Local differences in social media use by German hospitals comparing a metropolitan capital area and a territorial federal state

Social media has become an essential communication tool in healthcare, allowing hospitals to engage with patients. Nevertheless, individual differences may arise between hospitals depending on their ownership or geographic location. This study provides the first comparative analysis of social media use across German federal states. Over a 14-week period (January to April 2023), the public social media use of 118 hospitals in Berlin (capital urban area, n = 52) and Rhineland-Palatinate (RP; territorial area, n = 66) was analyzed. Six platforms were considered: Facebook, Instagram, Twitter (now: X), LinkedIn, Xing, and YouTube. Hospitals were categorized by ownership (non-profit, public, private) and region. Posting frequency and follower counts were compared using statistical tests (Mann–Whitney U-Test, Kolmogorov–Smirnov-Test, and Kruskal–Wallis-Test). The analysis aimed to identify usage patterns and the influence of structural factors. Posting activity and follower numbers varied widely across hospitals with social media accounts (n = 52 Berlin; n = 66 RP). Facebook and Instagram were the most frequently used platforms. Public hospitals posted most often (average: 7.41 posts/week), while private hospitals had the highest follower counts (average 27,227 followers). No statistically significant regional differences were found for weekly posting activity or total followers. Notably, in territorial areas, statistically significant differences were observed between non-profit and public hospitals in follower counts (p = 0.034), indicating that ownership type had a greater influence outside urban settings. These findings suggest that ownership structure plays a more relevant role than geography in shaping hospitals’ visibility on social media. As the first inter-state comparison of German hospitals’ social media presence, this study highlights important implications for digital communication strategy, resource planning, and future research in healthcare communication.