An Outbreak of Appreciation: A discursive analysis of tweets of gratitude expressed to the National Health Service at the outset of the COVID-19 pandemic

Giskin Day*, Glenn Robert, Kathleen Leedham-Green, Anne Marie Rafferty

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)
86 Downloads (Pure)


Background: The early stages of the coronavirus disease 2019 pandemic prompted unprecedented displays of gratitude to healthcare workers. In the United Kingdom, gratitude was a hotly debated topic in public discourse, catalysing compelling displays of civic togetherness but also attracting criticism for being an unhelpful distraction that authorized unrealistic expectations of healthcare workers. Expressions of thanks tend to be neglected as drivers of transformation, and yet, they are important indicators of qualities to which people attach significance. Objective: This study aimed to use discursive analysis to explore how the National Health Service (NHS) was constructed in attention-attracting tweets that expressed and/or discussed gratitude to the NHS. Methods: Having determined that Twitter was the most active site for traffic relating to gratitude and the NHS, we established a corpus of 834 most-liked tweets, purposively sampled from Twitter searches on a day-by-day basis over the period of the first lockdown in the United Kingdom (22 March–28 May 2020). We developed a typology for tweets engaging with gratitude as well as analysing what the NHS was thanked for. Results: Our analysis, informed by a discursive psychology approach, found that the meanings attributed to gratitude were highly mobile and there were distinct patterns of activity. The NHS was predominantly—and sometimes idealistically—thanked for working, effort, saving and caring. Displays of gratitude were seen as incommensurable with failures of responsibility. The clap-for-carers campaign was a potent driver of affect, especially in the early parts of the lockdown. Conclusions: The social value of gratitude is implicated in the re-evaluation of the risks and rewards of healthcare and social care work in the wake of the pandemic. We caution against cynicism about gratitude overshadowing the well-being effects that expressing and receiving gratitude can engender, particularly given concerns over the detrimental effects of the pandemic on mental health. Public Contribution: This study involves the analysis of data provided by the public and published on social media.

Original languageEnglish
Number of pages14
JournalHealth expectations : an international journal of public participation in health care and health policy
Early online date21 Sept 2021
Publication statusPublished - Sept 2021


  • COVID‐19
  • Twitter
  • Discursive psychology
  • Gratitude
  • NHS


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