Social media and the intrauterine device: a YouTube content analysis

Oocyte cryopreservation on TikTok and Instagram: Who is teaching whom?

PURPOSE

Oocyte cryopreservation (OC) is a medical intervention for reproductive-aged women, a demographic that uses social media heavily. This study characterizes the top TikTok videos and Instagram reels on OC.

METHODS

Five hashtags pertaining to OC were selected: #oocytepreservation, #oocytecryopreservation, #eggfreezing, #oocytefreezing, and #fertilitypreservation. Top videos for each hashtag were evaluated for source, content, impact, and quality on both platforms. Descriptive and inferential statistics were performed to analyze differences between laypeople and medical professionals.

RESULTS

From March to April 2023, 332 posts were reviewed. The most popular hashtags on TikTok and Instagram were #eggfreezing (n = 5.6 million views, n = 68,500 + posts) and #fertilitypreservation (n = 9 million views, n = 20,700 + posts). Laypeople dominated as sources (57.8%, 35.2%), followed by physicians (17.0%, 32.4%). No professional societies videos were found. Educational information (53.1%, 48.6%) was most frequently shared on both platforms respectively, followed by personal experiences (36.1%, 21.6%). Laypersons' posts were dominated by personal experiences (62.0%) with educational content second (33.3%). Educational content by medical professionals was more accurate on both TikTok and Instagram than patients (p < 0.001, p < 0.001). #Eggfreezing had the greatest impact for both patients and medical professionals based on shares (n = 9653, n = 3093), likes (n = 713,263, n = 120,700), and comments (n = 35,453, n = 1478). Notably, laypersons had a larger follower count than medical professionals (p < 0.001).

CONCLUSION

The majority of available videos are from laypeople, focus on education topics, and are less accurate in comparison to those from medical professionals. Professional societies have an opportunity to enhance their social media presence for better availability and accuracy of OC information.

Signs and symptoms: Adverse events associated with a sterilization device

Sterilization is now the most common contraceptive method used by women of in the U.S., and sterilization devices have played an important role in its increased popularity. This mixed methods study examines a random sample of 2500 U.S. Food and Drug Administration (FDA) adverse event reports made between 2006 and 2017 about Essure, a sterilization device. Quantitative coding was used to examine patient problems; pain and bleeding were reported most frequently. Qualitative coding analyzed impacts of symptoms on patients' everyday lives and patients' healthcare experiences, including intimate relationships, mothering, and paid employment. Findings suggest that some patients struggled when their reported "subjective" symptoms didn't result in "objective" clinical signs of problems, and when physicians dismissed or deflected their concerns in diagnostic encounters. This paper raises important issues regarding the symptoms patients associated with Essure, the diagnosis of device-driven disease and injury, and the FDA's regulation of medical devices.

Contraceptive content shared on social media: an analysis of Twitter

BACKGROUND

Information on social media may affect peoples' contraceptive decision making. We performed an exploratory analysis of contraceptive content on Twitter (recently renamed X), a popular social media platform.

METHODS

We selected a random subset of 1% of publicly available, English-language tweets related to reversible, prescription contraceptive methods posted between January 2014 and December 2019. We oversampled tweets for the contraceptive patch to ensure at least 200 tweets per method. To create the codebook, we identified common themes specific to tweet content topics, tweet sources, and tweets soliciting information or providing advice. All posts were coded by two team members, and differences were adjudicated by a third reviewer. Descriptive analyses were reported with accompanying qualitative findings.

RESULTS

During the study period, 457,369 tweets about reversible contraceptive methods were published, with a random sample of 4,434 tweets used for final analysis. Tweets most frequently discussed contraceptive method decision-making (26.7%) and side effects (20.5%), particularly for long-acting reversible contraceptive methods and the depot medroxyprogesterone acetate shot. Tweets about logistics of use or adherence were common for short-acting reversible contraceptives. Tweets were frequently posted by contraceptive consumers (50.6%). A small proportion of tweets explicitly requested information (6.2%) or provided advice (4.2%).

CONCLUSIONS

Clinicians should be aware that individuals are exposed to information through Twitter that may affect contraceptive perceptions and decision making, particularly regarding long-acting reversible contraceptives. Social media is a valuable source for studying contraceptive beliefs missing in traditional health research and may be used by professionals to disseminate accurate contraceptive information.

Social Media Videos on Contraceptive Implants: An Assessment of Video Quality and Reliability

STUDY OBJECTIVE

There are many videos on contraception on YouTube and TikTok, and women around the world use video platforms extensively to seek health information from videos of uncertain reliability and quality. The main objective of this research was to evaluate the scientific reliability and quality of the most popular social media videos about contraceptive subdermal implants.

METHODS

TikTok and YouTube videos were assessed separately by two gynecologists. The video quality was evaluated according to the DISCERN score, modified DISCERN score, and Global Quality Scale (GQS) score.

RESULTS

The study included the 100 most popular videos, 44 of which were uploaded by health care professionals. The median DISCERN score for videos shared by health care professionals was 50 (range 15-75), whereas it was 22 (range 15-56) for videos shared by independent users (P < .001). The median modified DISCERN score was 4 (min-max 0-5), and the median GQS score was 4 (min-max 1-5) for the videos uploaded by health care professionals. The modified DISCERN and GQS scores of TikTok videos were lower than those of YouTube videos (both P < .001).

CONCLUSION

Social media videos about contraceptive subdermal implants are popular and have been viewed tens of thousands of times, but the overall medical validity, which we evaluated according to the scoring systems, was poor. Despite the large number of videos, the content's quality and reliability are quite limited. There is a need to prioritize the education provided to patients by gynecologists, as well as to create high-quality content for YouTube and other similar platforms.

Oh Baby! A Content Analysis of Contraception Pins on Pinterest

BACKGROUND

Social media platforms have become a popular source for health information despite concerns about the quality of content shared. We examined how oral contraceptive pills and intrauterine devices are framed on the platform Pinterest using the Health Belief Model (HBM), as well as how fertility awareness methods are portrayed as an alternative to hormonal contraception.

METHODS

We collected pins in February 2021 using searches for birth control, oral contraceptives, and intrauterine devices. After excluding paid ads and pins not relevant to contraceptive use, we conducted a content analysis of 404 pins using a coding framework grounded in the HBM. We carried out descriptive statistics for all variables in the final sample.

RESULTS

Following coding, we found that 54.7% of pins mentioned oral contraceptive pills, 41.58% mentioned intrauterine devices, and 11.63% mentioned fertility awareness methods. Fertility awareness pins had the highest percentage of benefits conveyed (70.21%), followed by intrauterine devices (44.05%), then oral contraceptive pills (38.91%). Pill pins had the highest percentage of barriers conveyed (52.94%) and fertility awareness had the least (25.53%). Side effects were the most mentioned barrier among pill (37.10%) and intrauterine device pins (23.21%). Very few pins were made by (2.48%) or originated with medical institutions (5.45%).

CONCLUSIONS

Oral contraceptive pills are often negatively framed on Pinterest, whereas intrauterine devices and fertility awareness methods are more positively framed. This suggests a need for clear communication from clinicians regarding all contraceptive options and their relative merits and risks.

Reproductive Health Experiences Shared on TikTok by Young People: Content Analysis

BACKGROUND

TikTok is a popular social media platform that allows users to create and share content through short videos. It has become a place for everyday users, especially Generation Z users, to share experiences about their reproductive health. Owing to its growing popularity and easy accessibility, TikTok can help raise awareness for reproductive health issues as well as help destigmatize these conversations.

OBJECTIVE

We aimed to identify and understand the visual, audio, and written components of content that TikTok users create about their reproductive health experiences.

METHODS

A sampling framework was implemented to narrow down the analytic data set. The top 6 videos from each targeted hashtag (eg, #BirthControl, #MyBodyMyChoice, and #LoveYourself) were extracted biweekly for 16 weeks (July-November 2020). During data collection, we noted video characteristics such as captioning, music, likes, and cited sources. Qualitative content analysis was performed on the extracted videos.

RESULTS

The top videos in each hashtag were consistent over time; for example, only 11 videos appeared in the top 6 category for #BirthControl throughout the data collection. Most videos fell into 2 primary categories: personal experiences and informational content. Among the personal experiences, people shared stories (eg, intrauterine device removal experiences), crafts (eg, painting their pill case), or humor (eg, celebrations of the arrival of their period). Dancing and demonstrations were commonly used in informational content.

CONCLUSIONS

TikTok is used to share messages on myriad reproductive health topics. Understanding users' exposure provides important insights into their beliefs and knowledge of sexual and reproductive health. The study findings can be used to generate valuable information for teenagers and young adults, their health care providers, and their communities. Producing health messages that are both meaningful and accessible will contribute to the cocreation of critical health information for professional and personal use.

Claims in the clinic: A qualitative group interview study on healthcare communication about unestablished side effects of the copper IUD

BACKGROUND

Lay online communication about health-related issues has in recent years largely been associated with the spread of misinformation and decreased trust in healthcare. Such communication has included claims about systemic side effects of the copper IUD. In Sweden, a social media group centered on this issue now gathers around 8,700 members. This study aimed to use the case of reported yet unestablished side effects of the copper IUD to investigate experiences of and reasoning about healthcare encounters between caregivers and patients contesting established medical knowledge.

METHODS

We conducted qualitative, semi-structured, digital group interviews with members of the social media group (seven groups, n = 23) and with midwives and gynecologists (six groups, n = 15). We also gathered essays written by social media group members (n = 23). The material was analyzed thematically.

RESULTS

The participant accounts pointed towards tensions related to principles of evidence-based medicine, i.e., perceived insufficiency of research on the safety of the copper IUD and lack of clarity in routines for reporting and following up suspected side effects, and of patient-centered care, i.e., listening respectfully to patients. Tension between caregivers' obligation to adhere to evidence-based medicine while also providing patient-centered care was noted.

CONCLUSION

Healthcare providers' efforts to assess and address patient claims contesting established medical knowledge should include ensuring and communicating sufficient research, clarifying procedures for reporting suspected side effects, and improving person-centered care. This can increase the quality of care while contributing to the mitigation of distrust in healthcare and the spreading of health-related misinformation.

[Contraception on YouTube, Instagram, and TikTok : A content and quality analysis]

BACKGROUND

Young people and adults increasingly obtain information about contraception via social media.

RESEARCH AIM

Against this background, the aim of this study is to investigate for the first time the content and quality of German-language contraceptive posts on YouTube, Instagram, and TikTok. Research questions on providers (F1), content (F2), and quality of contraceptive posts (F3) as well as audience reactions (F4) will be answered.

MATERIALS AND METHODS

A sample of N = 1000 contraceptive posts from YouTube (500), Instagram (250), and TikTok (250) was drawn. A maximum of 20 contraception-related audience comments per post were included in the comment sample (N = 12,454). Posts and comments were analyzed using reliability-tested codebooks. SPSS was used for data analysis. The study is preregistered and all data, materials, and analysis scripts are publicly available.

RESULTS

The majority of contraceptive posts were found to be from health laypersons (52%), followed by media professionals and health professionals (F1). In terms of content, contraceptive posts covered all available contraceptive methods, with the pill (69%) and condoms (40%) dominating (F2). According to common quality criteria, there were clear deficits, with YouTube videos scoring best in comparison (F3). TikTok videos, on the other hand, were top performers in terms of audience interaction, attracting the most views, likes, and comments. Comment columns were often used by the audience to share their own contraceptive experiences or ask follow-up questions (F4).

DISCUSSION

Future research as well as practice interventions are needed to further assess the quality of contraceptive information in social media and improve it in a more targeted way.

Exploring Language Used in Posts on r/birthcontrol: Case Study Using Data From Reddit Posts and Natural Language Processing to Advance Contraception Research

BACKGROUND

Contraceptive choice is central to reproductive autonomy. The internet, including social networking sites like Reddit, is an important resource for people seeking contraceptive information and support. A subreddit dedicated to contraception, r/birthcontrol, provides a platform for people to post about contraception.

OBJECTIVE

This study explored the use of r/birthcontrol, from the inception of the subreddit through the end of 2020. We describe the web-based community, identify distinctive interests and themes based upon the textual content of posts, and explore the content of posts with the most user engagement (ie, "popular" posts).

METHODS

Data were obtained from the PushShift Reddit application programming interface from the establishment of r/birthcontrol to the start date of analysis (July 21, 2011, to December 31, 2020). User interactions within the subreddit were analyzed to describe community use over time, specifically the commonality of use based on the volume of posts, the length of posts (character count), and the proportion of posts with any and each flair applied. "Popular" posts on r/birthcontrol were determined based on the number of comments and "scores," or upvotes minus downvotes; popular posts had 9 comments and a score of ≥3. Term Frequency-Inverse Document Frequency (TF-IDF) analyses were run on all posts with flairs applied, posts within each flair group, and popular posts within each flair group to characterize and compare the distinctive language used in each group.

RESULTS

There were 105,485 posts to r/birthcontrol during the study period, with the volume of posts increasing over time. Within the time frame for which flairs were available on r/birthcontrol (after February 4, 2016), users applied flairs to 78% (n=73,426) of posts. Most posts contained exclusively textual content (n=66,071, 96%), had comments (n=59,189, 86%), and had a score (n=66,071, 96%). Posts averaged 731 characters in length (median 555). "SideEffects!?" was the most frequently used flair overall (n=27,530, 40%), while "Experience" (n=719, 31%) and "SideEffects!?" (n=672, 29%) were most common among popular posts. TF-IDF analyses of all posts showed interest in contraceptive methods, menstrual experiences, timing, feelings, and unprotected sex. While TF-IDF results for posts with each flair varied, the contraceptive pill, menstrual experiences, and timing were discussed across flair groups. Among popular posts, intrauterine devices and contraceptive use experiences were often discussed.

CONCLUSIONS

People commonly wrote about contraceptive side effects and experiences using methods, highlighting the value of r/birthcontrol as a space to post about aspects of contraceptive use that are not well addressed by clinical contraceptive counseling. The value of real-time, open-access data on contraceptive users' interests is especially high given the shifting landscape of and increasing constraints on reproductive health care in the United States.

Women's experiences of dealing with fertility and side effects in contraceptive decision making: a qualitative study based on women's blog posts

BACKGROUND

Worldwide, there is limited knowledge regarding women's views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women's experiences of contraceptive methods based on data gathered from individual blog posts.

METHODS

Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis.

RESULTS

Two themes were identified. Theme 1, 'Seeking control over reproduction and optimise fertility' including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women's sexuality, A wish to understand the body's normal fertility function and Limited knowledge-sharing information about the menstrual cycle during counselling and Theme 2, 'Making the complex decision on their own' including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods.

CONCLUSIONS

During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.

On the verge between the scientific and the alternative: Swedish women's claims about systemic side effects of the copper intrauterine device

The article intervenes in discussions on lay knowledge production about health in the Internet era, through the case of a group of women claiming that their use of copper intrauterine devices has led to systemic side effects. Based on online group interviews and written essays, we examine how women embracing these knowledge claims navigate various sources of information, focusing on the role of scientificity in these epistemic negotiations. The women were found to be involved in an active, scientifically oriented process of knowledge formation, which we refer to as a collective labour of scientific patchworking. Meanwhile, due to a perceived lack of scientifically based expertise on their condition, the women reported having little choice but turn to resources with weaker scientific foothold. We argue that the tendency to portray these women's claims as unscientific simplifies the nature of lay knowledge production, potentially deepening divides between medical authorities and the public.

Perception and use of reversible contraceptive methods in Germany: A social listening analysis

BACKGROUND

With an increasing array of contraceptives in the market, it is important to understand how users perceive them and how their interests evolve over time.

OBJECTIVES

In this analysis, we aimed to examine the contraceptive interests of women and couples in Germany using data derived from social media posts.

STUDY DESIGN

Social listening analysis.

METHODS

Posts from Urbia-a German Internet community-mentioning at least one reversible contraceptive method between April 2006 and April 2021 were carefully selected by searching for a defined set of keywords and phrases. The frequency of mention of each method was studied and their trend over the last 5 years was analyzed. The significance of trends was evaluated using Mann-Kendall test. Additionally, 656 random posts were individually assessed for method transitions and problems associated with specific contraceptives.

RESULTS

The contraceptive pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Although general interest in hormonal contraception was higher compared to non-hormonal, interest in the pill decreased and interest in natural family planning and copper/gold coil increased. Most women switched from the pill to non-hormonal methods, almost half of them using a condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The common problem associated with most contraceptives was side effects.

CONCLUSION

Social media provides valuable information about contraceptive experiences that can be used to monitor contraceptive prevalence patterns and attitudes within a large population in a very short span of time. A good understanding of how various contraceptives are currently perceived helps in identifying strategies for improving existing family planning policies.

PLAIN LANGUAGE SUMMARY

Currently, there are a variety of contraceptive products available in the market. To understand how users perceive them and how their interest evolves over time, we analyzed social media posts from Urbia, a German Internet platform. We scraped posts between 2016 and 2021 from the "child-desire" and "contraception" forums and analyzed the relative frequency of mentions of different contraceptive methods. We also looked at 1000 individual posts from 1000 different users, analyzed method switches and the problems associated with individual methods of use. The oral pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Over the last 5 years however, the mention of the pill dropped, whereas the mentions of natural family planning and copper or gold coil increased. Further analysis of individual posts showed most women migrating from the pill to other non-hormonal methods such as natural family planning and condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The most common problem associated with the pill and non-hormonal intrauterine devices was side effects. Through this analysis we show that social media serves as a useful tool to monitor contraceptive prevalence and attitudes within a large population in a very short span of time. Our findings give policy makers an idea on the topics where more counseling and education may be required to help women and couples find their best suited method of contraception.

TikTok, #IUD, and User Experience With Intrauterine Devices Reported on Social Media

TikTok, a video-sharing application, offers a growing platform for contraception-related content. The top 100 videos tagged "#IUD" were compiled using a web-scraping application. User demographics and video content were analyzed by two independent reviewers, with a third to arbitrate differences. More videos had a negative tone (37.8%) about intrauterine devices (IUDs) than positive (19.4%), and 27.6% mentioned distrust of health care professionals. Of videos conveying patient experiences, all had a negative or ambiguous tone and 96.8% highlighted pain and other side effects related to IUDs. Videos scored low on information health quality (1.2/5 on DISCERN) and averaged 73.8% in understandability and 17.7% in actionability on PEMAT (Patient Education Materials Assessment Tool). #IUD videos on TikTok often portray negative experiences related to pain and informed consent.

Social media in health communication: A literature review of information quality

BACKGROUND

Social media is used in health communication by individuals, health professionals, disease centres and other health regulatory bodies. However, varying degrees of information quality are churned out daily on social media. This review is concerned with the quality of Social Media Health Information (SMHI).

OBJECTIVE

The review sought to understand how SMHI quality issues have been framed and addressed in the literature. Health topics, users and social media platforms that have raised health information quality concerns are reviewed. The review also looked at the suitability of existing criteria and instruments used in evaluating SMHI and identified gaps for future research.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the forward chaining strategy were used in the document search. Data were sourced according to inclusion criteria from five academic databases, namely Scopus, Web of Science, Cochrane Library, PubMed and MEDLINE.

RESULTS

A total of 93 articles published between 2000 and 2019 were used in the review. The review revealed a worrying trend of health content and communication on social media, especially of cancer, dental care and diabetes information on YouTube. The review further discovered that the Journal of the American Medical Association, the DISCERN and the Health on the Net Foundation, which were designed before the advent of social media, continue to be used as quality evaluation instruments for SMHI, even though technical and user characteristics of social media differ from traditional portals such as websites.

CONCLUSION

The study synthesises varied opinions on SMHI quality in the literature and recommends that future research proposes quality evaluation criteria and instruments specifically for SMHI.

Assessing the accuracy and quality of YouTube videos on early pregnancy loss

Objective

To assess the accuracy and quality of YouTube videos pertaining to early pregnancy loss for use as a patient education tool.

Methods

A cross-sectional study was conducted via YouTube search using the keywords "miscarriage," "spontaneous abortion," "pregnancy loss," and "pregnancy failure." The first 20 results for each keyword search, sorted by both relevance and view count, were compiled into a list. Descriptive characteristics, including the numbers of views, likes, dislikes, video length, and duration of upload were collected. All videos were independently evaluated by two physician researchers using two unique assessment tools. The Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test was used to measure the reliability of video content. The Miscarriage-Specific Question Score (MSQS) criterion was used to objectively assess video content specific to miscarriage. Inter-rater agreement was analyzed via kappa coefficient and Pearson correlation.

Results

160 videos were screened, among which 74 videos were included for analysis. The mean CRAAP score was 8.3 out of a total possible score of 15, demonstrating good quality sources, though not of academic level. Mean MSQS score was 8.1 out of a total possible score of 24, demonstrating "fair" accuracy and comprehensiveness. Pearson correlations were 0.87 and 0.86 for CRAAP and MSQS total scores, respectively, demonstrating excellent inter-rater reliability.

Conclusion

YouTube videos related to early pregnancy loss span a wide range of quality, accuracy, and purpose. While some videos provide effective content, mean rater scores demonstrate that YouTube is not a reliable source for patient education on early pregnancy loss.

A Content Analysis of Reddit Users' Posts about Challenges to Contraceptive care-seeking during COVID-19-related Restrictions in the United States

The COVID-19 pandemic in the United States caused disruptions in care seeking and delivery during the spring of 2020, including for contraceptive care. We examined how some individuals experienced and responded to barriers to accessing contraceptive care by conducting a content analysis of relevant Reddit posts. We collected 2666 posts by scraping relevant subreddits from February 1, 2020, to April 15, 2020, and filtering by selected keywords. Among the 101 posts on contraception and the COVID-19 pandemic, we explored three main themes: barriers to accessing general healthcare during the early pandemic, problems and concerns specific to contraceptive use, and attempts to navigate the obstacles to contraceptive care or use-related concerns. The Reddit posts demonstrated the disruptive force the early pandemic had on contraceptive care and provided a unique window into the concerns posters expressed on Reddit during this time. Many posters asked questions related to accessing contraception and side effects and sought reassurance from these online forums. Our results suggest that there were barriers to accessing reliable, high-quality, and evidence-based information about contraception during this disruption in care. The findings also underscore that conversational and interactive means of seeking out information are important modes for learning about and discussing contraception for some and may be especially helpful during clinic closures and other restrictions on access.

How Did People with Functional Disability Experience the First COVID-19 Lockdown? A Thematic Analysis of YouTube Comments

People with functional disability endure barriers to health and other services and to full participation in social life. In the context of COVID-19, this discrimination has been intensified worldwide. We examine how the experience of COVID-19 lockdown was depicted in comments to a video about functional disability and COVID published on VICE's YouTube channel. We analysed the first 100 comments on the video, which was posted in spring 2020, during the first COVID-19 lockdown (roughly from March to June 2020, with some variations around the world). We identified four themes: lack of access to care and services, isolation and lifestyle changes, mental health consequences, and peer support. Legal regulations regarding COVID-19 and people with functional disability have not been sufficient in most countries. The COVID-19 pandemic has exposed inadequate care systems, even in Western countries with advanced social protection policies.

Attitudes Toward the Copper IUD in Sweden: A Survey Study

Background

While the efficacy and safety of the contraceptive copper intrauterine device (IUD) have been affirmed, alongside its importance for the prevention of unintended pregnancies, some studies have pointed to negative attitudes toward the device. In recent years, social media communication about it has included claims about systemic side effects, unsubstantiated by medical authorities. Research from the Swedish context is sparse. This study investigates attitudes toward the copper IUD and any correlations between negative attitudes toward or experiences of the device, and (1) sociodemographic characteristics, (2) the evaluation of the reliability of different sources of information, and (3) trust in healthcare and other societal institutions.

Methods

A survey was distributed online to adult women in Sweden (n = 2,000). Aside from descriptive statistics, associations between negative attitudes toward or experiences of the copper IUD and sociodemographic and other variables were calculated using logistic regressions and expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Open survey responses (n = 650) were analyzed thematically.

Results

While many reported positive attitudes toward and experiences of the IUD, 34.7% of all respondents reported negative attitudes and 45.4% of users reported negative experiences. Negative attitudes were strongly correlated with negative experiences. Negative attitudes and experiences were associated with low income, but no conclusive associations were identified with other socioeconomic variables. Negative attitudes and experiences were associated with lower levels of confidence in and satisfaction with healthcare, as well as lower self-assessed access and ability to assess the origin and reliability of information about the IUD. In open responses, negative comments were prevalent and included references to both common and unestablished perceived side-effects. Respondents pointed to problematic aspects of information and knowledge about the copper IUD and called for improved healthcare communication and updated research.

Conclusion

Healthcare provider communication about the copper IUD should promote reproductive autonomy and trust by providing clear information about potential side effects and being open to discuss women's experiences and concerns. Further research on copper IUD dissatisfaction and ways in which health professionals do and may best respond to it is needed.

[Contraception in the German-language Wikipedia: a content and quality analysis]

BACKGROUND

Adolescents and adults today often obtain information about contraception from the Internet, especially from the online encyclopedia Wikipedia. This is because Google searches usually return Wikipedia entries as top hits.

RESEARCH AIM

Against this background, the aim of the current study is to systematically analyze for the first time the content and quality of Wikipedia articles on contraceptive methods. Five central quality dimensions are examined: the degree of correctness (research question RQ1), completeness (RQ2), neutrality (RQ3), comprehensibility (RQ4), and currency (RQ5) of the contraceptive information - and on this basis the overall quality of the articles (RQ6).

MATERIALS AND METHODS

A sample of all German-language Wikipedia articles on all contraceptive methods was formed (N = 25). These articles were analyzed by three independent, trained coders using a codebook that was developed based on the current state of the research and tested for reliability. Data analysis was performed using SPSS. The study is preregistered and all data, materials, and analysis scripts are publicly available.

RESULTS

The 25 Wikipedia articles on contraceptive methods were found to vary widely in content quality. While they showed good quality on average in terms of correctness (RQ1) and neutrality (RQ3), they scored mediocre in terms of completeness (RQ2), comprehensibility (RQ4), and currency (RQ5), resulting in moderate overall quality (RQ6).

DISCUSSION

More research as well as practice measures are needed to further assess and improve the quality of contraceptive information on Wikipedia and in other social media in a more targeted way.

Condom Use at Coitarche Among Men in Non-Steady Relationships in the United States, 2006-2013

PURPOSE

Using U.S. National Survey of Family Growth (NSFG) data from 2006 to 2013, we characterized men aged 15-44 years who reported not using a condom at their first vaginal intercourse (coitarche), while in a non-steady relationship with a female partner.

METHODS

Men who reported ever having intercourse were asked about male and female contraceptives used at coitarche. Analysis was restricted to respondents whose first sexual relationship was reported as non-steady, thereby comprising a population for whom condoms are recommended for preventing both pregnancy and sexually transmitted infections. Demographic and behavioral factors were examined against condom use, with significant associations included in multivariable logistic regression. We additionally describe young men's receipt of various components of sex education prior to coitarche.

RESULTS

Nearly half (43%) of men aged 15-44 in the U.S. reported not using a condom at coitarche during a non-steady relationship. Among these men, coitarche was reported on average at 16 years old; more than one third (37%) endorsed mixed feelings or not wanting to have sex at the time. Older men (adjusted odds ratio [adjOR] 1.07, 95% confidence interval [CI] 1.06-1.08), as with men from earlier National Survey of Family Growth cycles, were increasingly likely to have reported unprotected coitarche. Similarly, men reporting coitarche before the age of 15 (adjOR 2.39, 95% CI 1.99-2.87) or having a younger sex partner at coitarche (adjOR 1.73, 95% CI 1.11-2.69) were more likely to have not used condoms. About three quarters of men received at least some form of sex education prior to coitarche.

CONCLUSIONS

Condomless coitarche is commonly reported among men in non-steady adolescent relationships and with mixed feelings about having sex. Condomless coitarche among these men is independently associated with initiating sex before the age of 15 and having sex with a younger female partner. These findings may guide how to structure young men's sexual education programing.

Self-removal of long-acting reversible contraception: A content analysis of YouTube videos

OBJECTIVE

To explore publicly available information about the self-removal of long-acting reversible contraception (LARC) on a popular video-sharing website.

STUDY DESIGN

We conducted a comprehensive keyword search of YouTube videos related to self-removal of LARC-namely intrauterine devices and implants. We analyzed video content to explore demographic characteristics, method and duration of LARC use, and motivations and experiences of self-removal.

RESULTS

Our keyword search identified 58 videos that met the criteria for inclusion, including 48 videos that featured individuals who removed an intrauterine device and 10 who removed an implant. Collectively, videos had over 4 million views. We identified most video creators as white (53%), 31% as Black, and 14% as Latinx. Users were motivated to remove their own device by both preferences and barriers to formal care. Most individuals in our sample (n = 56/58) successfully removed their device and described their experience in positive terms related to the ease of removal. Reasons for LARC discontinuation included negative side effects, fear of potential side effects, and desire for pregnancy.

CONCLUSION

This study builds upon prior research by describing publicly available information about LARC self-removal. The over representation of Black women in our sample may reflect a higher prevalence of LARC self-removal among this population. Positive experiences of self-removal and high levels of viewer engagement with online videos suggest a need for provider counseling on LARC removal at the time of insertion.

IMPLICATIONS

Prior to LARC insertion, patients should be made aware of any financial requirements for discontinuation. Provider counseling for self-removal at the time of insertion will likely minimize health risks and affirm patient reproductive autonomy.

[Sexual health information on social media: a systematic scoping review]

BACKGROUND

Information on sexual and reproductive health is increasingly disseminated via social media and reaches a large audience.

RESEARCH AIM

Against this background, the aim of this paper is to systematically summarize the international state of research on sexual health information on social media for the first time with a scoping review. Seven research questions were explored, relating to the amount (F1), methods (F2: content analysis, F3: quality analysis), and results (F4: providers, F5: target groups, F6: topics, F7: quality of information) of previous studies.

MATERIALS AND METHODS

The study follows the PRISMA framework for scoping reviews as well as the Open Science approach. It is preregistered, and all materials (codebook with reliability coefficients) and data (list of identified studies and coding of studies) are available on the Open Science Foundation server.

RESULTS

A total of 69 studies with 72 data sets were identified, with more than half of the publications referring to YouTube (F1). Qualitative and quantitative methods of content analysis are used equally (F2) and quality analyses are rare (F3). Health laypersons dominate as the information providers (F4). The target groups are mostly unspecified (F5). The health information on social media examined in the previous studies covers a broad range of topics (F6). Where quality assessments were made, they tended to be negative (F7).

DISCUSSION

More research is needed to better understand sexual and reproductive health information on social media and to promote its quality and constructive use.

A Thematic Analysis of Pre-Exposure Prophylaxis (PrEP) YouTube Videos

Pre-exposure prophylaxis (PrEP) is an encouraging approach to HIV prevention, yet there is a paucity of research aimed at understanding individual PrEP experiences. The current study aims to examine first-hand narratives of individuals detailing their PrEP experiences via the YouTube platform. We searched YouTube.com using the keywords, "pre-exposure prophylaxis" and "Truvada". Search results were limited to the 15 most-viewed videos. Informed by a thematic/content analysis approach, we conducted an iterative analysis of video transcripts. Narratives covered a wide range of topics including the reasons to start PrEP, interaction with providers, side effects, insurance coverage, and stigma. By and large, the videos encouraged those at risk for HIV to consider PrEP. Narratives were often characterized by emotional engagement. Given that YouTube videos are used to share individual PrEP experiences with a wider audience, our analysis may inform the development of strategies aimed at utilizing YouTube for increasing uptake of PrEP.

Population attitudes toward contraceptive methods over time on a social media platform

BACKGROUND

Contraceptive method choice is often strongly influenced by the experiences and opinions of one's social network. Although social media, including Twitter, increasingly influences reproductive-age individuals, discussion of contraception in this setting has yet to be characterized. Natural language processing, a type of machine learning in which computers analyze natural language data, enables this analysis.

OBJECTIVE

This study aimed to illuminate temporal trends in attitudes toward long- and short-acting reversible contraceptive methods in tweets between 2006 and 2019 and establish social media platforms as alternate data sources for large-scale sentiment analysis on contraception.

STUDY DESIGN

We studied English-language tweets mentioning reversible prescription contraceptive methods between March 2006 (founding of Twitter) and December 2019. Tweets mentioning contraception were extracted using search terms, including generic or brand names, colloquial names, and abbreviations. We characterized and performed sentiment analysis on tweets. We used Mann-Kendall nonparametric tests to assess temporal trends in the overall number and the number of positive, negative, and neutral tweets referring to each method. The code to reproduce this analysis is available at https://github.com/hms-dbmi/contraceptionOnTwitter.

RESULTS

We extracted 838,739 tweets mentioning at least 1 contraceptive method. The annual number of contraception-related tweets increased considerably over the study period. The intrauterine device was the most commonly referenced method (45.9%). Long-acting methods were mentioned more often than short-acting ones (58% vs 42%), and the annual proportion of long-acting reversible contraception-related tweets increased over time. In sentiment analysis of tweets mentioning a single contraceptive method (n=665,064), the greatest proportion of all tweets was negative (65,339 of 160,713 tweets with at least 95% confident sentiment, or 40.66%). Tweets mentioning long-acting methods were nearly twice as likely to be positive compared with tweets mentioning short-acting methods (19.65% vs 10.21%; P<.002).

CONCLUSION

Recognizing the influence of social networks on contraceptive decision making, social media platforms may be useful in the collection and dissemination of information about contraception.

Acceptability of a Comprehensive Sex Education Self-Study Website for Teaching Reproductive Health: A Pilot Study Among College Students and Obstetrics and Gynecology Resident Physicians

Introduction

There is a growing interest among adolescents to obtain sexual health information online, which could be helpful in rural areas where adolescents face unique obstacles to contraception access, and medically accurate sex education is not mandated.

Aim

This study piloted a comprehensive sex education self-study website among undergraduate students and resident physicians to assess the accuracy and feasibility for future use in younger adolescents.

Methods

A sex education website developed by a board-certified obstetrician-gynecologist (OBGYN) was piloted among a group of OBGYN resident physicians and undergraduates from West Virginia. Groups were chosen to assess the accuracy of information and acceptability for use in younger adolescents. The 30-minute curriculum was a series of short videos (2–4 minutes each) covering anatomy, physiology, sexuality, gender identity, relationship health, contraception, and sexually transmitted infection prevention. Data were obtained on subjects’ past experience and perception of sex education. Subjects also evaluated the website for usefulness and accuracy.

Outcomes

Main outcomes included a Likert scale assessment of each curriculum session’s usefulness, accuracy, and how easy it was to follow.

Results

24 subjects (14 undergraduates and 10 physicians) participated during September and October of 2019. All except for 1 subject had sex education taught in school; 11 (45.8%) reported it to be “low quality”; 23 (95.8%) reported being taught in a classroom. Individual website video sessions were reported to be highly accurate, very easy to follow, and very useful. All subjects (100%) felt that high school adolescents would be interested in the self-study website.

Conclusions

A self-study website was successfully tested and found to be a well-accepted way to teach sex education among this pilot group. Future work involves testing this tool among younger adolescent subjects.

Yoost J, Ruley M, Durfee L. Acceptability of a Comprehensive Sex Education Self-Study Website for Teaching Reproductive Health: A Pilot Study Among College Students and Obstetrics and Gynecology Resident Physicians. Sex Med 2021;9:100302.