Social Media and Health Care (Part II): Narrative Review of Social Media Use by Patients

HOPE for Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD)-A Pilot Randomised Controlled Trial of Feasibility, Acceptability and Appropriateness

BACKGROUND

Feasibility and effectiveness of online pain management programs for chronic widespread pain conditions have been shown; yet, there are no empirically evaluated programs for hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD). Bridging this gap, the Hypermobile Online Pain managemEnt (HOPE) program was developed with stakeholder input to be pilot tested.

METHODS

We conducted a randomised controlled trial of the HOPE program to assess Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) and eight clinical effectiveness outcomes. Intervention participants were given 8 weeks to complete 12 self-paced modules, while control participants continued treatment as usual. Participants were assessed at baseline, post-treatment and 3 months post-treatment using online surveys.

RESULTS

Seventy-two participants were recruited and randomised. Two control participants withdrew before starting, leaving 34 controls and 36 intervention participants for analysis. In all, 81%-91% agreed/completely agreed that the HOPE program was feasible with mean FIM score of 4.3/5 (SD 0.7), 62%-76% agreed/completely agreed that it was acceptable with mean AIM score of 3.9/5 (SD 0.96) and 67%-76% agreed/completely agreed that it was appropriate with mean IAM score of 4.0/5 (SD 0.9). Only two clinical effectiveness outcomes were significantly improved in the intervention group, with moderate and small effect sizes in worst pain intensity (Cohen's d = 0.63) and impact of hypermobility (Cohen's d = 0.32) at 3 months post-intervention, respectively.

CONCLUSION

The HOPE program seemed feasible, acceptable and appropriate, with preliminary improvements in worst pain intensity and impact of hypermobility. Our findings warrant a fully powered trial to further explore the clinical effectiveness of this online pain intervention.

SIGNIFICANCE STATEMENT

Pain is of high concern among people with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD), yet there are limited online pain management resources for them. This pilot trial of the novel Hypermobile Online Pain managemEnt (HOPE) program is important in guiding the creation of evidence-based and stakeholder-relevant online resources. Promising results suggest the importance of further refinement and retesting its effectiveness before wider implementation among the hEDS/HSD population so as to empower them in pain self-management.

Real needs of end-stage kidney disease patients awaiting kidney transplantation in China: A qualitative study

OBJECTIVE

To explore the true needs of patients awaiting kidney transplantation in China through the language used by them. We addressed the literature gap concerning this critical aspect of patient care and counselling.

METHODS

We interviewed 32 individuals-22 who were on the waiting list for a kidney transplant and 10 were kidney transplant recipients. The obtained data were analysed using Colaizzi seven-step method.

RESULTS

Four themes encompassing 86 coded statements were identified and crosschecked with each participant for validation.The waiting period needs of the participants fell into four distinct categories: emotional support, informational, medical support, and social support needs.

CONCLUSION

We can determine the needs of patients by interpreting their linguistic cues with a nuanced understanding.Transplant professionals must (1) understand patients' needs from their perspective; (2) recognise the dynamic changes in their emotional support demands; and (3) determine each patient's informational needs, their willingness to receive medical support, and the current state of their social support.

PRACTICE IMPLICATIONS

Our results offer insights for transplant professionals to better support patients awaiting kidney transplantation, highlighting the need to routinely attend to their unmet emotional, informational, medical and social support needs. This will enable patients to better prepare for transplantation while anticipating the arrival of a matched kidney.

The Impact of Orthodontists' Image-Based Social Media Posts on the Public's Willingness to Seek Treatment in the Central Region of Saudi Arabia

Background

Social media has transformed communication and information sharing, significantly impacting various fields, including healthcare. This study investigates the influence of orthodontists' social media posts on the Saudi public's willingness to seek orthodontic treatment.

Materials and Methods

A descriptive, cross-sectional online survey was conducted among Saudi adults residing in the central region of Saudi Arabia. The questionnaire comprised three main sections, respectively aiming to capture the respondents' demographic data, social media preferences, and willingness to seek orthodontic treatment (whereby images depicting different themes were rated on a 0-10 scale). ANOVA was used to compare continuous data across multiple groups, while the unpaired t-test compared continuous data between two groups. The Pearson chi-squared test assessed frequency differences, with p ≤ 0.05 considered statistically significant.

Results

Based on the survey involving 1267 Saudis, Snapchat is the most frequently browsed social media platform, followed by TikTok and Twitter. Image themes most likely to increase willingness to seek orthodontic treatment were "Before and After (Intraoral)" and "Before and After (Extraoral)", with the average scores of 8.06 and 7.83, respectively. In contrast, images of "orthodontic screws" (3.45) and "orthodontic elastics" (3.79) were the least impactful.

Conclusion

The types of images orthodontists share on social media can significantly influence the Saudi public's willingness to seek treatment. By strategically using social media and posting visually appealing content, orthodontists have the potential to enhance public interest and grow their practices effectively.

Factors Influencing Telemedicine Usage Intentions: A Comparative Study in Gynecology and Pediatrics

Introduction: Telemedicine has seen rapid growth, especially following the COVID-19 pandemic, providing diverse options for patient care. This study, grounded in the Technology Acceptance Model, examines and compares factors influencing women's usage intentions of telemedicine, considering their roles as both direct patients in gynecology and indirect patients in pediatrics. Methods: The study conducted a survey to collect data from women who have used telemedicine services (N = 758). Structural equation modeling was employed to assess the relationships between variables, including previous satisfaction, social media health content consumption, perceived ease of use (PEOU), perceived usefulness (PU), trust, and future usage intention. Results: The results demonstrate that social media health content consumption, PEOU, PU, and trust in telemedicine have significant direct effects on future usage intention. PEOU and trust mediate the relationships between social media consumption, previous satisfaction, and future usage intention. Notably, the study reveals differences in the factors influencing telemedicine usage between pediatrics and obstetrics/gynecology. Social media health content consumption positively affects usage intention for gynecological but not for pediatric. Trust in telemedicine significantly enhances usage intentions for gynecology but not for pediatrics. Conclusions: The findings reveal disparities in telemedicine usage patterns between obstetrics/gynecology and pediatrics. Practical implications suggest that telemedicine platforms should leverage social media to enhance health education and provide clear guidance, particularly for gynecological services. In addition, strengthening patient privacy protections is essential to build trust and promote telemedicine adoption.

Youth Perspectives on the Use of Medications for Weight Loss

PURPOSE

Semaglutide (Ozempic, Wegovy) has surged in popularity for its weight loss effects. Its widespread media coverage may have an outsized impact on adolescents and young adults due to their higher engagement in social media and their vulnerability to unintended consequences of weight-related discourse (e.g., body dissatisfaction, disordered eating, weight stigma). This study aimed to determine youth familiarity with and opinions about use of medications such as Ozempic and Wegovy for weight loss.

METHODS

Five open-ended questions were asked to 753 youth participants (14-24 years) in the MyVoice nationwide text message poll in March 2024. Responses were analyzed using content analysis and coding differences resolved by consensus. Differences by demographic characteristics were explored using chi-square tests.

RESULTS

Overall, 547 (73%) youth responded; average age was 20.4 ± 2.5 years, with 50.3% identifying as female. Nearly three-quarters (73.6%) had heard of medications like Ozempic and Wegovy, but the majority (57.5%) stated that these medications should not be used by youth. Three primary concerns arose: (1) safety; (2) inappropriate use; and (3) role of personal responsibility for healthy lifestyle (a belief that was more common among males than females or other gender).

DISCUSSION

Awareness about semaglutide was high, but perceptions of use were generally negative or hesitant, particularly among males, who emphasized the importance of healthy lifestyle behaviors. Hesitancy due to safety concerns and the role of weight stigma should be explored to determine the potential impact on users of such medications when medically indicated.

Social media and internet use among orthopedic patients in Germany-a multicenter survey

Background

Social media (SM) is increasingly used in the healthcare system and offers various benefits for patients such as accessible health information and communication with other patients and healthcare professionals. However, SM also poses risks, including the dissemination of medical misinformation and privacy concerns. This in turn can influence patients' health-related decision-making and the patient-physician relationship. There is limited data regarding which SM orthopedic patients use and what benefits and risks of SM they perceive.

Methods

An online survey was conducted from April to December 2023 among orthopedic and trauma patients in five German orthopedic clinics. The questionnaire with 32 variables was designed to assess internet and SM usage patterns, platform preferences, and perceived benefits and risks. Statistical analysis was performed, including subgroup analyses.

Results

A total of 267 patients participated, with 82.0% reporting regular SM use. In total 45.9% of the patients used SM for general health questions and 51.3% for orthopedic-related questions. The most used information platforms were conventional websites, YouTube, Instagram, and messenger apps. A total of 45.9% used SM infrequently for general health questions, and 51.3% for orthopedic-related queries. Only 13.7% of patients agreed that SM helped in medical decision-making, and 31.1% felt confident in assessing the credibility of SM content. Additionally, 58.6% of patients were unsure about allowing physicians to present their cases on SM, and 62.3% were uncertain about posting their medical images.

Conclusion

Among German orthopedic patients, the use of SM for health-related and gain of orthopedic information was low in the given study. While SM may offer valuable health information, their role in medical decision-making remains limited due to concerns over content credibility and privacy. Video-based content seems to achieve the best reach. Future research should explore these aspects longitudinally and across diverse populations to better understand and address the challenges and benefits of SM in healthcare.

Evaluation of a Digital Media Campaign to Promote Knowledge and Awareness of the GPFirst Program for Nonurgent Conditions: Repeated Survey Study

BACKGROUND

GPFirst is a primary care partnership program designed to encourage patients with nonurgent conditions to seek care at participating general practitioner clinics instead of visiting the emergency department. In 2019, a digital media campaign (DMC) was launched to raise awareness and knowledge about GPFirst among residents in eastern Singapore.

OBJECTIVE

This study aims to assess the DMC's impact on awareness and knowledge of GPFirst across different age groups, and the acceptability and satisfaction of GPFirst.

METHODS

The DMC, comprising Facebook posts and a website designed using the Andersen behavioral model, was evaluated through 2 repeated cross-sectional surveys. The first cross-sectional survey (CS1) was conducted with eastern Singapore residents aged 21 years and older, 2 1 year before the campaign's launch, and the second survey (CS2) 4 months after. Satisfaction was measured on a 5-point Likert scale (very poor to excellent) about GPFirst experiences. Acceptability was assessed with 3 yes or no questions on decisions to visit or recommend GPFirst clinics. Analyses used tests of proportions, adjusted multiregression models, and age-stratified secondary analyses.

RESULTS

The Facebook posts generated 38,404 engagements within 5 months, with "#ThankYourGP" posts being the most viewed (n=24,602) and engaged (n=2618). Overall, 1191 and 1161 participants completed CS1 and CS2 respectively. Compared to CS1, CS2 participants were more aware (odds ratio [OR] 2.64, 95% CI 2.11-3.31; P<.001) and knowledgeable of GPFirst (OR 4.20, 95% CI 2.62-6.73; P<.001). Awareness was higher among married individuals (OR 1.31, 95% CI 1.04-1.66; P=.03), those without a regular primary care physician (OR 1.79, 95% CI 1.44-2.22; P<.001), and with higher education levels. Similarly, knowledge was greater among individuals with secondary (OR 2.88, 95% CI 1.35-6.17; P=.006) and preuniversity education (OR 2.56, 95% CI 1.14-5.70; P=.02), and those without a regular primary care physician (OR 1.54, 95% CI 1.02-2.34; P=.04). For acceptability, among participants who visited a GPFirst clinic, 98.2% (163/166) reported they would continue to visit a GPFirst clinic before the emergency department in the future, 95.2% (158/166) would recommend the clinic, 60.2% (100/166) cited the clinic's participation in GPFirst as a factor in their provider's choice and 87.3% (145/166) were satisfied with GPFirst. Among those unaware of GPFirst, 88.3% (1680/1903) would consider visiting a GPFirst clinic before the emergency department in the future.

CONCLUSIONS

The DMC improved awareness and knowledge of GPFirst, with high satisfaction and acceptability among participants. Age-dependent strategies may improve GPFirst participation. The "#ThankYourGP" campaign demonstrated the potential of user-generated content to boost social media engagement, a strategy that international health systems could adopt.

Evolutionary Trend of Dental Health Care Information on Chinese Social Media Platforms During 2018-2022: Retrospective Observational Study

BACKGROUND

Social media holds an increasingly significant position in contemporary society, wherein evolving public perspectives are mirrored by changing information. However, there remains a lack of comprehensive analysis regarding the nature and evolution of dental health care information on Chinese social media platforms (SMPs) despite extensive user engagement and voluminous content.

OBJECTIVE

This study aimed to probe into the nature and evolution of dental health care information on Chinese SMPs from 2018 to 2022, providing valuable insights into the evolving digital public perception of dental health for dental practitioners, investigators, and educators.

METHODS

This study was conducted on 3 major Chinese SMPs: Weibo, WeChat, and Zhihu. Data from March 1 to 31 in 2018, 2020, and 2022 were sampled to construct a social media original database (ODB), from which the most popular long-text posts (N=180) were selected to create an analysis database (ADB). Natural language processing (NLP) tools were used to assist tracking topic trends, and word frequencies were analyzed. The DISCERN health information quality assessment questionnaire was used for information quality evaluation.

RESULTS

The number of Weibo posts in the ODB increased approximately fourfold during the observation period, with discussion of orthodontic topics showing the fastest growth, surpassing that of general dentistry after 2020. In the ADB, the engagement of content on Weibo and Zhihu also displayed an upward trend. The overall information quality of long-text posts on the 3 platforms was moderate or low. Of the long-text posts, 143 (79.4%) were written by nonprofessionals, and 105 (58.3%) shared personal medical experiences. On Weibo and WeChat, long-text posts authored by health care professionals had higher DISCERN scores (Weibo P=.04; WeChat P=.02), but there was a negative correlation between engagement and DISCERN scores (Weibo tau-b [τb]=-0.45, P=.01; WeChat τb=-0.30, P=.02).

CONCLUSIONS

There was a significant increase in the dissemination and evolution of public interest in dental health care information on Chinese social media during 2018-2022. However, the quality of the most popular long-text posts was rated as moderate or low, which may mislead patients and the public.

Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review

BACKGROUND

The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments.

OBJECTIVE

We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults' social media behaviors? and (4) What factors influence older adults' use of social media for health-related purposes?

METHODS

Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21% (767/1591) of publications remained. Ultimately, 1% (16/1591) of studies met the inclusion criteria. A research question-driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework.

RESULTS

The results indicated that older adults' general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75%), followed by self-management (8/16, 50%). Other themes included health decision-making (4/16, 25%), telemedicine (3/16, 19%), and health interventions (2/16, 13%). Cross-thematic analysis confirmed that older adults' social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors.

CONCLUSIONS

The reciprocal relationship between older adults' social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults.

Application of the LDA model to identify topics in telemedicine conversations on the X social network

The evolution experienced by global society, in the post-COVID 19 era, is marked by the quite obligatory use of digital media in many sectors, as is the case for the health sector. Quite frequently, both patients and health professionals use social media to express their telemedicine concerns or interests. The present research focuses on these social media comments as they represent a very interesting data source for researchers. In the present analysis, we focus on unstructured tweet texts written by Internet users and apply both machine learning and the Latent Dirichlet Allocation algorithm to model X databases and identify tweet topics. The results gathered provide professionals with information on the most important issues and factors of influence for telemedecine consumers.BackgroundThe use of new technologies has transformed society, affecting communication, information seeking and ways of working. Telemedicine, as a remote health practice through ICTs, has grown exponentially, especially after the pandemic.ObjectiveWe do apply a mixed methodology in our study and use both qualitative and quantitative techniques to explore the conversational topics generated about telemedicine through comments posted by users on X. This allows us to identify primary, secondary, and residual themes.MethodsNatural Language Processing (NLP) and Machine Learning techniques, specifically the Latent Dirichlet Allocation (LDA) model, were used to analyse 156,633 comments extracted from "X" related to telemedicine topics.ResultsThe study revealed several issues to be addressed. Data was collected using keywords such as "teleconsultation" and "telemedicine". We can see that the most frequent words in the comments include words such as "health", "service", "doctor" and "patient". The themes identified were grouped into four dimensions: general information, benefits sought, specific information and professional issues. The results showed that 60.1% of the comments focused on generic telemedicine topics, ease of use and service information. "X" queries were observed to be public and general in nature, focusing on benefits and accessibility, while disease or treatment specific topics were less frequent.ConclusionsThe results provide information for the proper development and study of telemedicine through social networks. "X" is a platform mainly used for general telemedicine queries, with convenience and accessibility as the main benefits mentioned. The results suggest that online telemedicine interactions are complex and offer valuable insights for improving telemedicine communication strategies. Future research could explore the use of hashtags and analyse differences in interaction patterns according to user profile, providing a deeper understanding of audiences' behaviour on social networks. These findings underline the importance of considering audience preferences to improve the effectiveness of telemedicine communications.

Understanding social media discourse on antidepressants: unsupervised and sentiment analysis using X

BACKGROUND

Antidepressants are essential in managing depression, including treatment-resistant cases. Public perceptions of these medications, shaped by social media platforms like X (formerly Twitter), can influence treatment adherence and outcomes. This study explores public attitudes toward antidepressants through sentiment and topic modeling analysis of tweets in English and Spanish from 2007 to 2022.

METHODS

Tweets mentioning antidepressants approved for depression were collected. The analysis focused on selective serotonin reuptake inhibitors (SSRIs) and glutamatergic drugs. Sentiment analysis and topic modeling were conducted to identify trends, concerns, and emotions in discussions across both languages.

RESULTS

A total of 1,448,674 tweets were analyzed (1,013,128 in English and 435,546 in Spanish). SSRIs were the most mentioned antidepressants (27.9% in English, 58.91% in Spanish). Pricing and availability were key concerns in English tweets, while Spanish tweets highlighted availability, efficacy, and sexual side effects. Glutamatergic drugs, especially esketamine, gained attention (15.61% in English, 25.23% in Spanish), evoking emotions such as fear, sadness, and anger. Temporal analysis showed significant increases in discussions, with peaks in 2012 and 2021 for SSRIs in Spanish, and exponential growth from 2018 to 2021 for glutamatergic drugs. Emotional tones varied across languages, reflecting cultural differences.

CONCLUSIONS

Social media platforms like X provide valuable insights into public perceptions of antidepressants, highlighting cultural variations in attitudes. Understanding these perceptions can help clinicians address concerns and misconceptions, fostering informed treatment decisions. The limitations of social media data call for careful interpretation, emphasizing the need for continued research to improve pharmacovigilance and public health strategies.

Comparative Quality Analysis of Bullous Pemphigoid Information Across Six Social Media Platforms

Social media has changed the digital health landscape, altering how the public consumes medical information and sparking concerns about the reliability of medical information. This study aims to assess the quality of online health information related to bullous pemphigoid by evaluating content type, information reliability, and user engagement across different social media platforms, using the Quality Evaluation Scoring Tool (QUEST) and Discerning the Quality of Written Consumer Health Information (DISCERN) questionnaires, quantitative tools designed to measure health information quality. Among the six social media platforms analyzed, educational content was most prevalent on YouTube (Google LLC, Mountain View, California, United States) (90.0%, n=10) and Threads (Meta Platforms, Inc., Menlo Park, California, United States) (100.0%, n=3), while TikTok (ByteDance Ltd., Beijing, China) (n=20) featured 60.0% educational and 30.0% patient experience content. X (X Corp., Bastrop, Texas, United States) (n=18) demonstrated the highest reliability, with a mean QUEST score of 16.8 (SD: 4.5) and a mean DISCERN score of 28.9 (SD: 6.7). In contrast, TikTok had the lowest reliability, with a mean QUEST score of 9.0 (SD: 3.0) and a mean DISCERN score of 20.1 (SD: 3.0). Dunn's test with Bonferroni correction revealed that TikTok scored significantly lower than X in both QUEST (Mean Difference: -7.83, p < 0.0001) and DISCERN scores (Mean Difference: -8.83, p <0.001). Instagram (n=9) outperformed TikTok in QUEST scores (Mean Difference: 6.66, p <0.001. These findings indicate that X offers the most reliable health information, whereas TikTok consistently ranks lower in reliability.

Analysing online forums to identify information needs and knowledge gaps in patients with left ventricular assist devices: a qualitative study

AIMS

The aim of the study was to explore the knowledge and unmet informational needs of candidates for left ventricular assist device (LVAD), as well as of patients, caregivers, and family members, by analysing social media data from the MyLVAD.com website.

METHODS AND RESULTS

A qualitative content analysis method was employed, systematically examining and categorizing forum posts and comments published on the MyLVAD.com website from March 2015 to February 2023. The data were collected using an automated script to retrieve threads from MyLVAD.com, focusing on genuine questions reflecting information and knowledge gaps. The study received approval from an ethics committee. The research team developed and continuously updated categorization matrices to organize information into categories and subcategories systematically. From 856 posts and comments analysed, 435 contained questions representing informational needs, of which six main categories were identified: clothing, complications/adverse effects, LVAD pros and cons, self-care, therapy, and recent LVAD implantation. The self-care category, which includes managing the driveline site and understanding equipment functionality, was the most prominent, reflecting nearly half of the questions. Other significant areas of inquiry included complications/adverse effects and the pros and cons of LVAD.

CONCLUSION

The analysis of social media data from MyLVAD.com reveals significant unmet informational needs among LVAD candidates, patients, and their support networks. Unlike traditional data, this social media-based research provides an unbiased view of patient conversations, offering valuable insights into their real-world concerns and knowledge gaps. The findings underscore the importance of tailored educational resources to address these unmet needs, potentially enhancing LVAD patient care.

#infertility in Brazil: an analysis of authorship and post content on Instagram

OBJECTIVE

To use hashtag and content analysis to determine the prevalence, authorship, and types of fertility-related and oncofertility information shared on Instagram in Brazil.

METHODS

Eleven fertility-related hashtags were chosen according to https://www.tagsfinder.com/: #infertility, #ivf, #endometriosis, #tryingotconceive, #maternity, #humanreproduction, #pregnancy, #invitrofertilization, #assistedreproduction, #pregnant, #difficulttogetpregnant. For oncofertility, the hashtags were #cancerandpregnancy, #oocytecryopreservation), #oncofertility, and #fertilitypreservation. Posts receiving over 20 comments in March 2021 were analyzed for topic and content. They were divided into six categories (educational, patient experience, outreach, emotional, social support, and coping mechanisms) before being analyzed by three authors. Authorship was divided into healthcare professionals (HCP) and lay people (LP). Posts not written in Brazilian Portuguese, videos, reposts of another account, and commercial posts were excluded.

RESULTS

A total of 220 posts with fertility-related terms were analyzed. HCP accounted for 52% (n=114) and LP for 48% (n=106). Most HCP posts were made by medical doctors (n=78; 68.4%) and fertility clinics (n=27; 23.6%). Authorship analysis (HCP vs. LP) for each hashtag was as follows: #infertility (35% vs. 65%), #ivf (35% vs. 65%), #endometriosis (45% vs. 55%), #tryingtoconceive (65% vs. 35%), #maternity (LP 100%), #humanreproduction (20% vs. 80%), #pregnancy (95% vs. 5%), #invitrofertilization (50% vs. 50%), #assistedreproduction (5% vs. 95%), #pregnant (85% vs. 15%), #difficulttogetpregnant (5% vs. 95%). The category breakdown was as follows: 39% educational, 19% emotional, 16% social support, 13% patient experience, 9% coping, and 4% outreach. A total of 98 posts with #oncofertility were retrieved. Most (77.5%; n=62) were written by HCP. They fell into the following categories: 55% educational, 15% patient experience, 12.5% emotional, 11.2% support, and 3.2% coping.

CONCLUSIONS

Both HCP and LP write about major fertility topics on Instagram. Oncofertility appears to gain less attention. In Brazil, educational content, followed by emotional content, prevails on Instagram.

How Does an Online Mental Health Community on Twitter Empower Diverse Population Levels and Groups? A Qualitative Analysis of #BipolarClub

BACKGROUND

Social media, including online health communities (OHCs), are widely used among both healthy people and those with health conditions. Platforms like Twitter (recently renamed X) have become powerful tools for online mental health communities (OMHCs), enabling users to exchange information, express feelings, and socialize. Recognized as empowering processes, these activities could empower mental health consumers, their families and friends, and society. However, it remains unclear how OMHCs empower diverse population levels and groups.

OBJECTIVE

This study aimed to develop an understanding of how empowerment processes are conducted within OMHCs on Twitter by identifying members who shape these communities, detecting the types of empowerment processes aligned with the population levels and groups outlined in Strategy 1 of the Integrated People-Centred Health Services (IPCHS) framework by the World Health Organization (WHO), and clarifying members' involvement tendencies in these processes.

METHODS

We conducted our analysis on a Twitter OMHC called #bipolarclub. We captured 2068 original tweets using its hashtag #bipolarclub between December 19, 2022, and January 15, 2023. After screening, 547 eligible tweets by 182 authors were analyzed. Using qualitative content analysis, community members were classified by examining the 182 authors' Twitter profiles, and empowerment processes were identified by analyzing the 547 tweets and categorized according to the WHO's Strategy 1. Members' tendencies of involvement were examined through their contributions to the identified processes.

RESULTS

The analysis of #bipolarclub community members unveiled 5 main classifications among the 182 members, with the majority classified as individual members (n=138, 75.8%), followed by health care-related members (n=39, 21.4%). All members declared that they experience mental health conditions, including mental health and general practitioner members, who used the community as consumers and peers rather than for professional services. The analysis of 547 tweets for empowerment processes revealed 3 categories: individual-level processes (6 processes and 2 subprocesses), informal carer processes (1 process for families and 1 process for friends), and society-level processes (1 process and 2 subprocesses). The analysis also demonstrated distinct involvement tendencies among members, influenced by their identities, with individual members engaging in self-expression and family awareness support and health care-related members supporting societal awareness.

CONCLUSIONS

The examination of the #bipolarclub community highlights the capability of Twitter-based OMHCs to empower mental health consumers (including those from underserved and marginalized populations), their families and friends, and society, aligning with the WHO's empowerment agenda. This underscores the potential benefits of leveraging Twitter for such objectives. This pioneering study is the very first to analyze how a single OMHC can empower diverse populations, offering various health care stakeholders valuable guidance and aiding them in developing consumer-oriented empowerment programs using such OMHCs. We also propose a structured framework that classifies empowerment processes in OMHCs, inspired by the WHO's Strategy 1 (IPCHS framework).

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

BACKGROUND

Kerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among 'hard to reach groups' as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.

METHODS

We conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.

RESULTS

A total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.

CONCLUSION

The 'Kerala Model of Development' has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations- especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms - as we move to a post-COVID scenario - should also be evaluated.

Moderating Effect of Coping Strategies on the Association Between the Infodemic-Driven Overuse of Health Care Services and Cyberchondria and Anxiety: Partial Least Squares Structural Equation Modeling Study

BACKGROUND

The COVID-19 pandemic has led to a substantial increase in health information, which has, in turn, caused a significant rise in cyberchondria and anxiety among individuals who search for web-based medical information. To cope with this information overload and safeguard their mental well-being, individuals may adopt various strategies. However, the effectiveness of these strategies in mitigating the negative effects of information overload and promoting overall well-being remains uncertain.

OBJECTIVE

This study aimed to investigate the moderating effect of coping strategies on the relationship between the infodemic-driven misuse of health care and depression and cyberchondria. The findings could add a new dimension to our understanding of the psychological impacts of the infodemic, especially in the context of a global health crisis, and the moderating effect of different coping strategies on the relationship between the overuse of health care and cyberchondria and anxiety.

METHODS

The data used in this study were obtained from a cross-sectional web-based survey. A professional survey company was contracted to collect the data using its web-based panel. The survey was completed by Chinese individuals aged 18 years or older without cognitive problems. Model parameters of the relationships between infodemic-driven overuse of health care, cyberchondria, and anxiety were analyzed using bootstrapped partial least squares structural equation modeling. Additionally, the moderating effects of coping strategies on the aforementioned relationships were also examined.

RESULTS

A total of 986 respondents completed the web-based survey. The mean scores of the Generalized Anxiety Disorder-7 and Cyberchondria Severity Scale-12 were 8.4 (SD 3.8) and 39.7 (SD 7.5), respectively. The mean score of problem-focused coping was higher than those of emotion- and avoidant-focused coping. There was a significantly positive relationship between a high level of infodemic and increased overuse of health care (bootstrapped mean 0.21, SD 0.03; 95% CI 0.1581-0.271). The overuse of health care resulted in more severe cyberchondria (bootstrapped mean 0.107, SD 0.032) and higher anxiety levels (bootstrapped mean 0.282, SD 0.032) in all the models. Emotion (bootstrapped mean 0.02, SD 0.008 and 0.037, SD 0.015)- and avoidant (bootstrapped mean 0.026, SD 0.009 and 0.049, SD 0.016)-focused coping strategies significantly moderated the relationship between the overuse of health care and cyberchondria and that between the overuse of health care and anxiety, respectively. Regarding the problem-based model, the moderating effect was significant for the relationship between the overuse of health care and anxiety (bootstrapped mean 0.007, SD 0.011; 95% CI 0.005-0.027).

CONCLUSIONS

This study provides empirical evidence about the impact of coping strategies on the relationship between infodemic-related overuse of health care services and cyberchondria and anxiety. Future research can build on the findings of this study to further explore these relationships and develop and test interventions aimed at mitigating the negative impact of the infodemic on mental health.

Understanding the Needs and Lived Experiences of Patients With Graft-Versus-Host Disease: Real-World European Public Social Media Listening Study

BACKGROUND

Graft-versus-host disease (GVHD) is the major cause of short- and long-term morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Treatment options beyond corticosteroid therapy remain limited, and prolonged treatment often leads to impaired quality of life (QoL). A better understanding of the needs and experiences of patients with GVHD is required to improve patient care.

OBJECTIVE

The aim of this study is to explore different social media (SM) channels for gathering and analyzing the needs and experiences of patients and other stakeholders across 14 European countries.

METHODS

We conducted a retrospective analysis of SM data from the public domain. The Talkwalker social analytics tool collected data from open-access forums, blogs, and various social networking sites using predefined search strings. The raw data set derived from the aggregator tool was automatically screened for the relevancy of posts, generating the curated data set that was manually reviewed to identify posts that fell within the predefined inclusion and exclusion criteria. This final data set was then used for the deep-dive analysis.

RESULTS

A total of 9016 posts relating to GVHD were identified between April 2019 and April 2021. Deduplication and relevancy checks resulted in 325 insightful posts, with Twitter contributing 250 (77%) posts; blogs, 49 (15%) posts; forums, 13 (4%) posts; Facebook, 7 (2%) posts; and Instagram and YouTube, 4 (1%) posts. Patients with GVHD were the primary stakeholders, contributing 63% of all SM posts. In 234 posts, treatment was the most discussed stage of the patient journey (68%), followed by symptoms (33%), and diagnosis and tests (21%). Among treatment-related posts (n=159), steroid therapy was most frequently reported (54/159, 34%). Posts relating to treatment features (n=110) identified efficacy (45/110, 41%), side effects (38/110, 35%), and frequency and dosage (32/110, 29%), as the most frequently discussed features. Symptoms associated with GVHD were described in 24% (77/325) of posts, including skin-related conditions (49/77, 64%), dry eyes or vision change (13/77, 17%), pain and cramps (16/77, 21%), and fatigue or muscle weakness (12/77, 16%). The impacts of GVHD on QoL were discussed in 51% (165/325) of all posts, with the emotional, physical and functional, social, and financial impacts mentioned in 69% (114/165), 50% (82/165), 5% (8/165), and 2% (3/165) of these posts, respectively. Unmet needs were reported by patients or caregivers in 24% (77/325) of analyzed conversations, with treatment-related side effects being the most common (35/77, 45%) among these posts.

CONCLUSIONS

SM listening is a useful tool to identify medical needs. Treatment of GVHD, including treatment-related side effects, as well as its emotional and physical impact on QoL, are the major topics that GVHD stakeholders mention on SM. We encourage a structured discussion of these topics in interactions between health care providers and patients with GVHD.

TRIAL REGISTRATION

Not applicable.

A Social Media Analysis of Pemphigus

An analysis of the pemphigus content on Facebook, Twitter, Instagram, and YouTube social media platforms.

Understanding Post-Sepsis Syndrome: How Can Clinicians Help?

Sepsis is a global health challenge, with over 49 million cases annually. Recent medical advancements have increased in-hospital survival rates to approximately 80%, but the escalating incidence of sepsis, owing to an ageing population, rise in chronic diseases, and antibiotic resistance, have also increased the number of sepsis survivors. Subsequently, there is a growing prevalence of "post-sepsis syndrome" (PSS). This syndrome includes long-term physical, medical, cognitive, and psychological issues after recovering from sepsis. PSS puts survivors at risk for hospital readmission and is associated with a reduction in health- and life span, both at short and long term, after hospital discharge. Comprehensive understanding of PSS symptoms and causative factors is vital for developing optimal care for sepsis survivors, a task of prime importance for clinicians. This review aims to elucidate our current knowledge of PSS and its relevance in enhancing post-sepsis care provided by clinicians.

Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care

Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics.

Methods for Analyzing the Contents of Social Media for Health Care: Scoping Review

BACKGROUND

Given the rapid development of social media, effective extraction and analysis of the contents of social media for health care have attracted widespread attention from health care providers. As far as we know, most of the reviews focus on the application of social media, and there is a lack of reviews that integrate the methods for analyzing social media information for health care.

OBJECTIVE

This scoping review aims to answer the following 4 questions: (1) What types of research have been used to investigate social media for health care, (2) what methods have been used to analyze the existing health information on social media, (3) what indicators should be applied to collect and evaluate the characteristics of methods for analyzing the contents of social media for health care, and (4) what are the current problems and development directions of methods used to analyze the contents of social media for health care?

METHODS

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched PubMed, the Web of Science, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for the period from 2010 to May 2023 for primary studies focusing on social media and health care. Two independent reviewers screened eligible studies against inclusion criteria. A narrative synthesis of the included studies was conducted.

RESULTS

Of 16,161 identified citations, 134 (0.8%) studies were included in this review. These included 67 (50.0%) qualitative designs, 43 (32.1%) quantitative designs, and 24 (17.9%) mixed methods designs. The applied research methods were classified based on the following aspects: (1) manual analysis methods (content analysis methodology, grounded theory, ethnography, classification analysis, thematic analysis, and scoring tables) and computer-aided analysis methods (latent Dirichlet allocation, support vector machine, probabilistic clustering, image analysis, topic modeling, sentiment analysis, and other natural language processing technologies), (2) categories of research contents, and (3) health care areas (health practice, health services, and health education).

CONCLUSIONS

Based on an extensive literature review, we investigated the methods for analyzing the contents of social media for health care to determine the main applications, differences, trends, and existing problems. We also discussed the implications for the future. Traditional content analysis is still the mainstream method for analyzing social media content, and future research may be combined with big data research. With the progress of computers, mobile phones, smartwatches, and other smart devices, social media information sources will become more diversified. Future research can combine new sources, such as pictures, videos, and physiological signals, with online social networking to adapt to the development trend of the internet. More medical information talents need to be trained in the future to better solve the problem of network information analysis. Overall, this scoping review can be useful for a large audience that includes researchers entering the field.

Multifaceted Role of Social Media in Healthcare: Opportunities, Challenges, and the Need for Quality Control

Social media, leveraging Web 2.0 technologies, plays a vital role in healthcare, medical education, and research by fostering collaboration and enabling research dissemination. Healthcare professionals use these platforms to improve public health literacy, but concerns about misinformation and content accuracy persist. In 2023, platforms like Facebook (Meta Platforms, Inc., Menlo Park, California, United States), YouTube (Google LLC, Mountain View, California, United States), Instagram (Meta Platforms, Inc.), TikTok (ByteDance Ltd, Beijing, China), and Twitter (X Corp., Carson City, Nevada, United States) have become essential in healthcare, offering patient communication, professional development, and knowledge-sharing opportunities. However, challenges such as breaches of patient confidentiality and unprofessional conduct remain. Social media has transformed medical education, providing unique networking and professional development opportunities. Further studies are needed to determine its educational value. Healthcare professionals must follow ethical and professional guidelines, particularly regarding patient privacy, confidentiality, disclosure rules, and copyright laws. Social media significantly impacts patient education and healthcare research. Platforms like WhatsApp (Meta Platforms, Inc.) effectively improve patient compliance and outcomes. Yet, the rapid dissemination of false news and misinformation on social media platforms presents risks. Researchers must consider potential biases and content quality when extracting data. Quality control and regulation are crucial in addressing potential dangers and misinformation in social media and healthcare. Stricter regulations and monitoring are needed due to cases of deaths resulting from social media trends and false news spread. Ethical frameworks, informed consent practices, risk assessments, and appropriate data management strategies are essential for responsible research using social media technologies. Healthcare professionals and researchers must judiciously use social media, considering its risks to maximize benefits and mitigate potential drawbacks. By striking the right balance, healthcare professionals can enhance patient outcomes, medical education, research, and the overall healthcare experience.

Promoting early childhood oral health and preventing early childhood caries on Instagram

Introduction

Early childhood caries (ECC) is prevalent worldwide. Oral health promotion effectively utilizes key messages to educate parents/caregivers and the public on how to prevent ECC. Instagram is one of the biggest social media platforms, and could be used to promote early childhood oral health. The purpose of this study was to determine if and how young children's oral health is promoted and supported on Instagram.

Methods

This study used inductive content analysis to categorize, quantify, and interpret pictorial and textual data derived from Instagram posts containing the most commonly used ECC-related hashtags in their captions (determined by an extensive search through Instagram's search bar).

Results

A total of 1,071 images and 3,228 comments were analyzed based on 13 hashtags. The most common types of images were those of people (57.5%) and graphics/memes (37.8%). Most people were older children (32.5%) or adults (20.3%), and were White (19.6%) or Asian (18.5%). A majority of images had people posing (79.1%) in dental clinics (81.3%). Most graphics/memes were instructional/informational (76.3%). A total of 173 posts had substantial discussions that were positive/constructive in nature. The majority of discussions had at least one comment providing advice, tips, or explanations (79.8%), or had users requesting further information (73.4%).

Conclusion

As more people engage with social media, health professionals should consider the potential for Instagram as a tool to promote early childhood oral health and to prevent ECC. Our study shows that many different users are providing and consuming content related to ECC. Targeted messaging, monitoring of content, and professional guidance could be beneficial to those seeking oral health information on this platform.

The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews

BACKGROUND

Several systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted.

OBJECTIVE

This overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions.

METHODS

Through a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors.

RESULTS

This overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted.

CONCLUSIONS

The application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients' clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers.

TRIAL REGISTRATION

PROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375.

The Contributions of Pandemic Severity, Government Stringency, Cultural Values and Internet Usage to Post-traumatic Stress Disorder During the COVID-19 Pandemic: An Analysis of Data From 35 Countries

Emergent symptoms of post-traumatic stress disorder (PTSD) have been frequently reported in the context of the COVID-19 pandemic, and may affect up to 17-18% of individuals. There is preliminary evidence that pandemic severity, cultural values, restrictions imposed by governments, and Internet usage may all influence the emergence of PTSD symptomatology. In this study, possible linear- and non-linear associations between these factors and the prevalence of PTSD symptoms across 35 countries were examined based on data from existing research. Evidence was found for a positive logarithmic relationship between the COVID-19 case-fatality ratio and PTSD (p = 0.046), a positive logarithmic relationship between power distance and PTSD (p = 0.047), and a trend toward a negative quadratic association with Internet usage (p = 0.051). No significant cross-national effect was observed for government restrictiveness. These findings suggest that strategies aimed at minimizing COVID-19 deaths, and at ensuring equitable access to essential resources, may be of use in reducing the emergence of PTSD symptoms at a population level during this pandemic.

Metal substitutions incarbonic anhydrase: a halide ion probe study

Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.