Social Media, E-Health, and Medical Ethics

The Role of Health Belief Model Constructs and Content Creator Characteristics in Social Media Engagement: Insights from COVID-19 Vaccine Tweets

INTRODUCTION

The Health Belief Model (HBM) has been widely studied, but it is unclear how social media post creators use HBM constructs to influence the public's awareness of health topics, particularly for COVID-19 preventative health behaviors. Moreover, there is limited knowledge about how content creators enhance user engagement with COVID-19 vaccine tweets.

METHODS

A content analysis of COVID-19 vaccine tweets (n = 362) examined how HBM constructs were used in social media posts and their relationship to content creator characteristics (e.g., race, education level) and user engagement behaviors (e.g., number of favorites).

FINDINGS

Content creators' tweets about COVID-19-related topics generally centered on two HBM constructs-benefits and barriers-while fewer tweets emphasized perceived susceptibility or self-efficacy; tweets containing these constructs were retweeted less often. Findings revealed that tweets from politicians, health experts, and white and Asian sources emphasized the perceived benefits of the COVID-19 vaccine. Individual tweets, especially from Black individuals and celebrities, generated more user engagement.

CONCLUSIONS

Understanding the factors that contribute to social media user engagement with health-related content is important for designing more focused and impactful health communication campaigns and promoting healthier habits and perspectives. Thus, by demonstrating the possible relevance of the HBM to digital communication strategies or health campaigns, our study provides useful guidance for health promoters and policymakers who use social media to raise public health awareness.

The application and uses of telemedicine in vascular surgery: A narrative review

Technological advances over the past century have accelerated the pace and breadth of medical and surgical care. From the initial delivery of "telemedicine" over the radio in the 1920s, the delivery of medicine and surgery in the 21st century is no longer limited by connectivity. The COVID-19 pandemic hastened the uptake of telemedicine to ensure that health care can be maintained despite limited face-to-face contact. Like other areas of medicine, vascular surgery has adopted telemedicine, although its role is not well described in the literature. This narrative review explores how telemedicine has been delivered in vascular surgery. Specific themes of telemedicine are outlined with real-world examples, including consultation, triaging, collaboration, mentoring, monitoring and surveillance, mobile health, and education. This review also explores possible future advances in telemedicine and issues around equity of care. Finally, important ethical considerations and limitations related to the applications of telemedicine are outlined.

Non-empirical methods for ethics research on digital technologies in medicine, health care and public health: a systematic journal review

Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the "empirical turn" in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the increased use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health.

How (Cautious) Social Media Use May Improve Education and Pipeline Efforts of a Growing Postpandemic Forensic Pathologist Workforce Shortage

ABSTRACT

Many subspecialties of pathology have initiated novel methods and strategies to connect with medical students and residents, stimulate interest, and offer mentorship. Emerging concern about the future of forensic pathology has been highlighted in contemporary literature as recruitment of new fellows has stagnated and workforce shortage concerns have blossomed. Amidst these challenges, the potential role of social networking platforms like social media (SoMe) in enhancing autopsy pathology/forensics education has garnered attention, yet literature focusing specifically on its application in autopsy and forensic pathology remains limited. This review aims to provide a comprehensive narrative overview of the current literature on the established uses of SoMe in forensic pathology. It seeks to build upon existing recommendations, introducing a contemporary compilation of online resources designed to facilitate virtual engagement among pathologists, learners, patients, and families. The review supports the idea that strategic, ethical, and conscientious use of SoMe has a place in addressing the growing workforce shortages and closing educational gaps in forensic pathology by enhancing exposure to the field and dispelling antiquated stereotypes.

Responding to the 'crowd' of voices and opinions in the paediatric clinical space: an ethics perspective

Ready access to the internet and online sources of information about child health and disease has allowed people more 'distant' from a child, family and paediatric clinician to inform and influence clinical decisions. It has also allowed parents to share aspects of their child's health and illness to garner support or funding for treatment. As a consequence, paediatric clinicians must consider and incorporate the crowd of opinions and voices into their clinical and ethical reasoning.We identify two key ethical principles and related ethics concepts foundational to this task. We then propose a series of exploratory ethics questions to assist paediatric clinicians to engage ethically with the multiple voices in the clinical encounter while keeping the child's needs as a central focus. Using two clinical hypothetical case examples, we illustrate how our proposed ethics questions can assist paediatric clinicians to navigate the crowd in the room and bring moral reasoning to bear.We highlight a need for specific practical interactional skills training to assist clinicians to ethically respond to the crowd in the room, including to identify and weigh up the harms and benefits of endorsing or going against proposed treatments for a child, and how to discuss social media and online sources of information with parents.

The Challenges in Using eHealth Decision Resources for Surrogate Decision-Making in the Intensive Care Unit

The mortality rate in intensive care units (ICUs) is notably high, with patients often relying on surrogates for critical medical decisions due to their compromised state. This paper provides a comprehensive overview of eHealth. The challenges of applying eHealth tools, including economic disparities and information inaccuracies are addressed. This study then introduces eHealth literacy and the assessment tools to evaluate users' capability and literacy levels in using eHealth resources. A clinical scenario involving surrogate decision-making is presented. This simulated case involves a patient with a hemorrhagic stroke who has lost consciousness and requires medical procedures such as tracheostomy. However, due to the medical surrogate's lack of familiarity with eHealth devices and limited literacy in using eHealth resources, difficulties arise in assisting the patient in making medical decisions. This scenario highlights challenges related to eHealth literacy and solution strategies are proposed. In conclusion, effective ICU decision-making with eHealth tools requires a careful balance between efficiency with inclusivity. Tailoring communication strategies and providing diverse materials are essential for effective eHealth decision resources in the ICU setting. Health professionals should adopt a patient-centered approach to enhance the decision-making experience, particularly for individuals with limited eHealth literacy.

Dental Practice Websites in Germany-How Do They Inform about Fluoridation?

Fluoridation (Fl) is effective in preventing caries; however, it is unclear to what extent its use is counteracted by misinformation on the internet. This study aimed to evaluate the information provided on professional websites of German dental practices regarding fluoridation. A systematic search was performed by two independent examiners, utilizing three search engines, from 10 September 2021 to 11 December 2021. Modified, validated questionnaires (LIDA, DISCERN) were used to evaluate technical and functional aspects, generic quality, and risk of bias. Demographic information and statements about Fl were also collected. The intra- and inter-rater reliability assessments were excellent. Of the 81 websites analyzed, 64 (79%) mentioned Fl, and 31 (38%) indicated it as a primary focus. Most websites met at least 50% of the LIDA (90%) and DISCERN criteria (99%), indicating that the general quality was good. Thirty (37%) of the websites explained the impact of Fl, and forty-five (56%) indicated an opinion (for/against) on Fl. The practice location and the clinical focus were not associated with the overall quality of websites. Only a minority of websites explained the effects of Fl. Taken together, this study highlights that there is a distinct lack of good-quality information on FL.

Social media for obesity education: a general overview for the novice creator

Rates of obesity continue to rise in the United States and across the globe. Obesity is a risk factor for developing insulin resistance, type 2 diabetes, and cardiovascular disease. For clinicians, other health care providers, and educators, providing patients with accurate and meaningful information about obesity, including lifestyle (diet and exercise) interventions and symptom monitoring, is challenging because of infrequent contact, methods of communication, a lack of effective patient education resources, and inefficient patient feedback methods. Evidence suggests that significantly more patients are now getting their health care information online from general medical websites, disease-specific network communities, and social media. Thus, harnessing the power of technologies, including personal computers and smartphones, with attention to social media may equip health care providers with methods to serve their patients better by addressing challenges, improving indirect patient contact, and enhancing health outcomes. This article aims to provide an overview of technology with a focus on social media use in obesity education and outreach. Practical information is provided related to creating content, delivering content, and managing the social media space for the novice creator.NEW & NOTEWORTHY Rates of obesity continue to increase. Health care providers have a limited time to cover the nuances of obesity. Technology and social media are tools that can help health care workers provide obesity education to a large audience. This article provides the foundations for obesity education content generation and delivery for the novice creator.

"Keep It Short and Simple": Perceptions of patients and healthcare professionals on the use of a mobile health app in the care for patients undergoing radical prostatectomy

Background

Patients undergoing radical prostatectomy for localised prostate cancer generally have good long-term survival rates. However, late recurrences can occur and require lifelong follow-up.

Objective

This research aims to investigate different stakeholders' perceptions on the use of mobile health (mHealth) applications for prostate cancer follow-up after radical prostatectomy.

Methods

A cross-sectional qualitative study was conducted to explore stakeholders' perceptions of an mHealth application for follow-up after radical prostatectomy. Urologists, nurses, and patients treated with radical prostatectomy were interviewed, and data were transcribed and analysed using thematic analysis according to Qualitative Analysis Guide of Leuven. Recommended features for an ideal mHealth application were grouped according to the Persuasive Systems Design model.

Results and Limitations

A total of 30 stakeholders, consisting of nurse specialists (n = 7), urologists (n = 8), and patients (n = 15), were interviewed. Expected benefits and barriers were mentioned and grouped in five overarching themes: healthcare optimisation, disease management, app compliance, legal and organisational requirements, and patient-mHealth interaction. Stakeholders provided a multitude of suggestions for an ideal mHealth app. Yet, not all types of stakeholders were interviewed, and patient selection limited generalisability of findings.

Conclusions

Stakeholders indicate that an mHealth app in the care for post-prostatectomy patients can improve patient care and promote disease management but consider app compliance as a major challenge.

Patient Summary

We interviewed patients, nurses, and urologists about using an mHealth application for follow-up after radical prostatectomy. The participants agreed that an mHealth app could improve care optimisation and disease management, but some concerns and barriers were expressed. This resulted in a list of recommended features for an ideal app.

Sustainable Involvement of Family Physicians for Improving Help-Seeking Behaviors in Rural Communities: A Thematic Analysis

Introduction Medicine, particularly family medicine, is crucial to community health and well-being. Its impact on sustainable community care is significant, especially in rural settings with unique dynamics. Recent trends highlight the need for collaboration between family physicians and community members to foster effective help-seeking behaviors (HSBs) linked to improved quality of life and self-efficacy in self-management. This study explores rural communities' perceptions of community care and the integration of family physicians into rural healthcare, enhancing its sustainability. Method A thematic analysis based on relativist ontology and constructivist epistemology was employed. The study was conducted in Unnan City, Japan, involving 81 rural community members. Focus group interviews were the primary data collection method. The research team, comprising a family physician, a non-profit organization director, and a medical educator, analyzed the data, ensuring a balanced and unbiased approach. Results Four key themes emerged, such as understanding the burden felt by existing organizations, continuously engaging in meaningful community activities, steady activities matched to the community's pace, and viewing all places as opportunities for exchange and learning. These themes reflect the need for better information sharing, respecting community dynamics, and incorporating family physicians into various community interactions for effective healthcare delivery. Conclusion This study emphasizes the critical role of family physicians in rural healthcare. It identifies the need for meaningful engagement with local communities, adapting healthcare to the rural context, and using various community spaces for health education. The findings advocate for a community-centric healthcare approach, which respects the unique dynamics of rural areas, fostering a sustainable and responsive healthcare system. Future research should include diverse rural settings and quantitative methods for broader applicability and deeper insights.

Parallel endodontic education via social media: An exploratory survey study

There is insufficient research to evaluate social media's influence on endodontic education. Therefore, this study assessed the percentage of students utilising Facebook in their education and the factors influencing their engagement. A survey was conducted on dental students, interns and dentists undertaking specialist programmes. Categorical data were analysed using Fisher's Exact test and multiple pairwise comparisons. The significance level was set at p < 0.05. Responses were received from 801 participants, with 98.4% using Facebook for endodontic knowledge. Although most students knew that scientific evidence is not always provided, they still deemed such information valuable as it was a practical demonstration of clinical cases. Most students turn to Facebook for endodontic education to compensate for the gap between their academic education and clinical practice. The utilisation of social media for education can be a concerning phenomenon and should not be ignored by academic institutes.

Social media use and paediatric practice: Hippocratic help, hype or harm?

Social media is increasingly a part of our personal and professional life and is here to stay. Here, I reflect on issues surrounding the use of social media (SMU) in the digital health context by clinicians in Australian paediatric health care. I aim to briefly highlight some inherent multifactorial and contextual ethical considerations which mainly relate to professionalism; including boundaries, obligations to patients and families within the therapeutic alliance, and balancing the help, hype and harm of SMU in clinical practice. I conclude that digital health and SMU are ubiquitous, and can be beneficial if used circumspectly with Hippocratic principles that have been updated for the modern era and are grounded in ancient moral codes. Unfettered SMU however, without adherence to ethical and legal guidelines is problematic, and may expose patients, families and clinicians to significant risk of harm and moral vulnerability. Justifiable, explicit, consistent and regularly reviewed boundaries, both professional and personal, are ethically advisable. These should reflect, and adapt to, the rapidly evolving nature of social media as imprudent digital health and SMU without proportionate limits, may undermine still relevant Hippocratic tenets, and the primacy of doing no harm.

Web-Based Information on the Treatment of Dental Hypomineralization

PURPOSE

To categorise and evaluate the quality and readability of the web-based information about the treatment of the variety of forms of dental hypomineralization.

METHODS

An internet search using two different search terms regarding treating dental hypomineralization was conducted using the Google search engine. The first 100 websites from each search were analysed. Data recorded included DISCERN instrument scores, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net seal (HON). Flesch Reading Ease Scores (FRES), Flesch-Kincaid Grade Level (FKGL), the Simplified Measure of Gobbledygook Index (SMOG), and the Coleman-Liau index were calculated to assess readability.

RESULTS

A search for "Treatment of hypomineralized teeth" on Google yielded 48,500 results. After excluding irrelevant websites, only 25 were evaluated based on affiliation with universities/medical centers, non-profit organizations, commercial entities, or government agencies. The majority of the content was medical facts presented as text and visuals such as images and videos. The study found that the scores for questions about the benefits and risks of treatment were low, while alternative treatments had high scores. Only one website met the HON code criteria, and a minority of websites achieved JAMA benchmarks. The readability ratings varied across different tests used in the study.

CONCLUSION

Most websites had university or medical center affiliation but only partially related to the specialty. Two-thirds of websites used images. The online information was inaccurate, poor quality, and hard to read for the average person. Dental professionals should be aware of this information's quality and work to improve it.

Comparing the Discussion of Telehealth in Two Social Media Platforms: Social Listening Analysis

Background

Social media is used as a source of information and platform to discuss health care; however, there is little research on discussion of telehealth in social media. Past research has looked at individual platforms, but a comparison of discussion on two platforms (Reddit and Twitter) has not been performed. Understanding telehealth-related social media discourse and the differences between platforms may provide insights into how telehealth is characterized online and which platforms provide patient perspectives. The COVID-19 pandemic provides a unique case study to examine how social media users approached both Reddit and Twitter during an international health crisis. This study used natural language processing tools and two social media platforms to (1) characterize and contrast each platform's telehealth-related posts according to themes and (2) assess the frequency of telehealth and telehealth-related terms posts before and during the onset of the COVID-19 pandemic.

Methods

We collected 6 years (2016 through 2021) of social media posts from Twitter and Reddit. The themes of the corpus were extracted using hashtags, subreddits, and Latent Dirichlet Allocation (LDA) and were analyzed using descriptive statistics.

Results

Both Twitter and Reddit showed exponential growth in the use of the term "telehealth" and telehealth-related terms in early 2020. The use of telehealth-related terms and discussion of COVID-19 coincided in both social media sites; however, other themes were discussed, including how to use telehealth. Reddit LDA clusters showed greatest usage of "telehealth" when associated with using or suggesting telehealth for receiving therapy, counseling, or psychoanalysis while Twitter focused on sharing telehealth news, products, and services.

Discussion

Twitter and Reddit had extensive growth in the use of telehealth-related terms after the COVID-19 pandemic. Twitter and Reddit showed themes connecting COVID-19 to telehealth, especially in reference to services, therapy, and counseling, however, Reddit had more discussion suggesting use of telehealth services or requesting peer insights into how to use telehealth as compared with Twitter, which appeared more focused on telehealth as a business or product.

Online short videos promoting public breast cancer literacy: a pretest-posttest control group trial on efficiency, attitude, and influencing factors

Background

Short videos on social media are playing an increasingly important role in cancer health education today. It is important to explore how the actual communication effect of health videos and the knowledge absorption of users are influenced by different factors of the video creation process.

Objective

The objective of our study is to access the factors influencing breast cancer health education through short videos on efficiency and quality.

Methods

Three pairs of videos about breast health were created and participants completed questionnaires before and after watching the videos. A paired t-test was used to analyze within-group change scores. RM-ANOVA was used to assess the relationship between the pretest, posttest, and three variables.

Results

Watching short videos can significantly increase viewers' knowledge of related health topics (p < 0.05). The viewers' concentration level while watching was significantly higher for the video with background music (BGM) than for the video without BGM (p = 0.006). The viewers' willingness to share was significantly higher for the video with a progress bar than for the video without a progress bar (p = 0.02). Using an interpreter wearing a doctor's uniform instead of casual wear and setting a progress bar can significantly improve the efficiency of knowledge absorption (p < 0.05).

Conclusion

A uniformed interpreter, BGM and a progress bar are factors influencing the efficiency of short health videos. They can be applied in video making to explore better ways of promoting cancer health education in the new mobile Internet environment.

Characterizing the Discourse of Popular Diets to Describe Information Dispersal and Identify Leading Voices, Interaction, and Themes of Mental Health: Social Network Analysis

BACKGROUND

Social media has transformed the way health messages are communicated. This has created new challenges and ethical considerations while providing a platform to share nutrition information for communities to connect and for information to spread. However, research exploring the web-based diet communities of popular diets is limited.

OBJECTIVE

This study aims to characterize the web-based discourse of popular diets, describe information dissemination, identify influential voices, and explore interactions between community networks and themes of mental health.

METHODS

This exploratory study used Twitter social media posts for an online social network analysis. Popular diet keywords were systematically developed, and data were collected and analyzed using the NodeXL metrics tool (Social Media Research Foundation) to determine the key network metrics (vertices, edges, cluster algorithms, graph visualization, centrality measures, text analysis, and time-series analytics).

RESULTS

The vegan and ketogenic diets had the largest networks, whereas the zone diet had the smallest network. In total, 31.2% (54/173) of the top users endorsed the corresponding diet, and 11% (19/173) claimed a health or science education, which included 1.2% (2/173) of dietitians. Complete fragmentation and hub and spoke messaging were the dominant network structures. In total, 69% (11/16) of the networks interacted, where the ketogenic diet was mentioned most, with depression and anxiety and eating disorder words most prominent in the "zone diet" network and the least prominent in the "soy-free," "vegan," "dairy-free," and "gluten-free" diet networks.

CONCLUSIONS

Social media activity reflects diet trends and provides a platform for nutrition information to spread through resharing. A longitudinal exploration of popular diet networks is needed to further understand the impact social media can have on dietary choices. Social media training is vital, and nutrition professionals must work together as a community to actively reshare evidence-based posts on the web.

Why should we care about social media codes of conduct in healthcare organisations? A systematic literature review

Background

The conduct of healthcare organisation employees on social media can impact both their personal reputation and that of the organisation. However, social media has blurred the lines between professional and personal communication, and what is acceptable and ethical conduct is not always clear. Furthermore, the global COVID-19 pandemic has changed how healthcare organisations and their employees approach the use of social media, expediting the need to ensure that employees communicating health-related information adhere to employee codes of conduct.

Aims

This review aims to investigate the challenges associated with healthcare organisation employees' use of social media for sharing health-related information, identify the crucial elements for inclusion in social media codes of conduct for healthcare organisations, and examine the enablers for good codes of conduct.

Methods

A systematic review of the literature from six research database platforms on articles related to codes of conduct addressing the use of social media for healthcare organisation employees was conducted. The screening process yielded 52 articles.

Results

The key finding in this review focuses on privacy, protecting both patients and healthcare organisation employees. While maintaining separate professional and personal social media accounts is a much-discussed approach, training and education on social media codes of conduct can clarify acceptable behaviour both personally and professionally.

Conclusion

The results raise essential questions about healthcare organisation employees' use of social media. It is evident that organisational support and a constructive culture will enable healthcare organisations to fully realise the benefits of using social media.

Unravelling the truth: Examining the evidence for health-related claims made by naturopathic influencers on social media - a retrospective analysis

Background: Social media platforms are frequently used by the general public to access health information, including information relating to complementary and alternative medicine (CAM). The aim of this study was to measure how often naturopathic influencers make evidence-informed recommendations on Instagram, and to examine associations between the level of evidence available or presented, and user engagement. Methods: A retrospective observational study using quantitative content analysis on health-related claims made by naturopathic influencers with 30000 or more followers on Instagram was conducted. Linear regression was used to measure the association between health-related posts and the number of Likes, and Comments. Results: A total of 494 health claims were extracted from eight Instagram accounts, of which 242 (49.0%) were supported by evidence and 34 (6.9%) included a link to evidence supporting the claim. Three naturopathic influencers did not provide any evidence to support the health claims they made on Instagram. Posts with links to evidence had fewer Likes (B=-1343.9, 95% CI=-2424.4 to -263.4, X=-0.1, P=0.02) and fewer Comments (B=-82.0, 95% CI=-145.9 to -18.2, X=-0.2, P=0.01), compared to posts without links to evidence. The most common areas of health were claims relating to 'women's health' (n=94; 19.0%), and 'hair, nail and skin' (n=74; 15.0%). Conclusion: This study is one of the first to look at the evidence available to support health-related claims by naturopathic influencers on Instagram. Our findings indicate that around half of Instagram posts from popular naturopathic influencers with health claims are supported by high-quality evidence.

Cross-Platform Detection of Psychiatric Hospitalization via Social Media Data: Comparison Study

BACKGROUND

Previous research has shown the feasibility of using machine learning models trained on social media data from a single platform (eg, Facebook or Twitter) to distinguish individuals either with a diagnosis of mental illness or experiencing an adverse outcome from healthy controls. However, the performance of such models on data from novel social media platforms unseen in the training data (eg, Instagram and TikTok) has not been investigated in previous literature.

OBJECTIVE

Our study examined the feasibility of building machine learning classifiers that can effectively predict an upcoming psychiatric hospitalization given social media data from platforms unseen in the classifiers' training data despite the preliminary evidence on identity fragmentation on the investigated social media platforms.

METHODS

Windowed timeline data of patients with a diagnosis of schizophrenia spectrum disorder before a known hospitalization event and healthy controls were gathered from 3 platforms: Facebook (254/268, 94.8% of participants), Twitter (51/268, 19% of participants), and Instagram (134/268, 50% of participants). We then used a 3 × 3 combinatorial binary classification design to train machine learning classifiers and evaluate their performance on testing data from all available platforms. We further compared results from models in intraplatform experiments (ie, training and testing data belonging to the same platform) to those from models in interplatform experiments (ie, training and testing data belonging to different platforms). Finally, we used Shapley Additive Explanation values to extract the top predictive features to explain and compare the underlying constructs that predict hospitalization on each platform.

RESULTS

We found that models in intraplatform experiments on average achieved an F₁-score of 0.72 (SD 0.07) in predicting a psychiatric hospitalization because of schizophrenia spectrum disorder, which is 68% higher than the average of models in interplatform experiments at an F₁-score of 0.428 (SD 0.11). When investigating the key drivers for divergence in construct validities between models, an analysis of top features for the intraplatform models showed both low predictive feature overlap between the platforms and low pairwise rank correlation (<0.1) between the platforms' top feature rankings. Furthermore, low average cosine similarity of data between platforms within participants in comparison with the same measurement on data within platforms between participants points to evidence of identity fragmentation of participants between platforms.

CONCLUSIONS

We demonstrated that models built on one platform's data to predict critical mental health treatment outcomes such as hospitalization do not generalize to another platform. In our case, this is because different social media platforms consistently reflect different segments of participants' identities. With the changing ecosystem of social media use among different demographic groups and as web-based identities continue to become fragmented across platforms, further research on holistic approaches to harnessing these diverse data sources is required.

Effectiveness of WeChat-group-based parental health education in preventing unintentional injuries among children aged 0-3: randomized controlled trial in Shanghai

BACKGROUND

Unintentional injuries to children are a major public health problem. The online social media is a potential way to implement health education for caregivers in online communities. Using WeChat, a free and popular social media service in China, this study evaluated the effectiveness of social online community-based parental health education in preventing unintentional injuries in children aged 0-3.

METHODS

We recruited 365 parents from two community health centers in Shanghai and allocated them into intervention and control groups randomly. Follow-up lasted for one year. The intervention group received and followed their WeChat group and a WeChat official account for dissemination of reliable medical information. The control group received only the WeChat group.

RESULTS

Between the intervention and control groups, changes in unintentional injuries (OR = 1.71, 95% CI: 1.02-2.87, P = .04), preventability (β = 0.344, 95% CI: 0.152-0.537, P &lt; .001), daily supervision behavior (β = 0.503, 95% CI: 0.036-0.970, P = .04), and behaviors for preventing specific injuries (β = 2.198, 95% CI: 1.530-2.865, P &lt; .001) were significantly different, and change in first-aid skills for treating a tracheal foreign body were nearly significant (P = .06).

CONCLUSIONS

The WeChat-group-based parental health education can reduce the occurrence of unintentional child injuries by improving parents' skills, beliefs, and behaviors. Online social communities promote health education and reduce unintentional injuries among children.

TRIAL REGISTRATION

ChiCTR1900020753. Registered on January 17, 2019.

Eight Patients With Pilonidal Carcinoma in One Decade—Is the Incidence Rising?

Introduction: Carcinoma secondary to pilonidal disease is very rare with fewer than 130 reported cases so far. It is presumed that underreporting and underpublishing contribute to the low reported incidence.

Methods: A post was published on a closed Facebook group with about 30,000 Syrian doctors asking if anyone had ever seen a patient with pilonidal carcinoma before. The patients' data were collected retrospectively from the treating physicians.

Results: Between 2010 and 2019, we identified eight patients with pilonidal carcinoma. All patients were males with a mean age of 55.5 years. The mean interval between diagnosis of pilonidal disease and diagnosis of carcinoma was 6.9 years. A growing ulcer on the background of a pilonidal sinus disease was the presenting complaint in 50% of cases. Three patients were lost from follow-up after the diagnosis due to referral. All other five patients underwent surgical resection and three of them received postoperative chemoradiation. Four patients were followed for six months or longer: two died of metastases, one survived after recurrence and re-excision, and one survived with no recurrence.

Conclusion: This paper presents the largest cohort of pilonidal carcinoma so far and the first that describes the disease in the Syrian population. Due to underreporting, the real incidence of pilonidal carcinoma exceeds what is reported so far in the literature.

Emerging technologies adoption in healthcare: A SOHI model

The internet and emerging technologies have increased the utilisation of digital platforms. This study aims to draw on performance expectancy, social influence, and satisfaction to investigate a proposed model which is geared toward social media healthcare information (SOHI) adoption. The proposed model uses a structured online questionnaire, and 300 responses were evaluated using partial least squares and structural equation modelling [PLS-SEM]. From the findings, performance expectancy of social media (PESM) and satisfaction with social media (SATSM) were revealed to be significant predictors of behavioural intention towards social media (BISM). Satisfaction with social media (SATSM) had the greatest impact on BISM, accounting for 63.8 per cent of the variance in users' intentions to utilise SOHI. Similarly, PESM and social influence on social media (SISM) had the most predictive influence on SATSM, accounting for 50.5 per cent of the variance in users' social media satisfaction, which led to SOHI adoption. Unlike others, the social influence on social media (SISM) did not have a significant effect on BISM. BISM and satisfaction with social media (SATSM) were significant predictors of SOHI adoption, accounting for 54.5 per cent of the variance in SOHI adoption. The recommendations in this study would help healthcare professionals change their approach to digital healthcare engagement.

How to improve public health literacy based on polycentric public goods theory: preferences of the Chinese general population

Background

In the current era of big data, it is critical to address people’s demand for health literacy. At present, the traditional mode of communicating scientific health knowledge and information technology is interchangeable, resulting in the emergence of a new mode of communicating health literacy. To publicize health education and health literacy in a targeted way, to meet the public’s needs, and to understand how the public’s demand for subjects, contents, and forms of health literacy service has changed in the era of COVID-19, the investigation of public’s demand for health information and health literacy was conducted.

Objective

This study aims to understand the differences in demand for health literacy service providers, contents, channels, forms, and facilities among Chinese citizens with different genders, ages, education levels, economic conditions, and living environments, and to provide reasonable recommendations for developing public health literacy.

Methods

Questionnaire Star was used to conduct a large sample of random online surveys. In Wuhan, Hubei Province, 2184 questionnaires were issued, 8 invalid questionnaires were eliminated, and 2176 were recovered, with an effective rate of 99.6%. IBM SPSS Statistics 20 was utilized to analyze the survey data.

Results

(1) In health literacy service providers selected by the public, the proportion of government departments or government collaboration with other institutions exceeded 73%, indicating that health literacy services are public goods; (2) access to health literacy services was lower in township areas than in urban areas (P < 0.001, 3) internet media and communicating with acquaintances, which have the highest popularity rate, were also the two channels that were least trusted by the public; and (4) the differences in contents and service channels of health literacy among residents with different genders, ages, education levels, economic status, and living environments were statistically significant.

Conclusions

(1) It is recommended to establish an integrated health literacy service model with multi-center supply. Government departments, medical institutions, and media should cooperate effectively to provide health literacy services. (2) The government should pay attention to the fairness of health education and strengthen the supply of health literacy services in township areas. (3) It is critical to strengthen the public’s ability to discriminate network information and pay attention to scientific thinking cultivation. (4) Health literacy service providers must focus on the differences between public demands and improve the connotation of health literacy services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13272-z.

Artificial Intelligence Tools for Suicide Prevention in Adolescents and Young Adults

Background:

Artificial Intelligence is making a significant transformation in human lives. Its application in the medical and healthcare field has been also observed making an impact and improving overall outcomes. There has been a quest for similar processes in mental health due to the lack of observable changes in the areas of suicide prevention. In the last five years, there has been an emerging body of empirical research applying the technology of artificial intelligence (AI) and machine learning (ML) in mental health.

Objective:

To review the clinical applicability of the AI/ML-based tools in suicide prevention.

Methods:

The compelling question of predicting suicidality has been the focus of this research. We performed a broad literature search and then identified 36 articles relevant to meet the objectives of this review. We review the available evidence and provide a brief overview of the advances in this field.

Conclusion:

In the last five years, there has been more evidence supporting the implementation of these algorithms in clinical practice. Its current clinical utility is limited to using electronic health records and could be highly effective in conjunction with existing tools for suicide prevention. Other potential sources of relevant data include smart devices and social network sites. There are some serious questions about data privacy and ethics which need more attention while developing these new modalities in suicide research.

A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation

COVID-19 is currently the third leading cause of death in the United States, and unvaccinated people continue to die in high numbers. Vaccine hesitancy and vaccine refusal are fueled by COVID-19 misinformation and disinformation on social media platforms. This online COVID-19 infodemic has deadly consequences. In this editorial, the authors examine the roles that social media companies play in the COVID-19 infodemic and their obligations to end it. They describe how fake news about the virus developed on social media and acknowledge the initially muted response by the scientific community to counteract misinformation. The authors then challenge social media companies to better mitigate the COVID-19 infodemic, describing legal and ethical imperatives to do so. They close with recommendations for better partnerships with community influencers and implementation scientists, and they provide the next steps for all readers to consider. This guest editorial accompanies the Journal of Medical Internet Research special theme issue, “Social Media, Ethics, and COVID-19 Misinformation.”

Communication in Healthcare: Global challenges in the 21st Century

This article explores the communication challenges brought about by the digital revolution in the 21st century for healthcare professionals internationally. It particularly focuses on the use of content-generating and sharing platforms like social media. Globally, healthcare has been irrevocably altered by digital innovation and health professionals deploy an extensive range of social media and web-based tools on a daily basis. However, many healthcare professionals use these platforms in a regulatory vacuum-where there may not be specific legal or ethical guidance-and without an appreciation of the associated risks. Given the special protections afforded to the practitioner-patient relationship, and the importance of a health practitioners' reputation, it is vital that we understand how to traverse the many ethical and legal challenges of the digital interaction. A comprehensive set of recommendations (see "Guidelines for Good Digital Citizenship in the Health Professions" on page 5 ff.) to keep practitioners out of trouble is provided. These hinge on the notion of being a "good person and a good doctor" as a formative maxim for ethical and legal safety. The constituents of publication, and the consequences of falling foul of acceptable publication standards on social media, are specifically discussed. "Publication" involves sharing content with a third party, or a group of people, and social media refers to platforms on which content can be shared with more than one person. Hence, most information that we post on social media can be considered as "published," and as such may attach liability for health professionals who do not use these platforms with requisite care and sufficient forethought.

Social media enabled interactions in healthcare: Towards a taxonomy

Healthcare users and providers increasingly utilize social media to interact with one another. For a future understanding of when and how these interactions supplement or replace offline doctor-patient interactions, it is essential to understand who interacts, about what, and how these interactions can be categorized in a taxonomy. We draw on affordance theory and employ a mixed-methods approach to study social media interactions among healthcare users and providers. We first engage in qualitative content analysis, which is followed by cluster analysis. We identify five archetypal interactions and categorize these in a taxonomy that adds to current literature on how social media is utilized in the healthcare context. We also provide a clear and systematic overview of the interactions in different social media categories that can stimulate future research regarding doctor-patient interactions. Furthermore, we identify a new and distinct type of social media enabled interaction in healthcare, namely lifestyle support, focusing on prevention.

Using social media in contemporary nursing: risks and benefits

Social media has become incorporated into the practice of contemporary nursing. It must be acknowledged by the nurse and the nursing profession that social media has the power to enable the nurse to network with colleagues and share research findings through both private and open forums. However, it also has the potential to negatively influence patient care. This article discusses the use of social media and the dilemmas both ethical and legal. It highlights the need for the nurse and the nursing profession to remain vigilant regarding its use within both their personal and professional lives, to ensure that no boundaries are inadvertently crossed.

Mind the Gaps: Ethical and Epistemic Issues in the Digital Mental Health Response to Covid-19

Well before the Covid‐19 pandemic, proponents of digital psychiatry were touting the promise of various digital tools and techniques to revolutionize mental health care. As social distancing and its knock‐on effects have strained existing mental health infrastructures, calls have grown louder for implementing various digital mental health solutions at scale. Decisions made today will shape the future of mental health care for the foreseeable future. Here, in hopes of countering this hype, we examine four ethical and epistemic gaps surrounding the growth of digital mental health: the evidence gap, the inequality gap, the prediction‐intervention gap, and the safety gap. We argue that these gaps ought to be considered by policy‐makers before society commits to a digital psychiatric future.

The Role of Providers and Influencers in the Use of Social Media as Solace for Psoriasis: Qualitative and Quantitative Study

BACKGROUND

Psoriasis is a multisystem chronic inflammatory skin disease and is a relatively common disorder in children and adults. The burden of psoriasis impacts both the physiological and psychological areas of one's life. Given the robust use of the internet and social media, patients have turned to Instagram for educational and social support to discuss psoriasis.

OBJECTIVE

This study aimed to characterize how patients interact with Instagram to cope with the biopsychosocial aspects of psoriasis. We analyzed journals and organizations, and compared them with the public profiles of individuals diagnosed with psoriasis who provided information and refuge. Our goal was to identify how followers engaged and what type of content they were most receptive to in terms of psoriasis.

METHODS

All journals and organizations representing psoriasis were selected for review. The top 10 public profiles of individuals diagnosed with psoriasis were also selected for comparison. The numbers of followers, followings, and posts were noted to evaluate popularity. The numbers of likes and comments were also recorded to understand engagement.

RESULTS

On comparing journals and organizations to public profiles, we found that the former had a greater number of followers but engaged less with the audience on Instagram based on the number of profiles they followed. Profiles of individuals with psoriasis produced content that was more personal and relatable, including experiences with flares, motivational text, and emotional support. The content produced by journals and organizations was geared toward education and providing peer-reviewed resources and commentary from licensed health care professionals. Followers were more engaged via "likes" than "comments" on the Instagram profiles of journals and organizations, as well as the public profiles of individuals diagnosed with psoriasis.

CONCLUSIONS

There was evident online presence of journals and organizations, and public profiles of individuals providing content regarding psoriasis on Instagram. However, there were distinguishing features for the type of content being produced. Journals and organizations took the traditional approach in providing evidence-based information, whereas the public profiles of individuals provided content related to the psychosocial needs of the psoriasis community. The 10 profiles of individuals provided posts involving creativity and real experiences, which were evidently well-received based on "likes" and "comments." This research helps us appreciate what the audience on Instagram is looking for to further address how we can merge these needs to provide a holistic platform on Instagram for both providers and patients. Social media creates a space for collaboration, which can be advantageous for journals and organizations to work with patient volunteers from diverse backgrounds who can help build a therapeutic alliance and public presence on Instagram with their viewers in order to deliver medical peer-reviewed information.

Implications of Age on Social Media Utilization in Health Care Practice Development: Cross-sectional Survey Study

BACKGROUND

Medical practices, which are businesses through which one or more physicians treat patients, have likely not yet taken full advantage of the reach of social media. This study analyzed data collected using an anonymous survey to assess the potential utilization of large, established social media platforms in health care. The survey collected data from a diverse population of health care professional students, faculty, and physicians affiliated with the Texas Tech University Health Sciences Center (TTUHSC). This study provides significant, actionable data to more efficiently implement a social media strategy focused on age to help developing private practices and outpatient clinics from the perspective of those with experience in the field of medicine.

OBJECTIVE

This cross-sectional, exploratory, descriptive study aims to explore the most effective strategies to use social media based on patient age to bring further success to a medical practice.

METHODS

Data were gathered from an anonymous, peer-validated Qualtrics survey created by the corresponding authors based on the recommendations from a panel of experts including executive leadership at TTUHSC. The survey used a variety of question styles to measure differences between social media platforms, including frequency of use, current and future implications in medicine, and comfort in a health care setting. The sample population included students, interns, faculty, and physicians affiliated with the TTUHSC located throughout West Texas.

RESULTS

The anonymous survey included 673 individuals from several different age groups predetermined at the beginning of the study. There were 154 respondents aged between 18 and 25 years, 171 aged between 26 and 35 years, 133 aged between 36 and 45 years, 104 aged between 46 and 55 years, and 111 aged between 56 and 89 years. The sample population also has a variety of educational achievements. The respondents were grouped based on the highest level of education attained, and this included 23.5% (n=158) of respondents who earned a high school diploma, 42% (n=283) who earned a bachelor's degree, 17.1% (n=115) who earned a master's degree, and 17.4% (n=117) who earned a doctorate degree.

CONCLUSIONS

As social media continues to gain momentum, efficient utilization of the available platforms can help medical practices achieve larger patient populations and deliver more personalized care. However, privacy and security concerns should be considered while using social media in health care settings. Although this study demonstrated overwhelming interest in using social media in the medical field across all age groups, adoption willingness appears to be higher in younger respondents than in older respondents. Facebook was the most widely accepted social media platform in health care settings among all age groups. Nonetheless, other social media platforms could potentially be used more effectively depending on the age range of the targeted patient population.

Artificial Intelligence, Social Media and Depression. A New Concept of Health-Related Digital Autonomy

The development of artificial intelligence (AI) in medicine raises fundamental ethical issues. As one example, AI systems in the field of mental health successfully detect signs of mental disorders, such as depression, by using data from social media. These AI depression detectors (AIDDs) identify users who are at risk of depression prior to any contact with the healthcare system. The article focuses on the ethical implications of AIDDs regarding affected users' health-related autonomy. Firstly, it presents the (ethical) discussion of AI in medicine and, specifically, in mental health. Secondly, two models of AIDDs using social media data and different usage scenarios are introduced. Thirdly, the concept of patient autonomy, according to Beauchamp and Childress, is critically discussed. Since this concept does not encompass the specific challenges linked with the digital context of AIDDs in social media sufficiently, the current analysis suggests, finally, an extended concept of health-related digital autonomy.

What's trending: a review of social media in ophthalmology

PURPOSE OF REVIEW

With social media use continuing to increase in popularity, ophthalmologists use social media daily for interactions with patients, colleagues, and the academic community.

RECENT FINDINGS

The potential reach of social media is overwhelmingly encouraging, but academic organizations have much work to do in order to compete for viewership on social media platforms, and users need to remain vigilant of easily spread misinformation. Individual ophthalmology practices can tailor their social media presence to attract and educate patients. Using hashtags to supplement the experience of academic conferences has boosted engagement both of attendees and other interested parties. As an effective indicator of the popularity of different subjects in medicine, new studies are leveraging social media for epidemiological models. Finally, social media is emerging as a powerful tool for patient advocacy in ophthalmology.

SUMMARY

The accessibility of social media uniquely positions it to educate patients, disseminate public eye health initiatives, and increase the reach of individual physicians. It is also able to enhance the academic experience of conferences, connecting new research colleagues, and is becoming the subject of epidemiologic studies itself. Whether using social media for patient education, research, clinical practice, or patient advocacy, ophthalmologists will find social media an increasingly important workplace contributor.

Do we need the criminalization of medical fake news?

Uncontrolled access to information on the Internet has many advantages, but it also leads to the phenomenon of fake news. Fake news is dangerous in many spheres, including that of health. For example, we are facing an increase in the amount of vaccine hesitancy. This has been w considered by the World Health Organization in 2019 as one of the greatest threats to public health. This specific phenomenon is linked with the spread of information on the Internet around that issue. In this paper, I discuss a proposition of new crime, which has the aim of fighting medical fake news by stopping its spread. This proposition should be considered only if other non-criminal measures are inefficient. The proposal is "Whoever publicly disseminates information evidently discrepant with medical knowledge is subject to a penalty."

Is There an App for That?: Ethical Issues in the Digital Mental Health Response to COVID-19

Well before COVID-19, there was growing excitement about the potential of various digital technologies such as tele-health, smartphone apps, or AI chatbots to revolutionize mental healthcare. As the SARS-CoV-2 virus spread across the globe, clinicians warned of the mental illness epidemic within the coronavirus pandemic. Now, funding for digital mental health technologies is surging and many researchers are calling for widespread adoption to address the mental health sequelae of COVID-19. Reckoning with the ethical implications of these technologies is urgent because decisions made today will shape the future of mental health research and care for the foreseeable future. We contend that the most pressing ethical issues concern (1) the extent to which these technologies demonstrably improve mental health outcomes and (2) the likelihood that wide-scale adoption will exacerbate the existing health inequalities laid bare by the pandemic. We argue that the evidence for efficacy is weak and that the likelihood of increasing inequalities is high. First, we review recent trends in digital mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities.

Telemedicine versus on-site treatment at a surgical university clinic: Study of 225 consecutive patients

INTRODUCTION

Recently, telemedical services are increasingly used. It remains unclear, if outpatients in general surgery can be treated via telemedicine (e.g. telework). We aimed to evaluate, if diagnosis and therapies of outpatients in general surgery can be found using a mobile healthcare communication app instead of personal contact.

MATERIAL AND METHODS

In a prospective, double blind, anonymized clinical study we included consecutive outpatients at a general surgery department at a university hospital. For the telemedical "treatment" the on-site doctors uploaded variables (e.g. anamnesis, radiograph, etc.) for each patient. The telemedical doctor received the information only via app and did not see the patient physically. Both, the doctor on-site and the virtual telemedical-doctor then uploaded the diagnosis and their suggested therapy - blinded to each other. The outpatient received the on-site treatment only. The virtual treatment was solely for scientific purposes and had no therapeutic impact.

RESULTS

225 consecutive surgical outpatients (53 % female and 47 % male) were included. Mean age was 61 years. In 84 % of cases the telemedical diagnosis matched the on-site diagnosis. The telemedical treatment was not inferior as compared to the on-site treatment in 94 % of all cases and the same therapy was proposed in 76 %. In 6% of all cases the telemedical therapeutic regimen could possibly harm or lead to an over- or under treatment of the patient.

CONCLUSION

Telemedical consultation seems to work in the field of general surgery. Telemedicine in general surgery potentially could decrease waiting time for an appointment and patient frequency. However, the potential harm of a wrong therapy remains due to the lack of a clinical observation.

Ethical tipping point: Nurses' presence on social media

ABSTRACT

This article discusses ethical concerns surrounding social media content posted by nurses; specifically, how these posts may violate public trust. It also summarizes considerations for nurses to contemplate before posting to social media and provides examples of positive uses of social media.

Social Media, Research, and Ethics: Does Participant Willingness Matter?

Objective : To summarise the state of the art published in 2019 in consumer health informatics and education, with a special emphasis on “Ethics and Health Informatics”.

Methods : We conducted a systematic search of articles published in PubMed using a predefined set of queries, which identified 368 potential articles for review. These articles were screened according to topic relevance and 15 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers according to the external reviewers’ ranking were discussed in a consensus meeting. Finally, the paper that received the highest score from four of the five experts was selected as the best paper on social media and ethics for patients and consumers of the year 2019.

Results : Despite using the terms “ethics” and “ethical” in the search query, we retrieved very few articles. The bibliometric analysis identified three major clusters centred on “social”, “health”, and “study”. Among the top five papers, one was a review where the authors identified ethical issues across four areas at the intersection of social media and health: 1) the impact of social networking sites on the doctor-patient relationship; 2) the development of e-health platforms to deliver care; 3) the use of online data and algorithms to inform health research; and 4) the broader public health consequences of widespread social media use. The other papers highlighted ethical concerns in using social media to interact with patients at different phases of a clinical research protocol, such as recruitment phase, participant engagement, data linkage, and detection and monitoring of adverse events.

Conclusions : Findings suggest that most users do not think that using social media for patient monitoring in clinical research, for example using Twitter for clinical trial recruitment, constitutes inappropriate surveillance or a violation of privacy. However, further research is needed to identify whether and how views on ethical concerns differed between social media platforms and across populations.

Human-Computer Interaction, Ethics, and Biomedical Informatics

Objectives : To provide an overview of recent work at the intersection of Biomedical Informatics, Human-Computer Interaction, and Ethics.

Methods : Search terms for Human-Computer Interaction, Biomedical Informatics, and Ethics were used to identify relevant papers published between 2017 and 2019.Relevant papers were identified through multiple methods, including database searches, manual reviews of citations, recent publications, and special collections, as well as through peer recommendations. Identified articles were reviewed and organized into broad themes.

Results : We identified relevant papers at the intersection of Biomedical Informatics, Human-Computer Interactions, and Ethics in over a dozen journals. The content of these papers was organized into three broad themes: ethical issues associated with systems in use, systems design, and responsible conduct of research.

Conclusions : The results of this overview demonstrate an active interest in exploring the ethical implications of Human-Computer Interaction concerns in Biomedical Informatics. Papers emphasizing ethical concerns associated with patient-facing tools, mobile devices, social media, privacy, inclusivity, and e-consent reflect the growing prominence of these topics in biomedical informatics research. New questions in these areas will likely continue to arise with the growth of precision medicine and citizen science.

Nature and Diffusion of COVID-19-related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo

BACKGROUND

Social media has become increasingly important as a source of information for the public and is widely used for health-related information. The outbreak of the coronavirus disease (COVID-19) has exerted a negative impact on dental practices.

OBJECTIVE

The aim of this study is to analyze the nature and diffusion of COVID-19-related oral health information on the Chinese social media site Weibo.

METHODS

A total of 15,900 tweets related to oral health and dentistry information from Weibo during the COVID-19 outbreak in China (December 31, 2019, to March 16, 2020) were included in our study. Two researchers coded 1000 of the total tweets in advance, and two main thematic categories with eight subtypes were refined. The included tweets were analyzed over time and geographic region, and coded into eight thematic categories. Additionally, the time distributions of tweets containing information about dental services, needs of dental treatment, and home oral care during the COVID-19 epidemic were further analyzed.

RESULTS

People reacted rapidly to the emerging severe acute respiratory syndrome coronavirus 2 threat to dental services, and a large amount of COVID-19-related oral health information was tweeted on Weibo. The time and geographic distribution of tweets shared similarities with epidemiological data of the COVID-19 outbreak in China. Tweets containing home oral care and dental services content were the most frequently exchanged information (n=4803/15,900, 30.20% and n=4478, 28.16%, respectively). Significant differences of public attention were found between various types of bloggers in dental services-related tweets (P<.001), and the tweets from the government and media engaged the most public attention. The distributions of tweets containing information about dental services, needs of dental treatment, and home oral care information dynamically changed with time.

CONCLUSIONS

Our study overviewed and analyzed social media data on the dental services and oral health information during the COVID-19 epidemic, thus, providing insights for government organizations, media, and dental professionals to better facilitate oral health communication and efficiently shape public concern through social media when routine dental services are unavailable during an unprecedented event. The study of the nature and distribution of social media can serve as a useful adjunct tool to help make public health policies.

An Ethical Obligation for Bioethicists to Utilize Social Media

In this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti respond to recent efforts to address the "digital attention crisis," arguing that "[b]ioethicists should make their voices heard in the debate on the responsibilities of social media companies toward their consumers and society at large." I strongly agree. I have frequently been asked by my colleagues why I spend time on social media professionally, on top of all the competing demands associated with my work as a bioethicist and medical educator. There is sometimes a dismissive tone in these questions, a sense that attention to social media is beneath a bioethicist's proper intellectual pursuits. Such perspectives overlook the extraordinary opportunities of social media and the important role for bioethics, as a field, in examining them.

Welcoming the "Intel-ethicist"

In this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti, urge ethicists to devote scholarly attention to a wave of troubling artificial intelligence applications affecting health consumers' rights and the quality of their care. I very much agree. We already have neuroethicists, business ethicists, and genetics ethicists; AI-related systems in health care present more than enough warrant to herald the appearance of a new ethics specialist-the "intel-ethicist," let's say. Nonetheless, Terrasse and colleagues may have exaggerated some of the potential moral problems of AI. Examining only social media and e-health programs, the authors produce an impressive array of questions to consider, but I will argue that two of them are not nearly as worrisome as might be supposed.

Deep Ethical Learning: Taking the Interplay of Human and Artificial Intelligence Seriously

From predicting medical conditions to administering health behavior interventions, artificial intelligence technologies are being developed to enhance patient care and outcomes. However, as Mélanie Terrasse and coauthors caution in an article in this issue of the Hastings Center Report, an overreliance on virtual technologies may depersonalize medical interactions and erode therapeutic relationships. The increasing expectation that patients will be actively engaged in their own care, regardless of the patients' desire, technological literacy, and economic means, may also violate patients' autonomy and exacerbate access. Moreover, since AI design is both a technical and social process, algorithms may mirror human biases, calling into question the vision of AI technologies surpassing human judgment and avoiding prejudices in decision-making. The best answer to these problems is to develop AI health technologies as part of a culture of health care quality improvement, responding to existing needs while being proactive about potential technical and ethical problems that can arise from the technologies' design and implementation.

Ethical Use of Social Media Data: Beyond the Clinical Context

In "Social Media, e-Health, and Medical Ethics," in this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti address and suggest recommendations for several ethical issues central to the systematic ethical analysis of the effects of social media on clinical practice, health services research, and public health. The topic is as timely as it is important: social media data collected by device and web applications are constantly increasing and might have both individual and public health benefits. The authors focus their analysis primarily on the health care context. Yet the implications of the intersection of social media data and research warrant focused consideration, as even the most thorough ethical analysis in the clinical context is not necessarily directly applicable in the research context. While many ethical issues are present in both settings, the research context poses new challenges and calls for consideration of distinct factors. In particular, because the legal framework is less protective in research, critical ethical analysis of the research-specific issues and considerations is essential to the ethical conduct of research using social media data as well as to the design and operation of social media device and web applications themselves.

Ethical Considerations for Participatory Health through Social Media: Healthcare Workforce and Policy Maker Perspectives

OBJECTIVES

To identify the different ethical issues that should be considered in participatory health through social media from different stakeholder perspectives (i.e., patients/service users, health professionals, health information technology (If) professionals, and policy makers) in any healthcare context.

METHODS

We implemented a two-round survey composed of open ended questions in the first round, aggregated into a list of ethical issues rated for importance by participants in the second round, to generate a ranked list of possible ethical issues in participatory health based on healthcare professionals' and policy makers' opinions on both their own point of view and their beliefs for other stakeholders' perspectives.

RESULTS

Twenty-six individuals responded in the first round of the survey. Multiple ethical issues were identified for each perspective. Data privacy, data security, and digital literacy were common themes in all perspectives. Thirty-three individuals completed the second round of the survey. Data privacy and data security were ranked among the three most important ethical issues in all perspectives. Quality assurance was the most important issue from the healthcare professionals' perspective and the second most important issue from the patients' perspective. Data privacy was the most important consideration for patients/service users. Digital literacy was ranked as the fourth most important issue, except for policy makers' perspective.

CONCLUSIONS

Different stakeholders' opinions fairly agreed that there are common ethical issues that should be considered across the four groups (patients, healthcare professionals, health IT professionals, policy makers) such as data privacy, security, and quality assurance.