DISCUSSION
This is the first study to investigate bullying in individuals with CLP
on Twitter. Considering the impact of social media on today’s society
and its capacity to reach everyone with internet access, the importance
of the subject of this study will emerge.
Teasing and bullying are two major problems in the daily life of an
individual with CLP due to the multitude of visible implications of
cleft such as facial scarring, speech and hearing loss, which can be
easily identified by peers. These individuals were shown to experience
bullying at a higher rate than those who were non-CLP and that it
results in psychosocial problems that start in the early
ages.17 It has been reported by the parents of
children with CLP that their children have various psychosocial
problems.18 Nicholls et al.19reported that subjects with CLP frequently experienced teasing and
bullying and that it peaked in adolescence and decreased in adulthood.
They also stated that adults with a CLP defined the need for
psychological support as a required but inaccessible service that could
have helped them develop a coping mechanism for teasing earlier.
The findings of our study are important in terms of showing the bullying
that individuals with CLP are exposed to and its effects. Most tweets
posted by individuals with CLP and their relatives were about their
personal experiences of being bullied and how it affected their lives.
This finding was in accordance with the previous studies of Twitter
posts regarding orthodontic treatment, retention, and aligners in which
most of the tweets also belonged to individuals sharing their
experiences.1,20,21 Our findings showed that
individuals with CLP who experienced bullying and tweeted about it
shared their opinions and feelings in their tweets. We observed that
bullying caused individuals with CLP to feel sad and hopeless, with many
expressing difficulties in coping with their experiences. Although these
personal experiences might be helpful for some individuals to cope with
their experience, others might be influenced negatively.
A greater proportion of the analyzed tweets were categorized as negative
(49.3%), while less were identified as positive (16.7%) and neutral
(34%). The fact that many of the tweets in which bullying victims share
their story of being bullied reflects a negative tone is the clearest
example of the destructive effect of bullying on individuals. Even if
the bullying had occurred years ago, it could be observed that the
emotional effects of it continue. Tweets with a positive sense were
mostly about social support and overcoming bullying.
Most of the tweets in this study reflected personal experiences of being
bullied (43%), followed by the parental experience of a child being
bullied (17%) and criticism of bullying (17%), news about bullying in
CLP (14%), and social support against bullying (9%), in descending
order. Our findings showed that individuals with CLP who are being
bullied and their parents use Twitter as a platform where they can share
their experiences. Chan et al. (2017) showed that people feel
comfortable sharing their own stories of being bullied on Twitter and
different social media sites could be valuable sources of data regarding
causes of bullying due to oral health and its consequences. It may be
more comfortable to tweet about their personal experiences of bullying
rather than talking about it directly for individuals with CLP too.
However, most of the tweets did not include the type of bullying
suffered.
It could be seen that most of the tweets (46%) belonged to individuals
with CLP. While it is encouraging to see that the tweets containing the
selected keywords are not owned by the individuals intending to
victimize people with CLP, it is worth noting that they are less likely
to use those words in their tweets. Furthermore, the tweets posted by
bullies are difficult to detect, since they do not have a specific
pattern and could contain a wide variety of words.
The number of tweets included in this study was comparable with previous
relevant studies.1,22 We used both qualitative and
quantitative methods to evaluate the tweets. This methodology employed
both qualitative and quantitative approaches and the validity and
trustworthiness of our results enhanced since two different
investigators identified the themes of the tweets separately at first
and then, they exchanged ideas in cases of conflict to determine the
final theme. A manual coding process was used in this study rather than
sentiment analysis software to identify tweets as positive, neutral, or
negative, as the analysis is not able to identify irony and sarcasm and
comprehend unusual phrases.23
It was previously shown that 64% of teen users of Twitter prefer public
tweets and 24% choose private tweets, while 12% don’t know if their
tweets are public or private.24 A limitation of the
current study was that the tweets that could be evaluated were only the
public ones. The inability to access the tweets which were posted by the
protected profiles prevented access to all tweets about bullying in
individuals with CLP.
The popularity of social media sites is very high, and it seems that it
will continue to increase in the years to come. Today, social media
sites are a part of the daily lives of many people, including children
and adolescents. Therefore, these sites provide important data about
society’s perspective on bullying and their experiences. However, it is
usually not possible to obtain much information about the demographic
data of Twitter users. This was because unlike other social media
platforms, fewer Twitter users share private information such as age,
gender, and ethnicity.25
Social media sites could be used by individuals with CLP for many
different purposes. Considering that dental and medical professionals
frequently use social platforms today, they provide the advantage of
facilitating communication with an orthodontist for patients with CLP.
They also provide individuals with CLP and their parents’ quick
information. Individuals with CLP who are being bullied want emotional
support and seek it on social media.26 Twitter enables
victims of bullying to interact with each other and with different
people from all around the world, which is of great importance as it
provides psychological support and could make them feel that they are
not alone. Since 9 percent of the tweets examined in our study consisted
of support tweets, it is pleasing to see that individuals with CLP can
find this support on Twitter if they search for it. The dental and
medical team should be sharing links to sources of
professional/regulated support for those experiencing bullying in their
profiles to raise awareness of the issue and encourage those who
have/are experiencing bullying to seek support. This will increase
social awareness and highlight the availability of support that these
individuals seek.
When patients with CLP are referred to the clinic for orthodontic
treatment, the approach of the orthodontist is very important as these
patients require psychological assessment. It should be taken into
consideration that these patients may have been bullied in the past or
may be potential victims of bullying. If they have not yet received such
support, CLP patients who are victims of bullying should be directed to
get psychological help so that they can get adequate emotional and
psychological support.