Health Information in the Era of Social Media: An Analysis of the Nature and Accuracy of Posts Made by Public Facebook Pages for Patients with Endometriosis

Quality and Misinformation About Health Conditions in Online Peer Support Groups: Scoping Review

BACKGROUND

The use of health-related online peer support groups to support self-management of health issues has become increasingly popular. The quality of information and advice may have important implications for public health and for the utility of such groups. There is some evidence of variable quality of web-based health information, but the extent to which misinformation is a problem in online peer support groups is unclear.

OBJECTIVE

We aimed to gain insight into the quality of information and advice about health conditions in online peer support groups and to review the tools available for assessing the quality of such information.

METHODS

A scoping review was undertaken following the Joanna Briggs Institute scoping review methodology. We searched electronic databases (MEDLINE [Ovid], CINAHL, Web of Science, ASSIA, ProQuest Dissertation and Theses, and Google Scholar) for literature published before November 2023, as well as citations of included articles. Primary research studies, reviews, and gray literature that explored the quality of information and advice in online peer support groups were included. Title and abstracts were independently screened by 2 reviewers. Data were extracted and tabulated, and key findings were summarized narratively.

RESULTS

A total of 14 (0.45%) relevant articles, from 3136 articles identified, were included. Of these, 10 (71%) were primary research articles comprising diverse quality appraisal methodologies, and 4 (29%) were review articles. All articles had been published between 2014 and 2023. Across the literature, there was more evidence of poor quality information and misinformation than of good quality information and advice, particularly around long-term and life-threatening conditions. There were varying degrees of misinformation about non-life-threatening conditions and about mental health conditions. Misinformation about noncommunicable diseases was reported as particularly prevalent on Facebook. Fellow online peer support group users often played an active role in correcting misinformation by replying to false claims or providing correct information in subsequent posts. Quality appraisal tools were reported as being used by researchers and health care professionals in appraising the quality of information and advice, including established tools for the appraisal of health-related information (eg, DISCERN, HONcode criteria, and Journal of the American Medical Association benchmark criteria). No tools reported were specifically designed to appraise online peer support group content.

CONCLUSIONS

While there is good quality information and advice exchanged between users in online peer support groups, our findings show that misinformation is a problem, which is a matter of public health concern. Confidence in the quality of information shared may determine the utility of online peer support groups for patients and health care professionals. Our review suggests that clinical and academic experts in health conditions could play a valuable role in ensuring the quality of content. Several quality appraisal tools are available to support such an initiative.

Impact of social media on patient expectations and decision-making in gynecology

PURPOSE OF REVIEW

Social media has transformed how patients access and interpret gynecological health information, significantly influencing their expectations and medical decision-making. This comprehensive review examines how social media impacts patients' understanding of diagnoses, pursuit of treatment options, and interactions with healthcare providers. The increasing reliance on online content presents challenges, particularly when patients prioritize social media content over evidence-based recommendations. Given the rapid evolution of digital platforms, it is essential to understand the current trends and their impact on clinical practice.

RECENT FINDINGS

Recent studies demonstrate that while social media offers unprecedented access to health information and community support, it simultaneously propagates misinformation that can adversely affect clinical encounters. Patients frequently turn to platforms such as TikTok, Instagram, X (formerly Twitter), and YouTube for gynecologic health information, though much of this content is anecdotal and lacks scientific validity. Research shows that while these platforms offer a wealth of information, the quality of this information is inconsistent, often leading to misconceptions about medical conditions and treatments. Healthcare providers face the dual challenge of addressing misconceptions while leveraging these platforms to enhance patient education and shared decision-making.

SUMMARY

Understanding the influence of social media can help improve the accuracy of online health information and reduce stigma and social barriers surrounding gynecologic issues. Strengthening digital literacy and integrating reliable online resources into clinical practice can enhance patient education and promote informed decision-making in gynecology and gynecologic surgery.

Endometriosis Communities on Reddit: Quantitative Analysis

BACKGROUND

Endometriosis is a chronic condition that affects 10% of the people with a uterus. Due to the complex social and psychological impacts caused by this condition, people with endometriosis often turn to online health communities (OHCs) for support.

OBJECTIVE

Prior work identifies a lack of large-scale analyses of the experiences of patients with endometriosis and of OHCs. This study aims to fill this gap by investigating aspects of the condition and aggregate user needs that emerge from 2 endometriosis OHCs, r/Endo and r/endometriosis.

METHODS

We used latent Dirichlet allocation topic modeling, an unsupervised machine learning method, to extract the subject matter ("topic") of >30,000 posts and >300,000 comments. In addition to latent Dirichlet allocation, we leveraged supervised classification. Specifically, we fine-tuned a series of the DistilBERT models to identify the people and relationships (personas) a post mentions as well as the type of support that the post seeks (intent). Combining the results of these 2 methods, we identified associations between a post's topic, the personas mentioned, and the post's intent.

RESULTS

The most discussed topics in posts were medical stories, medical appointments, sharing symptoms, menstruation, and empathy. Through the combination of the results from topic modeling and supervised classification, we found that when discussing medical appointments, users were more likely to mention the endometriosis OHCs than medical professionals. Medical professional was the least likely of any persona to be associated with empathy. Posts that mentioned partner or family were likely to discuss topics from the life issues category, particularly fertility. Users sought experiential knowledge regarding treatments and health care processes, and they also wished to vent and establish emotional connections about the life-altering aspects of the condition.

CONCLUSIONS

We conclude that members of the OHCs need greater empathy within clinical settings, easier access to appointments, more information on care pathways, and more support for their loved ones. Endometriosis OHCs currently fulfill some of these needs as they provide members with a space where they can receive validation, discuss care pathways, and learn to manage symptoms. This study demonstrates the value of quantitative analyses of OHCs. Computational analyses can support and extend findings from small-scale studies about patient experiences and provide insights into hard-to-reach groups. Finally, we provide recommendations for clinical practice and medical training programs.

Endometriosis Influencers on Instagram: Who are They and What are They Posting?

STUDY OBJECTIVE

To examine endometriosis-related content on Instagram, a platform increasingly used for health communication, to understand: 1) the identity of Instagram content creators; 2) themes, tones, and emotions evoked from posts; and 3) accuracy of educational information. The relevance of this study lies in its potential to inform healthcare providers on how to better engage with social media to support individuals with endometriosis.

DESIGN

This mixed methods cross-sectional observational study was performed on June 6, 2021. Instagram content was collected via two approaches: 1) searching hashtags related to endometriosis from a list of 30 hashtags and analyzing the top 20 and 10 most recent posts and 2) searching endometriosis-related terms under accounts to examine the first 30 accounts retrieved. Posts were categorized into themes and evaluated for tone and emotion, with educational posts also evaluated for accuracy.

SETTING

Publicly available data on Instagram.

PARTICIPANTS

None.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The study analyzed 768 Instagram posts and 228 accounts. Of these, 59.9% of posts and 92.1% of accounts contained endometriosis-related content. Most posts (55.4%) and accounts (59.0%) were authored by people with endometriosis. Accounts owned by people with endometriosis were significantly more active and had more followers compared to those who identified as healthcare providers (mean difference of total # of posts = 714.4, p < .001, mean difference of total # of followers = 27,194.7, p < .001, respectively). Social support was the most common theme (67.2%). Many posts had a negative tone (43.7%) and evoked sadness (57.6%). Objective educational posts contained 85.0% accurate information. Allied healthcare providers were most likely to post accurate educational information compared to all other content creators (p < .001).

CONCLUSION

Instagram is widely used by people with endometriosis, with posts predominantly centered around social support and personal narratives. Healthcare providers can use this information better understand the experiences of people with endometriosis, and to engage more effectively on Instagram.

Informational support for women with endometriosis: a scoping review

BACKGROUND

Ten per cent of women of reproductive age suffer from endometriosis, a painful and incurable disease that leaves women with severe implications for their health and overall well-being. Due to the absence of a cure and the limited effectiveness of available treatments, acquiring accurate information is paramount for women to successfully navigate both their daily lives and the complexities of the healthcare system. This scoping review aimed to map the current literature on women with endometriosis information needs, their information seeking behaviour, and the format and scope of current information resources available.

METHODS

The scoping review was conducted using the JBI methodology for scoping reviews and reported according to the PRISMA-ScR statement. The final search was conducted in August 2024, through the databases Medline, Cinahl, Embase, Scopus, and WebofScience. Studies on information resources on endometriosis and information seeking behaviour as well as information needs of women with endometriosis were eligible for inclusion.

RESULTS

The majority of the 25 included studies focused on information resources, specifically webpages and social media sites. While few studies analysed information seeking behaviour and information needs, the evidence shows women's high interest in a broad spectrum of information topics. Across all studies, the internet was the most important access point for information.

CONCLUSION

Addressing the absence of systematic analyses on the information seeking behaviour and needs of women with endometriosis is crucial for future research. This step is essential for the development of customised information resources that cater specifically to the diverse needs of women affected by endometriosis.

Social media activism and women's health: Endometriosis awareness and support

Objective

While endometriosis is estimated to affect 1 in 10 women globally, awareness of the disease as well as research and funding to fight the disease remains lacking as compared with other chronic diseases. This study examines how social media users utilized Instagram to raise awareness of and mobilize activism around endometriosis by analyzing prominent topics, word associations, and feminism themes in endometriosis-tagged posts on Instagram.

Methods

We used a mixed-method approach of combining computational analyses (topic modeling and word association) and human coding (qualitative thematic analysis) of Instagram posts on endometriosis.

Results

Our results show that while Instagram users discussed a variety of issues related to the disease on the social media platform, these issues tend to focus on four topic areas: (i) living with endometriosis, (ii) pregnancy and endometriosis, (iii) awareness and empowerment, and (iv) women's health and wellbeing. In addition, social media users widely incorporated three feminism themes: (i) bringing attention to invisible disability, (ii) solidarity and support among women, and (iii) advocacy and activism around women's health.

Conclusion

People with endometriosis use Instagram to create an online public sphere for raising awareness of the disease, offering networking and support to other endometriosis patients, and creating a movement for enhancing women's health and wellness. In doing so, they are also addressing sexism and misconceptions about endometriosis that have traditionally contributed to normalizing women's experience of pain associated with endometriosis and consequently delaying endometriosis diagnoses.

Understanding AI's Role in Endometriosis Patient Education and Evaluating Its Information and Accuracy: Systematic Review

BACKGROUND

Endometriosis is a chronic gynecological condition that affects a significant portion of women of reproductive age, leading to debilitating symptoms such as chronic pelvic pain and infertility. Despite advancements in diagnosis and management, patient education remains a critical challenge. With the rapid growth of digital platforms, artificial intelligence (AI) has emerged as a potential tool to enhance patient education and access to information.

OBJECTIVE

This systematic review aims to explore the role of AI in facilitating education and improving information accessibility for individuals with endometriosis.

METHODS

This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to ensure rigorous and transparent reporting. We conducted a comprehensive search of PubMed; Embase; the Regional Online Information System for Scientific Journals of Latin America, the Caribbean, Spain and Portugal (LATINDEX); Latin American and Caribbean Literature in Health Sciences (LILACS); Institute of Electrical and Electronics Engineers (IEEE) Xplore, and the Cochrane Central Register of Controlled Trials using the terms "endometriosis" and "artificial intelligence." Studies were selected based on their focus on AI applications in patient education or information dissemination regarding endometriosis. We included studies that evaluated AI-driven tools for assessing patient knowledge and addressed frequently asked questions related to endometriosis. Data extraction and quality assessment were conducted independently by 2 authors, with discrepancies resolved through consensus.

RESULTS

Out of 400 initial search results, 11 studies met the inclusion criteria and were fully reviewed. We ultimately included 3 studies, 1 of which was an abstract. The studies examined the use of AI models, such as ChatGPT (OpenAI), machine learning, and natural language processing, in providing educational resources and answering common questions about endometriosis. The findings indicated that AI tools, particularly large language models, offer accurate responses to frequently asked questions with varying degrees of sufficiency across different categories. AI's integration with social media platforms also highlights its potential to identify patients' needs and enhance information dissemination.

CONCLUSIONS

AI holds promise in advancing patient education and information access for endometriosis, providing accurate and comprehensive answers to common queries, and facilitating a better understanding of the condition. However, challenges remain in ensuring ethical use, equitable access, and maintaining accuracy across diverse patient populations. Future research should focus on developing standardized approaches for evaluating AI's impact on patient education and exploring its integration into clinical practice to enhance support for individuals with endometriosis.

Analysis of Participant Stigma and Associated Costs of a Peer-Led Social Media HIV Intervention

HIV-related stigma is a primary barrier to seeking HIV care. Online social media interventions utilizing peer-led approaches provide an opportunity to revolutionize HIV health behavior change. Secondary analysis of the UCLA HOPE Study (6 waves) was done to examine the effectiveness of an online peer-led intervention in reducing HIV-related internalized stigma (IS), association between IS and sexual risk behaviors (SRB), and associated costs for changing the likelihood of HIV testing. Among 897 participants, an inverse relationship between IS (Discomfort with people with HIV, Stereotypes, Moral Judgment) and SRB (Number of Sexual Partners, Sexual Encounters) factors was identified over time (p < .05). Engagement in stigma conversations increased participant likelihood to request HIV tests (B = 0.02, Wald = 8.10, p = .004) when made in group versus one-on-one contact. Innovative technology has potential to improve HIV-care efforts through expanded reach to at-risk populations, improved communication maintenance, ease of accessibility, and user anonymity.

Social Media, Endometriosis, and Evidence-Based Information: An Analysis of Instagram Content

Social media platforms are used for support and as resources by people from the endometriosis community who are seeking advice about diagnosis, education, and disease management. However, little is known about the scientific accuracy of information circulated on Instagram about the disease. To fill this gap, this study analysed the evidence-based nature of content on Instagram about endometriosis. A total of 515 Instagram posts published between February 2022 and April 2022 were gathered and analysed using a content analysis method, resulting in sixteen main content categories, including "educational", which comprised eleven subcategories. Claims within educational posts were further analysed for their evidence-based accuracy, guided by a process which included fact-checking all claims against the current scientific evidence and research. Of the eleven educational subcategories, only four categories (cure, scientific article, symptoms, and fertility) comprised claims that were at least 50% or greater evidence-based. More commonly, claims comprised varying degrees of evidence-based, mixed, and non-evidence-based information, and some categories, such as surgery, were dominated by non-evidence-based information about the disease. This is concerning as social media can impact real-life decision-making and management for individuals with endometriosis. Therefore, this study suggests that health communicators, clinicians, scientists, educators, and community groups trying to engage with the endometriosis online community need to be aware of social media discourses about endometriosis, while also ensuring that accurate and translatable information is provided.

Communication is key: at-risk families' perspectives on follow-up in New Jersey's early hearing detection and intervention program

Babies whose families possess multiple marginalized identities are at-risk for being late or lost to follow-up although there is a universal effort to screen and treat hearing loss in babies as part of state Early Hearing Detection and Intervention (EHDI) programs. Lack of timely follow-up puts young children at risk for delays in language acquisition, social skills, cognitive development, and school success. This qualitative study explored barriers to follow-up audiological care in at-risk families in New Jersey. Using thematic analysis, this research uncovered two major findings: 1) communication normalizes failed screenings, and 2) parents need clearer and more in-depth information. Health care social workers are well-suited to address these challenges due to their training in integrated social work practice, which can help them understand the complex interplay between individuals and their environments. In doing so social workers can improve access to needed services and promote health equity.

Users' Concerns About Endometriosis on Social Media: Sentiment Analysis and Topic Modeling Study

BACKGROUND

Endometriosis is a debilitating and difficult-to-diagnose gynecological disease. Owing to limited information and awareness, women often rely on social media platforms as a support system to engage in discussions regarding their disease-related concerns.

OBJECTIVE

This study aimed to apply computational techniques to social media posts to identify discussion topics about endometriosis and to identify themes that require more attention from health care professionals and researchers. We also aimed to explore whether, amid the challenging nature of the disease, there are themes within the endometriosis community that gather posts with positive sentiments.

METHODS

We retrospectively extracted posts from the subreddits r/Endo and r/endometriosis from January 2011 to April 2022. We analyzed 45,693 Reddit posts using sentiment analysis and topic modeling-based methods in machine learning.

RESULTS

Since 2011, the number of posts and comments has increased steadily. The posts were categorized into 11 categories, and the highest number of posts were related to either asking for information (Question); sharing the experiences (Rant/Vent); or diagnosing and treating endometriosis, especially surgery (Surgery related). Sentiment analysis revealed that 92.09% (42,077/45,693) of posts were associated with negative sentiments, only 2.3% (1053/45,693) expressed positive feelings, and there were no categories with more positive than negative posts. Topic modeling revealed 27 major topics, and the most popular topics were Surgery, Questions/Advice, Diagnosis, and Pain. The Survey/Research topic, which brought together most research-related posts, was the last in terms of posts.

CONCLUSIONS

Our study shows that posts on social media platforms can provide insights into the concerns of women with endometriosis symptoms. The analysis of the posts confirmed that women with endometriosis have to face negative emotions and pain daily. The large number of posts related to asking questions shows that women do not receive sufficient information from physicians and need community support to cope with the disease. Health care professionals should pay more attention to the symptoms and diagnosis of endometriosis, discuss these topics with patients to reduce their dissatisfaction with doctors, and contribute more to the overall well-being of women with endometriosis. Researchers should also become more involved in social media and share new science-based knowledge regarding endometriosis.

Informational Preferences of Women Seeking Treatment for Symptomatic Uterine Fibroids: A Qualitative Study

STUDY OBJECTIVE

To establish the informational needs and preferences of women navigating treatment options for symptomatic uterine fibroids.

DESIGN

Qualitative study using semistructured interviews.

SETTING

Academic institution.

PATIENTS

Participants had a diagnosis of symptomatic uterine fibroids with an active treatment plan.

INTERVENTIONS

Semistructured video interviews were conducted with female patients undergoing treatment for symptomatic uterine fibroids (n = 20). Women were recruited from the outpatient Center for Complex Gynecology in Chicago, IL. Interviews were recorded and transcribed verbatim. A codebook was developed based on the interview transcripts, and the finalized coding was used to conduct a thematic analysis.

MEASUREMENTS AND MAIN RESULTS

Four distinct themes emerged from the interviews: (1) Social supports-including social media-play an important role in informing patients' treatment choices; (2) Patients spend significant energy seeking additional information beyond their obstetrician-gynecologist; (3) Patients prioritize receiving full and complete information from their provider; and (4) Patients experience information-related delays in receiving care.

CONCLUSION

Patients seeking care for symptomatic uterine fibroids have strong preferences about both the quality and extent of information they receive from their gynecologists. Physicians treating these conditions must adapt to changing informational desires and consider expanding physician engagement with patients' social media needs.

Smokers' Engagement Behavior on Facebook: Verbalizing and Visual Expressing the Smoking Cessation Process

The "processes of change" and "motivational language" are common in smoker Facebook users' comments under smoking cessation support contents. Smokers can combine this verbalization of the smoking cessation process with visual expression when they use comments and Facebook reactions at the same time. The aim of this study was to understand the relationship between processes of change, motivational language, and the Facebook reaction buttons. A total of 821 smokers' comments were analyzed in the current study (n = 821), which responded to image-based smoking cessation support contents. The processes of change and the motivational language used in the investigated comments were identified. These linguistic categories were compared with the usage of reaction buttons. The Facebook users who used the "Haha" reaction button wrote a significantly higher proportion of sustain talk than those who used the "Like" or "Love" reaction buttons. The Facebook users who combined the comment and "Love" reaction wrote significantly more change talk than those who did not utilize these buttons. We suggest that the "Haha" reaction may be a negative indicator, the "Like" reaction may be a neutral indicator, and the "Love" reaction may be a positive engagement indicator in terms of the smoking cessation process during Facebook-based interventions. These results may highlight how to evaluate Facebook reactions relating to smoking cessation support contents.

The social media effect: the impact of fake news on women affected by endometriosis. A prospective observational study

OBJECTIVES

Our purpose was to evaluate women's awareness of endometriosis and their ability to identify fake news about endometriosis on the internet. The second outcome was to identify those characteristics which make women more likely to believe in fake news.

STUDY DESIGN

This prospective observational study was conducted at our academic outpatient clinic for endometriosis and pelvic pain. We enrolled 172 patients referred to our Center due to the suspicion of endometriosis, who were asked to fill in a two-part questionnaire. The first part included socio-demographic information, the evaluation of anxiety status (STAI Y6 and GAD-7), and endometriosis related-symptoms (EHP-5). The second part of the questionnaire was about fake news: women were asked whether they had encountered six different statings when searching the Internet, and to judge the likelihood that those 6 topics were true.

RESULTS

76.3% of patients found fake news about endometriosis online. Higher STAI-Y6 scores were associated with a higher risk of finding fake news about endometriosis (OR 1.05, 95% C.I. 1.01-1.09, p = 0.013). More than half of patients who came across the news regarding the impossibility of obtaining pregnancy for women affected by endometriosis considered this news moderately or highly credible, 6% of them even considered it completely plausible. No demographic characteristics were associated with thehigher perceived plausibility of the fake news.

CONCLUSION

Gynecologists should be aware that some hot topics concerning endometriosis are widely talked about on the web and that many statements found online have no scientific base. Through this knowledge physicians could more easily engage patients by acquiring important insight into their main concerns and doubts, and could provide women with reliable and correct information regarding their disease, dissipating doubts and misconceptions.

Examining the Influence on Perceptions of Endometriosis via Analysis of Social Media Posts: Cross-sectional Study

Background

Social media platforms, such as Facebook and Instagram, are increasingly being used to share health-related information by “influencers,” regular users, and institutions alike. While patients may benefit in various ways from these interactions, little is known about the types of endometriosis-related information published on social media. As digital opinion leaders influence the perceptions of their followers, physicians need to be aware about ideas and beliefs that are available online, in order to address possible misconceptions and provide optimal patient care.

Objective

The aim of this study was to identify and analyze frequent endometriosis-related discussion topics on social media in order to offer caregivers insight into commonly discussed subject matter and aspects.

Methods

We performed a systematic search using predefined parameters. Using the term “endometriosis” in Facebook’s search function and a social media search engine, a list of Facebook pages was generated. A list of Instagram accounts was generated using the terms “endometriosis” and “endo” in Instagram’s search function. Pages and accounts in English with 5000 or more followers or likes were included. Nonpublic, unrelated, or inactive pages and accounts were excluded. For each account, the most recent 10 posts were identified and categorized by two independent examiners using qualitative content analysis. User engagement was calculated using the numbers of interactions (ie, shares, likes, and comments) for each post, stratified by the number of followers.

Results

A total of 39 Facebook pages and 43 Instagram accounts with approximately 1.4 million followers were identified. Hospitals and medical centers made up 15% (6/39) of the Facebook pages and 5% (2/43) of the Instagram accounts. Top accounts had up to 111,600 (Facebook) and 41,400 (Instagram) followers. A total of 820 posts were analyzed. On Facebook, most posts were categorized as “awareness” (101/390, 25.9% of posts), “education and research” (71/390, 18.2%), and “promotion” (64/390, 16.4%). On Instagram, the top categories were “inspiration and support” (120/430, 27.9% of posts), “awareness” (72/430, 16.7%), and “personal story” (72/430, 16.7%). The frequency of most categories differed significantly between platforms. User engagement was higher on Instagram than on Facebook (3.20% vs 0.97% of followers per post). On Instagram, the highest percentage of users engaged with posts categorized as “humor” (mean 4.19%, SD 4.53%), “personal story” (mean 3.02%, SD 4.95%), and “inspiration and support” (mean 2.83%, SD 3.08%). On Facebook, posts in the categories “awareness” (mean 2.05%, SD 15.56%), “humor” (mean 0.91%, SD 1.07%), and “inspiration and support” (mean 0.56%, SD 1.37%) induced the most user engagement. Posts made by hospitals and medical centers generated higher user engagement than posts by regular accounts on Facebook (mean 1.44%, SD 1.11% vs mean 0.88%, SD 2.71% of followers per post) and Instagram (mean 3.33%, SD 1.21% vs mean 3.19%, SD 2.52% of followers per post).

Conclusions

Facebook and Instagram are widely used to share endometriosis-related information among a large number of users. Most posts offer inspiration or support, spread awareness about the disease, or cover personal issues. Followers mostly engage with posts with a humoristic, supportive, and awareness-generating nature. Health care providers should be aware about the topics discussed online, as this may lead to an increased understanding of the needs and demands of digitally proficient patients with endometriosis.

Healthcare Providers' Impact on the Care Experiences of Patients with Endometriosis: The Value of Trust

Endometriosis is a chronic and often painful inflammatory disease affecting one in ten biological females. It has been characterized as enigmatic and the average diagnostic delay is nearly seven years, time which patients experience as tumultuous and uncertain. This paper presents responses to a final open comment question of a large-scale survey documenting patients' experiences with (mis)diagnosis and highlights how patients perceived healthcare providers (HCPs) as barriers and facilitators to care. Drawing on a framework of trust, we observed that most participants, when discussing HCP-related barriers, raised concerns about HCPs' lack of technical competence, insufficient knowledge about endometriosis and inadequate medical training, followed by concerns about fidelity in which patients recounted experiences of their symptoms being trivialized or dismissed. Respondents also described a causal relationship between competence and fidelity, whereby a lack of competence was perceived to lead HCPs to be dismissive or neglectful. Respondents underscored how patient self-advocacy efforts and online patient communities helped them manage mistrust with HCPs. Although less frequently described, respondents also highlighted the value of HCPs as facilitators to care that similarly emphasized these two dimensions of trust and their inter-connectedness. We discuss the importance of HCPs in shaping patients' care experiences and, in particular, the value of trust for patients with endometriosis and likely other patient populations who seek legitimacy from the medical community but often feel unheard.