worth) and the context in which they live (e.g., psychological, social, and cultural factors) (Mégret & Hoffmann, 2009). Furthermore, dignity is socially constructed as it develops and depends on social interaction between individuals or groups, and it is also determined by and intersects with other human rights (Mégret & Hoffmann, 2009). For these reasons, marginalized individuals or groups may be at greater risk of experiencing vulnerability (i.e., older adults, children, immigrants, Indigenous people, low-income individuals, and sexually and gender-diverse communities) are at a greater risk of losing their dignity. In extreme cases, dignity violations may undermine personhood, as individuals risk being treated as “not human or less than human–as a thing or instrument or subhuman creature” (Kateb, 2014). Indeed, in the context of COVID-19, initially, the discourse surrounding older adults living in long-term care homes focused heavily on the loss of dignity in healthcare and in dying (Carrieri et al., 2020; Colombo, 2021; Kowsalya & Sundara, 2021; Vellani et al., 2021). Much of the discourse was ageist, promoting notions that all older adults need protection, are vulnerable, and should be socially isolated (Fraser et al., 2020; Lagacé et al., 2020) –all factors that infringe on human rights and dignity. The impact of COVID-19 on human dignity has been negative, but it has also raised awareness about dignity and the importance of including it as a priority in health system reform (Galea, 2021).

Social media and marketplace sentiment

Sociologist Bruno Latour (2007) explores how language and representation shape social interactions and worldviews. His perspective is relevant to our study of social media discourse on dignity during the COVID-19 pandemic, as we analyzed how users interact through tweets, using symbols and narratives to construct and express their views on dignity. Similarly, researchers who examine media discourse and public opinion also focus on the symbols and reasoning devices used to present and discuss issues, such as metaphors, exemplars, catchphrases, depictions, and visual images, as well as the roots, consequences, and appeals to principle that suggest how to think about an issue (Gamson & Modigliani, 1989).

With the increasing convergence of online and offline realms, digital methods of studying communication behaviour have become helpful in gaining insight into people's experiences (Caliandro, 2018) and sentiments or shared emotional dispositions (Gopaldas, 2014). As a result, researchers have increasingly turned to social media conversations to understand what people discuss and express. Users post messages on social media that offer a “window into experience” as they share their expertise, exchange questions or concerns, and reinforce each other's positions (Eriksson & Salzmann-Erikson, 2013). This approach has the advantage of “listening in” on conversations and avoiding certain response biases that may occur when asking questions in interviews or surveys (Rappaport, 2011). Following Gopaldas (2014), public sentiment is more complex and fluid than simple positive/negative dichotomies suggest; sentiments can be composed of mixed feelings, depending on the social, cultural, and economic context, and lend themselves to qualitative analysis.

Applications of social listening in public health and well-being contexts include studies of patients' reactions to knee replacement surgery (Pitt, Mulvey, & Kietzmann, 2018), gamblers' reflections on problem gambling (Brown, Caruna, Mulvey, & Pitt, 2021), expressions of stigma against people with dementia (Bacsu et al., 2022), public attitudes towards vaccines (Fazel et al., 2021), ageist expressions (Elliott, 2022; Ng & Indran, 2022), monitoring depression and anxiety (Boettcher, 2021), public opinion and misinformation about e-cigarettes (Cole-Lewis et al., 2015), opioid use and addiction (Anderson et al., 2017), job satisfaction and turnover (Lam, Mulvey, & Robson, 2022), and retirement travel planning (Mulvey, Padgett, & Lever, 2022), using diverse online data sources including discussion forums, review platforms, Facebook, Twitter, and Reddit. In addition, social media methods are well-suited to collecting and analyzing data rapidly in times of crisis or responding to emerging trends, such as the COVID-19 pandemic (Picone et al., 2020; Reid & Duffy, 2018). Furthermore, advice sharing on social networks is inherently social–people exchange ideas, solicit and deliver advice, and develop relationships with other community members (Kozinets, 2002; Mulvey, Padgett, & Lever, 2022). Like others, we contend that crowdsourcing holds enormous potential to identify problems and share solutions in times of crisis. For example, self-help groups and advice on social media may improve affected populations' resilience during a disaster, “replacing their helplessness with dignity, control, as well personal and collective responsibility” (Keim & Noji, 2011).

Top-level indicators and metrics

The prevalence and engagement with dignity-based tweets

The Sprout Social key performance metrics affirm the popularity of dignity in the January to December 2020 reporting period and establish that the topic was well-established in COVID-era discourse. The keywords (dignity OR #dignity) appeared in 46,420 original messages (not including shared or mentioned), contributed by 41,060 unique authors, generating 2.89 billion impressions and 5.12 million engagements (total likes, dislikes, comments and shares). These values translate to daily averages of 126.8 messages, 112 new authors, 7.9 million impressions, and 13,991 engagements.

Figure A illustrates the volume and engagement levels of tweets from our sample. There are two panels: the top includes all dignity tweets, excluding dignity tweets focused on older adults, depicted in the bottom panel. Comparatively, the volume of dignity tweets focused on older adults is only 4.4% of the total sample. Each circle denotes a tweet, and its size represents the level of message engagement (the total likes, comments, and shares). Most tweets earned low engagement (small dots), whereas some striking exceptions generated exceptionally high engagement (the circles). For reference, the post with the highest level of engagement (=88,390) generated 56,771 likes, 20,174 comments, and 11,445 shares. Notably, Twitter algorithms favour popular posts, amplifying posts with engagement, feeding them into users' streams and generating more impressions.

Figure A. Sample of dignity tweets by month with engagements.

The heat map shading indicates the relative volume of posts by month (red shading represents the highest density, and yellow is the least). Some observations: dignity discourse on Twitter was sparse in January and February and rose exponentially in March, April, and May following events including the WHO's pandemic declaration, rising hospitalization and death rates, imposition of lockdown measures, and the Black Lives Matter protests. The volume of tweets decreased and maintained steady levels through the summer and fall months, but it faded into December.

Tweets with the most engagements

Next, we focus on the posts that earned top-10 engagement scores. Foremost, politicians championed the cause of dignity, led by a handful of well-known members of the United States Democratic Party, including Hillary Clinton (#1: 56,771 likes, 20,174 comments, 11,445 shares), Senator Bernie Sanders (#4: 30,568 likes, 1,362 comments, 7070 shares), Chelsea Clinton (#8: 10,625 likes, 206 comments, 3059 shares; #10: 9,324 likes, comments, shares), and House Speaker and congresswoman Nancy Pelosi (#9: likes, comments, shares). In addition, his Holiness Pope Francis (also known as Pontifex, #2: 32,615 likes, 664 comments, 6,307 shares; #3: 32,606 likes, 557 comments, 6,272 shares), medical doctor Craig Spencer (#5: 23,062 likes, 658 comments, 6,437 shares), journalist Miles Howard (#6: 28,877 likes, 46 comments, 5,982 shares), and author/retired registered nurse Juanita Broaddrick (#7: 17,478 likes, 1,117 comments, 4,502 shares) shared views. These posts demonstrated diverse construals of dignity, invoking tensions between democracy and authoritarianism and respect for persons, including older adults, people who are unemployed, patients and healthcare professionals, small business owners, and leaders (not) doing their duty.

Core and peripheral words in tweets

Still, simple word frequency counts and exemplars only tell part of the story of dignity discourse. Figures B, C, and D include word clouds created using Scimago Graphica that illustrate the relative frequencies of terms, hashtags, and emojis in messages that contain the keyword dignity. For example, Figure B shows the prevalence of terms like pandemic and people and negatively charged words such as corruption, authoritarianism, and lawlessness. Figure C indicates how users attach hashtags to messages, linking posts to related conversations, for instance, #blacklivesmatter, #mentalhealth, and #protectreprodignity. Finally, Figure D displays emojis in messages, using visual symbols to convey abstract emotions and feelings, including anger , disgust , and sadness , and calls to action to wear a mask , attend to disabled persons , and pray for better outcomes . We also examined mentions of prominent people and brands, signalled by the @ sign, which calls out usernames on Twitter. The list of mentions included the names of many well-known politicians, public health agencies, and news outlets. Increasingly, researchers are attending to hashtags, and emojis as these paratexts that accompany the words may play a prominent role in the reception or interpretation by the public (Bakker, 2022; Luangrath et al., 2022; Völcker, 2020). By extension, these terms, hashtags, emojis, and mentions suggest a bigger picture, like puzzle pieces, yet they do not form a coherent image.

Figure B. Word cloud of terms in dignity tweets.

Figure C. Word cloud of hashtags in dignity tweets.

Figure D. Word cloud of emojis in dignity tweets.

Thematic analysis and word clusters

Next, our attention turned to analyzing clusters of words used together, focusing on the 200 most frequently used words derived using the Leiden community detection algorithm. Terms of 13 groups form clusters or communities of dignity-based topics in our dataset. Our analysis of these results and iterative readings of the verbatim tweets helped derive the framework illustrated in Figure E, organizing the thirteen clusters into five broad themes. These words and ideas are typical of the cluster, yet variation exists within clusters, and messages can blend ideas from one or more clusters.

Figure E. Dignity themes and word clusters.

We summarized the tweets’ content to protect users’ privacy and confidentiality and present these findings as themes below. This prevents individual tweets from being traced back to specific users in compliance with data protection regulations and research integrity (Markham & Buchanan, 2012). While this may limit the detail of our analysis, it ensures that our study adheres to ethical standards and protects participant privacy.

Recognize dignity as a fundamental right

The first theme affirms dignity as a fundamental human right (see Figure E for keywords). Users consider dignity a necessary condition for the enjoyment of human rights, as, without dignity, individuals cannot fully exercise or realize their rights. The global pandemic created crisis conditions that eroded a basic sense of humanity and justice as inequalities in wealth, power, race, and housing conditions threatened individuals' inherent worth and dignity. These inequalities came to the fore with discussions about unequal access to vaccines. For example, one tweet advocated for universal access to vaccines for all citizens of South Africa, including migrants. Similarly, hashtags demonstrated solidarity with the social equity priorities of groups like Black Lives Matter, Latinos, Pride, and Veterans. Next, we discuss the overarching principle of recognizing dignity as a fundamental right, echoed in other themes focusing on specific populations.

Upholding the dignity of essential workers

The second theme highlights the importance of upholding the dignity of frontline and healthcare workers. The COVID-19 pandemic threatened the dignity of these essential workers in several ways. One such threat is the inadequate provision of personal protective equipment, which puts their health and safety at risk. To address this issue, employers must provide workers with the necessary resources and support to carry out their work safely and effectively, including proper equipment, suitable testing measures, adequate training, and sufficient staffing (The Lancet, 2020; WHO, 2020).

Another way to uphold the dignity of frontline and healthcare workers is to recognize and value their work and contributions. For example, a tweet shared by the Teamsters labour union thanked a member of Local 150 for performing essential work for the Sierra Nevada Memorial Hospital during the pandemic. Employers —and society as a whole—can express gratitude and appreciation for these workers’ efforts by providing them with fair compensation and benefits and offering support and assistance for their physical and mental well-being.

The high stress and isolation many essential workers experience during the pandemic can lead to burnout, so it is crucial to provide them with the support they need. For example, in a Tweet, the UK-based Living Wage Foundation thanked workers, including school caterers, care workers, cleaners, and delivery drivers, for keeping society going during the pandemic, asserting that they merited a living wage and sufficient work hours to maintain health and live with dignity.

Finally, other messages championed the dignity of frontline and healthcare workers by calling for respect for their rights and dignity as individuals—and avoiding discrimination or harassment. This public support can empower essential workers and motivate them to continue providing vital services to society (Shan et al., 2022).

Preserving the dignity of at-risk populations

The third theme focuses on the close connection between dignity and populations at risk of experiencing vulnerability (Russell-Bennett, Bedggood, & Raciti, 2024). For example, India-based WHO South-East Asia issued a tweet that called attention to the need to protect diverse groups in response to the pandemic. This includes older people, persons with disabilities, people who are homeless, refugees and migrants, people without access to sanitation, and people living in crowded places. Such individuals are more likely to experience disadvantage, discrimination, or exclusion. In addition, due to their limited access to resources, they may struggle with inadequate access to healthcare, education, or social support, which can negatively impact physical and mental health—and undermine dignity and self-worth (Armitage & Nellums, 2020; Croft & Fraser, 2022). Therefore, providing at-risk populations with the necessary support to live decent and fulfilling lives is essential.

One factor that can threaten the dignity of older adults is ageism. This discrimination and prejudice can manifest as negative stereotypes, lack of recognition and respect, or unequal access to opportunities and services (World Health Organization, 2021). As a result, adults may feel marginalized and devalued, undermining their dignity and self-worth. Another factor that can threaten the dignity of older adults is the inadequate provision of healthcare and social support services–especially during the pandemic. For instance, an individual's sarcastic tweet called out the Liberal–National Coalition (LNP) in Australia for failing to protect older adult supporters who voted them into power. Other messages submitted that when such services are lacking, older adults may face isolation, loneliness, and loss of independence, all of which can harm their dignity. Additionally, lack of access to adequate housing and financial security can threaten older adults' dignity by limiting their ability to meet their basic needs and participate in society.

Older and younger women faced unique challenges that threatened their dignity as access to necessary healthcare services exacerbated existing issues. Many older women took on additional caregiving roles during the pandemic without adequate support, adding to the burden of unpaid domestic work and putting stress on their physical and mental well-being (Age International, 2021). Additional challenges include pregnancy, parenting responsibilities, domestic abuse, or homelessness, and addressing these issues may require special attention and support. For example, the United Nations Population Fund (UNFPA) Kenya announced a collaboration to provide “dignity kits” to girls living in informal settlements.

Preventing cascading disasters that exacerbate dignity's decline

The fourth theme specifies factors that pose a particular challenge to upholding dignity during the pandemic. Critics describe how well-intentioned COVID mitigation strategies suffer from blind spots of missing information about unresolved social problems, neglecting risks, compounding the harm, and leaving dignity in peril (Dorn et al., 2020; Kharas & Dooley, 2021).

First, dysfunctional politics can erode individual dignity by endorsing discriminatory policies, such as voter suppression laws and travel bans targeting predominantly Muslim countries. Additionally, propaganda campaigns, which promote biased narratives for political gain, and misinformation, such as false claims about voter fraud or the COVID-19 pandemic, undermine public trust and exacerbate division. On social media, sharp criticisms and personal attacks between American political figures often provoke equally harsh responses, creating an environment where public discourse lacks respect. Dignity emerged as a central theme in the polarized political climate leading up to the U.S. November 2020 presidential election. Thus, advocating for inclusive and respectful politics that uphold the dignity and rights of all individuals remains crucial.

Second, food insecurity can undermine individuals' dignity by forcing them to make difficult choices and limiting their access to nutritious and healthy food. The COVID-19 pandemic worsened this problem, leading Nourish Scotland to campaign for communities to respond to food insecurity by providing people with access to healthy food options and ensuring social connections.

Third, poverty can undermine individuals' dignity by limiting their access to basic needs and opportunities. Conversely, addressing poverty can help to restore and uphold individuals' dignity by providing them with the means to meet their basic needs and participate in society. Finally, chronic deficits in many domains require a coordinated solution, as the New York-based advocacy group Women Deliver emphasized, calling for world leaders to embrace international collaboration in recovery plans.

Fourth, healthcare and insurance can support and protect an individual's dignity by providing access to necessary medical care and services and protecting them from financial hardship. For example, an individual from Texas tweeted a reminder that coronavirus does not discriminate and that everyone in the country should be able to see a doctor, irrespective of employment or insurance status. Healthcare system designs differ across countries and regional jurisdictions, influencing access to primary and secondary healthcare services without financial burden. These variations can significantly affect individuals’ ability to uphold their dignity.

Attending to death, dignity, and the sanctity of life

The fifth theme considers the consequences of failing to uphold dignity in the face of death and illness. As the COVID-19 pandemic swept across the world, nations faced a tragedy of unprecedented proportions. Each day, the death toll rose as more people fell victim to the deadly virus. Unfortunately, political tensions—particularly in the United States—plus a lack of a cohesive and effective national response exacerbated the situation. As the tragedy unfolded, it became evident that the nation had failed to safeguard its people's dignity adequately. An English political pundit posted an updated death toll, ascribed blame, and urged people to vote.

Respecting an individual's dignity during their end-of-life can be crucial to providing decent end-of-life care (Kennedy, 2016). Dignity is a quality or state of being worthy of respect and honour. As individuals approach the end of life, they often wish for a “good death” that is peaceful, pain-free, and by the individual's wishes and values (Meier et al., 2016). Respecting an individual’s dignity during end-of-life care is crucial for a peaceful transition (Meier et al., 2016). Yet, several barriers emerged during the COVID-19 pandemic, including reduced access to loved ones, overwhelmed healthcare systems, lack of personal care, the need for personal protective equipment, and distressed healthcare workers (Hernández-Fernández & Meneses-Falcón, 2023).

Additionally, a Kenyan argued that providing protective suits might allow people to give their final respects to their loved ones with dignity. Finally, some followers of an Indian spiritual leader tweeted claims that they had received a divine cure for the deadly virus, telling of healing without medicine. The COVID-19 pandemic highlighted the need for adaptive practices that honour cultural rituals while safeguarding public health, revealing the deep connection between culture, spirituality, and the dignified handling of death.

Tweets focused on older adults

Older adults constitute an underserved population during the COVID-19 pandemic due to higher health risks, increased social isolation, economic insecurity, disrupted healthcare access, and interrupted routine health services. These factors highlight the urgent need for targeted support and interventions (Age International, 2021; Jowell et al., 2020; WHO, 2020).

Given our interest in examining older adults' challenges in the pandemic, we next examined the subset of tweets that mention older adults. We flagged messages in the sample that included at least one of the following keyword variants: elder* (n=29), senior* (n=28), older (n=24), pension* (n=11), retire* (n=6), or aged (n=1). This procedure netted 86 unique tweets, equal to 4.4% of the sample.

Most messages echoed the dignity themes discussed previously. Foremost, dignity is a human right protected by the United Nations and World Health Organization, a message affirmed by the UN Secretary-General, who reminded world leaders to respect the rights and dignity of older people. Older persons were disproportionately harmed by COVID-19, as reflected in death tolls and social isolation (Fraser et al., 2020; Sharma, 2021; Wu, 2020). Furthermore, older age intersects with other risk factors, including poverty, disabilities, race, homelessness, immigrants, non-native speakers, and incarcerated persons.

Problems with long-term care homes drew considerable attention as facilities struggled to protect residents from the virus, maintain adequate staffing and care levels, balance social distancing measures, and reduce isolation from family members. The tragic loss of lives sparked calls to hold government officials accountable and to reform the system.

Finally, some seniors' meal delivery services were suspended during the pandemic, placing recipients at risk of not having enough groceries, risking hunger, malnutrition, or even starvation. Poverty increases these risks, as some posts drew attention to low incomes and inadequate pensions or social security benefits.