Online Social Support for the Prevention of Smoking Relapse: A Content Analysis of the WhatsApp and Facebook Social Groups

How People with Physical Disabilities Can Obtain Social Support through Online Videos: A Qualitative Study in China

BACKGROUND

Online video creation is becoming an option for many people with physical disabilities in China. However, few studies have considered how physically disabled individuals access social support through online video creation.

METHODS

For this qualitative study, semi-structured interviews were conducted with 18 online video creators with physical disabilities. The starting point of this study was video creation by people with physical disabilities, with a focus on the social interactions between creators, online video platforms, followers, viewers and sponsors, as well as the perceived social support in the process.

RESULTS

Thematic analysis was used to identify six social support themes: (i) meeting emotional needs; (ii) obtaining informational support; (iii) obtaining creative benefits; (iv) constructing identity; (v) reconstructing social relationships; and (vi) discovering self-worth. Four risk-related themes were identified: (i) online language violence; (ii) invasion of commercial capital; (iii) online video addiction; and (iv) fragile social support.

CONCLUSIONS

The findings indicate that, although people with physical disabilities can obtain effective social support through creating online videos, it is accompanied by many risks. In addition, the social support gained through creating online videos differs from traditional online social support (e.g., changes in online support groups, emphasis on creative gain).

PROSPECT

Future research should perform more detailed analyses of different types of social support and specific risks of creation, while taking into account individual differences and sociodemographic backgrounds.

Adaptive interventions to optimise the mobile phone-based smoking cessation support: study protocol for a sequential, multiple assignment, randomised trial (SMART)

BACKGROUND

Mobile health (mHealth) is promising in developing personalised smoking cessation interventions. By using an adaptive trial design, we aim to evaluate the effectiveness of personalised mHealth intervention in increasing smoking cessation.

METHODS

This study is a two-arm, parallel, accessor-blinded Sequential Multiple-Assignment Randomised Trial (SMART) that randomises 1200 daily cigarette smokers from 70 community sites at two timepoints. In the first phase, participants receive brief cessation advice plus referral assistance to smoking cessation services and are randomly allocated to receive personalised instant messaging (PIM) or regular instant messaging (RIM). In the second phase, PIM participants who are non-responders (i.e. still smoking at 1 month) are randomised to receive either optional combined interventions (multi-media messages, nicotine replacement therapy sampling, financial incentive for active referral, phone counselling, and family/peer support group chat) or continued-PIM. Non-responders in the RIM group are randomised to receive PIM or continued-RIM. Participants who self-report quitting smoking for 7 days or longer at 1 month (responders) in both groups continue to receive the intervention assigned in phase 1. The primary outcomes are biochemical abstinence validated by exhaled carbon monoxide (< 4 ppm) and salivary cotinine (< 10 ng/ml) at 3 and 6 months from treatment initiation. Intention-to-treat analysis will be adopted.

DISCUSSION

This is the first study using a SMART design to evaluate the effect of adaptive mHealth intervention on abstinence in community-recruited daily smokers. If found effective, the proposed intervention will inform the development of adaptive smoking cessation treatment and benefits smokers non-responding to low-intensity mHealth support.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03992742 . Registered on 20 June 2019.

Mixed methods evaluation of the ‘real-world’ implementation of group-based behavioral stop smoking support through Facebook

INTRODUCTION

While promising evidence from trials of social-media-based stop smoking support informs service-planning, there is a need for more prospective, observational studies of smoking cessation interventions to build ‘real-world’ evidence. Specifically, user experiences have been under-explored with qualitative methods to date. This mixed-method evaluation of a closed Facebook group-based behavioral stop smoking support program, which was conducted in Ireland in 2018, aimed to address these issues.

METHODS

Pre- and post-program surveys measured smoking abstinence (self-reported 7-day point prevalence), changes in smoking attitudes and behavior, and participant experiences. Engagement with Facebook was measured through counting ‘likes’ and comments, and was used to categorize groups as ‘more active’ and ‘less active’ over a 12-week period of support. Thematic content analysis of semi-structured participant interviews explored program experience in depth.

RESULTS

In total, 13 of 52 participants reported smoking abstinence post-program (25.0%, 95% CI: 14.0–39.0). Participant engagement with Facebook was variable and decreased over the program. Membership of a ‘more active’ group was associated with better reported participant experience (e.g. 90.9% agreeing ‘Facebook group helped me to quit or reduce smoking’, versus 33.3% in the ‘less active’ group, p<0.05). Qualitative analysis identified three over-arching themes: importance of social interactions; perception of health information; and appeal of online support.

CONCLUSIONS

Facebook can be used to deliver group-based behavioral stop smoking support in the real world. In Ireland, the one-month post-program abstinence outcomes achieved by other stop smoking services is approximately 50%, and while the outcomes for this service was lower (25%), it is still better than outcomes estimated for unassisted quitting. Engagement and peer-to-peer interactivity should be maximized to support positive participant experience.

It Takes Two to Tango: How the COVID-19 Vaccination Campaign in Israel Was Framed by the Health Ministry vs. the Television News

Background

The internet has become a major resource in information transfer during COVID-19, and traditional means of communication are digitized and accessible online to the public at large.

Objectives

This study seeks to examine how Israel's two main television news channels (Channel 12 and Channel 13) covered the Covid-19 vaccination campaign, compared to how the Ministry of Health ran the campaign.

Methods

A qualitative study based on triangulation of online content analyses from three different sources: advertising campaigns, social media posts and reports on television news channels. The research sample included 252 reports from the newsrooms of Channel 13 (n = 151) and Channel N12 (n = 101), Israel's two leading news channels, all broadcast between December 1, 2020 and November 30, 2021. The sample also included posts from Israel Ministry of Health Facebook page and advertising campaigns from the Facebook page of the Israel Government Advertising Agency (LAPAM), which constructs advertising campaigns for the MOH (113 items).

Results

The research findings reveal congruence between the way the MOH framed its vaccination campaign and news coverage of the vaccination issue. The vaccination campaign used three primary framing strategies: (1) positive framing (emphasizing the vaccine's advantages and stressing that the vaccine is safe and effective based on cost-benefit calculations and public health perspectives); (2) fear appeal strategy (conveying persuasive messages that seek to arouse fear through threats of impending danger or harm); (3) attribution of responsibility strategy (blaming the unvaccinated and targeting all those who criticized Israel's generic vaccination policy).

Conclusion

As the watchdog of democracy, the news should function as a professional and objective source that criticizes government systems if necessary and strives to uncover the truth throughout the crisis. Public trust, which is so essential during such a crisis, can be achieved only if the news channels provide reports and meaningful journalistic investigations that challenge the system. By doing so, they can help fight conflicts of interest that divert management of the crisis from the professional health field to the political-economic arena.

A Double-Edged Impact of Social Smartphone Use on Smartphone Addiction: A Parallel Mediation Model

Evidence supports predictive roles of non-social smartphone use for smartphone addiction, but the relationship of social smartphone use and smartphone addiction is unclear. This study explored whether social smartphone use has a double-edged impact on smartphone addiction. Using data from a sample of 909 Chinese undergraduates, we tested a parallel mediation model that considered online social support and realistic social support as mediators. As predicted, social smartphone use weakened smartphone addiction through realistic social support and contributed to smartphone addiction through online social support. Moreover, we tested the moderating role of agreeableness in the mediation path of online social support. Agreeableness only moderated the indirect effects. Specifically, the predictive effects of online social support on smartphone addiction was greater for lower rather than higher agreeableness. The results suggest that social needs play an important role in the formation of smartphone addiction. Several limitations and implications are also discussed herein.

Evaluating Outcomes of a Social Media-Based Peer and Clinician-Supported Smoking Cessation Program in Preventing Smoking Relapse: Mixed Methods Case Study

BACKGROUND

Smoking relapse prevention after completion of a smoking cessation program is highly germane to reducing smoking rates.

OBJECTIVE

The purpose of this study was to evaluate the 1-year outcomes of a social media-based and peer and clinician-supported smoking cessation program on Facebook and examine communication patterns that could support smoking cessation and identify risk of relapse.

METHODS

We used a mixed methods case study evaluation approach featuring a single-case holistic design. We recruited volunteers who signed up after successful completion of a 12-week clinical smoking cessation program in a general medicine department in Japan. Participants contemporaneously accessed a closed Facebook page, and we analyzed their posts including text and emoticons. We used joint display analysis, which involved iterative structuring and restructuring construct-specific tables with both types of data to find the most effective approach for integrating the quantitative results with the qualitative results of content analysis.

RESULTS

One successful participant and 2 relapsed participants were analyzed to explore the specific patterns of postings prior to relapse. Decisive comments about quitting smoking were common among participants, but encouraging messages for peers were more common from the successful participant. Comments seeking social support and reassurance were warning signs of relapse. Conflicted comments also may be a warning sign of relapse risk.

CONCLUSIONS

These findings based on a mixed methods case study of a social media platform supporting smoking cessation could be used to guide messaging in other online social networking service communities after a smoking cessation program to help reduce smoking relapse.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000031172; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000035595.

The effect of an instant message-based lifestyle and stress management intervention on the reduction of cardiovascular disease risk

AIM

This study investigated the effectiveness of an instant message-based lifestyle and stress management intervention delivered by nurses on cardiovascular disease risk reduction.

METHODS

In this nonrandomized concurrent controlled trial conducted from March 2013 to September 2013, 164 eligible employees in two companies were assigned to the intervention (n = 83) and control (n = 81) groups based on their worksites. Only participants were blinded to group assignment. All participants received two education sessions during 1 month, and the intervention group also received an instant message-based lifestyle and stress management intervention for 5 months. The primary outcome was the Framingham Risk Score, and the data were collected at the first month and the sixth month.

RESULTS

The final analysis included 80 participants in the intervention group and 76 in the control group. After the intervention, significant intervention effects were found for the mean value and the changes of the Framingham Risk Score and the proportion of participants who improved their diet and exercise (P < 0.05). There were trends for improvement in the proportion of smoking and levels of stress, but statistically significant levels (P > 0.05) were not met.

CONCLUSION

An instant message-based lifestyle and stress management intervention can reduce cardiovascular disease risk in high-risk individuals.

What parents of adolescents in residential substance use treatment want from continuing care: A content analysis of online forum posts

BACKGROUND

Parents of adolescents in residential substance use (SU) treatment face a myriad of barriers to continuing care services. Growing research suggests that mobile health (mHealth) technologies can overcome common barriers to continuing care services, yet no work has addressed parents' needs. To gain insight into parents' continuing care needs, we analyzed online forum posts made by parents who received a novel mHealth intervention. Methods: Thirty parents received access to an online networking forum where they could connect with our adolescent SU expert or the community of parents also navigating their adolescent's post-discharge transition. In real-time, participants could ask questions and share information, experiences, and emotional support. Results: Twenty-one parents (70%) posted at least once; 12 parents made 15 posts to our expert, while 18 parents made 50 posts to the parent community. Thematic analysis uncovered five major themes: parenting skills; parent support; managing the post-discharge transition; adolescent SU; and family functioning. Conclusions: Parents discussed a range of topics directly and indirectly related to their adolescent's treatment. Incorporating networking forums into mHealth continuing care interventions offers parents a secure space to ask questions, share concerns, and gather information needed to support their adolescent's transition home.

Digital inequalities in health information seeking behaviors and experiences in the age of web 2.0: A population-based study in Hong Kong

BACKGROUND

Inequalities in health information seeking behaviors (HISBs) using mass media and internet websites (web 1.0) are well documented. Little is known about web 2.0 such as social networking sites (SNS) and instant messaging (IM) and experiences of HISBs.

METHODS

We surveyed representative Hong Kong Chinese adults (N = 10143, 54.9% female; 72.3% aged 25-64 years) on frequency of HISBs using traditional sources, internet websites, SNS (e.g., Facebook, Twitter), and IM (e.g., WhatsApp, WeChat) and experiences measured using Information Seeking Experience Scale. Adjusted prevalence ratios (aPRs) for HISBs and experiences by sociodemographic and health-related characteristics were yielded using multivariable Poisson regression with robust variance estimators. aPRs for experiences by HISBs using internet websites, SNS, and IM adjusting for sociodemographic and health-related characteristics were also yielded.

RESULTS

Being female, higher educational attainment, not smoking, and being physically active were associated with HISBs using any source (all P<0.05). Older age had decreased aPRs for HISBs using traditional sources (P for trend = 0.03), internet websites (P for trend<0.001), and SNS (P for trend<0.001) but not for IM (aged 45-64 years: aPR = 1.48, 95% CI 1.07, 2.03). Lower educational attainment and income were associated with negative experiences including feelings of effort and difficulties in understanding the information (all P for trend<0.05). Older age had increased aPRs for difficulties in understanding the information (P for trend = 0.003). Compared with internet websites, HISBs using IM was associated with feelings of frustration (aPR = 1.39, 95% CI 1.08, 1.79), difficulties in understanding the information (aPR = 1.36, 95% CI 1.12, 1.65), and quality concern (aPR = 1.20, 95% CI 1.08, 1.32).

CONCLUSIONS

We identified correlates of web-based health information seeking and experiences in Hong Kong Chinese adults. Providing greater access to and improved information environment of web 2.0 to the target groups may help address digital inequalities.

Use of Facebook by Academic Medical Centers in Taiwan During the COVID-19 Pandemic: Observational Study

Background

The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan’s success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success.

Objective

This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic.

Methods

We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19–related posts or non–COVID-19–related posts. COVID-19–related posts were split into 4 categories: policy of Taiwan’s Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of “likes,” number of messages left, number of shares, video or non-video post, and date of search.

Results

The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more “likes,” comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook.

Conclusions

Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19.

Effectiveness of WhatsApp online group discussion for smoking relapse prevention: protocol for a pragmatic randomized controlled trial

BACKGROUND AND AIMS

Sustained psychosocial support via online social groups may help former tobacco users maintain abstinence. This study aims to examine the effectiveness of participating in a WhatsApp social group for long-term smoking cessation.

DESIGN

Two-arm, open-labelled, pragmatic, individually randomized controlled trial.

SETTING

All participants are service users of smoking cessation clinics, and all interventions are delivered via mobile phones.

PARTICIPANTS

Participants included 1008 adult quitters who self-report no tobacco use in the past 3-30 days.

INTERVENTIONS

The intervention group (n = 504) will join a WhatsApp social group to receive standardized and theory-based reminders of smoking relapse prevention and participate in discussion with other WhatsApp group members using their own mobile phones. All social groups will be led by counselors or specialist nurse practitioners. The control group (n = 504) will receive similar reminders via short messages to their own mobile phones but will not interact with other participants. The intervention duration for both groups is 8 weeks. Both groups will receive a booklet at baseline about how to prevent smoking relapse.

MEASUREMENTS

The primary outcome is biochemically validated tobacco abstinence at 12 months after consent.

COMMENTS

The findings will provide evidence concerning the utility of operating online social group discussion for prevention of smoking relapse and sustaining long-term abstinence.

Effectiveness and Parental Acceptability of Social Networking Interventions for Promoting Seasonal Influenza Vaccination Among Young Children: Randomized Controlled Trial

BACKGROUND

Seasonal influenza vaccination (SIV) coverage among young children remains low worldwide. Mobile social networking apps such as WhatsApp Messenger are promising tools for health interventions.

OBJECTIVE

This was a preliminary study to test the effectiveness and parental acceptability of a social networking intervention that sends weekly vaccination reminders and encourages exchange of SIV-related views and experiences among mothers via WhatsApp discussion groups for promoting childhood SIV. The second objective was to examine the effect of introducing time pressure on mothers' decision making for childhood SIV for vaccination decision making. This was done using countdowns of the recommended vaccination timing.

METHODS

Mothers of child(ren) aged 6 to 72 months were randomly allocated to control or to one of two social networking intervention groups receiving vaccination reminders with (SNI+TP) or without (SNI-TP) a time pressure component via WhatsApp discussion groups at a ratio of 5:2:2. All participants first completed a baseline assessment. Both the SNI-TP and SNI+TP groups subsequently received weekly vaccination reminders from October to December 2017 and participated in WhatsApp discussions about SIV moderated by a health professional. All participants completed a follow-up assessment from April to May 2018.

RESULTS

A total of 84.9% (174/205), 71% (57/80), and 75% (60/80) who were allocated to the control, SNI-TP, and SNI+TP groups, respectively, completed the outcome assessment. The social networking intervention significantly promoted mothers' self-efficacy for taking children for SIV (SNI-TP: odds ratio [OR] 2.69 [1.07-6.79]; SNI+TP: OR 2.50 [1.13-5.55]), but did not result in significantly improved children's SIV uptake. Moreover, after adjusting for mothers' working status, introducing additional time pressure reduced the overall SIV uptake in children of working mothers (OR 0.27 [0.10-0.77]) but significantly increased the SIV uptake among children of mothers without a full-time job (OR 6.53 [1.87-22.82]). Most participants' WhatsApp posts were about sharing experience or views (226/434, 52.1%) of which 44.7% (101/226) were categorized as negative, such as their concerns over vaccine safety, side effects and effectiveness. Although participants shared predominantly negative experience or views about SIV at the beginning of the discussion, the moderator was able to encourage the discussion of more positive experience or views and more knowledge and information. Most intervention group participants indicated willingness to receive the same interventions (110/117, 94.0%) and recommend the interventions to other mothers (102/117, 87.2%) in future.

CONCLUSIONS

Online information support can effectively promote mothers' self-efficacy for taking children for SIV but alone it may not sufficient to address maternal concerns over SIV to achieve a positive vaccination decision. However, the active involvement of health professionals in online discussions can shape positive discussions about vaccination. Time pressure on decision making interacts with maternal work status, facilitating vaccination uptake among mothers who may have more free time, but having the opposite effect among busier working mothers.

TRIAL REGISTRATION

Hong Kong University Clinical Trials Registry HKUCTR-2250; https://tinyurl.com/vejv276.

Using social media for smoking cessation interventions: a systematic review

Background:

Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media–based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation.

Methods:

We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention.

Results:

We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%–75%, regardless of the measurement time, study design, and analysis methods. Social media–based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al’s studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system).

Conclusions:

This review highlights the effectiveness of social media–based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.

Influence of Generational Cohorts on the Preferences for Information and Communication Technologies in Latin American Patients with Obstructive Lung Diseases

Background

Advances in information and communication technologies (ICTs) represent a growing platform for the expansion of healthcare related services, but there is little information on how generational differences might account for distinct patterns of use and interest for ICTs. Our study aims to achieve a better understanding on how generational cohorts might influence the use and preferences for ICTs among patients with obstructive lung diseases in Latin America.

Materials and Methods

We conducted an anonymous cross-sectional survey-based study, involving 968 patients with obstructive lung diseases (OLD) in Latin America. Patients rated their frequency of use and preferences of ICTs through a modified version of the Michigan Questionnaire. Chi-square test for association and adjusted regression analyses were performed.

Results

Of all, 63.6% of participants had Internet access. Younger generations, in particular Generation Z and Millennials, had the highest rate of Internet access and smartphone ownership, as well as of overall frequency of ICT use. Web-based Internet was found to be the main source to seek information about the disease (36.9%) across all generational cohorts. Generation Z and Millennials presented the highest odds to be interested in using Twitter (OR 31.79 and 8.86) for receiving health-related information, and email (OR 4.87 and 4.86) as the preferred way to ask physicians information related to their disease through ICTs.

Conclusion

Generational cohorts influence the use and preferences for ICTs among patients with obstructive lung diseases. Younger generational cohorts were associated with higher access to the Internet and smartphone ownership, as well as higher interest for using ICTs to receive and ask for health-related information.

Using Facebook for Qualitative Research: A Brief Primer

As Facebook continues to grow its number of active users, the potential to harness data generated by Facebook users also grows. As much of Facebook users’ activity consists of creating (and commenting on) written posts, the potential use of text data for research is enormous. However, conducting a content analysis of text from Facebook users requires adaptation of research methods used for more traditional sources of qualitative data. Furthermore, best practice guidelines to assist researchers interested in conducting qualitative studies using data derived from Facebook are lacking. The purpose of this primer was to identify opportunities, as well as potential pitfalls, of conducting qualitative research with Facebook users and their activity on Facebook and provide potential options to address each of these issues. We begin with an overview of information obtained from a literature review of 23 studies published between 2011 and 2018 and our own research experience to summarize current approaches to conducting qualitative health research using data obtained from Facebook users. We then identify potential strategies to address limitations related to current approaches and propose 5 key considerations for the collection, organization, and analysis of text data from Facebook. Finally, we consider ethical issues around the use and protection of Facebook data obtained from research participants. In this primer, we have identified several key considerations that should aid health researchers in the planning and execution of qualitative studies involving content analysis of text data from Facebook users.

A systematic review of mobile health interventions in China: Identifying gaps in care

INTRODUCTION

Mobile health has a promising future in the healthcare system in most developed countries. China's rapidly developing mobile technology infrastructure offers an unprecedented opportunity for wide adoption of mobile health interventions in the delivery of effective and timely healthcare services. However, there is little data on the current extent of the mobile health landscape in China. The aim of this study was to systematically review the existing mobile health initiatives in China, characterise the technology used, disease categories targeted, location of the end user (urban versus rural), and examine the potential effects of mobile health on health system strengthening in China. Furthermore, we identified gaps in development and evaluation of the effectiveness of mobile health interventions.

METHODS

A systematic review of the literature published from 18 December 2015 - 3 April 2019 was conducted and yielded 2863 articles from English and Chinese retrieval database and trial registries, including PubMed, EMBASE, China National Knowledge of Infrastructure and World Health Organization International Clinical Trials Registry Platform. Studies were included if they used mobile health to support patient healthcare outcomes.

RESULTS

A total of 1129 full-text articles were assessed and 338 were included in this study. The review found that most studies targeted client education and behaviour change via applications (apps) (65.4%), including WeChat, and text messaging (short text messages) (19.8%) to improve patient medical treatment outcomes such as compliance and appointment reminders. The most common disease-specific mobile health interventions focused primarily on chronic disease management and behaviour change in cardiology (13.3%), endocrinology/diabetes (12.1%), behavioural health (11.8%), oncology (11.2%) and neurology (6.8%). The mobile health interventions related to nutrition (0.6%) and chronic respiratory diseases (1.6%) are underrepresented in mobile health in comparison to the burden of disease in China. The majority (90.0%) of the mobile health interventions were conducted exclusively in urban areas, with few opportunities reaching rural populations.

CONCLUSIONS

Overall, mobile health has a promising future in China, with recent rapid growth in initiatives. The majority are focused on education and behaviour change in the realm of chronic diseases and target patients in urban areas. The imbalance in mobile health between the urban and rural areas, as well as between population disease spectrum and health service delivery, pose substantial dilemmas. However, mobile health may be redirected to correct this imbalance, possibly improving access to healthcare services, and filling the gaps in order to improve health equity for the underserved populations in China.

Smoking Patterns and Willingness to Quit: A Cross-sectional Study in Al Ain City, UAE

Background:

Tobacco use is the major cause of preventable morbidity and mortality. The main objectives of this study were to identify smokers willing to participate in quit smoking campaigns using social media and to identify smoking habits of everyday smokers in Al Ain City, United Arab Emirates (UAE).

Research Design and Methods:

Everyday smokers from Al Ain city of the UAE were surveyed in different locations of the city including malls and specialized tobacco-selling shops. They were interviewed using a semi-structured survey and the information was recorded by one assessor. The information gathered included type and frequency of tobacco use, smoking history and habits, quitting history, desire to quit, and the preferred communication platform.

Result:

A total of 412 regular adult smokers were interviewed in which the majority (95%) reported first smoking at or before the age of 28 years. Participants were mainly UAE nationals (33.7%), Egyptians (14.1%), Syrians (12.9%), and Jordanians (10.9%). Manufactured cigarettes were the main form of tobacco consumption (59.5%), and smoking was mainly solitary (56.3%) and at home (26.3%) and coffee shops (24.9%). The majority of interviewed subjects (76.7%; 95% confidence interval [CI]: 72.4%–80.5%) expressed their interest to quit smoking in the future and 55.3% (95% CI: 50.5%–60.2%) were ready to get involved immediately in a smoking cessation program. Of those, 80.3% (95% CI: 74.6%–84.9%) preferred WhatsApp for receiving smoking cessation motivational education.

Conclusion:

The majority of smokers started at younger ages, which warrant the age of smoking restriction to be raised to 29 years instead of 18 years by the health authority. Everyday smokers were aware of the potentially hazardous effects of tobacco smoking and many were willing to accept help to quit smoking that involves the use of WhatsApp.

Offspring Caregivers of Chinese Women with Breast Cancer: Their Social Support Requests and Provision on Social Media

Background: Although a number of studies have examined social support needs among women with breast cancer, little attention has been paid to the burden and needs for social support among their family caregivers, who often report mental and physical problems associated with caregiving. Objective: This study aims to examine the role of social media in providing social support for offspring caregivers of breast cancer patients. Methods: A peer support group, "Having a breast cancer patient in my family," was created on Douban (www.douban.com), one of China's most popular social media sites, to provide social support to family caregivers of women with breast cancer. We analyzed the content of 784 messages in the discussion threads where the latest update fell between January 2017 and July 2017. Results: The results revealed that the majority of messages (n = 690, 88.0%) provided or requested social support, and more than 64.5% of these messages (n = 445) were posted by caregivers who were offspring of the cancer patients. The results also suggested that these caregivers requested and provided informational support more frequently than they did emotional and instrumental support. Conclusions: This study suggests that social media could be a plausible platform for offspring caregivers of breast cancer patients to share caregiving experiences, access informational resources for their care recipients, gain knowledge about breast cancer prevention, and obtain emotional encouragement. Theoretical as well as practical implications are discussed.

Factors explaining participation in WhatsApp groups: an exploratory study

Purpose

To date, only a limited number of studies have considered WhatsApp groups. The purpose of this paper is to focus on single WhatsApp groups and explore their special characteristics and dynamics. The present study used the social support perspective, Big Five model and narcissism paradigm to predict the level of participation in WhatsApp groups with these variables.

Design/methodology/approach

The research was conducted in Israel during the Spring semester of the 2017 academic year and encompassed 127 students. Researchers used eight questionnaires to gather data: a demographic questionnaire; a perceived social support questionnaire; three characteristics from the BIG5 questionnaire: extroversion, openness to experience and neuroticism; a narcissistic questionnaire; questions about WhatsApp usage; questions about one meaningful WhatsApp group; participation level in the meaningful group; and group importance.

Findings

The findings confirmed that psychological factors such as social support, extroversion and narcissism significantly predict the level of participation in WhatsApp groups. It was also found that age, the level of group importance, being the group’s manager, WhatsApp usage and group’s subject play an important role in the participation level.

Originality/value

These results affirmed the importance of psychological factors when exploring new technological platforms, as the paper proposes that individuals may behave differently in various technological environments due to their psychological characteristics. The study expanded current research about a popular communication tool, WhatsApp, by examining it within the special context of WhatsApp groups. This focus enables researchers to follow the special dynamics that take place in a new technological platform.

Use of Facebook by Hospitals in Taiwan: A Nationwide Survey

Background: Social media advertising has become increasingly influential in recent years. Because Facebook has the most active users worldwide, many hospitals in Taiwan have created official Facebook fan pages. Our study was to present an overview of official Facebook fan pages of hospitals in Taiwan. Methods: All 417 hospitals were surveyed about their use of Facebook fan pages in December 2017. The last update time, posts in the past 30 days, number of “Likes”, and other features were analyzed and stratified according to the accreditation statuses of the hospitals. Results: In Taiwan, only 51.1% (n = 213) of the hospitals had an official Facebook fan page. Among these hospitals, 71.8% (n = 153) had updated their pages in the past 30 days, although 89.2% (n = 190) provided online interactions. Academic medical centers tended to have more “Likes” than regional and local community hospitals (on average 5947.4, 2644.8, and 1548.0, respectively). Conclusions: In spite of the popularity of Facebook among the general population, most hospitals in Taiwan do not seem to make good use of this kind of social media. The reasons for the use and nonuse of Facebook on the part of both hospitals and patients deserve further investigation.

A randomized controlled evaluation of the tobacco status project, a Facebook intervention for young adults

AIMS

To test the efficacy of the Tobacco Status Project (TSP) Facebook smoking cessation intervention for young adults relative to referral to an on-line program on biochemically verified 7-day abstinence from smoking.

DESIGN

Two-group parallel randomized controlled trial, comparing TSP (n = 251) to on-line control (n = 249) with follow-up to 12 months.

SETTING

On-line, throughout the United States.

PARTICIPANTS

Young adult cigarette smokers (mean age 21 years; 73% white, 55% female, 87% daily smokers).

INTERVENTIONS AND COMPARATOR

TSP provided private Facebook groups tailored to stage of change to quit smoking, daily contacts, weekly live counseling sessions, and for those ready to quit, six cognitive behavioral therapy counseling sessions. Some TSP groups were assigned randomly to receive a monetary incentive for engagement. Control provided referral to the National Cancer Institute Smokefree.gov website.

MEASUREMENTS

PRIMARY OUTCOME: Biochemically verified 7-day abstinence over 12 months.

SECONDARY OUTCOMES

Post-treatment (3-month) abstinence; reported abstinence, quit attempt, reduction in smoking, readiness to quit smoking over 12 months.

FINDINGS

Verified 7-day abstinence was not significantly different for intervention compared with control over 1 year: month 3 (8.3 versus 3.2%), 6 (6.2 versus 6.0%), and 12 (5.9 versus 10.0%); odds ratio (OR) = 1.07; 95% confidence interval (CI) = 0.23, 4.97; retention = 71%. There was an effect at 3 months (OR = 2.52; CI = 1.56, 4.04; P < 0.0001). There were no 12-month treatment effects for reported abstinence (P = 0.746), reduction in smoking by 50% or more (P = 0.533), likelihood of having made a quit attempt (P = 0.387) or stage of change over time (0.968). Participants in TSP engaged more and rated the intervention more favorably than those in the control condition.

CONCLUSIONS

Compared with referral to a smoking cessation website, a novel USA-focused Facebook smoking cessation intervention did not improve abstinence from smoking over 1 year, but increased abstinence at the end of treatment and was engaging to participants.

Using Facebook to address smoking and heavy drinking in young adults: Protocol for a randomized, controlled trial

INTRODUCTION

Tobacco and alcohol often are used simultaneously by young adults, and their co-use is associated with greater health consequences than from single use. Social media platforms offer low cost and highly accessible channels to reach and engage young people in substance use interventions. The current trial seeks to compare the Facebook Tobacco Status Project (TSP) smoking cessation intervention to an intervention targeting both tobacco use and heavy episodic drinking (TSP + ALC) among young adults who use both substances.

METHODS

This randomized clinical trial will evaluate the feasibility and initial efficacy of TSP + ALC compared to TSP with 225 US young adult smokers reporting heavy drinking. Participants will be recruited online and randomized to one of two conditions (TSP or TSP + ALC), both with assignment to a Facebook group tailored to readiness to quit smoking. Groups will receive a 90-day intervention including daily Facebook postings and weekly live counseling sessions. The TSP + ALC group will include content related to alcohol use. All participants will be offered a 2-week introductory supply of nicotine patch. Participants will complete baseline, 3-, 6-, and 12-month online assessments of substance use and other health risk behaviors. The primary efficacy outcome is biochemically-verified 7-day point prevalence abstinence. Secondary outcomes include alcohol and tobacco use, combined use, and thoughts about each substance.

DISCUSSION

This trial examines an innovative and scalable approach to engaging young adults online in tobacco and alcohol use treatment. Study findings will inform digital health interventions and best practices for treating multiple substance use in young adults.