Impact of Service Quality on Patient Satisfaction: In a Public Hospital in Cap Vert

Patient satisfaction is recognized as one of the most important quality dimensions and key success indicators in the health care industry. Identifying the most critical factors in hospitals related to the service quality will ensure survival and success in the future. This study aims to investigate patients' perception of the service quality provided by a public hospital in Cap Vert and propose some improvement measures. A questionnaire adapted from the ServPerf model was used to measure the patient’s level of satisfaction. The findings of this study stated that all the dimensions namely reliable, responsiveness, assurance, empathy and tangibles are significantly related to the patient’s satisfaction. Besides, the study also found that older patients, with less literacy and the ones with a greater number of children, feel more satisfied. Overall the perception of the patients about the service quality provided by the hospital and it’s the satisfaction is quite poor. A report has been presented to the hospital administration, including results and suggestions in compliance with the findings.

services. By determining the significant variables influencing outpatients' satisfaction, this study gives an insight for managers and staff of public hospitals on the effect of service quality towards outpatients' satisfaction and also recommends ways for its improvement.

Service Quality
Healthcare is a leading issue for contemporary society so healthcare managers need a thorough understanding of the ways to increase the quality of care in practical terms.
Nowadays, the demand for quality health care is a leading issue in the world that is increasing (Huang, Lai, Hu, & Weng, 2014). Therefore, it is necessary to analyse the quality of hospital services for quality health care. Conceptualising and measuring the quality of hospital services, as a service system, directly influence public health (Rasouli & Zarei, 2015) although are complex (Um and Lau, 2018). Measuring quality implies selecting and adopting some evidence-based criteria that include client satisfaction with the service they receive (Mendes et al., 2018). There is evidence that patient perceptions of health service quality strongly influence their choice of healthcare provider (Handayani et al., 2015;Rashid & Jusoff, 2009). Given that the health providers need to gather information on patient needs, expectations and perceptions to adjust their services to patients rather than make their patients fit their services (Qin et al., 2015;Ramsaran-Fowdar, 2005). Service quality improvement can be possible by focusing the dissatisfactions in patients' hospital assessments as well. Reducing patient dissatisfaction in-hospital services is quite important for patients and decision-makers as well. Dissatisfaction affects patient loyalty to the service provider (Fatima et al., 2018;Rostami et al., 2019;. Decreasing patient dissatisfaction level leads to positive perceptions by patents and influences the competitive power of the hospitals positively. Measuring customer satisfaction is something broader and intangible and evaluating the quality of the service provided boils down to specific dimensions of the service (Falcão et al., 2017).

Customer Satisfaction
Customer satisfaction is a common term in numerous fields including marketing and finance (Fornell & Larcker, 1981;Yi & Nataraajan, 2018). Customer satisfaction is referred to the application of some procedures to bridge the gap that exists between the needs and expectations of a client and available products and services (Linqvist Leonardsen et al., 2016;Sadeh, 2017;Xesfingi & Vozikis, 2016). Customer satisfaction can be described as the attitude or the opinion of a person concerning aspects of health services according to previous experience (Sahoo & Ghosh, 2016).
Many researchers discussed customer satisfaction and attempted to improve their definition. As stated by Swies et al. (2017), customer satisfaction refers to attaining the provision needed by the customer. Satisfaction is a situation that occurs as a result of the customer's relationship with the organization over some time (Izogo & Ogba, 2015). According to Maria Stock et al. (2017), satisfaction is the consumers' assessment of a product or service in respect of whether their expectations and needs are met with regards to those products or services.
Satisfaction influences patient recommendations positive (McCall et al., 2016). Satisfaction is considered as a positive and emotional state determined through the assessment of all facets of the customer's relationship with the organization (Al-Abri & Al-Balushi, 2014). The major focus of an organization is customer satisfaction since it reflects the nature of services of products produced for the customers (Lagrosen & Lagrosen, 2016). Low satisfaction levels among patients are associated with a lack of trust in health institutions (Maria Stock et al., 2017;Züllich et al., 2012).
One of the most widely researched tools for increasing patient's satisfaction is ServQual model, developed by Parasuraman, Zeithmal, and Berry (1988). It is one of the best and most used models for evaluating customer expectations and their perceptions of the quality of services since it has flexibility, which makes it possible to be modified by the researcher according to the nature of the institution without changing its five-dimensional structure (Ali & Raza, 2017;Awang et al., 2015;Anbari & Tabaraie, 2013). It relies on the idea that quality is a subjective evaluation of the customer and suggests that five dimensions alter patient's perceptions about the quality of services offered by a hospital. Dimension reliability refers to the consistency and dependability of the hospital to offer promised services to their patients. Responsiveness refers to the provision of services promptly. Assurance represents the knowledge, skills and abilities of staff in establishing rapport and trust with patients for the services European Journal of Business and Management www.iiste.org ISSN 2222-1905(Paper) ISSN 2222-2839(Online) Vol.12, No.27, 2020 provided. Empathy represents the extent to which healthcare providers offer extended emotional support to their patients. Finally, tangibles refer to structural or facility-related elements. As the health care staff meets the expectation of patients, patient satisfaction will increase (Amole et al., 2015). Cronin and Taylor (1992) proposed, as an alternative, the ServPerf model, which has the same dimensions as ServQual, as it only uses patient perceptions to evaluate service quality.
Many types of research have measured service quality at different hospitals using different methodologies. Paul (2003) performed a comparison between the two prevalent service quality models, ServQual and ServPerf, and applied it in the setting of periodontists. He concluded that ServPerf without importance weights appears to be a better measure of service quality in periodontists. Gurbuz, et al. (2008) explained the reason of incompetency of ServQual scale that the consumers do not know about expectation related to service before they receive the service. They even do not know what to expect.
To sustain the advantage and be ahead of their rivals' organisations must focus on customers' needs and demands by fulfilling customer's expectations with improved service quality (Klementova, Zavadsky, & Zavadska, 2015;Martins, de Carvalho, Ramos, & Fael, 2015).

Methodology
This study focuses on the effect of service quality on outpatients' satisfaction in the public hospital -Hospital Baptista Sousa (HBS), San Vicent Isle, in Cap-Vert which is a developing country. The hospital treats, on average, 2272 patients every day.
As a research instrument, a questionnaire-based in the ServPerf scale, slightly modified to suit the specific features of the HBS, was used (El-Toamy et al., 2015;Izogo & Ogba, 2015;Saleh, 2017).
The survey questionnaire consisted of two sections. The first section includes questions to determine the sociodemographic profiles (gender, age, educational level, marital status, professional activity, number of children, medical visits (last year), knowledge of the complaints book and complaints). The second section of the questionnaire was a 23-item scale measuring the dimensions (Reliability, Responsiveness, Assurance, Empathy and Tangibility) of service quality. In this section respondents were required to rate on a 5-point Likert scale for data collection with "1" as "strongly disagree" and "5" as "strongly agree".
The questionnaire was pilot tested by ten patients who visited the hospital. Respondents in the pilot test did not have problems with the questionnaire, although minor changes of the wording were suggested. The research questionnaire was in Portuguese and face-to-face interviews were conducted to ensure a high response rate and to reduce the missing data in the questionnaires. Subjects were asked to assess items of the different dimensions and the overall satisfaction.
A convenience sample of patients, age 18 and up, who had been treated in the various departments of HBS hospital in 2018, was used. Thus, the research design is a cross-sectional, one sample at a one-time point. There were collected 413 valid questionnaires. In determining the sample size, we had a significance level of 5% and a sampling error of 4.77%.
Based on the literature on satisfaction assessment models, we designed a conceptual research model presented in Figure 1 to teste the impact of the service quality on customer satisfaction. To improve the outpatients' satisfaction item responses were classified as green if its average>4, yellow if its 3≤average≤4 and red if its average<3. Items classified red need special action measures and immediate intervention to be improved. Yellow items need attention to improve to green. Green items need to be stimulated to be maintained and improved.
To test the consistency of the sample, the Kaiser-Meyer-Olkin test (KMO) was used. The reliability of the dimensions and the questionnaire, in general, was calculated using the Cronbach's alpha coefficient.
To assess of group average differences of the contextual variables related to the outpatients' satisfaction oneway ANOVA, the Mann-Whitney U test, and the Kruskal-Wallis non-parametric, followed by multiple European Journal of Business and Management www.iiste.org ISSN 2222-1905(Paper) ISSN 2222-2839(Online) Vol.12, No.27, 2020 comparisons of the order means with ANOVA Tukey, as described by Maroco (2018) were used.
All statistical work was performed on IBM SPSS software (v25 -SPSS Inc Chicago, IL) and Excel (Microsoft Office 2015, Microsoft Corporation).

Results
The socio-demographic profile of the 413 respondents is described in Table 1. The majority of the respondents are female (54.72%), 74.33% have less than 45 years of age, 35.11% has the secondary as the Educational Level, 77.24% are unmarried, 28.33% work in the private sector, 49.64% have 3 or fewer children, 56.66% went last year between 1 and 3 visits to the hospital, 59.08% didn't know the existence of the complaints book and just 4.6% already complained.  Table 2, 17 items (73.91%) of the Service Quality dimensions had a red classification. Half of the yellow items belong to the Tangibles dimension. All the reliability items belonged to the red classification. Although the overall patient's perception of the service quality is quite poor (mean=2.81), it should be emphasized the all the items related to doctors' service laid in the yellow classification.   (Parsian & Dunning, 2009) and validity were deemed effective (Table 3).  2222-1905(Paper) ISSN 2222-2839(Online) Vol.12, No.27, 2020 6 satisfaction, can be explained by the five independent variables, namely, reliability, responsiveness, assurance, empathy and tangibles. The F value is equal to 667.719 (p<0.001) which shows that the Multiple Linear Regression is significant and at least one of the five dependent variables has a significant relationship with the outpatient's satisfaction. Therefore, the proposed conceptual framework model fits.
The Standardized Regression Model is: Outpatient Satisfaction=0.258 (Reliability) + 0.213 (Responsiveness) + 0.233 (Assurance) + 0.163 (Empathy) + 0.240 (Tangibles) All the ServPerf dimensions have a significant positive effect on outpatient' satisfaction and thus the whole hypothesis is supported. Reliability (=0.258) and tangibles (=0.240) most strongly predict the perception of outpatient satisfaction. As hypothesised, there is a significant positive relationship between the service quality dimensions and outpatient's satisfaction, thus all the hypothesis were supported. The results are in line with other findings: Reliability -Essiam (2015) and Zaim et al. (2010) concluded that the higher the ability to perform services accurately and dependably the higher the level of outpatient's satisfaction. Also are in line with the findings of Yousapronpaiboon and Johnson (2015) that health care providers who give proper explanations to outpatients would influence outpatient satisfaction. (2015), Amole et al. (2015) found that past experiences with health care services could influence a patient's expectations of services. Assurance - Hassali et al. (2014), who evidenced that the quality of the health care services provided affects patient's confidence in the skills of health care provided and Abioye et al. (2010), who stated that clear understandable information and/or explanation provided by health care staff to outpatients would lead to higher levels of outpatient's satisfactions. Empathy -the results of Zaim et al (2010) and Van De Ven (2014) were confirmed. Although the HBS is a public hospital where the service is given free of charge by the government, the outpatients expected polite staff, give supports and shows concern with the patient's problems. Tangibles -Alshatnawi and Ambus (2016), Pouragha and Zarei (2016) stated that hospitals with good infrastructures and equipment as well as neatly attired personnel that are visually appealing can attract patients since a positive perception of the hospital is created. Thus, tangibility encourages patients to visit hospitals with such environments for treatment.

Responsiveness -Yousapronpaiboon and Johnson
To improve the service quality provided by the HBS and leave some recommendations, we tried to find significant differences in the factors, gender, age, educational level, marital status, professional activity, number of children, medical visits per year, knowledge of the claiming book and complainants, related to each of the five dimensions of the ServPerf model.
The analysis revealed no significant differences associated with gender, knowledge of the claiming book, complainants (Mann-Whitney test, p>0.05), marital status, professional activity and medical visits per year (Kruskal-Walls test, p>0.05). In contrast, there were found significant differences in other factors.
Age was a highly significant variable. Patients with more than 60 years of age showing higher satisfaction then those of the other age echelons in all the dimensions -Kruskal-Wallis non-parametric (Table 6), followed by multiple comparisons of the order means with ANOVA Tukey, as described by Maroco (2018) (Table 7).
The results of Sadeh (2017) were confirmed only in the part that, older customers' satisfaction with health care is higher than younger customers. However, in this study no significant difference in satisfaction among gender were found. European Journal of Business and Management www.iiste.org ISSN 2222-1905(Paper) ISSN 2222-2839(Online) Vol.12, No.27, 2020 (Table 8 and 9). The respondents with 1st cycle education are more satisfied with the dimension responsiveness than the ones with the holders of the secondary level education.  (Table 2 and 3). In general, the respondents with four or more children are more satisfied in all dimensions than the one with less than three children. These results are aligned with the ones related to the variable Age considering that the older respondents also have more children (for example the totality of respondents with more than seven children have more than forty-five years).  None 0.42505* 0.017 * Average difference is significant at 0.05 level In sum, the overall service quality perceived by patients was quite bad. Although Cap-Vert is a developing country, where there is careful respect for the human being, the HBS needs to implement regulatory policies to provide better services for patients.
Thus, to improve the service quality provided by the HBS and consequently the satisfaction it is highly essential to identify the factors which satisfy the customers and strategize policies based on these requirements.

Suggestions and Recommendations 
Deepen efforts to reduce waiting times concerning appointments, examinations and treatments.  Make the appointments available via digital.  Disclose the existence of the complaint book and sensitize users/patients to its use.  Implement training processes, properly structured, in line with the real needs of workers to give them more skills on the provision of services, so that all those who use the services of this hospital are more satisfied. It is recalled that Satisfaction is a feeling of pleasure or disappointment resulting from the comparison of the expected performance of the service (or result) about customer expectations (Kotler, Keller, Ancarani, & Costabile, 2016). This satisfaction is also reflected in the client's actions as the indication of the service to others (Ricci, Wanderley, Oliveira, & Rebelatto, 2009).  Create the HBS organization chart so that stakeholders understand the hierarchical and organizational structure of this institution.  Improve the reporting process of HBS, in particular, that directed to users under 45 years of age to mitigate their dissatisfaction with the quality of services provided by this institution.  Start a certification process supported, for example, in ISO 9001:2015 -Management System and /or ISO 14001 Standard -Environmental Management.

Conclusions
This study used the ServPerf model to explain the relationship between the service quality and outpatient's satisfaction toward the public hospital, Hospital Baptista de Sousa in Cap-Vert. The R-square value of 0.891of the multiple regression model fit indicates that the ServPerf model with the five variables Reliability, Responsibility, Assurance, Empathy and Tangibles successfully provides the explanations about the influence of these service quality dimensions on the outpatient's satisfaction. Stated in another way, the quality of the services provided by HBS has a positive impact on the satisfaction of patients. Only the tangibles dimension was classified as yellow. All the other service quality dimensions laid in the red classification, which implies that the perceived quality of health services provided by Hospital Baptista de Sousa has not been satisfying to patients and needed to be improved. In this way, the HBS should heard permanently the voice of the patients to improve the quality of the services provided.
It is important to relieve that they are the older patients, with a greater number of children and fewer educational qualifications who say they are more satisfied with the quality of services provided by HBS. It is also noteworthy that the average classification in all items associated with medical interventions has a yellow


Accounting Records Using the Android Application to Evaluate Changes in Earnings

The purpose of this research is to test the difference in the logging of profit conducted by Micro, Small, and Medium Enterprises (MSME) with the recording in accordance with accounting standards and to test the feasibility of Akuntansi UKM application in the implementation in MSME business. The respondents of this research are the MSME in Bekasi City under the Dinas Koperasi dan UKM. There were 40 respondents in this study. This research is a case study research and uses quantitative descriptive methods. Data analysis Using test paired t-test and application feasibility test using PIECES. The results of this research are there is a difference between the average profit that has been recorded by the respondents with the profit recorded in accordance with the financial accounting standards, and the Akuntansi UKM application has fulfilled the eligibility criteria so that it can be applied in business actors, especially MSME.

INTRODUCTION
In the Era of Industrial Revolution 4.0, many businesses were required to be more advanced in conducting their business, including accounting. One type of business in Indonesia that are widely involved by the community is Micro, Small, and Medium Enterprises (MSME). The business sectors that include in MSME play an important role in the Indonesian economy, evidenced by the increase of Gross Domestic Product (GDP) year by year (Savitri and Saifudin, 2018). In addition to increasing GDP, MSME can also improve Gross Regional Domestic Product (GRDP), such as the city of Bekasi annually, in the increase of GRDP. The average increase in GRDP in 2014-2018 is 5% (BPS, 2019). The number of MSME in Bekasi throughout the year 2018 has increased. The MSME Data of the Bekasi city to 2018 reached 2,866 MSME, and this increased from the number of MSME in 2017, namely 2,667 MSME (Cendana News, 2018). In the year 2019, Bekasi City focuses on MSME empowerment ranging from packaging, marketing, and promotion. The important thing about MSME empowerment is not only on these three aspects but in terms of Indonesian Institute of Accountants publishes Financial accounting standards for MSME, i.e., Standard financial accounting of small and medium micro-entities that are effective from 1 January 2018. So far, MSME has recorded a financial statement with a manual report that only calculates the expenditure and income that has been earned in the given period. In the determination of the selling price of MSME, actors do not calculate the overhead costs and labor costs. The selling price determined by the MSME is only determined by the capital and the profit to be obtained. Overhead and labor costs are not calculated into the price calculation of production, but rather a deduction of income to calculate the profit. For the calculation, the amount of profit that has been calculated by MSME does not reflect the actual profit.
The results of the survey conducted by the Indonesian Internet Service Provider Association (APJII) in 2017 showed that 143.26 million Indonesian people are active as Internet users, 58.08% of them are residents of Java. To facilitate MSME in implementing accounting properly and properly need support tools so that MSME can make financial reports properly and correctly. The tool that can be used is the 5.7.4 version of the Akuntansi UKM app developed by WiinFeel and can be accessed for free on the Google Play Store. Based on the above phenomenon, it is necessary to do research on the application of Akuntansi UKM applications to MSME in Bekasi city to test the influence of accounting recording by using Android application and manual recording, whether it has a significant difference in the calculation of business profit.
Accurate accounting is needed for business actors, including MSME, to know financial information. Accounting records must be in accordance with the transaction and recorded in accordance with the applicable accounting standards (Andrianto, Nuraini, & Maharani, 2017). The current accounting records conducted by MSME do not necessarily reflect the actual financial information, MSME does not charge overhead and labor costs to products to be sold so that the resulting profit is not a real return. Adequate and reliable accounting records will reflect the real financial situation (Savitri and Saifudin, 2018). Based on the formulation, the hypotheses are as follows: = There is a significant difference in the recording of profit by MSME with the recording of profit in accordance with the accounting standards.
Conducting accounting records using the SME accounting application will be more detailed than manually recording accounting. In performing accounting records on the application, start from creating a journal to automatically generate financial reports. In accounting recording, using the Akuntansi UKM application will be more detailed, and all transactions will be recorded, including overhead and labor costs, so that it will generate financial statements with the actual profit.
Based on research conducted by Ria (2018) proved that MSME, after the use of Android-based financial applications, could obtain information on financial statements that are getting good and accurate. In another study conducted by Nainggolan et al. (2019) proved that an Android-based cash management application is capable of delivering efficiency for MSME in performing cash management so as to display more detailed and accurate calculation information. Furthermore, the research was done by Zahro et al. (2019) proved that after using an Android-based application then MSME does not need to do manual recording of the expense and acceptance cycles so that the resulting reports are more computerized and in accordance with the applicable accounting standards. The first objective of the study was to test the difference in profit recording conducted by MSME with the recording in accordance with accounting standards. The second objective is to test the feasibility of Akuntansi UKM application in implementing MSME.

METHOD
This research is a case study research conducted to examine a particular object. The Data obtained from the research results are analyzed and can only be generalized in related samples. This research uses quantitative descriptive methods that describe or describe the events that occur using numbers. The samples in this study were MSME in Bekasi City as many as 40 MSME. Prior to the research, a pilot test was conducted with the number of respondents as many as 30 respondents. Respondents were given the question of determining the cost of production, selling price, and profit calculation. Each respondent must fill in the matter according to his knowledge and in accordance with the records that are usually done. Once all the questions are filled, the hypothesis testing is done. Hypothesis testing using a paired test sample t-test to see the difference in the average record of profit performed by MSME with the recording that complies with accounting standards. Feasibility test for UKM Accounting Application using PIECES analysis. The PIECES analysis consists of Performance, Information, Economy, Control, Efficiency, and Services analysis. PIECES Analysis Questionnaire was adopted from Dewi et al. (2016) and several points of inquiry were developed and adapted to MSME conditions in Bekasi city. Table 1 shows the test results of normality. The Data in this study has been normally distributed so that it can be continued into the next statistical test.  Table 2 shows the test results paired sample correlation. The results of paired sample correlations showed a sig value of 0.002 < 0.005, which means there is a strong and significant correlation between the calculation of profit by MSME with the appropriate calculation of accounting standards.  Table 3 shows test results paired test samples. The results of the test paired sample test showed a sig (2-tailed) value of 0.002, which means there is a difference in the apparent average of profit recording by MSME with the recording in accordance with accounting standards. The hypothesis on this research is supported, i.e., the recording of profit by the MSME differs significantly from the recording in accordance with accounting standards. Accounting for MSME is not compliant with accounting standards. The initial recording mistake occurred is the listing price of the production. Out of the 40 respondents, only one respondent was in the recording of the production cost. The other respondents in calculating the cost of production included all the costs and expenses that had been incurred over the period, resulting in the amount of production base price too large. In addition, respondents are still not able to identify which transactions are classified into raw materials and overhead costs. It is also one of the reasons for the recording of the underlying product price is not in fact. Confusion in the price recording of the production tree will result in confusion in the sale price. The selling price will be too high if the percentage of profit has been determined first, or the percentage of profit will be too low if the selling price has been determined first. The error on the sale price will impact the revenue received and will affect the logging of the profit. So the profit recorded will not show the actual profit.

RESULTS AND DISCUSSION
The results of PIECES analysis for the use of Akuntansi UKM application are as follows: In the performance indicator, there are four statements that measure the extent of the performance of Akuntansi UKM application, following statements in performance indicators: Menu and navigation options make it easy to use the program 2.
Menu and navigation provided can be run easily and interactively 3.
Response slowness occurs when an application is used 4.
Easy command cancellation instructions while required Source: Research questionnaire In Figure 1, It is stated that 52% of respondents strongly agree and 42% agree that the menus and navigation available are easy to use. Other respondents were as much as 3% disagree with, and the other 3% strongly disagreed the menu and navigation available are easy to use. In other words, as much as 94% feel the menus and navigation available are easy to use.  In Figure 2, It is stated that 62% of respondents strongly agree and 35% agree that the menus and navigation provided can be run easily and interactively. Other respondents, as much as 3%, strongly disagree with the menu, and the provided navigation can be run easily and interactively. In other words, as much as 97% feel the menu and navigation can be run easily and interactively.

Figure 3. Statement 3 Performance
In Figure 3, It is stated that 62% of respondents disagree, and 8% strongly disagree that there is a response slowness when the application is used. More than 28% of respondents agreed, and 2% were very much agreed on response lags when applications were used. In other words, as much as 70% felt there was no response lag when the application was used.

Figure 4. Statement 4 Performance
In Figure 4, It is stated that 65% of respondents agreed, and 25% strongly agree that there are available command cancellation instructions easily while required. The other respondents as much as 7% disagree, and 3% of respondents very disagree that are available command cancellation instructions easily while required. In other words, as much as 90% felt the command cancellation instructions were easy to understand and run.
In the information indicator, there are four statements that measure the extent to which information in the SME accounting application can facilitate the work. Following statement in the information indicator: Available menus are easy to understand 2.
In the application, there are information/guidance needed 3.
Available information needed when inputting new transactions 4.
The resulting output is easy to understand Source: Research questionnaire In Figure 5, It is stated that 55% of respondents agreed and 40% strongly agree that the available menus are easy to understand. Another 5% of respondents do not agree the available menus are easy to understand. In other words, as much as 95% felt the menus available in the SME accounting application are easy to understand.

Figure 6. Statement 2 Information
In Figure 6, It is stated that 87% of respondents agreed, and 10% strongly agree that in the application, there is information/guidance needed. Other respondents, 3%, disagree in the application there is information guidance needed. In other words, as much as 97% feel the information and guidance available in the application according to their needs.  In Figure 7, it is stated that 60% of respondents agreed, and 37% strongly agree that there is the information needed when inputting new transactions. Other respondents, as much as 3%, disagree is available the information needed when inputting new transactions. In other words, as much as 97% of respondents feel when they will input new transactions available information needed.

Figure 8. Statement 4 Information
In Figure 8, It is stated that 42% of respondents agreed, and 55% strongly agree that the resulting output is easy to understand. The other 3% of respondents disagree that the resulting output is easy to understand. In other words, as much as 97% of respondents felt the resulting output is easy to understand. The resulting output is a financial statement in the form of the income statement and financial position report.
In the economics indicator, there are four statements that measure the economics level of use of MSME accounting application, following the statement in the economics indicator: Akuntansi UKM application is easy to get for free 2.
Akuntansi UKM application does not consume a lot of quotas 3.
Using the Akuntansi UKM application can save operational costs 4.
Benefits gained after using the Akuntansi UKM application are greater than the Internet quota issued. Source: Research questionnaire  In Figure 9, It is stated that 52% of respondents agreed, and 45% strongly agree that the Akuntansi UKM application is easily obtained for free. Another 3% of respondents did not agree that the Akuntansi UKM application is easy to obtain for free. In other words, 97% of respondents felt the Akuntansi UKM application is easy to obtain for free.

Figure 10. Statement 2 Economics
In Figure 10, it is stated that 45% of respondents agreed, and 40% strongly agree that the Akuntansi UKM application does not spend much quota. Of the other respondents, 15% did not agree that the Akuntansi UKM application did not spend much quota. In other words, 85% of respondents feel the use of the Akuntansi UKM application does not require a lot of quotas because the use of this application can be used in offline circumstances.

Figure 11. Statement 3 Economics
In Figure 11, It is stated that 35% of respondents agreed, and 57% strongly agree that using the Akuntansi UKM application can save on operational costs. Other respondents, 8%, do not agree that using the Akuntansi UKM application can save operational costs. In other words, 92% of E-ISSN : 2549-5992, P-ISSN : 2088 Available online at: http://ejournal.stiewidyagamalumajang.ac.id/index.php/wiga

Wiga : Jurnal Penelitian Ilmu Ekonomi
Volume 10 , Number 2 , September 2020| 140 respondents felt the use of the Akuntansi UKM application saves operational costs. The costs that are usually used to make current financial statements can be minimized because the use of this Akuntansi UKM application does not require any fees.

Figure 12. Statement 4 Economics
In Figure 12, it is stated that 45% of respondents agreed, and 52% strongly agree that the benefits gained after using the Akuntansi UKM application are greater than the Internet quota issued. Other respondents, 3%, disagree that the benefits gained after using the Akuntansi UKM application are greater than the Internet quota issued. In other words, 97% of respondents feel the benefits gained after using the Akuntansi UKM application is greater than the cost of the internet to be incurred. The use of the Akuntansi UKM application does not require an Internet quota so that the benefits that are charged by the user will be greater than the cost incurred.
In the control indicator, there are four statements that measure the level of user control of Akuntansi UKM application, following statements in the control indicator: There is a security system in the Akuntansi UKM application that can be trusted 2.
There is data backup that allows users to search for past data 3.
By using the Akuntansi UKM application, The business finances can be controlled well 4.
Akuntansi UKM application can be controlled according to the needs. Source: Research questionnaire In Figure 13, It is stated that 55% of respondents agreed, and 42% strongly agree that there is a security system in the Akuntansi UKM application that can be trusted. Another 3% of respondents do not agree that there is a security system in the Akuntansi UKM application that can be trusted. In other words, 97% of respondents felt that the security system in the Akuntansi UKM application could be trusted. The in-app security system uses a PIN that has already been plotted at the beginning of application usage. The security system that has recorded financial data can not be abused by others.

Figure 14. Statement 2 Control
Figure 14 stated that 53% of respondents agreed, and 47% strongly agree that there is a data backup that makes it easy for users to search for past data. In other words, all respondents feel that the data backup system can make it easier for users to search for past data. With this data backup system, users will be able to keep data securely even if changing devices because all input data will be back up and can be restored on a new device. Figure 14 stated that 53% of respondents agreed, and 47% strongly agree that there is a data backup that makes it easy for users to search for past data. In other words, all respondents feel that the data backup system can make it easier for users to search for past data. With this data backup system, users will be able to keep data securely even if changing devices because all input data will be back up and can be restored on a new device. Figure 15 stated that 40% of respondents agreed, and 58% strongly agree that by using the Akuntansi UKM application, The business finances can be well controlled. Other respondents, as much as 3%, disagree with the use of Akuntansi UKM application Business finance can be well controlled. In other words, as much as 98% of respondents felt their business could be well controlled if using the SME accounting application. In the Akuntansi UKM application, financial records can be controlled by activating the reminder, and with the correct record, then the user will know the balance per account so as to facilitate the user to know their credit and control the finances. In Figure 16, It is stated that 58% of respondents agreed, and 43% strongly agree that the Akuntansi UKM application can be controlled according to the needs. In other words, all respondents feel the Akuntansi UKM application can be adapted to the needs of each respondent. Akuntansi UKM application can be used by MSME that sells merchandise, processed goods, and services so that all MSME can use the application according to their needs.

Figure 15. Statement 3 Control
In the efficiency indicator, there are four statements that measure the efficiency level of use of Akuntansi UKM application, following statements in the efficiency indicators: Akuntansi UKM application speeds up job completion 2.
The resulting financial statements are trustworthy and accurate 3.
Using the Akuntansi UKM application can facilitate the completion of the financial report 4.
Using the Akuntansi UKM application can facilitate the completion of the generation of an annual tax return. Source: Research questionnaire In Figure 17, It is stated that 55% of respondents agreed, and 45% strongly agree that the Akuntansi UKM application accelerated the completion of the work. In other words, all respondents feel when using the SME accounting application job to compile financial statements can be faster because, in the system, the application users only need to enter transactions, and financial statements will be automatically made.

Figure 18. Statement 2 Efficiency
In Figure 18, it is stated that 58% of respondents agreed, and 43% strongly agree that the resulting financial statements are trustworthy and accurate. In other words, all respondents feel the financial statements that are produced can be trusted so that it can be used for decision making.

Figure 19. Statement 3 Efficiency
In Figure 19, It is stated that 52% of respondents agreed, and 45% strongly agree that using the Akuntansi UKM application can facilitate the completion of financial statement generation. At the same time, as many as 3% of other respondents do not agree that the use of the Akuntansi UKM application can easily resolve financial statements. In other words, 97% of respondents felt that using the app could facilitate the preparation of financial statements.

Figure 20. Statement 4 Efficiency
Figure 20 stated that 60% of respondents agreed, and 40% strongly agree that using the Akuntansi UKM application can facilitate the completion of the generation of the annual tax return. In other words, all respondents felt that the generation of an annual tax return could be simplified when using the application. In the service indicator, there are four statements that measure the level of service usage of Akuntansi UKM application, following statement in Service indicator: There is a help menu that can make it easier to use when users have difficulty operating 2.
Manual/Application Usage guide can be easily obtained so as to facilitate users in the operation 3.
A reminder menu is available that makes it easy for users to set schedules (example: annual tax return, receivables billing to customers, etc.) 4.
Application to automatically complete the account entry system according to transactions, making it easier to create journals Source: Research questionnaire In Figure 21, It was stated that 75% of respondents agreed, and 25% strongly agreed that there is a help menu that can make it easier to use when users have difficulty operating. In other words, all respondents feel when they have difficulty asking for help from the operator via the email listed in the application. In addition, in the Application menu, there are also helpful in the form of a module book that contains the application procedures and can be downloaded by all users.

Figure 22. Statement 2 Service
In figure 22, It is stated that 80% of respondents agreed, and 20% strongly agree that the manual/Application usage guide can be easily obtained so as to facilitate the user in operation. In other words, all respondents find it easy to operate the application because there are guidelines in application usage ranging from transaction input to the printing of financial statements.  In Figure 23, It is stated that 65% of respondents agreed and 32% strongly agree that a reminder menu is available that makes it easy for users to set schedules (e.g., annual tax return, billing receivables to customers, etc.). At the same time, the other 3% of respondents don't agree that the reminder menu can make it easier for users to set schedules. In other words, as much as 97% feel the reminder menu can help the user to set up the schedule so that the schedule of annual tax return, receivables Billing, and other schedules can be carried out in accordance with the specified time.

Figure 24. Statement 4 Service
In figure 24, It is stated that 65% of respondents agreed, and 35% strongly agree that the application automatically completes the account entry system according to transactions, making it easier to create journals. In other words, all respondents feel that the journal preparation can be made easy by using the application because the user only enters the transactions, and journals that will be created automatically will be composed.

CONCLUSION
Accurate accounting recording and in accordance with accounting standards are indispensable for businessmen. One of them is MSME. The MSME in determining the selling price does not charge the overhead and labor costs to the products to be sold. From the process, the specified selling price is not in accordance with the expected because the accounting recording is not in accordance with accounting standards. With this problem, it will need to be further examined whether there is a difference in profit recording while on MSME records with the recording in accordance with accounting standards. The test results stated that there was a significant difference between the profit recorded by the MSME with the profit that has been recorded in accordance with accounting standards. With the significant differences, there is a need to be a supply or training to MSME in


extfieldsofstudy:
Computer Science
Sociology

text:
Retweeting for COVID-19: Consensus building, information sharing, dissent, and lockdown life

Purpose: Public attitudes towards COVID-19 and social distancing are critical in reducing its spread. It is therefore important to understand public reactions, information dissemination and consensus building in all major forms, including social media. This article investigates important issues reflected on Twitter. Design/methodology/approach: A thematic analysis of the most retweeted English-language tweets on Twitter mentioning COVID-19 during March 10-29, 2020. Findings: The main themes identified for the 87 qualifying tweets accounting for 14 million retweets were: lockdown life; attitude towards social restrictions; politics; safety messages; people with COVID-19; support for key workers; work; and COVID-19 facts/news. Research limitations/implications: Twitter played many positive roles, mainly through unofficial tweets. Users shared social distancing information, helped build support for social distancing, criticised government responses, expressed support for key workers, and helped each other to cope with social isolation. A few popular tweets not supporting social distancing show that government messages sometimes failed. Practical implications: Public health campaigns in future may consider encouraging grass roots social web activity to support campaign goals. At a methodological level, analysing retweet counts emphasised politics and ignored practical implementation issues. Originality/value: This is the first qualitative analysis of general COVID-19-related retweeting.

Introduction
In the COVID-19 crisis, the social sciences have an important part to play in this disease because a core part of public health strategies defence is social distancing (e.g., Tian, Liu, Li, et al., 2020). This relies on communicating the necessary behaviour effectively to the population and engaging their consent to comply. Effective public communication is therefore critical. Moreover, public reactions to events need to be assessed to understand the mediums in which information and consensus spread effectively. The public perspective is therefore more central for this than for most other major public health threats in the past century. Information about public behaviours or attitudes may also help understand the epidemiology of the disease, which is important to help control it (Lipsitch, Swerdlow, & Finelli, 2020).
Social media can help to inform and connect the population, bringing social support during lockdown (e.g., Wiederhold, 2020). Twitter is an important source of breaking news for a minority of people in some Western countries (e.g., the USA: Shearer, 2018). It can also be an important vehicle for disseminating new public health information (Liang, Fung, Tse, et al., 2019), although it usually relies on retweeting to attract a large audience (Steele & Dumbrell, 2012). During a crisis, members of the public can be expected to tweet about their own situation and emotional reactions (Lachlan, Spence, Lin, Najarian, & Del Greco, 2016).
These tweets can be exploited to help public health officials to understand the situation on the ground. For example, tweets related to the Zika virus have been analysed to identify the main public concerns (Glowacki, Lazard, Wilcox, Mackert, & Bernhardt, 2016), and which messages were retweeted to the largest audience (Stefanidis, Vraga, Lamprianidis, et al., 2017). For Ebola, Twitter seemed to serve as a filter for topics with media coverage (Morin, Bost, Mercier, Dozon, & Atlani-Duault, 2018). Perhaps surprisingly, preventative measure information is not always the most widely retweeted (Vijaykumar, Nowak, Himelboim, & Jin, 2018). For COVID-19, some insights have already been gained from Twitter: females are more likely to discuss social distancing and males are more likely to tweet about sport cancellations (Thelwall & Thelwall, 2020), misinformation and valid information spread in similar ways (Cinelli, Quattrociocchi, Galeazzi et al., 2020) and tweeters with wider networks are less impolite when discussing the disease (Kim, 2020).
Retweeting is an important aspect of the social media information ecology (Alhabash & McAlister, 2015). Retweeting has previously been used to gain insights into public attitudes (e.g., Dare-Edwards, 2014;Gabarron, Makhlysheva, & Marco, 2015;McNeil, Brna, & Gordon, 2012) or social movements, as evidence of the effectiveness of official information dissemination strategies (e.g., for Hurricane Sandy: Wang & Zhuang, 2017), or as evidence of the importance of the retweeted content (e.g., Hermida, 2013;Starbird & Palen, 2012;David, Ong, & Legara, 2016). During the Japanese earthquake of 2012, tweets from people in the affected area were retweeted by those outside to share first-hand information quickly (Miyabe, Miura, & Aramaki, 2012). This illustrates that tweets from citizens (rather than politicians, experts, or celebrities) can reach large audiences during crises, especially when they have first-hand accounts or information to share.
Studies of political retweeting give some insights into factors influencing success. Official sources are not always the most successful (Sanjari & Khazraee, 2014;Segesten, & Bossetta, 2017), there may be geopolitical differences in the types of tweets that are most retweeted, humour seems to drive much retweeting (Driscoll, Ananny, Bar, et al., 2013) and bots can be problematic (Stewart, Arif, & Starbird, 2018). In normal times, a tweet is more likely to be retweeted if it contains a URL or hashtag, and if the tweeter has many followers and follows many people (Suh, Hong, Pirolli, & Chi, 2010). This article investigates highly retweeted tweets during March 2020 about COVID-19 for insights into public reactions to the pandemic and the role of Twitter in information spreading and consensus building. As the above brief review suggests, there is no expected type of tweet that may become highly retweeted, but the set is likely to include citizen tweets.

Public health campaigns
The informational component of the COVID-19 reaction has centred on public information campaigns in a health context. For a public health campaign to be successful, the message must be seen and acted upon. Between these two stages, recipients usually need to understand the message, believe that it applies to them and will benefit them or their community, have the will to carry out the necessary actions, and then translate this will into action. A break in any of these stages is likely to lead to an initiative failing (e.g., Passmore, Williams-Parry, Casper, & Thomas, 2017). The situation for COVID-19 has been different in that behaviour change is mandated by government, but it still relies on the public understanding the message and carrying it out effectively.

Global epidemics
Previous studies of health promotion strategies for global epidemics have few insights that would help an analysis of public reactions to COVID-19, and so are only discussed briefly here. For example, the Spanish flu pandemic of 1918-19 was addressed with social distancing measures (Caley, Philp, & McCracken, 2008;McCracken & Curson 2003) but communication measures used then may have little relevance today.
The SARS (severe acute respiratory syndrome) coronavirus epidemic of 2003 was contained primarily through finding infected patients, tracing their contacts and isolating them to reduce the transmission rate, although social distancing and mask wearing were also used (Bell, 2004;James, Shindo, Cutter, Ma, & Chew, 2006). The social distancing measures included school closures and cancelling mass events. The relatively rapid containment of the disease meant that it was not politicised in the news (Lewison, 2008). The role of social media has been examined for SARS from the perspective of health organisations disseminating their messages (Guidry, Jin, Orr, Messner, & Meganck, 2017), but this is not directly relevant here because it does not give insights into issues that resonated with the public. For Ebola, an analysis of retweeting found that tweets typically had little depth for retweeting, with 91% of retweets being from the original tweet (Liang, Fung, Tse, et al., 2019). Thus, prior research has little relevance for the current study.

Smoking bans
Knowledge from previous health promotion interventions and research can inform responses to COVID-19 (Van den Broucke, 2020). In particular, national strategies to reduce secondhand exposure to tobacco smoke provide a good starting point than global epidemic research for the current study. Like COVID-19 Reponses, they involve legal enforcement but need widespread partly voluntary compliance to be effective. These strategies have been extensively and systematically researched, providing detailed insights into the factors associated with success or compliance. In particular, a recent international qualitative systematic review found seven themes in studies of the barriers to effective implementation of smoke-free homes (Passey, Longman, Robinson, Wiggers, & Jones, 2016), which form a useful benchmark for the current study. Smoking-related issues most relevant to pandemics are highlighted below.
• Knowledge, awareness and risk perception: This includes risk denials, differing perceptions of acceptable risk levels, and differing engagement with the need to protect others' health. • Agency and personal skills/attributes: The environmental constraint of the need to share living space affected household policies. • Wider community norms and personal moral responsibilities: This includes the extent to which community responsibility is a cultural norm and the extent to which responsible actions are the community norm. • Social relationships and influence of others: Individuals within a family may trigger family-wide discussions about acceptable practices. • Perceived benefits, preferences and priorities: Positive side-effects of enforcing antismoking rules in a household helped to start and maintain them. • Addiction and habit: Habituation was a barrier to behaviour change.
• Practicalities: Inconvenience was a barrier to smoke-free homes unless practical solutions could be found.
These seven themes all seem relevant to COVID-19, except perhaps for addiction and habit.
To illustrate some of the factors: clear information about the harms of second-hand smoke is important for successfully setting up smoke-free homes (Milcarz, Bak-Romaniszyn, & Kaleta, 2017;Stevenson, Campbell, Gould, Robertson, & Clough, 2017); families negotiate around micro-level concerns to agree constraints to limit their children's smoke exposure (Poland, Gastaldo, Pancham, & Ferrence, 2009); and the greater prevalence of smoking amongst lower socio-economic groups in the USA is partly due to fewer being able to live in smoke-free homes (Vijayaraghavan, Benmarnhia, Pierce, et al., 2018).

Interpretation of retweet counts
Social media can help reach a wide audience (Korda & Itani, 2013) and retweeting can be used as an indicator of moderate engagement with a public health campaign (Neiger, Thackeray, Burton, Giraud-Carrier, & Fagen, 2013). The current article analyses tweets that have been retweeted at least 100,000 times, ignoring the presumably low percentage of retweets by bots (since this is not a primarily political topic). There are many reasons why someone might retweet, depending on the nature of the tweet and reliability of the original tweeter and the interests of the tweeter's followers (Engelmann, Kloss, Neuberger, & Brockmann, 2019;Metaxas, Mustafaraj, Wong, Zeng, O'Keefe, & Finn, 2015;Rudat, Buder, & Hesse, 2014). These reasons include at least the following topic-related factors (Boyd, Golder, & Lotan, 2010;Lee, Kim, & Kim, 2015;Metaxas et al., 2015).
• A belief that the information will be interesting, useful or entertaining.
• To persuade others.
• To associate with the message, such as by showing agreement.
• To reward the tweeter for positive content.
• To be a visible part of a conversation.
• To save the tweet for reference.
• In the hope of reciprocal retweets. The mix of reasons for retweeting varies based on the issue concerned and may be counterintuitive. For example, an analysis of Breast Cancer Awareness Month tweets found that the most retweeted were promoting the Month or fundraising rather than educational (Chung, 2017). In contrast, highly retweeted tweets about Hurricane Irma were likely to contain pictures, safety instructions or information (Lachlan, Xu, Hutter, Adam, & Spence, 2019).
There are multiple reasons for using Twitter, including information, socialising and entertainment (Alhabash & McAlister, 2015;Liu, Cheung, & Lee, 2010). There are also multiple corresponding causes of high retweet counts. Nevertheless, each highly retweeted tweet potentially gives an insight into an issue that resonates with the public. For a useful insight, the reason for the tweet must be inferred from its texts and context, which entails a qualitative judgement. Some reasons may be irrelevant or obvious, but others might give new insights. Thus, a multi-stage approach is needed to extract useful meaning from retweets.
1. Collection: Collect a relevant collection of tweets and identify a subset that is highly retweeted. 2. Typology: Make a subjective judgement about the type of information contained or the reason for retweeting in each case. 3. Insights: Match the types/reasons identified for highly retweeted tweets with what is known about the issue and identify those that represent new insights into the issue.
In comparison to typical qualitative research, qualitative retweet analysis is quick for data collection and analysis (because of the lower number of texts). Moreover, there is large sample support for each individual retweet, reducing the risk that findings apply to only a small group, as in typical qualitative case studies. For COVID-19, there are specific sources of bias on Twitter. In the UK, a government team is targeting fake news on social media, such as modifications of its core messages, "GOV.UK CORONAVIRUS ALERT New rules are in force: you must stay at home. More info & exceptions at gov.uk/coronavirus Stay at home. Protect the NHS. Save lives." (BBC, 2020). This message was texted across the UK and tweeted by the UK prime minister as a picture message on March 24 but had been retweeted only three thousand times by 30 March, 2020 1 . From March 16, Twitter had also been removing misleading advice that might have fatal consequences, in consultation with governments and other relevant organisations (Twitter, 2020). Thus, any set of highly retweeted tweets is censored, excluding widely believed but misleading posts. For example, scams, alternative medicine and religious messages advocating unsafe practices or ineffective cures could expect to be taken down.

Methods
Collection: A topical collection of tweets was collected from the Twitter API (Applications Programming Interface) using the free software Mozdeh between 10 and 29 March 2020 with the following queries: coronavirus; COVID-19; COVID19; "corona virus". The first three queries match the term irrespective of whether it is a hashtag. Testing with Twitter online and pilot testing with the API suggested that these would capture a substantial number of relevant tweets.
The queries produced 23,603,317 matching tweets. This set was processed to identify all tweets with a retweet count of at least 100,000, as reported by the API, which were separated for analysis and ranked in descending order. Duplicate tweets (one a truncated version of the other) were deleted, as were tweets originally posted before March 10, 2020.
Typology: Each of the top tweets was located on Twitter.com and read within the site to identify the full tweet (the API truncates long retweets) and check any embedded links or images. Using a thematic analysis approach (Braun & Clarke, 2006), the tweets were tagged with one or more descriptions, then repeatedly clustered and re-classified to generate a set of consistently applied tags reflecting the main purposes of each tweet. This process was conducted independently by both authors, then combining the themes and subthemes to produce a shared final set. This is a qualitative and subjective approach. This coding stage was conducted before the literature review and was not guided by the smoke free homes research, which was unknown to the authors at the time of coding. The second author is an experienced health promotion facilitator, nurse and nurse educator with a wide awareness of health promotion issues. This will have influenced the coding to some extent.
Many tweets involved humour. Although there are many current psychological theories of humour, two prominent ones emphasise the social context of a joke as central to its humour. Reversal theory (Apter, 1989) argues that a joke's context must increase physiological arousal in either positive or negative ways and then diminish it. The seriousness of COVID-19 might be one such context. For example, a joke centring on the threat of the virus would not be funny and therefore not retweeted by people that were not alarmed by COVID-19, so high retweets would be evidence of public perception of COVID-19 as threatening. Similarly, benign violation theory (McGraw & Warren, 2010) argues that humour arises when something is simultaneously threatening and non-threatening. For example, a threat expressed by paraphrasing a song lyric could be funny due to the song lyric playing the non-threatening role. A joke related to COVID-19 being funny therefore implies that an aspect of the joke was perceived to be threatening. Thus, when relevant to COVID-19, jokes were classified according to the underlying message rather than primarily as a joke.
Insights: Insights were identified in three stages. First, each theme and, when necessary, each tweet was evaluated for information relevant to COVID-19 that could be inferred from the high retweet status. This entailed judging the likely common motivation for retweeting. Second, motivations not directly relevant to COVID-19 as a public health issue were discarded (e.g., humour in one case). Third, the remaining motivations were assessed in the context of prior research and assessed for (a) confirming expected patterns or (b) new insights. The insights are reported in the Discussion section.
Ethics: Tweets are not private but are fully in the public domain and therefore do not need ethical approval to research at the University of Wolverhampton, although informed consent is needed before including quotes because these might generate unwanted publicity (Eysenbach & Till, 2001;Golder, Ahmed, Norman, & Booth, 2017;Wilkinson & Thelwall, 2011). In the current study, although all tweets have been seen by at least 100,000 tweeters, some were personal stories about the death of a family member, and many were tweeted by people without many followers. Thus, no exact quotes were included for the tweets and no list of tweets or Twitter IDs is included. Heavily modified pseudo-quotes are included in brackets (rather than quotes) and subheadings to give a flavour of the results, instead.

Results
After merging duplicates, 87 different English-language tweets posted on or after March 10, 2010 and containing coronavirus, COVID-19, COVID19, or "corona virus" had received at least 100,000 retweets by March 29, 2020. Collectively, they accounted for 14 million retweets and probably about twice as many Likes. The themes and subthemes identified are reported below in descending order of the total number of retweets.

Lockdown life: Penguins loose in the Chicago aquarium
Twenty-eight tweets (4.2 million retweets) discussed various aspects of life under selfisolation, lockdown or social distancing rules. Six (1.2m) discussed the situation of toddlers or animals during the lockdown, using cute videos or jokes (a penguin release story was apparently real: Guardian, 2020). Four (0.6m) discussed community-focused lockdown activities, such as community singing or helping people that could not afford to pay rent, one of which was humorous, and one (0.1m) tweeted a humorous picture of innovative solo timewasting. Three (0.3m) discussed what people might do after the lockdown ends (will we be as hygienic?). Two (0.3m) discussed event cancellations with crowds, both with humour. For example, one tweeted that a fictional race had been cancelled, the hyperbole presumably working on the realisation that everything had been cancelled. Three tweets (0.3m) were jokes about the virus dominating all news and conversation (when will we talk about me instead?) and three (0.5m) joked that extreme social distancing measures might be necessary (e.g., dogs fetching shopping).
The remaining tweets discussed different topics: wanting the lockdown to last at least two months (0.2m), fear of panic buying (033m), joking that some people were getting their core information from friends (0.1m), missing friends (0.1m, cute video), fear of testing joke (0.1m), and a tasteless joke about old people dying (0.1m, from March 12).

Attitude: COVID-19 jokes are funny but I'm still frightened
Eighteen tweets (2.6 million retweets) primarily expressed an attitude towards the COVID-19 pandemic restrictions. Eight tweets (1.2m) emphasised the threat or seriousness of the pandemic, all in the form of jokes or humour (e.g., a graphic of a city with a wall around it proposed as a solution). In contrast, three tweets (0.4m), one in the form of a joke, inferred dissent about the need for social distancing (e.g., I won't let it stop me going on holiday because COVID-19 is in every country). Between these two, five tweets expressed hope about personal protection (2 tweets, 0.4m), both jokes (e.g., the drugs already in my system will beat it), or for an end of pandemic (3 tweets, 0.3m), one joke (K-pop fans will cure it if it infects their idol), and one religious (e.g., I believe Jesus will end it soon). Finally, two tweets (0.3m) expressed dismay at the lockdown restrictions (e.g., all my plans are cancelled).
Partly conflicting opinions were expressed on Twitter but the apparently dominant attitude of fear was primarily expressed through humour, whereas the opposite was mainly expressed seriously. More sceptical tweets tended to be early (March 10-14), although the same was true for the threat tweets (exception: March 18). One of the dissent tweets had been removed at the time of testing, perhaps by the owner receiving negative feedback or as a Twitter.com safety action.

Political: Katie Porter wins free coronavirus testing
Fifteen tweets (2.2 million retweets) discussed political issues, primarily focusing on the USA, and none containing humour. Five tweets (0.9m) praised or criticised politicians' actions, two accusing President Trump of mismanagement, two praising or announcing Representative Katie Porter getting a free coronavirus testing promise from the US administration, and one attacking Senator Richard Burr for putting profits first. Five tweets (0.7m) attacked (mainly US) government policy (before the outbreak) about healthcare, human rights, and spending, based on COVID-19-related events. Three tweets (0.4m) accused business of greed or dishonesty before the virus (not allowing workers to stay at home) or during it (putting profits before lives). Two other political tweets praised Cuba for helping Italy or accused people of racism for calling COVID-19 a Chinese virus.

Safety messages: Stupid will kill us
Eleven tweets (1.9 million retweets) gave safety information, such as the need for social distancing or obeying government lockdown rules. Eight (1.3m) were straightforward and relatively serious exhortations to follow social distancing guidelines. These tweets did not include or explain the guidelines but attempted to persuade that they were important (if you childishly don't follow instructions, we'll all suffer). An additional three (0.6m) embedded specific social distancing advice in humour in the form of a comic video message (featuring Mel Brooks) and two song lyrics rewritten for social distancing advice (Queen's Bohemian Rhapsody; Dua Lipa's Don't Start Now). These did not give comprehensive social distancing instructions but implicitly or explicitly highlighted the need for it, as well as mentioning its nature.

People with COVID-19: It was like this for me
Eight tweets (1.5 million retweets) discussed individuals who had caught the disease. Three reported celebrities testing positive (0.6m), two as personal announcements (Boris Johnson, Idris Elba), and one in the form of a joke. Three further tweets reported in detail (Twitter threads) the experience of COVID-19 symptoms for the tweeter, who had just recovered (0.6m). Two (0.3m) reported the impact of a COVID-19 death (of a parent) on the tweeter, combining it with an exhortation to follow social distancing rules.
Support key workers: Nurses, doctors, cleaners, shopworkers are the vital people Four tweets (0.5 million retweets) were messages of support for all key workers during the crisis (two tweets, 0.3m) or messages of support for medics (2 tweets, 0.2m). These seemed to be partly expressing appreciation and partly making a political point (not bankers or traders, it's the nurses and cleaners that are saving us).

Work: Meetings by email
Three of the most retweeted tweets (0.5 million retweets) discussed separate work-related issues: the discovery that meetings can take place by email (0.2m), an ineffective workplace preventative measure against COVID-19 (0.1m, possibly a joke) and a criticism of social media influencers that were shaming people for working despite the restrictions, since they might need the money to live (0.1m).

COVID-19: Daily symptoms
Only two of the most retweeted tweets (0.3 million retweets) focused on the virus. One described the symptoms day by day with an animation showing the impact of the virus on the body (0.3m) and the other was a news story about a fast COVID-19 test (a genuine news story but false). There seemed to be relatively little interest in the virus itself or medical news about it.

Discussion
In addition to the limitations discussed above, this study focuses on information rather than behaviour. It is possible, for example, that people widely retweet public safety information and then ignore it. This seems unlikely, however, and one previous study of Zika virus concerns has shown a connection between public attitudes and the volume of tweets about Zika (Farhadloo, Winneg, Chan, Jamieson, & Albarracin, 2018), supporting the claim that Twitter can influence public health behaviour. The study is also limited in its focus on highly retweeted tweets. Other issues may well have been more extensively discussed on Twitter than some reported below but lacking individual highly retweeted tweets. The analysis also makes inferences about the purpose or impact of the tweets, which may not be correct. In particular, memetic qualities of jokes may have been missed, with the resulting associations changing their meaning (Shifman, Levy, & Thelwall, 2014).
In terms of cross-cutting themes, the prominence of joke tweets reflects the common use of Twitter for entertainment (Alhabash & McAlister, 2015;Liu et al., 2010). Humour almost always accompanied a COVID-19 message, although it is difficult to judge whether the message played a subordinate role in the retweeting. Humour seems likely to boost the audience of a tweet by making it more likely to be shared, however. Other cross-cutting themes include human interest stories and political points (including outside the politics theme). Politics is a known international use for Twitter (Ozturkcan, Kasap, Cevik, & Zaman, 2017).

Lockdown life
The 4.2 million retweets about quarantine, lockdown or social distancing rules reflect a rapid and substantial change in daily lives. The jokes and humorous videos may help people to come to terms with changes in their lives. Presumably the changes resulted in many sources of uncertainty and stress, which humour could partially alleviate, at least in the short term (Martin & Ford, 2018). The absence of tweets about real sports cancellations, in contrast to an earlier study of typical tweets (Thelwall & Thelwall, 2020), suggests that mass cancellations were more important than individual events.

Attitude
It is unsurprising that 2.6 million retweets expressed an attitude towards the COVID-19 restrictions, given their substantial negative impact on many lives. The tweets reveal substantial support for different opinions. Although accepting the issue as a serious threat was the dominant attitude (also evident in the safety message retweeting), this was only conveyed with humour. It is possible that those taking the outbreak most seriously tended to retweet a more proactive tweet, such as a safety message Popular tweets expressing dissent confirm that the population was divided about the issue and that initial government safety messages were not universally persuasive. As a practical implication, tracking Twitter might help governments to assess the level of credibility of their public health messages, as they presumably already do, in order to target advertising or campaign messages.

Political
The 2.2 million retweets focusing on political issues were all anti-establishment in the sense of being critical of the current national government. This might reflect the demographics of Twitter users rather than broader society, however. It seems likely that it is more used as an alternative news or politics channel by people that disagree with the mainstream media, for example. These tweets might play the important democratic function of holding the government to account and creating pressure on the government to carry out specific actions, or keep to its promises (e.g., on free testing in the USA). Political discussions on Twitter seem to mainly occur between likeminded people rather than being deliberations towards a consensus (Lorentzen, 2016). Thus, the highly retweeted tweets should not be interpreted as consensus opinions.

Safety messages
The 1.9 million retweets for non-official messages offering direct exhortation or indirect encouragement to follow safety rules represent a substantial free resource to spread information about social restrictions and, perhaps more importantly, to create community support for following them. The latter may be more important in the US and UK, for example, with the safety advice having been given by politicians (Trump, Johnson) that are distrusted by at least a substantial minority of the population. This support presumably helped to build compliance with the otherwise draconian measures. Support message seem likely to have been most effective when the message was purely serious since there would be little possibility to misinterpret it as entertainment.
The humour-related messages also reached a wide audience and their role may have been more informational for the reasons above. Celebrity endorsements (e.g., Mel Brooks) may well allow them to contain a persuasive element, through parasocial connections, respect or shared community membership. Humorous messages may also reach a different audience, those using Twitter primarily for entertainment rather than other purposes, such as news.
As a caveat, retweeting a safety message does not necessarily mean that the retweeter followed the advice or that their friends were persuaded by it. Moreover, even if someone felt persuaded then this would not necessarily transfer into behaviour changes (Cugelman, Thelwall, & Dawes, 2011). Thus, overall, safety messages were widely shared informally on Twitter, reaching a large audience quickly with a personal connection, and retweeting serious and celebrity-endorsed humorous messages seems likely to have helped build community-wide support for compliance.

People with COVID-19
The 1.5 million retweets about individuals who had caught the disease represent substantial human interest, perhaps partly due to concern for the celebrities testing positive and partly due to fear of the disease, leading to a desire for information and reassurance about the symptoms. Detailed reports of survivor experiences seem likely to have been reassuring to those who might become infected, and informational to help them self-diagnose. Together with the reports of individual family member deaths, they seem likely to have served as safety messages, illustrating that anyone can be infected. The detailed experience reports included careful disclaimers that other people's experiences, symptoms and prognoses might be different. Thus, the personal stories seem to have been useful additions to the information ecology for COVID-19 for safety messages and public health information.

Support key workers
The 0.5 million retweeted messages of support for all key workers or health professionals echoed public displays of gratitude in many countries (e.g., clapping on a pre-defined day and time). Both presumably helped to boost the morale of key workers (often low paid) performing critical and dangerous jobs.

Work: Meetings by email
The 0.5 million retweets for work-related issues reflect the conflict created by the tension between needing to work (as an employee or employer) and public safety. They seem to highlight the lack of clear guidelines for who should work and how at some stages of the pandemic. There were no highly retweeted tweets with work-advice or working from home stories, although some lockdown life stories may apply to people working from home.

COVID-19
There seemed to be relatively little interest in detailed technical information about COVID-19 or testing technology (0.3 million retweets). It is surprising that stories by individuals were less retweeted than detailed explanations of the full range of symptoms that could be experienced, which seems to be more useful information. This is a tentative conclusion, since the detailed technical information might have been shared in an earlier tweet or in multiple similar tweets, each with lower retweet counts. It seems more likely, however, that people needing detailed information would seek it in official government websites rather than social media.
Comparison with smoke-free environment research As argued above, smoke-free environment research forms an appropriate benchmark to compare the results with. The following compares the main themes from this area (Passey, Longman, Robinson, Wiggers, & Jones, 2016) with the main themes above.
• Knowledge, awareness and risk perception: Represented in safety messages, individuals with COVID-19, and COVID-19 tweets. • Agency and personal skills/attributes: Partly represented in the attitude theme.
• Wider community norms and personal moral responsibilities: Represented in the support for key workers to some extent. • Social relationships and influence of others: Partly represented by the attitude theme.
• Perceived benefits, preferences and priorities: Not directly represented.
• Addiction and habit: Not directly represented, but minor relevance to COVID-19.
• Practicalities: Meetings by email represent this to some extent. The political theme does not fit well into the above set, emphasising its relative importance for COVID-19 compared to other health campaigns, despite most seeming to have a political dimension. Although anti-smoking campaigns had a political dimension, politics seems to be more important for COVID-19.
The first issue above seems to be the most comprehensively covered by highly retweeted tweets. The remaining issues are only indirectly covered. For example, there are many known issues about the practicalities of COVID-19 lockdowns, such as domestic abuse risks, methods to deal with shared parenting for families living apart, households with vulnerable people but one member potentially exposed to COVID-19 at work, and the need for carers to protect the vulnerable, especially for those with multiple carers. Thus, issues that are of widespread relevance at a general level but are individualised in nature may not be found by retweet analysis. The omission of issues like this emphasises that analysing retweet counts will give little insights into many important issues, a methodological limitation with the emphasis on highly retweeted articles.

Conclusions
For people following COVID-19 on Twitter, the themes found may not be surprising, but the thematic analysis here adds structure and creates a long-term record of high profile initial COVID-19 reactions in English in this important social media site. The results suggest that Twitter made a positive impact on COVID-19 in terms of sharing information, encouraging support for social distancing guidelines and helping people to cope emotionally with the changes. The results also suggest that more fundamental political conclusions were being drawn from government reactions, or that government opponents found many reasons to believe that their criticisms were vindicated or highlighted by COVID-19. It also seems possible from the support for tweets opposing government restrictions that a lack of trust in governments in some or all English-speaking nations contributed to people ignoring social distancing restrictions, especially in the early stages of the pandemic. From a methodological perspective, a comparison of the themes found with a typology of issues known to be important for generating smoke-free homes found many gaps. Retweet analysis therefore seems likely to generate insights to a limited extent, systematically overlooking some types of issue, and particularly those with localised or individualised relevance. Thus, the relatively fast nature of retweet analysis should not be exploited at the expense of other methods.
Some suggestions for pandemic public information campaigns can be made, based on the above. These are evidence-based suggestions, in the sense of being derived from data, but are not proven or evidence-based conclusions because the data includes no ties to behaviour. Thus, the suggestions are insights for consideration by experts and, if possible, for more systematic evaluation with different methods in future research.
• Twitter, and other social media, should be considered in government information strategies since they can reach millions (at least). Arguably the most effective messages were serious tweets from citizens (rather than politicians) in support of the restrictions. Celebrity humorous support messages could also be effective. Future campaigns might consider how it is possible to ensure that such messages might spread early, such as by encouraging frontline health workers to report their experiences (if this did not already happen). Unofficial messages seemed to be more retweeted than official messages, although more people may have seen official messages. • The presence of some widely retweeted messages undermining social distancing restrictions might be used as an indicator that they are not fully effective. Moreover, perhaps (if ethical) Twitter might consider targeting retweeters of these with additional encouragement to comply or encouraging people to persuade friends that disagree. This is in addition to Twitter banning misleading information. • Twitter does not seem to be effective for spreading factual information about viruses, so campaigns to do this should focus elsewhere, or develop different Twitter-based strategies. • Given the likely substantial psychological impact of the lockdown restrictions, social media might be recommended by health professionals as a way for people to partly overcome social isolation and, through humour, cope psychologically with their new situation.