A systematic review of the use and effectiveness of social media in child health

Parenting Information on Social Media: Systematic Literature Review

BACKGROUND

Social media has become extremely popular among parents to seek parenting information. Despite the increasing academic attention to the topic, studies are scattered across various disciplines. Therefore, this study broadens the scope of the existing reviews by transcending narrow academic subdomains and including all relevant research insights related to parents' information seeking on social media and its consequent effects.

OBJECTIVE

The aims of this systematic literature review were to (1) identify influential journals and scholars in the field; (2) examine the thematic evolution of research on parenting and social media; and (3) pinpoint research gaps, providing recommendations for future exploration.

METHODS

On the basis of a criteria for identifying scholarly publications, we selected 338 studies for this systematic literature review. We adopted a bibliometric analysis combined with a content thematic analysis to obtain data-driven insights with a profound understanding of the predominant themes in the realm of parenting and social media.

RESULTS

The analysis revealed a significant increase in research on parenting and social media since 2015, especially in the medical domain. The studies in our review spanned 232 different research fields, and the most prolific journal was JMIR Pediatrics and Parenting. The thematic analysis identified 4 emerging research themes in the studies: parenting motivations to seek information, nature of parenting content on social media, impact of parenting content, and interventions for parents on social media.

CONCLUSIONS

This study provides critical insights into the current research landscape of parenting and social media. The identified themes, research gaps, and future research recommendations provide a foundation for future studies, guiding researchers toward valuable areas for exploration.

Influence of digital health literacy on online health-related behaviors influenced by internet advertising

BACKGROUND

The frequency of health-related information seeking on the internet and social media platforms has increased remarkably. Thus, the ability to understand and select accurate health-related information online, known as EHealth literacy, is crucial for the population. Therefore, this study aimed to evaluate how eHealth literacy influences the critical analysis of oral health-related information obtained from the Internet and its influence on oral health-related behaviors.  METHODS: A cross-sectional online study was conducted with 418 Brazilian adults who responded to the eHEALS questionnaire, with questions regarding the influence of online information on oral health decisions. Socioeconomic and demographic characteristics were also collected.

RESULTS

The mean eHEALS score was 27.85 (± 8.13), with a range spanning from 8 to 40 points. Participants with higher eHEALS scores reported using social media platforms to seek for dentists and to acque information about symptoms, diagnoses, and treatments. Furthermore, this group tended not to disregard professional health recommendations based on Internet information and abstained from utilizing products promoted by digital influencers. In multivariate models, increased eHEALS scores were associated with reduced consumption of products endorsed by digital influencers.

CONCLUSIONS

The findings from this study suggest that individuals with higher scores on the eHealth literacy questionnaire often conduct research on their health status and seek for health care providers on the Internet. Moreover, these individuals were less likely to be influenced by digital influencers.

Social media use and health risk behaviours in young people: systematic review and meta-analysis

OBJECTIVES

To examine the association between social media use and health risk behaviours in adolescents (defined as those 10-19 years).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXic, PsyArXiv, medRxiv, and Google Scholar (1 January 1997 to 6 June 2022).

METHODS

Health risk behaviours were defined as use of alcohol, drugs, tobacco, electronic nicotine delivery systems, unhealthy dietary behaviour, inadequate physical activity, gambling, and anti-social, sexual risk, and multiple risk behaviours. Included studies reported a social media variable (ie, time spent, frequency of use, exposure to health risk behaviour content, or other social media activities) and one or more relevant outcomes. Screening and risk of bias assessments were completed independently by two reviewers. Synthesis without meta-analysis based on effect direction and random-effects meta-analyses was used. Effect modification was explored using meta-regression and stratification. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).

RESULTS

Of 17 077 studies screened, 126 were included (73 included in meta-analyses). The final sample included 1 431 534 adolescents (mean age 15.0 years). Synthesis without meta-analysis indicated harmful associations between social media and all health risk behaviours in most included studies, except inadequate physical activity where beneficial associations were reported in 63.6% of studies. Frequent (v infrequent) social media use was associated with increased alcohol consumption (odds ratio 1.48 (95% confidence interval 1.35 to 1.62); n=383 068), drug use (1.28 (1.05 to 1.56); n=117 646), tobacco use (1.85, 1.49 to 2.30; n=424 326), sexual risk behaviours (1.77 (1.48 to 2.12); n=47 280), anti-social behaviour (1.73 (1.44 to 2.06); n=54 993), multiple risk behaviours (1.75 (1.30 to 2.35); n=43 571), and gambling (2.84 (2.04 to 3.97); n=26 537). Exposure to content showcasing health risk behaviours on social media (v no exposure) was associated with increased odds of use of electronic nicotine delivery systems (1.73 (1.34 to 2.23); n=721 322), unhealthy dietary behaviours (2.48 (2.08 to 2.97); n=9892), and alcohol consumption (2.43 (1.25 to 4.71); n=14 731). For alcohol consumption, stronger associations were identified for exposure to user generated content (3.21 (2.37 to 4.33)) versus marketer generated content (2.12 (1.06 to 4.24)). For time spent on social media, use for at least 2 h per day (v <2 h) increased odds of alcohol consumption (2.12 (1.53 to 2.95); n=12 390). GRADE certainty was moderate for unhealthy dietary behaviour, low for alcohol use, and very low for other investigated outcomes.

CONCLUSIONS

Social media use is associated with adverse health risk behaviours in young people, but further high quality research is needed to establish causality, understand effects on health inequalities, and determine which aspects of social media are most harmful.

STUDY REGISTRATION

PROSPERO, CRD42020179766.

Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review

BACKGROUND

Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media-based nutrition education interventions to inform the implementation of future social media-based nutrition education interventions.

OBJECTIVE

A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media-based nutrition education interventions for adolescents was conducted.

METHODS

We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media-based nutrition education interventions was extracted.

RESULTS

A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied.

CONCLUSIONS

Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media-based nutrition interventions and the need for user-centered design of the interventions.

A better start national science challenge: supporting the future wellbeing of our tamariki E tipu, e rea, mō ngā rā o tō ao: grow tender shoot for the days destined for you

The majority of children and young people in Aotearoa New Zealand (NZ) experience good health and wellbeing, but there are key areas where they compare unfavourably to those in other rich countries. However, current measures of wellbeing are critically limited in their suitability to reflect the dynamic, culture-bound, and subjective nature of the concept of 'wellbeing'. In particular, there is a lack of measurement in primary school-aged children and in ways that incorporate Māori perspectives on wellbeing. A Better Start National Science Challenge work in the areas of Big Data, Healthy Weight, Resilient Teens, and Successful learning demonstrates how research is increasing our understanding of, and our ability to enhance, wellbeing for NZ children. As we look ahead to the future, opportunities to support the wellbeing of NZ young people will be shaped by how we embrace and mitigate against potential harms of new technologies, and our ability to respond to new challenges that arise due to climate change. In order to avoid increasing inequity in who experiences wellbeing in NZ, wellbeing must be monitored in ways that are culturally acceptable, universal, and recognise what makes children flourish.

Development, Validation, and Utilization of a Social Media Use and Mental Health Questionnaire among Middle Eastern and Western Adults: A Pilot Study from the UAE

OBJECTIVES

We aimed to develop and validate a mental health stigma measurement tool for use within the social media context, utilizing the tool to assess whether the stigma shown in face-to-face interactions translates to social media, coupled with comparing whether social media use can cause the stigma among a sample of Middle Eastern and Western populations.

METHODS

The development and validation phase comprised a systematic process that was used to develop an assessment tool that could be used within the social media context and establish its validity and reliability. A 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) was developed to assess mental health stigma. The anonymous questionnaire was distributed from June 2022 to August 2022 on various social media platforms and groups predominated by the two demographics of interest, enrolling 1328 participants (with only 1001 responses deemed valid). The utilization phase consisted of bivariate and multivariable analysis of the data. The cutoff points for low, medium, and high scores were the 25th, 50th, and 75th percentil, respectively.

RESULTS

The instrument comprised three dimensions: acceptance, intolerance, and digital care sentiment. In the Middle Eastern subset of participants, a higher score of intolerance (more stigma) toward mental illness was found in 72.4% of the participants, with a higher score of acceptance being 35.1% and of digital care sentiment being 46.4%. The mean scores for all the scales were as follows: intolerance (3.08 ± 0.64), acceptance (3.87 ± 0.71), and digital care sentiment (3.18 ± 0.69). For Westerners, a higher score of intolerance toward mental illness was found in 24.0% of the participants, with a higher score of acceptance being 56.8% and of digital care sentiment being 38.2%. The mean scores for all the scales were as follows: intolerance (2.28 ± 0.73), acceptance (4.21 ± 0.61), and digital care sentiment (3.08 ± 0.62). Various results were obtained regarding the effect of individual social media platforms on the different subscales.

CONCLUSIONS

Stigma does follow people on social media, whether they are Middle Easterners or Westerners, although to varying degrees. The results of social media interaction and activity varied based on the group that used them, with some having an impact on one group but not the other. For these reasons, proper guidance is advised when utilizing and interacting with social media platforms.

[Examination of social media and technology use of mothers in breastfeeding period in a region of Turkey]

OBJECTIVE

The aim of this study is to examine the social media and technology use of mothers during breastfeeding.

METHOD

Descriptive cross-sectional study. The study was carried out with mothers who brought their children for follow-up in the pediatric outpatient clinics of a public hospital, a university hospital and a private hospital located in Turkey. A questionnaire developed «ad hoc» was used for data collection.

RESULTS

The total sample consisted of 275 mothers (n = 275). Mothers participating in the study 89.8% of the mothers used social media, 86.5% sought on the reliability of the information on the internet, 73.8% used the medical information on the internet to decide on any case about breastfeeding and 66.9% of them used cell phone or computer during breastfeeding. A statistically significant difference was determined between the education level of the mothers and social media use (p &lt; 0.05). It was determined that the mothers who were secondary school graduate and those with three or more children talked on a cell phone while breastfeeding.

CONCLUSIONS

Most of the mothers used social media and technology at a level limiting their interaction with their children. It is recommended to protect mothers from digital addiction and improve their digital literacy levels.

Understanding Australian adolescent girls' use of digital technologies for healthy lifestyle purposes: a mixed-methods study

Background

Little is known about girls’ use of a broad range of digital technologies to support a healthy lifestyle, particularly during the later adolescent years when they are expected to take greater responsibility for individually managing their health and wellbeing. The present study was designed to gain an in-depth understanding of adolescent girls’, 15 to 17 years of age, use of a broad range of digital technologies to support multiple healthy lifestyle purposes.

Methods

This study used a mixed-methods sequential research design (i.e. quantitative and qualitative data in two consecutive phases). A quantitative online survey was conducted to determine the use of digital technologies for healthy lifestyle purposes. Qualitative semi-structured interviews were conducted with a subset of survey respondents to explore factors influencing their technology use and preferences.

Results

Descriptive analysis of survey data (online survey, n = 336) demonstrated the popularity of social media and online video sharing platforms, with evidence that the use of digital technologies does not occur in isolation and girls draw on several resources simultaneously to achieve their desired healthy lifestyle outcomes. Thematic analysis of interview data (semi-structured interviews, n = 29) revealed seven interrelated themes around factors influencing girls’ use of, and satisfaction with, different digital technologies: accessibility, social connectivity, credibility, relatability, inspiration, safety, and customisability.

Conclusions

The findings reiterate that one size doesn’t fit all girls, and often one size might not even fit one girl, and thus highlight the challenge of catering to such varied use cases. Overall, it appears that current digital technology offerings meet the needs and preferences of adolescent girls for healthy lifestyle purposes, however there may be benefit in allowing greater customisation of use, and consumer driven tailoring of content, according to personal preferences and changing circumstances.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13869-4.

Usage of social media in epidemic intelligence activities in the WHO, Regional Office for the Eastern Mediterranean

Social media platforms are a massive source of information being used for monitoring and detecting various actual events such as natural disasters and disease outbreaks. This paper aims to present the experience of WHO, Regional Office for the Eastern Mediterranean in using social media for the detection and monitoring of COVD-19 pandemic alongside the other event-based surveillance tools. Over the period of 29 January 2020 to 31 May 2021, information was collected from social media and other media outlets (web news) as being the source of health information for early detecting and monitoring the situation of COVID-19 events. Signals were categorised into new events and event updates; where event updates captured from social media were categorised into official and unofficial. A total of 10 160 COVID-19 information were captured, out of which 95.8% (n=9732) were detected through social media. None of the information captured were discarded. 50.0% (n=11) of the COVID-19 events in the Eastern Mediterranean Region (EMR) were primarily captured from social media compared with 4.5% (n=1) primarily captured from other media outlets. Almost all (99.4%) of the event updates captured from social media were official updates. Real-time, transparent and relevant information posted on different social media platforms, especially the governmental official social media accounts, strengthened the early detection and follow-up of public health events in the EMR, especially during the current COVID-19 pandemic.

Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review

BACKGROUND

Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE.

METHODS

A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results.

RESULTS

Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence (n = 3), quality of life (n = 3), fatigue (n = 2), pain (n = 2), depressive symptoms (n = 1), anxiety (n = 1), and health-related outcomes including disease severity (n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function (n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue).

CONCLUSION

This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.

Is Social Media a New Type of Social Support? Social Media Use in Spain during the COVID-19 Pandemic: A Mixed Methods Study

This study examines Spanish adults’ social media use during the COVID-19 pandemic using mixed-methods to assess and understand frequency, context, and changes in social media use during two critical time points in Spain. We conducted semi-structured interviews in April 2020, and two waves of surveys (April 2020, April 2021) among Spanish adults. We coded and analyzed qualitative data related to social media use during the first lockdown period in Spain using Dedoose software; and ran descriptive statistics and chi-square tests to assess changes in social media use over the two survey waves related to perceived social support and loneliness. Participants ranged in age from 18–92 and were representative of the Spanish population’s sociodemographics. Interview data show that WhatsApp was most commonly used, and that social media allowed for social support and engaging in healthy behaviors. Survey data show that women and individuals aged 18–34 had the greatest increases in social media use. Statistically significant associations were found between social support and loneliness with social media use. Our results show that promoting social media use as an emotional resource for social support in times of crisis or isolation can minimize loneliness and can be a beneficial tool for general worldwide crises.

Social Media and Children's and Adolescents' Diets: A Systematic Review of the Underlying Social and Physiological Mechanisms

The association between social media (SM) and children's and adolescents' diet is poorly understood. This systematic literature review aims to explore the role of SM in children's and adolescents' diets and related behaviors, considering also the underlying mechanisms. We searched Medline, Scopus, and CINAHL (2008-December 2021) for studies assessing the relation of SM exposure with food intake, food preference, dietary behaviors, and the underlying mechanisms (e.g., brain activation to digital food images-as proxy for SM food images) among healthy children and adolescents aged 2-18 y. A total of 35 articles were included. Of 4 studies, 1 found that exposure to peers' videos on healthy eating, but not SM influencers', increased vegetable intake. Most studies reported that SM was associated with skipping breakfast, increased intake of unhealthy snacks and sugar-sweetened beverages, and lower fruit and vegetable intake, independent of age. Children and adolescents exposed to unhealthy compared with healthy digital food images showed increased brain response in reward- and attention-related regions. The mechanisms underpinning the abovementioned associations were 1) physiological (appetitive state, increased neural response to portion size and energy density of food depicted) and 2) social (food advertising via SM influencers and peers). SM exposure leads to unfavorable eating patterns both in children and adolescents. The identified mechanisms may help tailor future health interventions. Downregulating SM advertising and limiting SM exposure to children and adolescents may improve food intake and subsequent health outcomes. The protocol of this review was registered in PROSPERO as CRD42020213977 (https://www.crd.york.ac.uk/prospero/).

#Skinny girls: young girls' learning processes and health-related social media

This paper provides in-depth knowledge into young girls' learning processes in relation to physical activity, diet/nutrition and body image. Data were generated from interviews with 49 girls (age 13-15) in England. The practical epistemological analysis technique was used to explore young people as both producers and consumers, or prosumers, of content and knowledge. The data illustrate that adolescent girls navigate two interrelated health-related paradoxes within publicly private spaces: (i) skinny fat and (ii) naturally fake. Skinny fat refers to how participation in social media represents a continuous struggle of becoming skinny, but at the same time not trying too hard to become too skinny. Naturally fake refers to how having a 'natural' look is highly valued, but equally, it is acceptable to be 'fake'. Overall, adolescent girls are competent users of social media, who are able to navigate the complexity of the medium and its contents. At the same time, the adolescent girls sometimes found themselves, unintentionally, exposed to risks (e.g. bullying or body dysmorphia), particularly when social media was experienced publicly in a temporal order, connected to the past or present, and without control of potential future effects and impacts. Relevant adults should acknowledge young people's vast competence of life on social media and further empower young people to self-regulate their learning through social media, and in ways that help them to learn from experiences about their health and bodies to shape future actions.

Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study

BACKGROUND

This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships.

METHODS

An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16-88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted.

RESULTS

Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media.

CONCLUSIONS

The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.

The effect of social media interventions on physical activity and dietary behaviours in young people and adults: a systematic review

BACKGROUND

The objectives of this systematic review were to update the evidence base on social media interventions for physical activity and diet since 2014, analyse the characteristics of interventions that resulted in changes to physical activity and diet-related behaviours, and assess differences in outcomes across different population groups.

METHODS

A systematic search of the literature was conducted across 5 databases (Medline, Embase, EBSCO Education, Wiley and Scopus) using key words related to social media, physical activity, diet, and age. The inclusion criteria were: participants age 13+ years in the general population; an intervention that used commercial social media platform(s); outcomes related to changes to diet/eating or physical activity behaviours; and quantitative, qualitative and mixed methods studies. Quality appraisal tools that aligned with the study designs were used. A mixed methods approach was used to analyse and synthesise all evidence.

RESULTS

Eighteen studies were included: randomised control trials (n = 4), non-controlled trials (n = 3), mixed methods studies (n = 3), non-randomised controlled trials (n = 5) and cross-sectional studies (n = 3). The target population of most studies was young female adults (aged 18-35) attending college/university. The interventions reported on positive changes to physical activity and diet-related behaviours through increases in physical activity levels and modifications to food intake, body composition and/or body weight. The use of Facebook, Facebook groups and the accessibility of information and interaction were the main characteristics of social media interventions. Studies also reported on Instagram, Reddit, WeChat and Twitter and the use of photo sharing and editing, groups and sub-groups and gamification.

CONCLUSIONS

Social media interventions can positively change physical activity and diet-related behaviours, via increases in physical activity levels, healthy modifications to food intake, and beneficial changes to body composition or body weight. New evidence is provided on the contemporary uses of social media (e.g. gamification, multi-model application, image sharing/editing, group chats) that can be used by policy makers, professionals, organisations and/or researchers to inform the design of future social media interventions. This study had some limitations that mainly relate to variation in study design, over-reliance of self-reported measures and sample characteristics, that prevented comparative analysis. Registration number: PROPSERO; CRD42020210806 .

Young People's health-related learning through social media: What do teachers need to know?

International regulatory bodies have argued that young people should be better supported to engage safely, responsibly and effectively with social media. This paper considers ways in which the introduction of structured social media engagement in schools could bring educational benefits for young people, particularly in supporting them to deal with challenges relating to health and wellbeing. New evidence is provided on: (i) the value of social media as a health-related learning tool to bridge informal and formal learning contexts; (ii) how teachers should be supported to better understand and respond to young people's learning needs; and (iii) the school-based policies, expectations and resources that will help teachers to offer relevant support.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population

BACKGROUND

Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.

OBJECTIVES

We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.

SEARCH METHODS

We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.

DATA COLLECTION AND ANALYSIS

We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.

MAIN RESULTS

We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.

AUTHORS' CONCLUSIONS

This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.

Exploring Canadian Children's Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study

BACKGROUND

Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces.

OBJECTIVE

The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years.

METHODS

We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods.

RESULTS

Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside.

CONCLUSIONS

Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends.

Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study

BACKGROUND

Evidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure.

OBJECTIVE

The objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption.

METHODS

Data from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models.

RESULTS

Compared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2% to 17.5% less) and mobile health for self-regulation (0.8% to 9.7% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8% higher in 2018, P=.01; 10.1% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95% CI 1.26-3.11).

CONCLUSIONS

Our results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities.

Parents and carers' experiences of seeking health information and support online for long-term physical childhood conditions: a systematic review and thematic synthesis of qualitative research

OBJECTIVE

To systematically review and synthesise qualitative research exploring parents/carers' experiences of seeking online information and support for long-term physical childhood conditions.

DESIGN

Systematic review and thematic synthesis of qualitative research.

DATA SOURCES

Medline, CINAHL, Embase, PsycINFO and the International Bibliography of the Social Sciences were searched from inception to September 2019. We used thematic synthesis to analyse findings.

ELIGIBILITY CRITERIA

Primary research papers presenting qualitative data collection and analysis, focusing on parents/carers' experiences of seeking health information and support from online resources for long-term physical childhood health conditions. No language restrictions were placed.

RESULTS

23 studies from seven countries met inclusion criteria and were included in the synthesis. Included studies presented data collected through interviews/focus groups with 559 parents/carers; free-text surveys and essays with 26 parents/carers and 2407 messages from online support groups. Parents/carers developed a variety of strategies to obtain information and support online, based on personal preferences, appraisal of trustworthiness, perceived needs and previous experiences online. Many parents sought the benefits of online information and support, which included reassurance and validation from online communities, and feeling they had greater knowledge about their children's conditions. Some concerns and perceived risks were discussed, which often stemmed from prior unsatisfactory experiences of seeking information and support online, consultations with health professionals and seeing distressing stories online.

CONCLUSION

Most parents/carers were successful in obtaining information and support online. Many continued to share experiences with other parents/carers online. The need for information was particularly apparent early after diagnosis of the condition, whereas the need for peer support continued. The potential concerns and perceived risks with information and support online were especially apparent among parents/carers of children with life-limiting long-term conditions. Findings may be useful for health professionals to facilitate discussions regarding use of online resources, and researchers designing online health resources for parents/carers.

PROSPERO REGISTRATION NUMBER

CRD42018096009.

Application of WeChat-assisted peri-operative care in children with congenital megacolon

AIM

This study explored the clinical effects of WeChat-based peri-operative care on parents of children with congenital megacolon.

METHODS

Participants were randomly divided into WeChat group and telephone group. This study explored parents' knowledge of the care of children with megacolon, the follow-up rate of children, post-operative defaecation function and complications.

RESULTS

WeChat group scored better in nursing knowledge than telephone group, and the difference was statistically significant. The lost follow-up rate in WeChat group was lower than that in telephone group, and the difference was statistically significant. Post-operative defaecation was also better in the WeChat group than in the phone group. Most complications in the phone group were significantly higher than those in the WeChat group.

CONCLUSION

Peri-operative care for parents of children with megacolon through WeChat can effectively enhance the level of parental care knowledge, improve defaecation, reduce the occurrence of certain complications and reduce lost follow-up.

Parent Perspectives on Addressing Emotional Health for Children and Young Adults With Juvenile Myositis

OBJECTIVE

To assess parent perspectives regarding the emotional health impact of juvenile myositis (JM) on patients and families, and to assess preferences for emotional health screening and interventions.

METHODS

Parents of children and young adults with JM were purposively sampled for participation in focus groups at the Cure JM Foundation National Family Conference in 2018. Groups were stratified by patient age group (6-12, 13-17, and 18-21 years), and conversations were audiorecorded, transcribed verbatim, and co-coded via content analysis, with subanalysis by age group. A brief survey assessed preferences for specific emotional health interventions.

RESULTS

Forty-five parents participated in 6 focus groups. Themes emerged within 2 domains: emotional challenges, and screening and interventions. Themes for emotional challenges comprised the impact of JM on: 1) patient emotional health, particularly depression and anxiety; 2) parent emotional health characterized by sadness, grief, anger, guilt, and anxiety; and 3) family dynamics, including significant sibling distress. Subanalysis revealed similar themes across age groups, but the theme of resiliency emerged specifically for young adults. Themes for emotional health screening and interventions indicated potential issues with patient transparency, several barriers to resources, the facilitator role of rheumatology providers, and preferred intervention modalities of online and in-person resources, with survey responses most strongly supporting child/parent counseling and peer support groups.

CONCLUSION

JM is associated with intense patient and family distress, although resiliency may emerge by young adulthood. Despite existing barriers, increasing access to counseling, peer support groups, and online resources with rheumatology facilitation may be effective intervention strategies.

Qualitative evaluation of a social media campaign to improve healthy food habits among urban adolescent females in Indonesia

OBJECTIVE

The current study focuses on how adolescent girls in urban Indonesia accept technology in a social media (SM) campaign to promote healthy eating habits.

DESIGN

The study was a qualitative evaluation of the online campaign. In-depth interviews using semi-structured interview guidelines and focus group discussions were used to collect data. Data were analysed using a general inductive approach to provide simple and straightforward answers to our study questions.

SETTINGS

The study was conducted in two urban areas in Indonesia: Jakarta and Jogjakarta.

PARTICIPANTS

Adolescent girls aged 16-19 years.

RESULTS

The SM campaign was perceived as beneficial for increasing participants' knowledge. The campaign helped increase participants' awareness of healthy diets and the health risks of unhealthy diets as well as increase their motivation to change their behaviour and avoid foods containing salt, sugar and excess fat. The participants perceived information from the online campaign as complete and trustworthy. Instagram was cited as the easiest platform to use, while the website was cited as having the most complete information. YouTube provided the best viewing experience but was considered a data-heavy platform. The barriers to change were perceptions of taste, limited choices for healthy but affordable ingredients and family-related factors.

CONCLUSIONS

The online nutrition campaign was well accepted by Indonesian urban adolescent females and motivated them to act to protect their health. Future nutrition-related SM campaigns aimed at this demographic should focus on platforms with the greatest benefit and ease of use.

"Be sweet to babies": Use of Facebook as a method of knowledge dissemination and data collection in the reduction of neonatal pain

The Be Sweet to Babies video demonstrates the analgesic effects of breastfeeding, skin‐to‐skin care, and sweet‐tasting solutions as interventions to reduce pain during blood sampling in newborns. Although effective and safe, these strategies are implemented inconsistently in clinical settings. Given the increasing popularity of social media, there is a potential to disseminate and promote health information through it. The study aim was to  evaluate the use of Facebook as a means of disseminating the Be Sweet to Babies video in Portuguese, and to evaluate respondents’ prior knowledge, previous use of the three pain management strategies and intent to use the strategies in the future. We conducted a cross‐sectional study, using the “virtual snowball” sampling method. A Facebook webpage was created, in which the video was posted along with a brief survey. Data analyzed included number of views and visits to the page, number of views of the video, likes, dislikes, and survey responses. One year after posting, the page had 70 753 views and 2199 accesses; there were 1553 “likes”, no dislikes, and 43 positive comments. The survey was completed by 930 respondents (42% response rate based on the page access). Over two thirds of the respondents had previous knowledge about breastfeeding, skin‐to‐skin care, and sweet solutions for pain relief. After watching the video, 87% of the respondents intended to use breastfeeding or skin‐to‐skin care in the future, and 71% intended to use sweet solutions. Almost all viewers rated the video as very useful (n = 917, 99%), easy to understand (n = 926, 99%), and easy to apply in real‐life situations (n = 903, 97%). Using Facebook to deliver and evaluate an intervention is feasible, rapid in obtaining responses, low cost, and it is promising for data collection and knowledge dissemination. Further studies are warranted to evaluate the actual impact of the use of social media in practice change.

Can Parental Engagement in Social Media Enhance Outcomes of an Online Healthy Lifestyle Program for Preschool-Aged Children?

This study explored parental engagement, child BMI and secondary outcomes from the social media component of an online healthy lifestyle program for parents of preschool-aged children. Intervention group participants received access to an online program and Facebook group. Data were collected at baseline and 3- and 6-months follow-up. Facebook usage data on comments and posts were used to determine total active engagement. There was a high level of Facebook group membership and most parents actively engaged at least once. Although there were varying levels of engagement between modules and cohorts, it was modest overall. User acceptability of the Facebook group was lower than expected. Children of parents in the intervention who engaged more in the Facebook group (by posting and commenting) demonstrated greater sleep duration over time (estimate 1.79, 95% CI 0.42 to 3.17, p = .01) Children of parents who engaged more in the Facebook group also participated in less moderate- to vigorous-intensity physical activity (estimate -0.14, 95% CI -0.26 to -0.01, p = .03). This study is one of the first parent-focussed healthy lifestyle interventions to include a social media component. Further research is recommended with larger sample sizes and longer duration to further explore the potential of social media in childhood obesity interventions.

Is the American College of Surgeons Online Communities a safe and useful venue to ask for surgical advice?

BACKGROUND

Many surgeons rely on the American College of Surgeons (ACS) Community Forums for advice on managing complex patients. Our objective was to assess the safety and usefulness of advice provided on the most popular surgical forum.

METHODS

Overall, 120 consecutive, deidentified clinical threads were extracted from the General Surgery community in reverse chronological order. Three groups of three surgeons (mixed academic and community perspectives) evaluated the 120 threads for unsafe or dangerous posts. Positive and negative controls for safe and unsafe answers were included in 20 threads, and reviewers were blinded to their presence. Reviewers were free to access all online and professional resources.

RESULTS

There were 855 unique responses (median 7, 2-15 responses per thread) to the 120 clinical threads/scenarios. The review teams correctly identified all positive and negative controls for safety. While 58(43.3%) of threads contained unsafe advice, the majority (33, 56.9%) were corrected. Reviewers felt that a there was a standard of care response for 62/120 of the threads of which 50 (80.6%) were provided by the responses. Of the 855 responses, 107 (12.5%) were considered unsafe/dangerous.

CONCLUSION

The ACS Community Forums are generally a safe and useful resource for surgeons seeking advice for challenging cases. While unsafe or dangerous advice is not uncommon, other surgeons typically correct it. When utilizing the forums, advice should be taken as a congregate, and any single recommendation should be approached with healthy skepticism. However, social media such as the ACS Forums is self-regulating and can be an appropriate method for surgeons to communicate challenging problems.

Social media usage pattern and its influencing factors among celiac patients and their families

BACKGROUND/AIM

The aim of this study was to investigate social media usage patterns among celiac patients and explore the potential factors that may influence the frequency of its usage.

PATIENTS AND METHODS

A cross-sectional survey was conducted, in which an online questionnaire was sent to celiac patients registered in the Saudi celiac patients' support group through email and its related social media accounts. Eligible participants included all patients with biopsy-confirmed celiac disease or their parents.

RESULTS

In total, 221 participants completed the survey. The majority (96%, n = 212/221) reported using social media networks for their disease management. We included only those participants in the analysis. The median age was 36 years (range; 18-60 years). The majority of respondents (59.4%) were female. Most participants (65.6%) were patients with celiac disease and 34.4% were parents of celiac patients. The median duration of the disease was three years (range; 1 month-26 years). The three most frequently visited social media platforms were WhatsApp by 175 (82.5%) participants, Instagram by 132 (62.3%), and Twitter by 124 (58.5%) participants. The median time spent on social media was 60 min per day (range; 10-720 min). Multivariate logistic regression showed that celiac disease patients used social media two times more than the parents of celiac patients (OR 2.37, 95% CI: 1.19 - 4.72; P = 0.014).

CONCLUSIONS

Celiac patients are highly involved in social media activities for purposes related to their disease. We encourage healthcare providers to be available online to provide trustable and high-quality educational materials.

The relationship between fears of cancer recurrence and patient age: A systematic review and meta-analysis

BACKGROUND

Fears of cancer recurrence (FCR) is one of the most prevalent concerns and a common unmet need reported by cancer patients. Patient age is a demographic variable that has been linked to FCR, among others. Although it is recognised by researchers that age and FCR may be negatively correlated, the strength of this correlation has yet to be established.

AIM

The aims of this study were to (a) conduct a meta-analysis to investigate the overall association of patient age in years with FCR across studies from 2009 to February 2019 and (b) scrutinise for patterns of these effect sizes across studies.

METHODS AND RESULTS

Peer-reviewed papers were gathered from the literature via online databases (PubMed, EMBASE, MEDLINE, and PsycINFO). Systematic review guidelines including a quality assessment were applied to the 31 selected studies (pooled participant N size = 19 777). The meta-analysis demonstrated a significant negative association between age and FCR (ES = -0.12; 95% CI, -0.17, -0.07). Meta-regression revealed the association of patient age and FCR significantly reduced over the last decade. A significant effect (β = -0.17, P = 0.005) of breast cancer versus other cancers on this age by FCR association was also identified.

CONCLUSION

The reliable and readily accessible personal information of age of patient can be utilised as a weak indicator of FCR level especially in the breast cancer field, where the majority of studies were drawn. The suggestion that age and FCR association may be attenuated in recent years requires confirmation.

Socioeconomic inequalities and the equity impact of population-level interventions for adolescent health: an overview of systematic reviews

OBJECTIVES

Despite robust evidence on health inequalities in adulthood, less attention has been paid to inequalities in adolescence. The aim of this overview was to examine systematic review (SR) evidence on the equity impact of population-level interventions intended to improve health, happiness and wellbeing for adolescents.

STUDY DESIGN

An overview (review of systematic reviews).

METHODS

Eleven electronic databases were systematically searched to identify SRs of population-level interventions for adolescent health. A secondary data analysis of socioeconomic inequality was conducted to identify whether SRs reported on primary studies in terms of disadvantage, by measures of socioeconomic status (SES) and by differential effects.

RESULTS

35,310 review titles were screened; 566 full texts were retrieved and 140 SRs met the predefined selection criteria. Differential intervention effects were considered in 42/140 (30%) SRs, 18/140 (13%) reported primary studies using an SES measure and 16/140 (11%) explicitly reported differential effects. 15/140 SRs (11%) explicitly focused on socioeconomic inequalities; of these 4/15 reported differential intervention effects in more detail, 7/15 concluded there was insufficient primary evidence to identify the impact of interventions on socioeconomic inequalities and 4/15 planned to examine differential effects by SES, but this was not reported further.

CONCLUSIONS

Our overview identifies that there is limited SR evidence on the equity impact of population-level interventions for adolescent health. Strengthening the evidence on whether interventions narrow or widen inequalities for adolescents must be a priority for public health research.

Testing a Social Network Intervention Using Vlogs to Promote Physical Activity Among Adolescents: A Randomized Controlled Trial

There is a need to stimulate physical activity among adolescents, but unfortunately, they are hard to reach with traditional mass media interventions. A promising alternative is to carry out social network interventions. In social network interventions, a small group of individuals (influence agents) is selected to promote health-related behaviors within their social network. This study investigates whether a social network intervention is more effective to promote physical activity, compared to a mass media intervention and no intervention. Adolescents (N = 446; M_age = 11.35, SD_age = 1.34; 47% male) were randomly allocated by classroom (N = 26, in 11 schools) to one of three conditions: social network intervention, mass media intervention, or control condition. In the social network intervention, 15% of the participants (based on peer nominations) was approached to become an influence agent, who created vlogs about physical activity that were shown during the intervention. In the mass media intervention, participants were exposed to vlogs made by unfamiliar peers (i.e., vlogs of the social network intervention). The control condition did not receive vlogs about physical activity. All participants received a research smartphone to complete questionnaires and a wrist-worn accelerometer to measure physical activity. The trial was registered a priori in the Dutch Trial Registry (NTR6903). There were no differences in objectively measured physical activity between this social network intervention and the control condition in the short-term, but there was an unexpected increase in the control condition compared to the social network intervention in the long-term. No differences between the social network intervention and mass media intervention were observed. The current study does not provide evidence that this social network intervention is effective in increasing physical activity in adolescents. Exploratory analyses suggest that this social network intervention increased the perceived social norm toward physical activity and responses to the vlogs were more positive in the social network intervention than in the mass media intervention. These initial results warrant further research to investigate the role of the social norms and the added benefit of using influence agents for social network interventions.

Clinical Trial Registration:https://www.trialregister.nl/, identifier NTR6903.

Digital Wings: Innovations in Transition Readiness for Adolescent and Young Adult Transplant Recipients [corrected]

The Johns Hopkins University School of Medicine organized 2 multistakeholder symposia on February 2, 2018 and January 11, 2019 to address the problem of high graft failure in adolescent and young adult (AYA) solid organ transplant (SOT) recipients. Participants included international experts in transplantation, behavioral psychology, patient/parent advocacy, and technology. The objectives of the symposia were as follows: (1) to identify and discuss the barriers to and facilitators of effective transfer of care for AYA SOT recipients; (2) to actively explore strategies and digital solutions to promote their successful transfer of care; and (3) to develop meaningful partnerships for the successful development, evaluation, implementation, and dissemination of these digital solutions. Additionally, data were collected from 152 AYA SOT recipients demonstrating a substantial gap in how this population uses technologies for health-related activities, alongside an increased interest in an app to help them manage their transplant.

Indicators of adolescents' preference to receive oral health information using social media

OBJECTIVES

To assess (1) adolescents' preference to use social media (SM) to receive oral health information (OHI) and (2) factors associated with this preference.

MATERIALS AND METHODS

A cross-sectional survey was conducted in 2016, Eastern Province, Saudi Arabia including male middle school students. A questionnaire assessed explanatory variables including background, previous OHI seeking practices, internet use purposes, convenience of using SM for OHI and perceived usefulness of obtained OHI. The outcome variable was respondents' preference to use SM to receive OHI. Simple and multiple logistic regression models were used for statistical analysis.

RESULTS

The response rate was 91.2% (456/500). Of those, 57.5% preferred using SM to receive OHI. The odds for this were significantly associated with being Saudi (OR = 3.12, 95%CI = 1.36, 7.18), previously using Twitter (OR = 4.59, 95%CI = 1.77, 11.89) and Instagram for OHI (OR = 2.60, 95%CI = 1.51, 4.45), frequent use of the internet to obtain OHI (OR = 1.25, 95%CI = 1.02, 1.54) and ease of obtaining OHI using the Internet (OR = 2.69, 95%CI = 1.5, 4.39).

CONCLUSION

Most adolescents preferred using SM to receive OHI. This was associated with previous OHI seeking practices and convenience of using SM. These findings have implications for designing SM-based health education campaigns targeting adolescents.

Social Networks and Mobile Applications Use in Young Patients With Kidney Disease

Objective: To evaluate the use and benefits of social networking sites (SNS) and mobile applications (MA) in young patients with kidney disease (KD). Background: Pediatric KD is prevalent. The Internet is increasingly being used to communicate rapid healthcare information to children about acute and chronic diseases with greater medical care satisfaction. There is a lack of data on social media (SM) utility in pediatric KD. Materials and Methods: A descriptive, observational, and cross-sectional study was conducted on a national level. Data were collected from 4 different centers through a reviewed questionnaire. Results: 83.9% of the 428 participants were Lebanese. The average age was 11.4 years (±7.1). 69.9% had chronic KD out of which 17.4% had undergone a kidney transplant while 9% were on dialysis. 69.6% of the participants affirmed the need of SM for the health of the sick child while only 9.8% are participating in a scientific forum and 4.7% used SM to find a potential organ donor. Some study variables were statistically associated with the participants' age, nationality, and stage of KD. Conclusions: SM is important for the support and management of pediatric KD. We believe that SNS and MA will play a leading role in the lives of our patients in the upcoming future and will push the physician to be an active participant in the evolution of communication networks. To identify the efficacy of SM in enhancing communication between patients and health professionals, further stratified studies are needed.

Social Media Content About Children's Pain and Sleep: Content and Network Analysis

BACKGROUND

Social media is often used for health communication and can facilitate fast information exchange. Despite its increasing use, little is known about child health information sharing and engagement over social media.

OBJECTIVE

The primary objectives of this study are to systematically describe the content of social media posts about child pain and sleep and identify the level of research evidence in these posts. The secondary objective is to examine user engagement with information shared over social media.

METHODS

Twitter, Instagram, and Facebook were searched by members of the research team over a 2-week period using a comprehensive search strategy. Codes were used to categorize the content of posts to identify the frequency of content categories shared over social media platforms. Posts were evaluated by content experts to determine the frequency of posts consistent with existing research evidence. User engagement was analyzed using Netlytic, a social network analysis program, to examine visual networks illustrating the level of user engagement.

RESULTS

From the 2-week period, nearly 1500 pain-related and 3800 sleep-related posts were identified and analyzed. Twitter was used most often to share knowledge about child pain (639/1133, 56.40% of posts), and personal experiences for child sleep (2255/3008, 75.00% of posts). For both topics, Instagram posts shared personal experiences (53/68, 78% pain; 413/478, 86.4% sleep), Facebook group posts shared personal experiences (30/49, 61% pain; 230/345, 66.7% sleep) and Facebook pages shared knowledge (68/198, 34.3% pain; 452/1026, 44.05% sleep). Across platforms, research evidence was shared in 21.96% (318/1448) of pain- and 9.16% (445/4857) of sleep-related posts; 5.38% (61/1133) of all pain posts and 2.82% (85/3008) of all sleep posts shared information inconsistent with the evidence, while the rest were absent of evidence. User interactions were indirect, with mostly one-way, rather than reciprocal conversations.

CONCLUSIONS

Social media is commonly used to discuss child health, yet the majority of posts do not contain research evidence, and user engagement is primarily one-way. These findings represent an opportunity to expand engagement through open conversations with credible sources. Research and health care communities can benefit from incorporating specific information about evidence within social media posts to improve communication with the public and empower users to distinguish evidence-based content better. Together, these findings have identified potential gaps in social media communication that may be informative targets to guide future strategies for improving the translation of child health evidence over social media.

The use of social media in nutrition interventions for adolescents and young adults-A systematic review

OBJECTIVE

Social media is a potentially engaging way to support adolescents and young adults in maintaining healthy diets and learning about nutrition. This review identifies interventions that use social media to promote nutrition, examines their content and features, and evaluates the evidence for the use of such platforms among these groups.

MATERIAL AND METHODS

We conducted a systematic search of 5 databases (PubMed, CINAHL, EMBASE, PsycINFO, and ACM Digital Library) for studies that included: 1) adolescents and/or young adults (ages 10-19; ages 18-25); 2) a nutrition education or behavior change intervention component, or outcomes related to nutrition knowledge or dietary changes; and 3) a social media component that allowed users to communicate or share information with peers.

RESULTS

16 articles were identified that included a social media component in a nutrition-related intervention for adolescents or young adults. Interventions included features in 7 categories: social media; communication; tracking health; education; tailoring; social support; and gamification. 11 out of the 16 studies had at least one significant nutrition-related clinical or behavioral outcome.

CONCLUSION

Social media is a promising feature for nutrition interventions for adolescents and young adults. A limited number of studies were identified that included social media. A majority of the identified studies had positive outcomes. We found that most studies utilized only basic social media features, did not evaluate the efficacy of social media components, and did not differentiate between the efficacy of social media compared to other delivery mechanisms.

Novel public-private partnerships to address the double burden of malnutrition

Public–private partnerships are an effective way to address the global double burden of malnutrition. While public–private partnerships operate in multiple forms, their leadership usually falls to governments, public health agencies, or nongovernmental organizations, with the private sector taking a subordinate role. The rapid ascent of social media and mass communications worldwide has provided a disruptive technology for new nutrition intervention programs. A new model, provisionally called private–public engagement, takes advantage of social media, mass media, and integrated social marketing to reach parents, families, and communities directly. These new private–public engagement initiatives need to be managed in ways suggested for public–private partnerships by the World Health Organization, especially if the private sector is in the lead. Once the rationale for engagement is defined, there is a need to mobilize resources, establish in-country partnerships and codes of conduct, and provide a plan for monitoring, evaluation, and accountability. Provided here is an example consistent with the private–public engagement approach, ie, the United for Healthier Kids program, which has been aimed at families with children aged less than 12 years. Materials to inspire behavioral change and promote healthier diets and lifestyle were disseminated in a number of countries through both digital and physical channels, often in partnership with local or regional governments. A description of this program, along with strategies to promote transparency and communication among stakeholders, serves to provide guidance for the development of future effective private–public engagements.

Self-presentation in digital media among adolescent patients with obesity: Striving for integrity, risk-reduction, and social recognition

Background

Emerging research suggests that social media has the potential in clinical settings to enhance interaction with and between pediatric patients with various conditions. However, appearance norms and weight stigmatization can make adolescents with obesity uncomfortable about using these visual-based media. It is therefore important to explore these adolescents' perspectives to identify the implications and concerns regarding the use of social media in clinical settings.

Objective

To explore the experiences of adolescents in treatment for obesity in terms of how they present themselves on social media, their rationale behind their presentations, and their feelings related to self-presentation.

Methods

Interviews were conducted with 20 adolescents enrolled in a pediatric outpatient obesity clinic, then transcribed and categorized using qualitative content analysis and Goffman's dramaturgical model. Participants used a screen-recorded laptop to demonstrate their online self-presentation practices.Findings: Adolescent girls and boys undergoing treatment for obesity used visual-based social media, but girls in particular experienced weight stigma online and undertook self-presentation strategies to conceal weight-related content such as avoiding showing close-up photos of their bodies and not posting images of unhealthy "fattening" foods. Participants perceived the potential use of social media in clinical settings as being too risky and private.

Conclusions

Given the complexity of general visual-based social media use by adolescents, and not wanting their patient status to be visible to peers, healthcare should primarily focus on working with more restricted instant messaging when engaging with adolescents with obesity.

Accuracy of online discussion forums on common childhood ailments

Objectives

The research sought to determine if the health advice provided in online discussion forms aimed at parents of young children is accurate and in agreement with evidence found in evidence-based resources and to discover whether or not these forums are an avenue for misinformation.

Methods

To determine which online forums to use, Google was searched using five common childhood ailments. Forums that appeared five or more times in the first five pages of the Google search for each question were considered. Of these forums, those that met the inclusion criteria were used. Data from a six-month time period was collected and categorized from the discussion forums to analyze the advice being provided about common childhood ailments. Evidence-based resources were used to analyze the accuracy of the advice provided.

Results

Two discussion forums were chosen for analysis. Seventy-four questions from one and 131 questions from the other were health related. Data were not analyzed together. Of the health-related questions on the 2 forums, 65.5% and 51.8%, respectively, provided some type of advice. Of the advice provided, 54.1% and 47.2%, respectively, agreed with the evidence provided in evidence-based resources. A further 16.2% and 6.3% was refuted or was somewhat refuted by the evidence found in evidence-based resources.

Conclusion

While roughly half of the health-related advice provided in online discussion forums aimed at parents of young children is accurate, only a small portion of the advice is incorrect; therefore, these sources are not a major concern for the spread of misinformation.

Effective uses of social media in public health and medicine: a systematic review of systematic reviews

Introduction

Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our knowledge, no comprehensive synthesis of this literature has been conducted to date.

Aims and methods

To conduct a systematic review of systematic reviews of the benefits and harms (“effects”) of SM tools and platforms (such as Twitter and Facebook) in public health and medicine. To perform a synthesis of this literature and create a ‘living systematic review’.

Results

Forty-two (42) high-quality SRs were examined. Overall, evidence of SM’s effectiveness in public health and medicine was judged to be minimal. However, qualitative benefits for patients are seen in improved psychosocial support and psychological functioning. Health professionals benefited from better peer-to-peer communication and lifelong learning. Harms on all groups include the impact of SM on mental health, privacy, confidentiality and information reliability.

Conclusions

A range of negatives and positives of SM in public health and medicine are seen in the SR literature but definitive conclusions cannot be made at this time. Clearly better research designs are needed to measure the effectiveness of social technologies. For ongoing updates, see the wiki “Effective uses of social media in health: a living systematic review of systematic reviews”. http://hlwiki.slais.ubc.ca/index.php/Effective_uses_of_social_media_in_healthcare:_a_living_systematic_review_of_reviews

Study Protocol: Determining Research Priorities of Young Albertan Families (The Family Research Agenda Initiative Setting Project-FRAISE)-Participatory Action Research

Introduction: Pregnancy and childrearing can be an exciting and stressful time for new parents. The maternal-child health landscape has changed dramatically over the last few decades and research priorities need to address these rapid changes. There have been limited attempts to engage and collaborate with members of the public to develop research priorities for families who are expecting or parenting an infant to age 24 months. The work that has been completed has attempted to identify parental preference for information delivery and barriers to uptake of parenting programs but has not investigated parental research priorities. Methods: In collaboration with provincial research units and strategic clinical networks (SCN), we will use principles of participatory action research (PAR) as our theoretical framework/method, and a modified James Lind Alliance priority setting approach to prioritize a list of research questions that parents/knowledge users believe will support the health of their families. This will result in a top 10 list of parent/knowledge user-identified research priorities. This project will consist of three phases. In the first phase, we developed a steering committee of parents/knowledge users, healthcare providers, community agencies, and researchers to design a survey about health priorities for families. In the second phase, we will distribute the survey to diverse groups of parents/knowledge users/providers and hold a series of meetings to identify and prioritize potential questions from new parents about health issues from conception to age 24 months. In the third phase, we will collaboratively disseminate and translate findings. Discussion: This study will highlight parental health concerns and recommend parent-identified research priorities to inform future research projects needed to support the health of families between conception to age 24 months. Understanding the health research priorities of families in the community will help ensure future research contributes to meaningful changes in the health of young children, parents/knowledge users, and families. Ethics: This study and protocol have received ethical approved from the Conjoint Health Research Ethics Board at the University of Calgary (REB17-0014). Dissemination: The top 10 research priorities will be published and additional findings from the study will be distributed through pamphlets and newsletters.

Evaluation of Internet addiction and the quality of life of Brazilian adolescents from public and private schools

Abstract This study evaluated the profile of public and private high school students (N = 254, Mage = 15.1, SD = 1.3) in the city of São Paulo in relation to their Internet use patterns and quality of life. We used the Internet Addiction Test and the Pediatric Quality of Life Inventory. About 70% of the students had moderate Internet addiction. Those students from public school showed higher scores of Internet addiction (p < 0.001) than students from private schools. Regarding the quality of life, those from private school showed better scores regarding academic performance (p < 0.01) and worse scores in social aspect (p < 0.05). The data showed a strong association between Internet addiction and poor levels of quality of life, as observed in studies from other countries.

Assessing effective methods to educate caregivers on fever in children aimed at reducing input to the paediatric emergency department

Introduction:

Many paediatric emergency departments face a significant proportion of non-urgent attendances, leading to problems for both patients and healthcare systems. Our primary aim was to compare the effectiveness of pamphlet versus video in educating caregivers regarding fever management in children. Our secondary aim was to assess caregivers’ sentiments towards these methods.

Methods:

A randomized controlled trial was conducted with 50 participants over a four-week period (May–June 2015) in the KK Hospital Paediatric Emergency Department. The control group was exposed to the standard pamphlet available in the KK Hospital Paediatric Emergency Department, which provided basic information on fever management. The intervention group watched a video produced by our team, containing similar content. The same five-question questionnaire assessing fever management knowledge was issued to participants before and immediately following exposure to intervention.

Results:

The pamphlet group had a mean pre-intervention score=2.8 (out of five), post-intervention score=3.84, amounting to an improvement of 1.04. The video group had a mean pre-intervention score=2.56, post-intervention score=4.12, giving an improvement of 1.36. The study was powered at 80%, with calculated p-value=0.111, hence the results were statistically insignificant. Both groups had increased self-reported awareness post-exposure, found the intervention useful, would rely on it for future management and would recommend it to others.

Conclusion:

While the sample size was limited, this study demonstrates the potential that both pamphlet and video interventions have in educating caregivers, as participants reported favourable sentiments towards the methods. It would be worthwhile to conduct the study on a larger scale to yield statistically significant results.

Is Political Activism on Social Media an initiator of Psychological Stress?

Objective:

To find out the association of psychological stress with political activism on social networking sites (SNS) in adults. To find association of psychological stress and political activism with age, gender and occupational status.

Methods:

A descriptive cross-sectional study of 8 months (Aug 2014 to March 2015) was conducted on young adults between age group of 20-40 years of different universities of Rawalpindi, Pakistan. Closed ended standardized questionnaires (i.e. Cohen Perceived Stress-10) were distributed via non-probability convenient sampling among a total sample size of 237. Sample size was calculated using WHO sample size calculator and data was analyzed in STATA version 12.

Results:

The mean age of participants was 21.06±1.425 years. Out of the 237 participants, 150 (63.3%) were males and 87 (36.7%) females. Regarding their occupation, 13 (51.9%) were military cadets, 8 (3.4%) were consultant, 47 (19.8%) medical officer, 3 (1.3%) PG students and 56 (23.6%) MBBS students. Significant association of occupation was established with both political activism and psychological stress (p=0.4 and p=0.002 respectively). Among 237 individuals, 91 (38.4%) were stressed out and 146 (61.6%) were not. Among whole sample, political activists on SNS were found to be 23 (9.7%). Out of these 23 individuals who were politically active, 15 (65.2%) were stressed out and 8 (34.7%) were not. A significant association between stress and political activism was established (p=0.005).

Conclusion:

Political activism via social networking sites is playing significant role on adult person’s mental health in terms of stress among different occupation.

Hospitalized Adolescents’ Use of Mobile Technologies for Learning, Communication, and Well-Being

Hospitalized adolescents experience significant needs beyond medical treatment. They require emotional support for anxiety and stress, educational support for learning, and social support to reduce isolation. This qualitative study explored the use of mobile technologies to connect students to their schools, classmates, and families in an effort to reduce their isolation and disrupted schooling experiences. We conducted in-depth interviews with 18 hospitalized adolescents aged 12 to 18, 29 teachers, and four parents about the affordances of mobile technologies. We found that mobile technology use in a hospital school was critical to engage adolescents in learning and keep them up-to-date with schoolwork. Mobile technologies should be available and accessible in hospital for adolescent patients for the purpose of meeting their learning, communication, and well-being needs. In particular, mobile technology should be used as a therapeutic tool to overcome hospitalized adolescents’ social isolation and improve their well-being.

Empowering aspects for healthy food and physical activity habits: adolescents' experiences of a school-based intervention in a disadvantaged urban community

PURPOSE

This study aimed to describe adolescents' experiences of participating in a health-promoting school-based intervention regarding food and physical activity, with a focus on empowering aspects. Method: The school was located in a urban disadvantaged community in Sweden, characterized by poorer self-reported health and lower life expectancy than the municipality average. Focus group interviews with adolescents (29 girls, 20 boys, 14-15 years) and their teachers (n = 4) were conducted two years after intervention. Data were categorized using qualitative content analysis.

RESULTS

A theme was generated, intersecting with all the categories: Gaining control over one's health: deciding, trying, and practicing together, in new ways, using reflective tools. The adolescents appreciated influencing the components of the intervention and collaborating with peers in active learning activities such as practicing sports and preparing meals. They also reported acquiring new health information, that trying new activities was inspiring, and the use of pedometers and photo-food diaries helped them reflect on their health behaviours. The adolescents' experiences were also echoed by their teachers. Conclusions: To facilitate empowerment and stimulate learning, health-promotion interventions targeting adolescents could enable active learning activities in groups, by using visualizing tools to facilitate self-reflection, and allowing adolescents to influence intervention activities.