Addressing Public Health Emergencies via Facebook Surveys: Advantages, Challenges, and Practical Considerations

Validation of an online version of the rapid estimate of adult literacy in dentistry-30 for use by medical and dental students in Nigeria

BACKGROUND

The need for online adaptations of research instruments became more pronounced amidst the COVID-19 pandemic. This study sought to modify the REALD-30 for online application (eREALD-30) and evaluate its content validity and internal reliability among medical and dental students in Nigeria.

METHODS

The eREALD-30 required participants to identify if each of the listed words were related to dentistry by ticking either a 'yes' or 'no' response with the option to mark 'don't know' for words they were unsure about. Scores ranged from 0 to 30. Five oral health experts reviewed the eREALD-30 for cultural appropriateness, while content validity was evaluated by 10 medical and dental students. Internal reliability was assessed with 320 students recruited from 15 medical and dental schools spanning the country's six geopolitical zones. These students also completed an oral health status assessment tool. Data collection utilized an online survey platform. Validity of the eREALD-30 was determined through correlation analysis between eREALD-30 scores and the oral health status assessment tool. Furthermore, binary logistic regression analysis was employed to explore the assocations between participants' oral health status and their oral health literacy, adjusting for age, sex, and level of medical and dental education.

RESULTS

Out of the respondents, 178 (55.6%) exhibited poor oral health literacy, while 205 (64.1%) reported having good oral health status. Those with good oral health literacy demonstrated significantly higher odds of having good oral health status (OR: 1.61; 95% CI: 1.02-2.54; p = 0.04). However, individuals with good oral health literacy had increased odds of good oral health status after adjusting for confounding factors,, though this association did not retain statistical significance (AOR: 1.39; 95% CI: 0.86-2.24; p = 0.17). The eREALD-30 displayed strong internal consistency (Cronbach alpha = 0.933), indicating its reliability in assessing oral health literacy levels, alongside a high content validity score of 0.90.

CONCLUSION

The study finding suggests that the e-version of the REALD-30 was reliable and valid for use among medical and dental students in Nigeria.

Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey

BACKGROUND

During the initial phases of the vaccination campaign worldwide, nonpharmaceutical interventions (NPIs) remained pivotal in the fight against the COVID-19 pandemic. In this context, it is important to understand how the arrival of vaccines affected the adoption of NPIs. Indeed, some individuals might have seen the start of mass vaccination campaigns as the end of the emergency and, as a result, relaxed their COVID-safe behaviors, facilitating the spread of the virus in a delicate epidemic phase such as the initial rollout.

OBJECTIVE

The aim of this study was to collect information about the possible relaxation of protective behaviors following key events of the vaccination campaign in four countries and to analyze possible associations of these behavioral tendencies with the sociodemographic characteristics of participants.

METHODS

We developed an online survey named "COVID-19 Prevention and Behavior Survey" that was conducted between November 26 and December 22, 2021. Participants were recruited using targeted ads on Facebook in four different countries: Brazil, Italy, South Africa, and the United Kingdom. We measured the onset of relaxation of protective measures in response to key events of the vaccination campaign, namely personal vaccination and vaccination of the most vulnerable population. Through calculation of odds ratios (ORs) and regression analysis, we assessed the strength of association between compliance with NPIs and sociodemographic characteristics of participants.

RESULTS

We received 2263 questionnaires from the four countries. Participants reported the most significant changes in social activities such as going to a restaurant or the cinema and visiting relatives and friends. This is in good agreement with validated psychological models of health-related behavioral change such as the Health Belief Model, according to which activities with higher costs and perceived barriers (eg, social activities) are more prone to early relaxation. Multivariate analysis using a generalized linear model showed that the two main determinants of the drop of social NPIs were (1) having previously tested positive for COVID-19 (after the second vaccine dose: OR 2.46, 95% CI 1.73-3.49) and (2) living with people at risk (after the second vaccine dose: OR 1.57, 95% CI 1.22-2.03).

CONCLUSIONS

This work shows that particular caution has to be taken during vaccination campaigns. Indeed, people might relax their safe behaviors regardless of the dynamics of the epidemic. For this reason, it is crucial to maintain high compliance with NPIs to avoid hindering the beneficial effects of the vaccine.

Persuasive COVID-19 vaccination campaigns on Facebook and nationwide vaccination coverage in Ukraine, India, and Pakistan

Social media platforms have a wide and influential reach, and as such provide an opportunity to increase vaccine uptake. To date, there is no large-scale, robust evidence on the offline effects of online messaging campaigns. We aimed to test whether pre-tested, persuasive messaging campaigns from UNICEF, disseminated on Facebook, influenced COVID-19 vaccine uptake in Ukraine, India, and Pakistan. In Ukraine, we deployed a stepped-wedge randomized controlled trial (RCT). Half of the 24 oblasts (provinces) received five weeks of the intervention, the other half ten weeks of the intervention. In India, an RCT with an augmented synthetic control was conducted in five states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan), whereby 40 out of 174 districts were randomized to receive six weeks of intervention. In Pakistan we deployed a pre-post design, whereby 25 city districts received six weeks of the intervention. Weekly COVID-19 vaccination data was sourced through government databases. Using Poisson regression models, the association between the intervention and vaccine uptake was estimated. In Ukraine we conducted a survey among Facebook users at three time points during the RCT, to ascertain vaccination intentions and trust in vaccines. The campaigns reached more than 110 million Facebook users and garnered 2.9 million clicks. In Ukraine, we found that the intervention did not affect oblast-level vaccination coverage (Relative Risk (RR): 0.93, 95% Confidence Interval (CI) 0.86-1.01). Similarly, in India and Pakistan we found no effect of our intervention (India: RR 0.85, 95% CI 0.70-1.04; Pakistan: RR 0.64, 95% CI 0.01-29.9). The survey among Facebook users in Ukraine showed that trust in vaccines and information sources was an important predictor of vaccination status and intention to get vaccinated. Our campaigns on Facebook had a wide reach, which did not translate in shifting behaviours. Timing and external events may have limited the effectiveness of our interventions.

Internet Addiction and Depression among Syrian College Students: A Cross-Sectional Study

Background: Problematic internet use (PIU) or internet addiction has become increasingly prevalent, and concerns about its impact on mental health and social functioning have grown. This study aimed to investigate the prevalence of PIU among Syrian university students and its relationship with their demographics, internet user behavior, and mental health. Methods: A cross-sectional study was conducted among undergraduate medical students in Syrian government universities between 12 April and 29 May 2022. The survey included the Beck Depression Inventory and the Internet Addiction Scale. Results: Out of 2891 participants, 75.2% were female, with an average age of 21.87. The average Internet Addiction Test (IAT) score was 49.4, and the overall prevalence of PIU was 89%. Furthermore, 93.0% of participants displayed possible signs and symptoms of depression. PIU was significantly linked with physical abuse (p = 0.001) and mental stress (p = 0.0001). Internet addiction is (AOR:1.723, COR:2.289) fold more likely to occur in those with more than 8 h of sleep per night than in those who sleep for less than 6 h (p-value < 0.05). Unadjusted regression analysis showed that 13 predictors of the independent variables were statistically significant in predicting the presence of internet addiction, such as participants who suffered from a breakup (COR:2.039), domestic violence (COR:2.136), physical abuse (COR:2.190), or mental stress (COR:2.621) were more likely to be affected by internet addiction than those who did not (p-value < 0.05). Conclusions: The study found a high rate of internet addiction among Syrian medical students, with those experiencing mental health problems and depression symptoms more likely to be internet addicts. To prevent PIU, students should be encouraged to participate in extracurricular activities, such as sports, and awareness programs should be enhanced to highlight the negative effects of internet addiction.

Data collection in pandemic times: the case of the Belgian COVID-19 health surveys

BACKGROUND

Survey data were needed to assess the mental and social health, health related behaviors and compliance with preventive measures of the population during the COVID-19 pandemic. Yet, the pandemic challenged classical survey methods. Time and budgetary constraints at the beginning of the pandemic led to ad hoc recruitment of participants and easily manageable data collection modes. This paper describes the methodological choices and results in terms of participation for the COVID-19 health surveys conducted in Belgium.

METHODS

The COVID-19 health surveys refer to a series of ten non-probability web surveys organized between April 2020 and March 2022. The applied recruitment strategies were diverse including, amongst others, a launch through the website and the social media of the organizing research institute. In addition, the survey links were shared in articles published in the national press and participants were requested to share the surveys in their network. Furthermore, participants were asked consent to be re-contacted for next survey editions using e-mail invitations.

RESULTS

These mixed approaches allowed to reach a substantial number of participants per edition ranging from 49339 in survey 1 to 13882 in survey 10. In addition, a longitudinal component was created; a large share of the same individuals were followed up over time; 12599 participants completed at least 5 surveys. There were, however, sex, age, educational level and regional differences in participation. Post-stratification weighting on socio-demographic factors was applied to at least partly take this into account.

CONCLUSION

The COVID-19 health surveys allowed rapid data collection after the onset of the pandemic. Data from these non-probability web surveys had their limitations in terms of representativeness due to self-selection but were an important information source as there were few alternatives. Moreover, by following-up the same individuals over time it was possible to study the effect of the different crisis phases on, amongst others, the mental health. It is important to draw lessons from these experiences: initiatives in order to create a survey infrastructure better equipped for future crises are needed.

The deployment of social media by political authorities and health experts to enhance public information during the COVID-19 pandemic

Social media have increasingly been used by political bodies and experts to disseminate health information to the public. However, we still know little about how the communication of these actors on social media is received by other users and how it reflects trends in public trust. We examined social media dynamics in the communication of information by major actors (n = 188) involved in COVID-19 online discussions in Switzerland. These actors are scientists (experts), policymakers (government officials, cantonal executives, and other parties), and representatives of mass media. We found little correlation between Twitter features (other users' engagement and negativity in other users' replies) and the level of public trust found in representative opinion surveys. We used topic modelling in combination with correspondence analysis, and including additional variables for actor types and the period of the public debate further enabled us to detect salient episodes related to the pandemic on social media. In particular, we found that differing roles were played by the (health) experts and political authorities in terms of both topics and influence on the specific timing of the pandemic. The results of this study provide helpful conclusions for communication among political authorities, health experts, and the public.

Assessing the Feasibility of Studying Awareness of a Digital Health Campaign on Facebook: Pilot Study Comparing Young Adult Subsamples

Background

Mass media campaigns for preventive health messaging have been shown to be effective through years of research. However, few studies have assessed the effectiveness of campaigns on digital media, which is currently how youths and young adults are primarily consuming media. In particular, a platform that can accurately assess exposure to digital messaging in a real-life setting has yet to be developed.

Objective

This study examines the feasibility of a unique survey platform, Virtual Lab, to conduct a study on exposure to a media campaign within Facebook using a chatbot-style survey administration technique.

Methods

Virtual Lab is a survey platform that was used to recruit and survey participants within Facebook and Facebook Messenger, respectively. We created a Facebook business account with 2 Facebook pages: one for recruitment and disseminating the survey and the other one for serving the target advertisements. Pre- and postexposure surveys were administered via Facebook Messenger using a chatbot-style questionnaire 1 week apart. During this time, the target advertisements were shown to participants who completed the pre-exposure survey. The total time from recruitment to completion of the postexposure survey was 13 days, and incentive costs were US $10 per participant. Survey data were compared between those who completed both pre- and postexposure surveys and those who only completed the pre-exposure survey; that is, those who were lost to follow-up. The demographics of the complete cases were also compared to the US census data.

Results

A total of 375 Facebook users aged between 18 and 24 years met eligibility requirements and consented to the study, which consisted of complete cases (n=234) and participants lost to follow-up (n=141). A few differences between complete cases and participants lost to follow-up were observed. Regarding gender, complete cases comprised 40.2% males and 59.4% females, and among participants lost to follow-up, 44.0% were male and 50.4% were female (P=.003). Differences were also observed for e-cigarette use status, where a greater number of current users and fewer past and never users were lost to follow-up than complete cases (P=.01).

Conclusions

The use of Virtual Lab yielded a diverse sample quickly and cost-effectively. Demographic characteristics of participants who completed the study and those who were lost to follow-up were similar, indicating that no biases were caused by the platform during recruitment or testing. This study suggests the feasibility of the Virtual Lab survey platform for studies of media campaign exposure within Facebook. This platform can advance health campaign research by providing more accurate data to inform digital messaging.

Cohort profile: the British Columbia COVID-19 Population Mixing Patterns Survey (BC-Mix)

PURPOSE

Several non-pharmaceutical interventions, such as physical distancing, handwashing, self-isolation, and school and business closures, were implemented in British Columbia (BC) following the first laboratory-confirmed case of COVID-19 on 26 January 2020, to minimise in-person contacts that could spread infections. The BC COVID-19 Population Mixing Patterns Survey (BC-Mix) was established as a surveillance system to measure behaviour and contact patterns in BC over time to inform the timing of the easing/re-imposition of control measures. In this paper, we describe the BC-Mix survey design and the demographic characteristics of respondents.

PARTICIPANTS

The ongoing repeated online survey was launched in September 2020. Participants are mainly recruited through social media platforms (including Instagram, Facebook, YouTube, WhatsApp). A follow-up survey is sent to participants 2-4 weeks after completing the baseline survey. Survey responses are weighted to BC's population by age, sex, geography and ethnicity to obtain generalisable estimates. Additional indices such as the Material and Social Deprivation Index, residential instability, economic dependency, and others are generated using census and location data.

FINDINGS TO DATE

As of 26 July 2021, over 61 000 baseline survey responses were received of which 41 375 were eligible for analysis. Of the eligible participants, about 60% consented to follow-up and about 27% provided their personal health numbers for linkage with healthcare databases. Approximately 83.5% of respondents were female, 58.7% were 55 years or older, 87.5% identified as white and 45.9% had at least a university degree. After weighting, approximately 50% were female, 39% were 55 years or older, 65% identified as white and 50% had at least a university degree.

FUTURE PLANS

Multiple papers describing contact patterns, physical distancing measures, regular handwashing and facemask wearing, modelling looking at impact of physical distancing measures and vaccine acceptance, hesitancy and uptake are either in progress or have been published.

Acceptability of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening in a Cohort of Patients from Romania (Stage 2)

(1) Background: Low patient’s adherence to conventional cervical cancer screening methods determined the need to take into consideration alternative approaches, and vaginal HPV self-sampling is one of them. We aimed to evaluate, using an online survey, the Romanian women’s acceptability of vaginal HPV self-sampling. (2) Methods: A 13-questions online survey was distributed on three Facebook groups, and the results were summarized. (3) Results: Despite of good educational background, 10.8% (n = 60) of the respondents did not know what a Pap smear is, and 33% (n = 183) were not informed about the free national cervical cancer screening program. Multivariate analysis revealed an increased likelihood of vaginal self-sampling acceptance among respondents who did not know about Pap test (OR: 7.80; 95%CI: 1.062−57.431; p = 0.021), national cervical cancer screening program (OR: 1.96; 95%CI: 1.010−3.806; p = 0.02), HPV infection (OR: 7.35; 95%CI: 3.099−17.449; p< 0.001) or HPV test (OR: 1.67; 95%CI: 0.950−2.948; p = 0.03). Moreover, women who did not previously undergo a cervical cancer screening program were more likely to accept the new screening method (OR: 1.62; 95%CI: 0.878−3.015; p = 0.04). (4) Conclusions: Our results showed high acceptability rates of vaginal HPV self-sampling among participants.

Has demography witnessed a data revolution? Promises and pitfalls of a changing data ecosystem

Over the past 25 years, technological improvements that have made the collection, transmission, storage, and analysis of data significantly easier and more cost efficient have ushered in what has been described as the 'big data' era or the 'data revolution'. In the social sciences context, the data revolution has often been characterized in terms of increased volume and variety of data, and much excitement has focused on the growing opportunity to repurpose data that are the by-products of the digitalization of social life for research. However, many features of the data revolution are not new for demographers, who have long used large-scale population data and been accustomed to repurposing imperfect data not originally collected for research. Nevertheless, I argue that demography, too, has been affected by the data revolution, and the data ecosystem for demographic research has been significantly enriched. These developments have occurred across two dimensions. The first involves the augmented granularity, variety, and opportunities for linkage that have bolstered the capabilities of 'old' big population data sources, such as censuses, administrative data, and surveys. The second involves the growing interest in and use of 'new' big data sources, such as 'digital traces' generated through internet and mobile phone use, and related to this, the emergence of 'digital demography'. These developments have enabled new opportunities and offer much promise moving forward, but they also raise important ethical, technical, and conceptual challenges for the field.

Close Social Networks Among Older Adults: The Online and Offline Perspectives

Qualitative studies have found that the use of Information and Communication Technologies is related to an enhanced quality of life for older adults, as these technologies might act as a medium to access social capital regardless of geographical distance. In order to quantitatively study the association between older people’s characteristics and the likelihood of having a network of close friends offline and online, we use data from the Survey of Health, Ageing and Retirement in Europe and data from Facebook. Using a novel approach to analyze aggregated and anonymous Facebook data within a regression framework, we show that the associations between having close friends and age, sex, and being a parent are the same offline and online. Migrants who use internet are less likely to have close friends offline, but migrants who are Facebook users are more likely to have close friends online, suggesting that digital relationships may compensate for the potential lack of offline close friendships among older migrants.

Differential impact of physical distancing strategies on social contacts relevant for the spread of SARS-CoV-2: evidence from a cross-national online survey, March-April 2020

OBJECTIVES

We investigate changes in social contact patterns following the gradual introduction of non-pharmaceutical interventions and their implications for infection transmission in the early phase of the pandemic.

DESIGN, SETTING AND PARTICIPANTS

We conducted an online survey based on targeted Facebook advertising campaigns across eight countries (Belgium, France, Germany, Italy, the Netherlands, Spain, UK and USA), achieving a sample of 51 233 questionnaires in the period 13 March-12 April 2020. Poststratification weights based on census information were produced to correct for selection bias.

OUTCOME MEASURES

Participants provided data on social contact numbers, adoption of protective behaviours and perceived level of threat. These data were combined to derive a weekly index of infection transmission, the net reproduction number [Formula: see text] .

RESULTS

Evidence from the USA and UK showed that the number of daily contacts mainly decreased after governments issued the first physical distancing guidelines. In mid-April, daily social contact numbers had decreased between 61% in Germany and 87% in Italy with respect to pre-COVID-19 levels, mostly due to a contraction in contacts outside the home. Such reductions, which were uniform across age groups, were compatible with an [Formula: see text] equal or smaller than one in all countries, except Germany. This indicates lower levels of infection transmission, especially in a period of gradual increase in the adoption rate of the face mask outside the home.

CONCLUSIONS

We provided a comparable set of statistics on social contact patterns during the COVID-19 pandemic for eight high-income countries, disaggregated by week and other demographic factors, which could be leveraged by the scientific community for developing more realistic epidemic models of COVID-19.

Behaviours and attitudes in response to the COVID-19 pandemic: insights from a cross-national Facebook survey

BACKGROUND

In the absence of medical treatment and vaccination, individual behaviours are key to curbing the spread of COVID-19. Here we describe efforts to collect attitudinal and behavioural data and disseminate insights to increase situational awareness and inform interventions.

METHODS

We developed a rapid data collection and monitoring system based on a cross-national online survey, the "COVID-19 Health Behavior Survey". Respondent recruitment occurred via targeted Facebook advertisements in Belgium, France, Germany, Italy, the Netherlands, Spain, the United Kingdom, and the United States. We investigated how the threat perceptions of COVID-19, the confidence in the preparedness of organisations to deal with the pandemic, and the adoption of preventive and social distancing behaviours are associated with respondents' demographic characteristics.

RESULTS

We analysed 71,612 questionnaires collected between March 13-April 19, 2020. We found substantial spatio-temporal heterogeneity across countries at different stages of the pandemic and with different control strategies in place. Respondents rapidly adopted the use of face masks when they were not yet mandatory. We observed a clear pattern in threat perceptions, sharply increasing from a personal level to national and global levels. Although personal threat perceptions were comparatively low, all respondents significantly increased hand hygiene. We found gender-specific patterns: women showed higher threat perceptions, lower confidence in the healthcare system, and were more likely to adopt preventive behaviours. Finally, we also found that older people perceived higher threat to themselves, while all respondents were strongly concerned about their family.

CONCLUSIONS

Rapid population surveys conducted via Facebook allow us to monitor behavioural changes, adoption of protective measures, and compliance with recommended practices. As the pandemic progresses and new waves of infections are a threatening reality, timely insights from behavioural and attitudinal data are crucial to guide the decision-making process.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1140/epjds/s13688-021-00270-1.

Reliance on scientists and experts during an epidemic: Evidence from the COVID-19 outbreak in Italy

Research suggests trust in experts and authorities are important correlates of compliance with public health measures during infectious disease outbreaks. Empirical evidence on the dynamics of reliance on scientists and public health authorities during the early phases of an epidemic outbreak is limited. We examine these processes during the COVID-19 outbreak in Italy by leveraging data from Twitter and two online surveys, including a survey experiment. We find that reliance on experts followed a curvilinear path. Both Twitter and survey data showed initial increases in information-seeking from expert sources in the three weeks after the detection of the first case. Consistent with these increases, knowledge about health information linked to COVID-19 and support for containment measures was widespread, and better knowledge was associated with stronger support for containment policies. Both knowledge and containment support were positively associated with trust in science and public health authorities. However, in the third week after the outbreak, we detected a slowdown in responsiveness to experts. These processes were corroborated with a survey experiment, which showed that those holding incorrect beliefs about COVID-19 gave no greater - or even lower - importance to information when its source was stated as coming from experts than when the source was unstated. Our results suggest weakened trust in public health authorities with prolonged exposure to the epidemic as a potential mechanism for this effect. Weakened responsiveness to expert sources may increase susceptibility to misinformation and our results call for efforts to sustain trust in adapting public health response.