Communication for health through TikTok. Study of influencers in the pharmaceutical field and connection with their audience
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Revista Mediterránea de Comunicación (RMC)
Mediterranean Journal of Communication (MJC)
ISSN: 1989-872X
Dr. Raquel MARTÍNEZ-SANZ
University of Valladolid. Spain. raquel.martinez.sanz@uva.es. https://orcid.org/0000-0002-4753-0282
Dr. Álex BUITRAGO
University of Valladolid. Spain. alejandro.buitrago@uva.es. https://orcid.org/0000-0002-1709-6972
Dr. Alberto MARTÍN-GARCÍA
University of Valladolid. Spain. alberto.martin.garcia@uva.es. https://orcid.org/0000-0003-2254-8811
Communication for health through TikTok. Study of influencers in the
pharmaceutical field and connection with their audience
Comunicación para la salud a través de TikTok. Estudio de influencers de
temática farmacéutica y conexión con su audiencia
Deadlines | Received: 01/09/2022- Reviewed: 29/09/2022 - Accepted: 12/10/2022 - Published: 01/01/2023
Abstract Resumen
The consolidation of TikTok as a platform aimed at La consolidación de TikTok como una plataforma
mere entertainment has not limited the informative orientada al mero entretenimiento no ha limitado
efforts of professionals from very different fields el empeño divulgativo de profesionales de muy
who have found an opportunity to share rigorous, diferentes ámbitos que han encontrado en esta
useful and demystifying knowledge on this social red social una oportunidad para compartir de
network (Guiñez-Cabrera, & Mansilla-Obando, 2022; forma masiva conocimientos rigurosos, útiles y
Yalamanchili et al., 2022). Through a methodology desmitificadores (Guiñez-Cabrera y Mansilla-
based on content analysis, the publications and Obando, 2022; Yalamanchili et al., 2022). A través de
reactions of the main pharmaceutical-themed una metodología basada en el análisis de contenido,
profiles on TikTok are examined, delving into the se examinan las publicaciones y las reacciones de
communication resources, interaction strategies and los principales perfiles de temática farmacéutica en
topics with which they connect with their audience. TikTok, profundizando en los recursos comunicativos,
The results reveal that, unlike other digital spaces, estrategias de interacción y temas con los que
which are more prone to tension and confrontation, conectan con su audiencia. Los resultados revelan
pharmaceutical influencers can openly expose que, a diferencia de otros espacios digitales más
their experience and professional opinion, and also propensos a la crispación y el enfrentamiento,
demonstrate their mastery of the technical resources los influencers farmacéuticos pueden exponer
offered by TikTok to create informative videos about abiertamente su experiencia y opinión profesional,
health. The use of a close language and away from demostrando, además, un dominio de los recursos
technicalities, added to a natural tone and with a técnicos que ofrece TikTok para crear vídeos
certain dose of humour, represent its hallmarks and divulgativos sobre salud. El empleo de un lenguaje
© 2023 Raquel Martínez-Sanz, Álex Buitrago, Alberto Martín-García
the key to its good reception by an audience that cercano y alejado de tecnicismos, sumado a
responds (79,696 comments analysed) assertively, un tono natural y con ciertas dosis de humor,
raising doubts, recounting their own experiences representan sus señas de identidad y la clave de la
and, above all, expressing support for the theses buena acogida por parte de una audiencia que
defended by the professional. Faced with a topic of responde (79.696 comentarios analizados) de forma
general interest such as health, every effort to use asertiva planteando dudas, relatando sus propias
the communication tools and codes of the young experiencias y, sobre todo, expresando apoyo a las
population contributes to integrating them into the tesis defendidas por el profesional. Ante un tema de
new dissemination channels. interés general como es la salud, todo esfuerzo por
emplear las herramientas y códigos de comunicación
Keywords propios de la población joven contribuye a integrarlos
Audiences; health communication; scientific en los nuevos circuitos de divulgación.
dissemination; influencers; social media; TikTok
Palabras clave
Audiencias; comunicación para la salud; divulgación
científica; influencers; redes sociales; TikTok
Martínez-Sanz, R., Buitrago, Á., & Martín-García, A. (2023). Communication for health through TikTok. Study of influencers in the
pharmaceutical field and connection with their audience. Revista Mediterránea de Comunicación/Mediterranean Journal of
Communication, 14(1), 83-98. https://www.doi.org/10.14198/MEDCOM.23435
83
1. Introduction It is evident that dissemination outside official scientific circles —for example, via massive digital media— does not pass through the control processes (selection, peer review, successive editions, etc.) to which papers in prestigious scientific journals and publications are submitted. For this reason, a large part of the scientific community rejects these new channels, as they consider that the digital environment simplifies and trivialises any type of information or content concerning science (Cárdenas, 2017; Cassany, Cortiñas & Elduque, 2018). Such disapproval grows when talking of social networks and, particularly, those platforms of greater popularity among the young, such as Instagram or TikTok. Regardless of whether the person sharing the information is a scientist, professional in their field or just an amateur, there is still a bias against the platforms, and distrust of the rigour of any content, even though the creators may be qualified in the subject or highly trained in the field that they are speaking about (Vizcaíno-Verdú, De-Casas-Moreno & Contreras-Pulido, 2020). Validity is not ascribed to the digital platforms; only official scientific sources being looked on as legitimate. However, we have found content analysis that supports the rigour of certain informative videos online finding in them sufficient theoretical underpinning, corroborated information and citation of the sources utilised (Buitrago & Torres Ortiz, 2022a). Although it is true that dissemination via digital platforms is not subject to any scientific or academic regulation, it is undeniable that the transmission of scientific knowledge through these channels is multiplied among the population (Cárdenas, 2017). The results of the X Survey on Social Perception of Science & Technology (FECYT, 2021), indicate that 61.4% of the population choose digital media to inform themselves on scientific matters, ahead of radio (41%), the press (34.4%), books (15.8%) or scientific papers (14.5%). Among digital media, social platforms and networks are identified as the main means of accessing this knowledge. The age range most likely to take an interest in scientific matters is between 15 and 24 years of age (FECYT, 2021), which is precisely the group who are the most assiduous users of online video platforms such as TikTok (IAB Spain, 2021). It is therefore pertinent to reflect on whether it makes sense to avoid the dissemination of knowledge precisely on those digital media vehicles with the highest presence among the general population. The efficient communication of science via mass media facilitates audience access to knowledge and can help to combat hoaxes and pseudo-science, as it is indeed here on these most popular channels where disinformation abounds (García-Marín & Salvat Martinrey, 2022a; Molina-Cañabate & Magallón-Rosa, 2020). Thus, scientific dissemination and initiatives on media education should find in the social platforms and networks an ally, not a foe (Buitrago & Torres Ortiz, 2022a). 2. Online videos: a way to transmit scientific communication The boom in academic, cultural and scientific dissemination via online video (León & Bourk, 2018) makes for a specific research channel among the many areas of study that have emerged around the world of social networks and their impact on the population: worthy of mention are; the phenomenon of ‘platformisation’ (Nieborg & Poell, 2018); participation culture (Burgess & Green, 2009; Kim, 2012; Van Dijck, 2013); the popularity and characteristics of content creators (González-Fernández & Martínez- Sanz, 2018; Pereira, Moura & Fillol, 2018; Scolari & Fraticelli, 2019); or the crucial role these platforms have amongst the young (Aran-Ramspott, Fedele & Tarragó, 2018; Pérez-Torres, Pastor-Ruiz & Abarrou-Ben- Boubaker, 2018; Pires, Masanet & Scolari, 2019). Looking specifically at scientific communication, we find studies focused exclusively on influencers or promotors of science on certain platforms. Examples are the work on scientific dissemination on YouTube (Buitrago, Martín-García & Beltrán-Flandoli, 2022; Pattier, 2021; Welbourne & Grant, 2016; Zaragoza Tomás & Roca Marín, 2020); on Twitch (Buitrago & Torres Ortiz, 2022b); or on Instagram (Álvarez-Herrero & Hernández-Ortega, 2021; Sidorenko, Cabezuelo & Herranz, 2021). However, with the exception of this study, there have been no studies specifically examining the work of science influencers on TikTok. It is important to comment on the studies concerning the online video format as a vehicle for the communication of scientific matters (Erviti & Stengler, 2016), as well as the peculiarities of the format as regards: narrative possibilities (Davis & León, 2018); production and audio-visual formats (Erviti, 2018); or scientific rigour, which must always be present at the heart of any scientific communication (Francés & Peris, 2018). However, maintaining rigour should not be incompatible with communicating content in an accessible, interesting and engaging way, this being essential for capturing the audience’s attention (Bourk, León & Davis, 2018). Although aspects such as objectivity, evidence and discernment are the foundations of scientific discourse, the addition of an emotional component to educational exposition has a positive effect on its repercussion (Durántez-Stolle, Martínez-Sanz & Rodríguez-de-Dios, 2022; Lugo- Ocando & Glück, 2018). Screens and audio-visual language represent one of the best ways to connect with emotions, as they are more efficient at grabbing and holding attention for longer. it is in this area of the audio-visual 84
networks, alongside others such as YouTube (the predominant repository of online videos), Twitch (the
leading platform for video-streaming), or Instagram (originally dedicated to still images); where we
come across the platform that this study is focused on: TikTok.
3. TikTok: the triumph of brief vertical videos
Of the six most commonly used social networks around the world (We Are Social & Hootsuite, 2022),
TikTok is without a doubt the newest (2016). It is owned by the Chinese technology giant ByteDance
(Brennan, 2020), and was launched in 2016 as Douyin, as it is still known in China. Thanks to its 2018 merger
with another Chinese social network, Musical.ly, it became available internationally both on Android
and iOS. However, its meteoric rise on a global level came about with the Covid-19 pandemic in 2020,
boosted by the long periods of confinement suffered by the populations of many countries (Olivares-
García & Méndez-Majuelos, 2020). Just a year later it had grown beyond a billion active monthly users
(Wallaroo Media, 2021) and 3 billion downloads (García Alcalde, 2021). A staggering success being,
as it is, in a media niche, that of social networks, which was already thought to be saturated before its
emergence (Cid, 2021) but which was to be witness to the popular blooming of a platform specifically
for the creation and sharing of short videos (Xu, Yan & Zhang, 2019).
It should be pointed out that TikTok is a platform designed expressly to be accessed via smartphone
(Vitelar, 2019), the audio-visual content of which is principally based on the vertical video format (Ryan,
2018). TikTok has a highly agile pattern of consumption, based on the creation and viewing of short
videos (depending on the category they may last from 2 seconds up to 3 minutes). Among the various
types of videos found on the network we should highlight: 1) musical videos, 2) looped videos; one of
the platform’s defining features: 3) lip-synch videos; in which the user dubs a pre-existing fragment of
audio synchronised with the original.
A differentiating factor of TikTok in comparison with other platforms is the significant role of the
algorithmic neural networks which control its content recommendation system (Galeano, 2020). This set
of algorithms –strictly speaking we should not talk of a single algorithm– is colloquially called ‘For you’
(Xu, Yan & Zhang, 2019) and controls the user’s experience of the platform holistically. For you is fed
by each search, interaction, ‘like’, comment, item of personal data, own content, account followed,
etc. (Wang, 2020). All of this serves to determine and hone the specific content offered to the user;
thus developing a video catalogue increasingly suited to one’s personal tastes, interests and opinions
(Alonso-López & Sidorenko-Bautista, 2022). The epicentrism of these algorithmic neural networks has
previously been addressed by studies into the presence of misinformation on TikTok (Alonso-López,
Sidorenko-Bautista & Giacomelli, 2021; García-Marín & Salvat-Martinrey, 2022b; Sidorenko-Bautista,
Alonso-López & Giacomelli, 2021).
Just as on platforms such as YouTube or Instagram, TikTok’s exponential growth and the popularity of
its content has made it a key space in the influencer phenomenon. Above and beyond the creators
associated with the purest social media entertainment (Cunningham & Craig, 2019), since 2020 the
platform has seen the blossoming of channels for academic, cultural and scientific dissemination –known
as science influencers (Buitrago & Torres-Ortiz, 2022a)–; who are often professionals in their respective
sectors, interested in achieving massive circulation through the gateway to the world offered by TikTok.
Among their number we find collectives such as the ‘booktokers’ (Guiñez-Cabrera & Mansilla-Obando,
2022) or those who figure in this study: communicators on pharmaceutical matters.
Although TikTok’s potential for informing on the subject of health has been looked at (Alonso-López
& Sidorenko-Bautista, 2022; Sidorenko, Herranz de la Casa & Cantero, 2020); there do not seem to be
any studies focused on the relationship between the social network and the pharmaceutical world.
This field of health is arguably more closely and commonly linked to the general public as, since the
Covid-19 pandemic, it has gained greater weight in the media due to the flow of information generated
concerning treatment, vaccines and the various medication developed to fight SARS-CoV-19.
4. Research questions & hypothesis
In order to identify how the main creators of pharmaceutical material on TikTok disseminate their content
and what strategies they employ to reach their audience, the study looks into both the broadcasting
mechanisms of the informative and educational messages related to health and their reception. To this
end, the following research questions were formulated:
Q1. What degree of acceptance do professional pharmacists’ profiles receive on TikTok in Spain?
Q2. What communication resources have a place on the network for the transmission of health
information?
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Q3. How does the audience react to content and images projected on TikTok by the professionals
analysed? Is there any interaction between the users themselves when dealing with these matters?
We have formulated a series of hypotheses which strive to go deeper into the initial proposal:
H1. The professional character of the creators of pharmaceutical material limits the subjects, which,
moreover, concentrate on dealing with the younger public’s principal concerns: covid, sex and daily
life.
H2. Despite the natural and spontaneous character adopted by the pharmacists, their posts are far
from the usual influencer lifestyle, although the comments received do formulate proposals which
invade their intimacy.
H3. As is common on the other mass social networks (Twitter, Instagram, or Facebook), some users’
belligerent reactions are somewhat exaggerated and serve to muddy the influencer’s relationship with
the community.
5. Methodology
Through content analysis, posts by the principal profiles on TikTok in Spain concerning pharmaceutical
matters are examined. The application itself, by means of key words on its search engine
(“pharmaceutical”, “pharmacist” and “pharmacy”) suggested profiles defined by these parameters,
though to determine the sample, the authors established a series of prerequisites to provide homogeneity
and consistency:
- An active personal and professional profile in Spain. The account must be managed by someone
trained in Pharmacy and clearly identified, which would eliminate companies and commercial
establishments.
- An active profile over the whole course of the study, that is, from January to June 2022.
- A profile with informative content, regularly posted, with a minimum of three videos per week.
7 accounts have been identified which meet the requirements: @farmaceuticofernandez; @
farmaceutico_guille; @sisterscloud; @infarmarte; @farmatiks; @its.noeliafarma and @demiguelfarmacia.
They all have a community of users on TikTok made up of over 100,000 followers (Table 1) and with self-
managed accounts on, at least, two other social networks, according to data registered in July 2022,
which suggests certain dedication and history.
Table 1. The Influencers analysed
Author Account Opening Engagement rate
Álvaro May 14,
10%
Fernández 2020
September
Guillermo Martín 12%
19, 2020
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Author Account Opening Engagement rate
Almendra
February 4,
y Paloma 6%
2020
Fernández
April 14,
Elena Monje 5%
2021
Sandra Druba July 2, 2020 3%
August 28,
Noelia Bermejo 4%
2018
Álvaro de March 22,
6%
Miguel 2020
Source: created by the authors from the TikTok accounts of the 7 influencers analysed
using mavekite.com
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In order to study the profiles’ development, all the publications posted on TikTok were analysed, as
well as all the comments received. This was done in two waves six months apart: from January 1 to 15,
2022 and between June 16 and 30, 2022. An analysis table created by the authors and made up of 4
categories was utilised:
• Quantitative metrics (Buitrago & Torres Ortiz, 2022a; Yalamanchili et al., 2022): number of
‘likes’, viewings and comments received.
• The intention of the message (Basch, Hillyer & Jaime, 2020; González-Fernández &
Martínez-Sanz, 2018): its orientation, subject, tone, topicality and level of communication,
entertainment and promotion or self-promotion.
• Verbal, audio-visual, and printed resources (Castro-Higueras et al., 2021; Martínez-Sanz,
2021): discourse, titles, sound effects, superimposed text, staging and costumes.
• Audience attention and reaction: proposals encouraging participation (Fernández-Gómez
& Martín-Quevedo, 2018) and the type of reaction to the influencer’s content (Martín-
García, Buitrago & Aguaded, 2022): creator of debate, concurring with the communicator,
belligerent or spreader of hate.
The total output of the 7 influencers with pharmaceutical content over the study period was 336 TikToks,
which, combined with the 79,696 comments, makes up our unit of analysis.
6. Results & discussion
In order to see how the main influencers manage their TikTok profiles, to examine their communication
techniques and to determine what their relationship is with the corresponding community of users, the
content posted by the 7 most representative Spanish accounts was analysed in two waves (January
and June 2022). In total, 336 posts and 79,696 comments.
6.1. Profile of the pharmaceutical influencer: constant, an activist and coherent with their digital identity
The main pharmaceutical profiles in Spain are relatively recent to TikTok, with an average age of 26
months (Me=24.5; s2=75.2) (Table 1). There is an uneven volume of activity, with up to three typologies
being identified: the highly active influencer, with more than two daily posts –@farmaceuticofernandez
(M=3.77) and @farmaceutico_guille (M=2.30)–, the moderately active influencer, with one publication
per day –@sisterscloud (M=1.13), @farmatiks (M=1.27) and @its.noeliafarma (M=1.37)– and the low-
activity influencer, who does not average one daily video –@demiguelfarmacia (M=0.63) and @
infarmarte (M=0.73)– over the period studied.
Table 2. Number of posts per wave
1-15 Jan 16-30 June Variation Tiktoks Responses
@farmaceuticofernandez 50 63 +16.6% 113 32,916
@farmaceutico_guille 42 27 -35.7% 69 40,430
@its.noeliafarma 24 17 -29.2% 41 1,941
@farmatiks 16 22 +37.5% 38 1,116
@sisterscloud 13 21 +61.5% 34 415
@infarmarte 9 13 +44.4% 22 2,547
@demiguelfarmacia 10 9 -10% 19 331
M= +40% 336 79,696
Source: created by the authors. Data obtained from TikTok
Perseverance has been the habitual note, as none of the pharmacists has ceased striving to inform
(table 2). Furthermore, all bar three of the profiles (@farmaceutico_guille, @demiguelfarmacia and
@its.noeliafarma) increased their number of posts during the second wave of the study, in June, by
an average of 40%, although only @farmatiks and @demiguelfarmacia managed to increase their
interactions with their audience, tripling the number of comments and ‘likes’.
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It should be pointed out, moreover, that the most active profiles are the ones with most followers.
The proliferation of TikToks and their affinity with the audience’s interests contributed to the network’s
algorithm granting them greater reach and thus they achieved a percentually higher volume of
responses (Guiñez-Cabrera & Mansilla-Obando, 2022). However, there is no indication of a permanent
relationship between greater activity and engagement, because, as expounded below, tone and
subject were direct determinants of the results obtained by the posts.
As regards content, the accounts analysed combined, in equal measure, dissemination and
entertainment in their quest to draw and keep the follower’s attention. We found dissemination, defined
as the transmission of complex knowledge, that was highly visual and uninhibited, which sought, among
other objectives, to unmask hoaxes, identify health issues and highlight the effects of imprudent or
incorrect behaviour, which is to effectively give priority to prevention over cure. An example would
be drawing users’ attention to the risks of sunburn or of neglecting to use contraceptives in terms of
unwanted pregnancies or STDs.
Taken together (336), and considering the orientation of the message, the videos demonstrate, in
descending order: explanations (20.92%), brief comments or opinions (15.40%), identification of illnesses
(11.77%), description of preventative measures (11.39%) and the relating of curiosities (10.88%). Those
TikToks dedicated to cures (3.48%), reviews (4.39%), reflections (6.06%), and others (7.06%) and the re-
enactment of scenes (8.66%) were fewer in number.
Such diversity is also present in the subject matter covered. Health issues were the commonest, from
food intolerances to skin decolourisation not forgetting excess weight. On average, health issues figured
in 15.6% of the videos. Covid was also highly prevalent in the content (13.42%), especially during the
first wave of the study. The most frequently addressed aspects were tests: how they work, positive
results caused by other substances, their price etc.; the improper use of face masks, and defence of
vaccines. Guillermo Martín was the influencer who dedicated most posts to the subject (27-64.2%),
in the second wave as well (3-11.11%), countering intensely and vehemently both negationists and
those who opposed vaccines. The pharmacist also gave voice to a message concerning the damage
caused by users transmitting false or unverified information and defending the role of pharmacists as
well-informed and trustworthy advisors.
Regarding sex, there were constant allusions to it in the most successful profile in the sample, that of
Álvaro Fernández, who dedicated it 23.89% (Image 1) of his posts. The audio-visuals which received
most ‘likes’ in the two waves –228.2K and 70.6K, respectively– had a clear sexual orientation. The first
compares male preservatives with female ones and the second has an ironic comment on the benefits
of semen for the skin.
Image 1. Word cloud of matters touched on by @farmaceuticofernandez, this being the account with
the highest content volume and number of followers
Source: created by the authors from the @farmaceuticofernandez profile
All the profiles alluded to their work as pharmacists, this figuring in an average of 16.91% of content.
Utilising anecdotes and re-enactments, more or less dramatized, they reflect their daily work, how difficult
it can be to deal with the public, and particularly, the value of pharmacists as professionals who can
advise sensibly and who are in the front line of health care. This effort to forge a closer relationship with
the public and to make their work visible online serves to reinforce vocation (Pérez-Manzano & Almeida-
Baeza, 2018). Such re-enactments, involving more than one character, gained a large number of ‘likes’,
showing that the audience appreciated the effort, as their making –sets, characters and visuals– clearly
requires a lot of time. It was also observable that there was a strong defence of the pharmaceutical
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profession by the community, in reaction to the comments of some users who belittled pharmacists or derided them as shopkeepers, criticized their use of lab coats, or accused them of forming part of ‘big pharma’ which hides the cures to many illnesses. Despite having some features in common, it should be pointed out that each influencer has their own communication style and rate of posting which, as well as being sustained over time, is coherent with the description in their profile and with their presence on the networks. All of them are present on other platforms, which makes their TikTok account another complement to their digital identity. An almost continuous desire to re-direct users to their other self-managed spaces can be perceived, in an attempt to keep their attention. 6.2 Uninhibited and rigorous informative proposals that entertain In order to present the general public with complex information regarding health matters, the profiles studied utilise an informal, uninhibited tone, with varying touches of humour and irony. While the information load of the posts may vary, a wide range of resources are called upon, be they oral or written, to enhance understanding. These resources include enumeration, both verbally and on-screen; accentuation and using measured diction for less common terms; simplification “the coronavirus is the bug”; use of metaphors, parallelisms and comparisons; logical-deductive reasoning and demonstrations. To underpin their statements the TikTokers provide data, and allude to studies or show representative images, while to disprove hoaxes they take the issue apart bit by bit to separate evidence from fallacy, employing irony to reveal trickery. Brevity is key, explanations are simple, as is the on-screen appearance of the central concepts or issues. This conciseness can be extended to the replies received from the audience, where emoticons and short phrases predominate, except when it is the user who is sharing their experience of the matter in hand. The profile of @farmatiks was the most committed to informing, both in terms of constancy and by the selection and handling of subject matter, much of which is complex, such as the explanation of key scientific progress, and controversial, such as the utilisation of marihuana in medication, and which are approached from different points of view. The dissemination found in all the profiles is intrinsically linked to entertainment. Though it is clear that music and dance are associated with TikTok, for these profiles they are not an end in themselves, but a mechanism for the transmission of an important message. An example is the post by the sisters Almendra and Paloma (@sisterscloud), which enumerates the typical errors made when washing one’s face, while they dance to music; or the call by Sandra Druba (@Farmatiks) for a more efficient and fluid digital communication system between family doctors and pharmacists utilising gesticulation and lip movements to reproduce the ingenious discourse of a third party. These resources add humour to and take the drama out of the complex issues in question, as happens in the videos dealing with the stigmatisation of people with skin conditions or difficulty in losing weight. Therefore, the use of music, choreography, and the voices of third parties serves a nobler purpose than simply trying to be funny and to entertain, involving a workload –of searching, selecting, and adapting– that should not be understated. The profiles of @farmaceuticofernandez, @sisterscloud and @farmatiks made the greatest use of these elements. However, the videos which reflect situations from daily life, but kept away from illnesses or medication, were also warmly accepted. The public identified with and shared their reactions with others. The posts dedicated to explaining why one gets sleepy after eating, how digestive gases form, what the effects of excessive coffee consumption are, or getting out of the shower by @farmaceuticofernandez with 31,000 ‘likes’ and 235 comments, reaffirm the idea that, once a loyal group of followers is established, varied content, while not losing the tone which originated the popularity, works. TikTokers also try to retain their audience’s attention by using curious or striking images, such as the hand with no fingernails of @infarmarte; by the telling of personal experiences or anecdotes; with simple jokes, such as the video of a contestant on First Dates who says “I’m a ninja” instead of “nymphomaniac”; or encouraging controversies, as is frequent on @farmaceutico_guille. This being compatible with his profile as #farmaciaenfurecida (#furiouspharmacist), not only the hashtag he utilised most but the name by which he is known on Instagram, Twitter and Facebook, and which gives us a heads up about his position and way of communicating. The staging employed supports the messages, adding credibility with the coherence between the scene chosen and the matter in question. Thus, when speaking of a face-cleansing routine, the creator appears in a bathroom; and if the talk is focused on the work in a pharmacy, we see shelves full of medication or the influencer behind a counter. In spite of this, the spaces shown do not seek to overwhelm. On most occasions we find the inside of a home, with neutral backdrops and without distracting elements. 90
The clothes worn also seek to emphasise the ethos, authority, with a white lab coat, or using other
colours typical of health professionals. However, not all content on the subject is accompanied by the
garment. Álvaro Fernández recognises in one of his videos that he is aware that the lab coat gives an
air of credibility, and Guillermo Martín dedicates a post to it saying ironically that he has no intention of
ironing it.
Little attention is paid to the titles on the posts, whether in their form –spelling mistakes are common,
especially with accents, and clangers that suggest improvisation– or in the content, as they are generally
composed of generic hashtags or the name of the Instagram profile, and therefore, aimed more at the
self-aggrandisement of the influencer than in helping the user to identify the content. On the other
hand, most of the audio-visuals made by the creator include on-screen text describing the subject
matter, visible from the feed, as can be seen in image 2 which also shows the diversity of backdrops and
the reiterated use of lab coats as costume.
Image 2. Overview of postings by @farmatiks, @sisterscloud & @farmaceutico_guille
Source: TikTok profile of the 3 accounts analysed
In this constant search for scientific information via entertainment using a light-hearted tone, it should
not be forgotten that comments are generated, though they be few in number, which refute the
influencer’s statements. Such dissention arises mainly with reference to covid (vaccines, the business
and mala praxis of the pharmaceutical industry and the use of face masks), differences in the behaviour
between establishments, or the lack of information:
“Why does no pharmacist predict the side effects of everything they defend, making clear their
impartiality?” / “My friend has Fentanyl 50 on prescription, and they never ask him for ID, nor for the
prescription for the narcotic. Years ago they used to, but not now.” / “It’s true, the vaccine is good for
nothing, plain and simple. I know people who’ve been vaccinated, and they had a worse time than
when they caught it being unvaccinated.” / “With the vaccine I passed it on and have been infected.
I know of people who have died of Covid after three shots of vaccine”.
Furthermore, and in comparison, with the other widely available social networks (Twitter, Facebook and
Instagram), a conversational air can be observed, without partisan tension and confrontation, except
for the few critical comments mentioned above. This is probably due to its entertainment-related use,
and softened by the platform’s humour, which helps to ease the tension found on other sites (Martín-
García, Buitrago & Aguaded, 2022).
6.3 Connection with the audience: straightforwardness and personal touches with an invitation to
uniform participation
The pharmacists’ target audience on TikTok is young people, as seen by the most frequent subject
matter (attention to physical appearance, sex and covid); the messages’ orientation, a particular
tendency to explain and to prevent, given the collective’s more impulsive character; and the similarity
of the protagonists’ socio-demographic profiles in the videos posted. Moreover, one can see the use of
certain expressions such as “burnt!”, “lip smacks” or “laters”, related to the slang of this group.
91
Despite the manifest professionality of the profiles in the sample, the authors reveal certain aspects of their private lives, sharing personal moments with their audience such as Christmas presents, their pastimes (“I play golf”, confessed @demiguelfarmacia), health issues, such as @its.noeliafarma’s lactose intolerance, or leisure plans. This serves to make them more human and helps them to connect with their potential audience’s way of life or thinking. However, it can also be seen that they have all been subject to awkward questions or comments at some moment, inappropriate remarks about their physical appearance or comments of a sexual nature. This type of participation is minimal and has not received any replies either from the pharmacists or from the community of users. An example of this is the TikTok by @farmaceuticofernandez, pushing back at a comment asking about the pharmacist’s sexual orientation, turning the response into a new video where he tackles the intromission with humour and respect, staying loyal to the atmosphere that predominates on his profile. Considerable interest can be perceived in dealing with the community’s requests, so much so that all but @demiguelfarmacia, dedicate, on average, 20.97% of their audio-visual content to replying to specific doubts or comments sent by the audience which appear in new videos. These followers could be termed as loyal, as they tend to back up the pharmacist. Moreover, the occasions on which they give an ingenious response to critical users is when this strong support is most apparent, as these examples taken from the account of Guillermo Martín demonstrate: “I deeply regret the time you waste answering pointless comments. I love your videos.” / “Thanks a lot for the way you use irony and sarcasm to raise awareness of science and its experts. Congrats.” Although one can see a tone that is amenable to conversation, we should not forget that the responses were not always favourable: “I’m disappointed in you. The effects of turmeric have not been demonstrated; it would seem that paid advertising works wonders.” Despite this, the prototypical user who replies is someone who believes in science, trusts what health professionals say and shows appreciation for what the influencer posts. And one of the principal motives leading the user to give an opinion is, apart from showing appreciation for a TikTok, a wish to share experiences, this also being a reason for their very presence on social networks (IAB Spain, 2021). Audience participation is encouraged, but only weakly and monotonously. The formulas utilised, when they are used, are identical on each profile and consist of tossing out a rhetorical question, either in the heading of a post or verbally during a video. Álvaro de Miguel alone adds the expression “I read all comments sent” as a reminder of his interest in knowing his audience’s opinions. What is common to all the accounts is that this sort of comment does not receive a massive response compared to others, despite containing an express request by the influencer for participation. Only a few initiatives are dynamic, typically encouraging the user to take a specific action at that moment, as opposed to open questions such as ‘Have you ever…?’ or ‘What would you do if….?’ which get a limited response, as mentioned. For example, Sandra Druba challenged users to do a simple exercise to strengthen their pelvic floor while she does a countdown, with the result that the audience described their experience on the title page; or the directed question asked by Noelia Bermejo (“which test is negative?”), who promised to give the answer very soon (Image 3) and thus managed to mobilise her followers. 92
Image 3. Participative content & audience reaction
Source: TikTok account of @itsnoeliafarma
The pharmacists are attentive to the comments and criticism on their respective feeds, as these written
observations become on occasions the centre of attention of a new TikTok, while others are replied to
by the influencer on the feed. @farmaceuticofernandez and @farmaceutico_guille are the commonest
users of this resource, adopting very different attitudes when dealing with criticism: while the former
uses humour and a certain degree of condescendence, the latter takes a more ironic and combative
stance, generating more reactions, and thus deflecting attention form purely health-related matters.
6.4 Common techniques of promotion and self-promotion among other influencers
The promotion of brands and their products on the pharmaceutical profiles analysed is explicit and rare,
with an average of around two posts per month, while self-promotion is more frequent, subtle, and in
secondary spaces, such as the headings of posts or message towards the end of the videos.
As regards commercial allusions, only @sisterscloud and @farmaceutico_guille make constant, clear
and unmistakable reference to the fact that what the viewer is watching is a paid collaboration, while
Álvaro Fernández opts for placing the tag ‘#publi’ on the only commercial promotion he has in his 113
posts. The rest (Álvaro de Miguel and Elena Monje) leave the door open to interpretation as to whether
the influencer is recommending a certain product guided by professional criteria, which, if it were not
so, would be contrary to the Spanish law Ley 34/1988, of November 11, 1988, General de Publicidad, as
has been reported in the research by González-Fernández and Martínez-Sanz (2018) or Martínez-Sanz
(2021).
Concerning followers’ attitudes to such actions, the appearance of collaborators with brands results in
a marked decrease in engagement, which may explain its cautious use. As a representative example
of this tendency, we find the video by Guille Martín with Oral B which has 496 ‘likes’ and 9 responses,
while the day before, a humorous content about how to eliminate nits attracted 26,900 ‘likes’ and 277
responses. Moreover, it can be seen that the audience responds to this sort of content ironically and
derisively (Image 4).
93Image 4. Commercial recommendation with no allusion to possible paid content
Source: TikTok account of @infarmarte
When it occurs, this commercial exhibition is both evident and insistent, as well as displaying the product,
the brand is shown and mentioned, be it verbally or written in hashtags. Moreover, the products
performance is described –the most common ones being, electric toothbrushes and suntan lotion–
as Is how to use it. The problem with not indicating if there is a commercial relationship behind the
recommendation is that it blurs the line between sincere recommendation and financial interest.
Self-promotion, on the other hand, tends towards boasting of the author’s achievements: their books,
awards, interviews, TV appearances and especially, seeks to re-direct the audience to other digital
platforms where the pharmacist has a profile. References to Instagram are especially frequent. The
profiles @its.noeliafarma and @demiguelfarmacia go one step further and establish a connection
between some of their content on TikTok and Instagram, as the videos encourage the user to skip to
the other network with the promise of finding extended content, as if it were a transmedia strategy
(Bandhari & Bimo, 2022).
7. Conclusions
With its arrival, TikTok as a new social network originally tending more towards social media entertainment
(Cunningham & Craig, 2019), swiftly created a space for itself where it gained popularity with younger
audiences in competition with other, more established platforms like Facebook, Twitter and Instagram
(IAB Spain, 2021). Professional pharmacists, the object of this study, discovered an effective way to
communicate information on their area of expertise, health, contributing to a positive learning situation
among their followers, who found in these content creators an approachable way to access rigorous
data at a time when hoaxes and fake news are constants in the digital arena. The influencers analysed
herein acted as a firebreak against rumours and misinformation, and generated comments from their
followers that show they reassessed what they had heard once there was a voice that spent time
explaining things, using an easily understandable, unambiguous language.
The success of this approach to the audience stems from an ongoing effort which is anything but
sporadic; these are perseverant profiles who want to inform —and to do so to prevent and bust myths—
and to keep a community of followers who trust pharmacists that cover matters of social interest. They
employ communicative codes and stylistic resources popular on TikTok, these being highly entertaining
and humorous, which help the pharmaceutical influencers to get their messages across in a positive
manner, taking the drama out of serious issues without trivializing them.
TikTok offers itself as a digital platform with substantially less confrontation between users and against
the originator of the content than is common on other social networks, thus refuting our third hypothesis,
which foresaw a harsh atmosphere when the communicator takes a position on controversial matters
such as vaccines. Covid is the most controversial issue, which generated the largest number of comments
opposing the pharmacist, although the percentages were much lower than the amount of support
received, while sex was the subject which created most participation, keeping to the amusing tone
with which it was generally dealt with by the pharmacists. Respect and good manners were the norm,
and part of the criticism received was turned into fresh content by the professionals in the analysis, these
dedicating the time needed to counter those opinions not based on scientific or objective data. It is
also worth noting the corporativism apparent in the 7 accounts analysed, with a zealous defence of the
pharmacists’ profession and a palpable interest in explaining their work and the difficulties encountered
in their day-to-day labours.
94As regards the other two hypotheses propounded, concerning H1, we have found a wide range of
subjects covered, mostly health related, although the management of the accounts analysed also
included other, more personal or less serious videos, characterised by their use of humour. Despite
everything, Covid, sex and the minutiae of daily life were the commonest subjects. The need to
constantly create fresh content so that the algorithm does not drastically reduce the posting’s reach,
does not lead to a banalization of the videos’ content, or an abandoning of the editorial line which had
made them popular in the first place. Regarding H2, our original proposal has been corroborated by
the analysis of spontaneous, unselfconscious interventions, using a natural tone which avoids excessive
technicisms, and intended principally to draw the TikTok audience’s attention to health matters. The
community of followers is highly active and loyal. However, uncomfortable questions and comments of
a sexual nature or concerning the creators’ private lives can also be observed, the creators generally
ignoring such inappropriate participation and denying it the oxygen of attention.
Concerning the limitations of this study, the fact that professional pharmacists alone are covered means
that not all health professionals are included, and that therefore future lines of research should perhaps
look at the dissemination of science on TikTok from medical and nursing perspectives, thus extending
the area of study in the interests of drawing more wide-ranging conclusions,
8. Specific contributions of each author
Contributions Authors
Conception and design of the work Author 1, author 2, author 3
Document search Author 1, author 2
Data collection Author 1, author 2, author 3
Critical interpretation and analysis of data Author 1, author 2, author 3
Drafting, formatting, revision and approval of Author 1, author 2, author 3
versions
9. Acknowledgement
This article falls within the work dynamics of the Social Media Education Lab, at the María Zambrano
Campus in Segovia (University of Valladolid). Likewise, the author Raquel Martínez-Sanz is the beneficiary
of a requalification grant (2022-2024) sponsored by the European Commission -NextGenerationEU.
Translator: Brian O’Halloran.
10. Declaration on conflict of interest
The authors declare that no conflict of interests exists.
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