A Call for a Public Health Agenda for Social Media Research

Peer-to-peer sharing in public health interventions: strategies when people share health-related personal information on social media

PURPOSE

As sharing on social media has become an integrated part of everyday life, health and public health actors have started to show interest in the potential of people's peer-to-peer sharing of health-related personal information (HRI) for health interventions. In this article we focus on how people make sense of sharing HRI on social media.

METHODS

Twenty-two people between the ages 40 and 60 who had taken part in a regional health intervention were interviewed. Using theories about social media sharing, we explore their understandings and negotiations about whether, how much, and how to share HRI and discuss the results in relation to peer-to-peer sharing as a strategy in interventions.

RESULTS

We identified three aspects that were perceived as particularly risky: loss of control, effects on identity, and affecting others negatively, along with strategies that were used to manage risks in practice: avoiding sharing, allocating, and embedding HRI.

CONCLUSIONS

By allocating and embedding HRI, people can unlock motivating affordances for health work. However, strategies to manage risks can also be counterproductive. For actors to provide equality in health promotion, initiatives that include social media sharing need to be mindful of the sometimes counterproductive effects this may have on people's engagement.

Examining the growth in willingness to pay for digital wellbeing services on social media: A comparative analysis

In recent years, there has been a growing need for social media platforms to offer services that preserve and promote users' digital wellbeing, including better protection of personal data and balanced technology usage. However, the current business model of social media is often seen as in conflict with users' digital wellbeing. In 2020, a study investigated users' willingness to pay monetary fees for social media digital wellbeing services. In the present work, we replicated this study in Q4 of 2022, aiming to explore any changes in interest and willingness to pay for these services. In addition, we extended the replication by conducting qualitative analysis on participants' comments to gain deeper insight and identify reasons for payment and reasons for rejecting to pay. Data were collected from 262 participants through an online questionnaire. The survey focused on four services: better data protection, less use of data for marketing, aiding users in controlling their prolonged usage, and reducing fake news and radicalisation on social media. The results showed that the willingness to pay for these services was significantly higher in 2022 compared to the results published in 2020. Participants expressed concerns about the feasibility and fairness of the alternative business model, which requires users to pay for safety and support. Our findings suggest a growing interest in digital wellbeing services, emphasizing the need for social media platforms to assess the feasibility of alternative business models, identify user segments, and take measures to enhance consumers' trust, accordingly.

Brain fog in chronic pain: Protocol for a discourse analysis of social media postings

Brain fog is a phenomenon that is frequently reported by persons with chronic pain. Difficulties with cognition including memory impairments, attentional issues, and cloudiness are commonly described. The current medical literature demonstrates a similar cloudiness: there is no clear taxonomy or nomenclature, no well-validated evaluations and a dearth of effective interventions. To focus our understanding of this complex phenomenon, we will perform a discourse analysis to explore how brain fog is described in public posts on social media. Discursive methodology will generate insights regarding the societal understanding and meanings attributed to brain fog, by sampling perspectives of persons with lived experience, currently underrepresented in the medical literature. It is anticipated that the results of the proposed study will 1) help healthcare professionals better understand the experience of chronic pain-related brain fog and 2) generate hypotheses for future research. To conclude, by incorporating innovative and contemporary methods, this proposed discourse analysis of social media sources will generate nuanced insights, bridging the gap between researchers, health care providers, and persons with lived experience.

The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data

BACKGROUND

 Social media (SM) was essential in promoting physical activity during the COVID-19 pandemic, especially among people confined to their homes. Joe Wicks, a fitness coach, became particularly popular on SM during this time, posting daily workouts that millions of people worldwide followed.

OBJECTIVE

 This study aims to investigate the influence of Joe Wicks on SM and the impact of his content on physical activity levels among the public.

METHODS

 We used NodeXL Pro (Social Media Research Foundation) to collect data from X (formerly Twitter) over 54 days (March 23, 2020, to May 15, 2020), corresponding to the strictest lockdowns in the United Kingdom. We collected 290,649 posts, which we analyzed using social network analysis, thematic analysis, time-series analysis, and location analysis.

RESULTS

 We found that there was significant engagement with content generated by Wicks, including reposts, likes, and comments. The most common types of posts were those that contained images, videos, and text of young people (school-aged children) undertaking physical activity by watching content created by Joe Wicks and posts from schools encouraging pupils to engage with the content. Other shared posts included those that encouraged others to join the fitness classes run by Wicks and those that contained general commentary. We also found that Wicks' network of influence was extensive and complex. It contained numerous subcommunities and resembled a broadcast network shape. Other influencers added to engagement with Wicks via their networks. Our results show that influencers can create networks of influence that are exhibited in distinctive ways.

CONCLUSIONS

Our study found that Joe Wicks was a highly influential figure on SM during the COVID-19 pandemic and that his content positively impacted physical activity levels among the public. Our findings suggest that influencers can play an important role in promoting public health and that government officials should consider working with influencers to communicate health messages and promote healthy behaviors. Our study has broader implications beyond the status of fitness influencers. Recognizing the critical role of individuals such as Joe Wicks in terms of health capital should be a critical area of inquiry for governments, public health authorities, and policy makers and mirrors the growing interest in health capital as part of embodied and digital experiences in everyday life.

Ethical dilemmas in conducting qualitative, public health research on social media: using a study on Facebook as a case

AIM

Platforms on social media are increasingly used for public health research. While social media provides an exceptional opportunity to explore communication about public health topics, this practice is not without ethical dilemmas. Our aim was to identify and unfold some of these dilemmas and to suggest possible solutions and ways forward for future research.

METHODS

Using our own research within a closed forum for people experiencing suicidal thoughts as a case, we explored certain dilemmas and possible answers relating to whether what is to be researched falls under a public or private social media domain; we investigated avenues for obtaining access to participants in an evolving online environment; how to secure informed consent from participants; and ways of ensuring anonymity.

RESULTS

We provide recommendations and reflections that we hope will offer inspiration for researchers embarking on similar social media public health research within and beyond suicide research.

CONCLUSIONS

The ethical framework commonly referred to in health research, based on confidentiality, anonymity, informed consent and doing no harm must be adjusted to be relevant for a social media context where technologies and regulations are constantly being altered.

Promotion of E-Cigarettes on TikTok and Regulatory Considerations

E-cigarettes are promoted extensively on TikTok and other social media platforms. Platform policies to restrict e-cigarette promotion seem insufficient and are poorly enforced. This paper aims to understand how e-cigarettes are being promoted on TikTok and provide insights into the effectiveness of current TikTok policies. Seven popular hashtag-based keywords were used to identify TikTok accounts and associated videos related to e-cigarettes. Posts were independently coded by two trained coders. Collectively, the 264 videos received 2,470,373 views, 166,462 likes and 3426 comments. The overwhelming majority of videos (97.7%) portrayed e-cigarettes positively, and these posts received 98.7% of the total views and 98.2% of the total likes. A total of 69 posts (26.1%) clearly violated TikTok's own content policy. The findings of the current study suggest that a variety of predominantly pro-vaping content is available on TikTok. Current policies and moderation processes appear to be insufficient in restricting the spread of pro-e-cigarette content on TikTok, putting predominantly young users at potential risk of e-cigarette use.

Social media analytics and their applications to evaluate an activity in online health interventions using CRITIC and TOPSIS techniques

The usage of social media is increasing by leaps and bounds in our day-to-day lives. It affects daily routines and brings a lot of change in different departments like health and education systems during the COVID-19 pandemic. Healthcare research and practice have been significantly impacted by the astounding growth of social media. Social media are changing health information management in several ways, from offering appropriate ways to enhance healthcare professional contact and share health-related knowledge and experience to facilitating the development of innovative medical research and wisdom. Social media analytics (SMAs) are efficient and effective interaction instruments that can be useful for both patients and clinicians in health interventions. Moreover, a significant portion of those involved in clinical practices (such as clinicians, professional colleges, and departments of health) are unaware of the importance of social media, its potential applications in their daily lives, as well as the possible consequences and how these will be handled. In the presented study, we proposed MCDM-based approaches known as "Criteria Importance Through Inter Correlation" (CRITIC) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) in order to identify the effective alternative among several options and make a better decision. After extracting features from the literature review, we choose six significant and relevant features and assign weights to them using CRITIC techniques while utilizing the TOPSIS technique to rank the alternatives based on their performance values. After the implementation of both methods and evaluation procedure, it is determined that the alternative with the highest score is placed at the top and called the "best alternative," while the alternative with the lowest score is placed at the bottom and called the worst alternative. Finally, we suggest a variety of research initiatives and new research areas where the aforementioned procedures become extremely useful in evaluating SMAs and their uses in online health interventions.

Developing Public Health Promotion Strategies for Social Networking Sites: Perspectives of Young Immigrant Women in Norway

BACKGROUND

Social networking sites (SNS) have emerged as digital settings for youth participation and health promotion. Understanding the complex dynamic of analog/digital participation has become crucial for settings-based health promotion strategies that aim to enable people to increase control over their health and environments. Previous research demonstrates that SNS influence young people's health in complex ways, but less is known about how processes related to intersectionality are reflected in digital settings. This study asked the following question: how do young women with immigrant backgrounds experience and navigate SNS and how can this inform settings-based health promotion strategies?

METHODS

The study included three focus groups with 15 women aged 16-26 years and used thematic content analysis.

FINDINGS AND CONCLUSION

Young women with immigrant backgrounds reported that transnational networks provided a sense of belonging. However, their presence on SNS strengthened negative social control and had consequences for endeavors to connect with local peers in both digital and analog settings. Both challenges and resources were amplified. The participants reported that sharing strategies to navigate complex networks was useful; they emphasized the importance of anonymous chats, they shared health-related information with extended networks with lower e-literacy, and they saw opportunities for the cocreation of health promotion strategies.

What are the ways in which social media is used in the context of complementary and alternative medicine in the health and medical scholarly literature? a scoping review

BACKGROUND

Despite the increased use of social media to share health-related information and the substantial impact that complementary and alternative medicine (CAM) can have on individuals' health and wellbeing, currently, to our knowledge, there is no review that compiles research on how social media is used in the context of CAM. The objective of this study was to summarize what are the ways in which social media is used in the context of CAM.

METHODS

A scoping review was conducted, following Arksey and O'Malley's five-stage methodological framework. MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL databases were systematically searched from inception until October 3, 2020, in addition to the Canadian Agency for Drugs and Technology in Health (CADTH) website. Eligible studies had to have investigated how at least one social media platform is used in the context of a single or multiple types of CAM treatments.

RESULTS

Searches retrieved 1714 items following deduplication, of which 1687 titles and abstracts were eliminated, leaving 94 full-text articles to be considered. Of those, 65 were not eligible, leaving a total of 29 articles eligible for review. Three themes emerged from our analysis: 1) social media is used to share user/practitioner beliefs, attitudes, and experiences about CAM, 2) social media acts as a vehicle for the spread of misinformation about CAM, and 3) there are unique challenges with social media research in the context of CAM.

CONCLUSIONS

In addition to social media being a useful tool to share user/practitioner beliefs, attitudes, and experiences about CAM, it has shown to be accessible, effective, and a viable option in delivering CAM therapies and information. Social media has also been shown to spread a large amount of misleading and false information in the context of CAM. Additionally, this review highlights the challenges with conducting social media research in the context of CAM, particularly in collecting a representative sample.

Activism in the Digital Age: The Link Between Social Media Engagement With Black Lives Matter-Relevant Content and Mental Health

Introduction: Research shows that participation in political activism on social media is linked to psychological stress. Additionally, race-based stress disproportionately affects minorities and is linked to greater psychological symptoms. Yet, the impact of the social media presence of Black Lives Matter (BLM) on mental health has yet to be meaningfully assessed.Methods: This study assessed whether engagement with BLM-related social media vignettes was related to mental health symptoms in two non-clinical samples (total N = 389), using a mixed-methods design. Participants completed an online survey with social media vignettes, self-report inventories of mental health symptoms, and open-ended questions about experiences with and the impact of BLM.Results: Correlations revealed that greater engagement with BLM-related social media posts was related to more severe mental health symptoms. Further, moderation analyses revealed that race significantly moderated the relationship between engagement and anxiety and trauma-related symptoms, such that these relationships were stronger for participants who identified as racial minorities. Qualitative analyses revealed that most participants who were engaged in mental health treatment had not discussed BLM-related topics with their providers, despite many participants reporting disrupted relationships and negative emotions due to exposure to BLM-related social media content.Discussion: Taken together, results suggest that engagement with BLM-related content online is linked to increased mental health symptoms, but these issues are infrequently addressed in treatment. Future research should extend these findings with clinical samples, assess the comfort of therapists in addressing these topics in therapy, and develop interventions to improve mental health in digital activists.

Health literacy on COVID-19 and COVID-19 vaccinations in Indonesia

Introduction: Health literacy on the coronavirus disease 2019 (COVID-19) affects people's capability to ascertain their health and health care quality during the pandemic. The objective of this study was to determine the levels of health literacy about COVID-19 vaccines and vaccinations (Vaccines and Vaccinations literacy-VL) in the Indonesian adult general population, assessing the perceptions of the respondents about current adult immunization and beliefs about vaccinations in general, and analyzing correlations of these variables with the VL levels. Methods: A cross-sectional study using a rapid survey was administered via the Internet. Data were analyzed using descriptive and inferential statistics; the internal consistency of the VL scales was evaluated using Cronbach's alpha coefficient; the inter-correlation between the functional and interactive-critical VL questions, the underlying components (factors) and each question's load on the components were identified using a Principal Component Analysis (PCA). An alpha level lesser than 0.05 was considered significant. Results: Responses to functional- and interactive/ critical- VL questions were acceptable and showed internal consistency (Cronbach's alpha = 0.817 and 0.699, respectively), lowest values observed were 0.806 for functional scale and 0.640 for the interactive-critical scale. The PCA demonstrated that there were two components accounting for 52.45% of the total variability. Approximately 60% of respondents were females (n=686). Almost all respondents used the internet to seek information regarding COVID-19 and COVID-19 vaccinations. Many used at least one social media actively with 74.4% of respondents sometimes believing the validity of this information. Conclusions: High scores were observed in both functional- and interactive/ critical-VL, and were quite in a balance between sexes in the prior VL and higher in females for the latter; these were also closely related to the educational level and age group. It is crucial to increase public health literacy in managing the pandemic.

Promoting blood donation through social media: Evidence from Brazil, India and the USA

Social media has the potential to encourage prosocial behaviors at scale, yet very little causal evidence exists on the impact of related efforts. Blood donation is a particularly difficult, but essential prosocial behavior that is often critically undersupplied. We examine the effect of Facebook's blood donation tool on voluntary blood donation. We partnered with four major blood banks in the United States covering 363 collection facilities in 46 states and Washington, D.C. We tracked the tool's impact on blood donations during its staggered rollout on a sample of more than 47,000 facility-date observations from March 2019 to September 2019. The tool caused an increase of 0.55 total donations per facility per day (+4.0% [95% CI: 0.04%-8.0%]), and an increase of 0.15 donations from first-time donors per facility per day (+18.9% [95% CI: 4.7%-33.1%]). Longitudinal evidence from Brazil and India suggests the share of donors who both received a message from the tool and stated they were influenced by Facebook to donate increased from 0% to 14.1% [95% CI: 12.1%-16.2%] in the first year of the tool's deployment (i.e., September 2018 to August 2019). These meaningful increases, especially from first-time donors, demonstrate that social media platforms can play an important role in fostering offline prosocial behaviors that benefit the health and well-being of societies around the world.

Public perceptions on Twitter of nurses during the COVID-19 pandemic

BACKGROUND

The use of social media platforms to convey public opinions and attitudes has exponentially increased over the last decade on topics related to health. In all these social media postings related to the pandemic, specific attention has been focused on healthcare professionals, specifically nurses.

OBJECTIVE

This study aimed to explore how the keyword 'nurse' is located in COVID-19 pandemic-related tweets during a selected period of the pandemic in order to assess public perception.

METHODS

Tweets related to COVID-19 were downloaded from Twitter for the period January 1st, 2020, to November 11th, 2021. Sentiment analysis was used to identify opinions, emotions, and approaches expressed in tweet which included 'nurse', 'COVID-19', and 'pandemic' as either keyword or hashtags.

RESULTS

A total of 2,440,696 most used unique words in the downloaded 582,399 tweets were included and the sentiment analysis indicated that 24.4% (n = 595,530) of the tweets demonstrated positive sentiment while 14.1% (n = 343,433) of the tweets demonstrated negative sentiment during COVID-19. Within these results, 17% (n = 416,366) of the tweets included positive basic emotion words of trust and 4.9% (n = 120,654) of joy. In terms of negative basic emotion words, 9.9% (n = 241,758) of the tweets included the word fear, 8.3% (n = 202,179) anticipation, 7.9% (n = 193,145) sadness, 5.7% (n = 139,791) anger, 4.2% (n = 103,936) disgust, and 3.6% (n = 88,338) of the tweets included the word surprised.

CONCLUSIONS

It is encouraging to note that with the advent of major health crises, public perceptions on social media, appears to portray an image of nurses which reflects the professionalism and values of the profession.

A Social Media-Based Intervention for Chinese American Caregivers of Persons With Dementia: Protocol Development

BACKGROUND

Racial/ethnic minority and immigrant caregivers of persons with dementia experience high rates of psychosocial stress and adverse health outcomes. Few culturally tailored mobile health (mHealth) programs were designed for these vulnerable populations.

OBJECTIVE

This study reports the development of a culturally tailored mHealth program called Wellness Enhancement for Caregivers (WECARE) to improve caregiving skills, reduce distress, and improve the psychosocial well-being of Chinese American family caregivers of persons with dementia.

METHODS

Community-based user-centered design principles were applied in the program development. First, the structure and curriculum of the WECARE program were crafted based on existing evidence-based interventions for caregivers with input from 4 experts. Second, through working closely with 8 stakeholders, we culturally adapted evidence-based programs into multimedia program components. Lastly, 5 target users tested the initial WECARE program; their experience and feedback were used to further refine the program.

RESULTS

The resulting WECARE is a 7-week mHealth program delivered via WeChat, a social media app highly popular in Chinese Americans. By subscribing to the official WECARE account, users can receive 6 interactive multimedia articles pushed to their WeChat accounts each week for 7 weeks. The 7 major themes include (1) facts of dementia and caregiving; (2) the enhancement of caregiving skills; (3) effective communication with health care providers, care partners, and family members; (4) problem-solving skills for caregiving stress management; (5) stress reduction and depression prevention; (6) the practice of self-care and health behaviors; and (7) social support and available resources. Users also have the option of joining group chats for peer support. The WECARE program also includes a back-end database that manages intervention delivery and tracks user engagement.

CONCLUSIONS

The WECARE program represents one of the first culturally tailored social media-based interventions for Chinese American caregivers of persons with dementia. It demonstrates the use of community-based user-centered design principles in developing an mHealth intervention program in underserved communities. We call for more cultural adaptation and development of mHealth interventions for immigrant and racial/ethnic minority caregivers of persons with dementia.

Evaluating the Efficacy of a Social Media-Based Intervention (Warna-Warni Waktu) to Improve Body Image Among Young Indonesian Women: Parallel Randomized Controlled Trial (Preprint)

BACKGROUND

Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists.

OBJECTIVE

We aimed to evaluate the acceptability and efficacy of Warna-Warni Waktu, a social media-based, fictional 6-episode video series with self-guided web-based activities for improving body image among young Indonesian adolescent girls and young women. We hypothesized that Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. We also anticipated improvements in state body satisfaction and mood immediately following each video.

METHODS

We conducted a web-based, 2-arm randomized controlled trial among 2000 adolescent girls and young women, aged 15 to 19 years, recruited via telephone by an Indonesian research agency. Block randomization (1:1 allocation) was performed. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome) and the internalization of appearance ideals, mood, and skin shade dissatisfaction at baseline (before randomization), time 2 (1 day after the intervention [T2]), and time 3 (1 month after the intervention [T3]). Participants also completed state body satisfaction and mood measures immediately before and after each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Intervention adherence was tracked. Acceptability data were collected.

RESULTS

There were 1847 participants. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F_1,1758=40.56, P<.001, partial η²=0.022) and T3 (F_1,1782=54.03, P<.001, partial η²=0.03) and reduced skin shade dissatisfaction at T2 (F_1,1744=8.05, P=.005, partial η²=0.005). Trait body satisfaction improvements occurred in the intervention group at T3 (F_{1, 1781}=9.02, P=.005, partial η²=0.005), which was completely mediated by the internalization change scores between baseline and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. Trait mood showed no significant effects. Dependent sample t tests (2-tailed) found each video improved state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and poststate body satisfaction and mood. Intervention adherence was good; participants watched an average of 5.2 (SD 1.66) videos. Acceptability scores were high for understandability, enjoyment, age appropriateness, usefulness, and likelihood to recommend.

CONCLUSIONS

Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among Indonesian adolescent girls and young women. Although the effects were small, Warna-Warni Waktu is a scalable, cost-effective alternative to more intense interventions. Initially, dissemination through paid social media advertising will reach thousands of young Indonesian women.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807 ; ISRCTN Registry ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/33596.

What the grey literature can contribute to addictive behaviour disorder classification •

This commentary examines the proposal made by Brand et al. (2022) regarding a framework outlining relevant criteria for considering possible behavioural addictions within the current World Health Organisation's International Classification of Diseases (ICD-11) category of 'other specified disorders due to addictive behaviours'. We agree with the framework as it highlights the clinical perspective requiring agreed-upon classifications and criteria to produce effective diagnostic procedures and efficacious treatments. Additionally, we propose to add the need of recognising potential addictive behaviour through the inclusion of a fourth meta-level criterion: 'grey literature evidence'. Utilising non-academic evidence can provide validity in the social context where the behaviour takes place, and it can support authorities in taking action to prevent and treat the resultant behavioural problems. The inclusion of the proposed fourth criterion will aid comprehensibility of the current proposal and provide clarity, as indicated in the present commentary, which includes the fourth criterion analysis for problematic pornography use, shopping/buying and social networking site use.

Illusion of Truth: Analysing and Classifying COVID-19 Fake News in Brazilian Portuguese Language

Public health interventions to counter the COVID-19 pandemic have accelerated and increased digital adoption and use of the Internet for sourcing health information. Unfortunately, there is evidence to suggest that it has also accelerated and increased the spread of false information relating to COVID-19. The consequences of misinformation, disinformation and misinterpretation of health information can interfere with attempts to curb the virus, delay or result in failure to seek or continue legitimate medical treatment and adherence to vaccination, as well as interfere with sound public health policy and attempts to disseminate public health messages. While there is a significant body of literature, datasets and tools to support countermeasures against the spread of false information online in resource-rich languages such as English and Chinese, there are few such resources to support Portuguese, and Brazilian Portuguese specifically. In this study, we explore the use of machine learning and deep learning techniques to identify fake news in online communications in the Brazilian Portuguese language relating to the COVID-19 pandemic. We build a dataset of 11,382 items comprising data from January 2020 to February 2021. Exploratory data analysis suggests that fake news about the COVID-19 vaccine was prevalent in Brazil, much of it related to government communications. To mitigate the adverse impact of fake news, we analyse the impact of machine learning to detect fake news based on stop words in communications. The results suggest that stop words improve the performance of the models when keeping them within the message. Random Forest was the machine learning model with the best results, achieving 97.91% of precision, while Bi-GRU was the best deep learning model with an F1 score of 94.03%.

Digital interventions for promoting sun protection and skin self-examination behaviors: A systematic review

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A considerable number of digital interventions for skin cancer prevention have been evaluated.

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Most skin cancer digital interventions focus on sun protection-related outcomes.

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Most interventions use web-based digital technology (websites, webpages, mobile apps) rather than videos, emails or text messages alone as the delivery platform.

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Multi-component digital interventions are effective in promoting sun protection and skin self-examination.

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Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions.

The skin cancer incidence rate has been rising, and digital health interventions can promote skin cancer prevention and detection behaviors. A systematic review was conducted to investigate the outcomes of digital interventions that promote sun protection and skin self-examination (SSE). This review examined studies that utilized randomized controlled designs or quasi-experiments, included outcomes related to sun safety or SSE, employed at least one digital platform, and were published in English from January 2000 to October 2020. A total of 62 studies were included in the review. Digital modalities included web-based (e.g., websites) alone (n = 29), mobile-based (e.g., mobile apps) alone (n = 12), game-based (n = 1), emails or text messages alone (n = 8), videos alone (n = 6), social media (n = 3), both text messages and mobile apps (n = 2), or both text messages and video (n = 1). Most studies (n = 44) only evaluated sun protection-related outcomes, seven studies assessed SSE outcomes only, nine studies examined both, and two assessed other related outcomes. Digital interventions are effective compared to non-intervention control conditions in promoting sun safety or SSE. Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions. This review suggests that although the digital interventions varied, they showed promising effects on improving sun protection or SSE outcomes. Future research should include more sophisticated phase-based and rigorous longitudinal research designs, additional investigation of social media and other newer technologies, as well as more detailed reporting of methods and results.

Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study

BACKGROUND

The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance.

OBJECTIVE

The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic.

METHODS

We retrieved public query data for the Spanish equivalent of the term "chlorine dioxide" from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021.

RESULTS

From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, -71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001).

CONCLUSIONS

Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information.

Social Media - Key Opinion Leaders of the Future?

Physicians and patients are increasingly represented on social media and perform as so-called medical influencers. As key opinion leaders, they can influence and change opinions on health topics and also establish their work within a specialist community.

The Role of Social Media in Raising Public Health Awareness during the Pandemic COVID-19: An International Comparative Study

The main objective of this research is to investigate the role of social media campaigns (the type of social media platform, type of message, and message source sender) in raising public health awareness and behavioral change during (COVID-19) as a global pandemic across national selected countries (Poland and Jordan). The research utilizes a quantitative method with an exploratory and descriptive design to accumulate the initial data from a research survey given to the respondents from Jordan and Poland. A total of 1149 web questionnaires were collected from respondents in the two countries (Poland 531 and Jordan 618). In addition, multiple regression analysis was used to test the study hypotheses. The findings showed positive relationships between the components of a social media campaign, public health awareness, and behavioral change during (COVID-19) in the two countries at the same time. However, the preferred type of social media platforms, the message types and type of source sender significantly differ among the respondents due to their countries. This is the first study that examines the role of social media campaigns (the type of social media platform, type of message and message source sender) in public health awareness and behavioral change during (COVID-19) as a global pandemic in across national selected countries (Poland and Jordan).

Debunking Health Misinformation on Social Media: The Challenge of Dynamic Conversations (Preprint)

Background

The spread of false and misleading health information on social media can cause individual and social harm. Research on debunking has shown that properly designed corrections can mitigate the impact of misinformation, but little is known about the impact of correction in the context of prolonged social media debates. For example, when a social media user takes to Facebook to make a false claim about a health-related practice and a health expert subsequently refutes the claim, the conversation rarely ends there. Often, the social media user proceeds by rebuking the critic and doubling down on the claim.

Objective

The aim of this study was to examine the impact of such extended back and forth between false claims and debunking attempts on observers’ dispositions toward behavior that science favors. We tested competing predictions about the effect of extended exposure on people’s attitudes and intentions toward masking in public during the early days of the COVID-19 pandemic and explored several psychological processes potentially underlying this effect.

Methods

A total of 500 US residents took part in an online experiment in October 2020. They reported on their attitudes and intentions toward wearing masks in public. They were then randomly assigned to one of four social media exposure conditions (misinformation only vs misinformation+correction vs misinformation+correction+rebuke vs misinformation+correction+rebuke+second correction), and reported their attitudes and intentions for a second time. They also indicated whether they would consider sharing the thread if they were to see it on social media and answered questions on potential mediators and covariates.

Results

Exposure to misinformation had a negative impact on attitudes and intentions toward masking (β=–.35, 95% CI –.42 to –.29; P<.001). Moreover, initial debunking of a false claim generally improved attitudes and intentions toward masking (β=.35, 95% CI .16 to .54; P<.001). However, this improvement was washed out by further exposure to false claims and debunking attempts (β=–.53, 95% CI –.72 to –.34; P<.001). The latter result is partially explained by a decrease in the perceived objectivity of truth. That is, extended exposure to false claims and debunking attempts appear to weaken the belief that there is an objectively correct answer to how people ought to behave in this situation, which in turn leads to less positive reactions toward masking as the prescribed behavior.

Conclusions

Health professionals and science advocates face an underappreciated challenge in attempting to debunk misinformation on social media. Although engaging in extended debates with science deniers and other purveyors of bunk appears necessary, more research is needed to address the unintended consequences of such engagement.

Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study

BACKGROUND

Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions.

OBJECTIVE

In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram.

METHODS

We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States.

RESULTS

Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study.

CONCLUSIONS

Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection.

The Particularities of Pharmaceutical Care in Improving Public Health Service during the COVID-19 Pandemic

Nowadays, humanity is confronted with one of the most difficult challenges. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified for the first time in Hubei, China in December 2019 and produced the COVID-19 pandemic, a devastating disease that led to many complications and deaths. The authorities and the global healthcare system have been alerted regarding the prevention and treatment of this pathology. Even though worldwide quarantine was declared, health care professionals, including pharmacists, have been at the frontline in this war. Since the beginning of the pandemic, the authorities relied on the involvement of the community, hospital, or clinical pharmacists in offering support to the entire population. Also, the authorities implemented measures for emergency authorization of the vaccines, or the drugs used in COVID-19 treatment. In order to facilitate the population's access to healthcare services, the authorities have established regulations regarding, the extension of prescriptions by pharmacists, working hours, prevention of shortages and price-increase, drive-thru services, etc. However, several countries have taken financial measures to support the pharmacies' activity. At the same time, pharmaceutical associations elaborated guidelines for the protection of pharmacists and patients alike. Additionally, the pharmacies have come to support the health system and patients by adapting pharmaceutical care to the new needs like preparation and supply of disinfectants, patient care, information, and counseling, especially to COVID-19 patients, as well as the implementation of home drugs-delivery systems. The important roles played by pharmacists were to perform COVID-19 tests and further vaccines, as well as to combat the abundance of misinformation and fake news. The clinical and hospital pharmacy services have also been adapted. Strengthening the role of the pharmacist in the medical team was important for the purpose of providing correct and complete information regarding drugs used in the COVID-19 pathology. In all these activities, pharmacists needed creativity and professionalism, but also the support of pharmacy owners and managers. With this crisis, pharmaceutical care has entered a new phase, demonstrating the ability of pharmacists to be competent and accessible providers of public health. Based on this information, we conducted a narrative review whose purpose was to identify the impact of the authorities' decisions on pharmaceutical practice, the involvement of professional associations, and the responsibilities of the pharmacy owners and management. On the other hand, we performed a global assessment on the pharmaceutical care services provided by community pharmacists as well as by clinical or hospital pharmacists during the COVID-19 pandemic.

'Falsehood flies, and the truth comes limping after it': social media and public health

PURPOSE OF REVIEW

To highlight the various uses of social media by public health practitioners and organizations, with special emphasis on how social media has been successfully applied and where applications have struggled to achieve the desired effects.

RECENT FINDINGS

Social media has been used effectively in improving the timeliness and accuracy of public health surveillance. Social media has also been used to communicate information between public health organizations and reinforce consistent messaging about enduring threats to public health. It has been applied with some success to coordinate of disaster response and for keeping the public informed during other emergency situations. However, social media has also been weaponized against the public health community to spread disinformation and misinformation, and the public health community has yet to devise a successful strategy to mitigate this destructive use of social media.

SUMMARY

Social media can be an effective tool for public health practitioners and organizations who seek to disseminate information on a daily basis, rapidly convey information in emergent situations, and battle misinformation. Social media has been uniquely valuable and distinctly destructive when it comes to protecting and improving public health.

Global Burden of Skin Disease Representation in the Literature: Bibliometric Analysis

BACKGROUND

The global burden of skin disease may be reduced through research efforts focused on skin diseases with the highest reported disability-adjusted life years.

OBJECTIVE

This study evaluates the representation of dermatologic conditions comprising the highest disability-adjusted life years in dermatology literature to identify areas that could benefit from greater research focus.

METHODS

The top 10 skin disorders according to their respective disability-adjusted life years as per the 2013 Global Burden of Disease were identified using previous studies. The top 5 dermatology journals ranked by the 2019 h-index were also identified. A PubMed search of each journal was performed using individual skin disease terms. From 2015 to 2020, all indexed publications pertaining to each disease were recorded and compared to the total number of publications for each journal surveyed.

RESULTS

A total of 19,727 papers were published in the 5 journals over the span of 2015-2020. Although melanoma ranked as the eighth highest in disability-adjusted life years, it had the highest representation in the literature (1995/19,727, 10.11%). Melanoma was followed in representation by psoriasis (1936/19,727, 9.81%) and dermatitis (1927/19,727, 9.77%). These 3 conditions comprised a total of 29.69% (5858/19,727) of the total publications, while the remaining 7 skin conditions were represented by a combined 6.79% (1341/19,727) of the total publications.

CONCLUSIONS

This research identifies gaps in the literature related to the top skin diseases contributing to the global burden of disease. Our study provides insight into future opportunities of focused research on less-studied skin diseases to potentially aid in reducing the global burden of skin disease.

What do people post on social media relative to low back pain? A content analysis of Australian data

OBJECTIVE

Low back pain is the leading contributor to the global disability burden. The Global Spine Care Initiative (GSCI) recommend patient-centred care to stem the cost of low back pain. One way to enhance patient-centred care is by better understanding what is relevant for people with low back pain. Exploring social media posts about low back pain could offer this insight and provide valuable information for health care professionals to facilitate active participation in patient-centred care.

METHODS

We used an inductive content analysis method. In the form of social media posts, data on Twitter and Instagram were collected from June to August 2018. The posts were geo-targeted to Australia. We recorded the number of status broadcasts that contained a low back pain keyword and responses. We developed a codebook to describe the data and applied it to identify low back pain themes.

RESULTS

We analysed 768 posts containing 457 status broadcasts and 311 responses. Almost half (49%) of status broadcasts about low back pain seemed to seek validation. Expressing sympathy (31%) was the most common response to a status broadcast about low back pain. There were no public responses to 76% of status broadcasts about low back pain. Our analysis yielded two core themes, "hear my pain" and "I feel for you".

CONCLUSIONS

Posts about low back pain on social media often seem to suggest that the person posting is seeking validation. Responses typically express sympathy or a shared experience; yet, there is no response to most social media posts about low back pain.

A systematic review of the engagement with social media-delivered interventions for improving health outcomes among sexual and gender minorities

BACKGROUND

Sexual and gender minority (SGM) persons face a number of physical and mental health disparities closely linked to discrimination, social stigma, and victimization. Despite the acceptability and increasing number of digital health interventions focused on improving health outcomes among SGM people, there is a lack of reviews summarizing whether and how researchers assess engagement with social media-delivered health interventions for this group.

OBJECTIVE

The objective of this systematic review was to synthesize and critique the evidence on evaluation of engagement with social media-delivered interventions for improving health outcomes among SGM persons.

METHODS

We conducted a literature search for studies published between January 2003 and June 2020 using 4 electronic databases. Articles were included if they were peer-reviewed, in English language, assessed engagement with a social media-delivered health intervention for improving health outcomes among sexual and gender minorities. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed quality of data reporting using the CONSORT extension for pilot and feasibility studies and CONSORT statement parallel group randomized trials.

RESULTS

We included 18 articles in the review; 15 were feasibility studies and 3 were efficacy or effectiveness randomized trials. The quality of data reporting varied considerably. The vast majority of articles focused on improving HIV-related outcomes among men who have sex with men. Only three studies recruited cisgender women and/or transgender persons. We found heterogeneity in how engagement was defined and assessed. Intervention usage from social media data was the most frequently used engagement measure.

CONCLUSION

In addition to the heterogeneity in defining and assessing engagement, we found that the focus of assessment was often on measures of intervention usage only. More purposeful recruitment is needed to learn about whether, how, and why different SGM groups engage with social media-interventions. This leaves significant room for future research to expand evaluation criteria for cognitive and emotional aspects of intervention engagement in order to develop effective and tailored social media-delivered interventions for SGM people. Our findings also support the need for developing and testing social media-delivered interventions that focus on improving mental health and outcomes related to chronic health conditions among SGM persons.

Development of Reporting Guidelines for Social Media Research (RESOME) using a modified Delphi Method: Study protocol (Preprint)

Background

Objective

Methods

Results

Conclusions

International Registered Report Identifier (IRRID)

Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study

Background

Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions.

Objective

This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination.

Methods

We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization’s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media.

Results

Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online.

Conclusions

COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts.

Influence of Social Media Use on Practice of COVID-19 Preventive Measures Among Ethiopian Residents: An Online Cross-Sectional Study

BACKGROUND

Infection with coronavirus disease 2019 (COVID-19) has become a severe public health issue worldwide. A broad amount of information related to the novel coronavirus (COVID-19) pandemic was disseminated by social media in Ethiopia. To date, there is limited evidence on the influence of social media use for COVID-19-related information on COVID-19 preventive practice. Therefore, this study aimed to assess the influence of social media use on the practice of COVID-19 preventive measures in Ethiopia.

METHODS

This study used an anonymous Internet-based online cross-sectional survey using Google Forms to collect the data from the respondents from May 15 to June 17, 2020, in Ethiopia. Multivariable logistic regression was used to assess the relationship between social media use as a predictor and COVID-19 preventive practice, after adjusting for socio-demographic and risk perception of COVID-19 variables. The data were analyzed using SPSS version 21.

RESULTS

A total of 372 respondents have participated in the study. From 372, a total of 208 (55.9%) respondents in this study were male. Study participants who had good use of social media to get COVID-19-related information were 9.5 times more engaged in COVID-19 preventive practices compared with study participants who had poor use of social media to get COVID-19-related information (adjusted odds ratio [AOR] = 9.59; 95% confidence interval [CI]: 5.70-16.13). Also, study participants who had a high-risk perception of COVID-19 were 2.6 times more engaged in COVID-19 practices compared with study participants who had a low-risk perception of COVID-19 (AOR = 2.63; 95% CI: 1.58-4.38). Study participants who were students at the time of this study were 4 times more likely to show an adequate COVID-19 preventive practice score compared with those who had another occupational status (AOR = 4.07; 95% CI: 1.66-9.98).

CONCLUSIONS

Our results show that the use of social media networks can have a positive effect on the practice of preventive measures and public safety against COVID-19; high-risk perception contributed to preventive activities against COVID-19. Social networking platforms can be used by public health agencies as an important method to raise public health understanding by disseminating concise messages to targeted audiences.

Social Network Analysis of the Effects of a Social Media-Based Weight Loss Intervention Targeting Adults of Low Socioeconomic Status: Single-Arm Intervention Trial

Background

Obesity is a known risk factor for cardiovascular disease risk factors, including hypertension and type II diabetes. Although numerous weight loss interventions have demonstrated efficacy, there is considerably less evidence about the theoretical mechanisms through which they work. Delivering lifestyle behavior change interventions via social media provides unique opportunities for understanding mechanisms of intervention effects. Server data collected directly from web-based platforms can provide detailed, real-time behavioral information over the course of intervention programs that can be used to understand how interventions work.

Objective

The objective of this study was to demonstrate how social network analysis can facilitate our understanding of the mechanisms underlying a social media–based weight loss intervention.

Methods

We performed secondary analysis by using data from a pilot study that delivered a dietary and physical activity intervention to a group of participants via Facebook. We mapped out participants’ interaction networks over the 12-week intervention period and linked participants’ network characteristics (eg, in-degree, out-degree, network constraint) to participants’ changes in theoretical mediators (ie, dietary knowledge, perceived social support, self-efficacy) and weight loss by using regression analysis. We also performed mediation analyses to explore how the effects of social network measures on weight loss could be mediated by the aforementioned theoretical mediators.

Results

In this analysis, 47 participants from 2 waves completed the study and were included. We found that increases in the number of posts, comments, and reactions significantly predicted weight loss (β=–.94, P=.04); receiving comments positively predicted changes in self-efficacy (β=7.81, P=.009), and the degree to which one’s network neighbors are tightly connected with each other weakly predicted changes in perceived social support (β=7.70, P=.08). In addition, change in self-efficacy mediated the relationship between receiving comments and weight loss (β=–.89, P=.02).

Conclusions

Our analyses using data from this pilot study linked participants’ network characteristics with changes in several important study outcomes of interest such as self-efficacy, social support, and weight. Our results point to the potential of using social network analysis to understand the social processes and mechanisms through which web-based behavioral interventions affect participants’ psychological and behavioral outcomes. Future studies are warranted to validate our results and to further explore the relationship between network dynamics and study outcomes in similar and larger trials.

Correcting HPV Vaccination Misinformation Online: Evaluating the HPV Vaccination NOW Social Media Campaign

The human papillomavirus (HPV) vaccine provides protection from six HPV-related cancers. Approximately half of South Carolina adolescents have not completed the vaccination series, representing a missed opportunity to prevent cancer. The HPV Vaccination NOW: This is Our Moment social media campaign is an initiative of the South Carolina Cancer Alliance (SCCA) and Hollings Cancer Center at the Medical University of South Carolina (MUSC). This statewide social media campaign aimed to increase parental awareness of and build vaccine confidence around HPV vaccination in S.C. The ten-week campaign was strategically implemented between June and August 2019 to encourage HPV vaccination at back-to-school medical appointments. A process evaluation showed that the campaign resulted in over 370,000 total impressions, reached over 33,000 individuals, and culminated with over 1122 followers. There were over 2700 engagements on Facebook and Twitter. A qualitative content analysis indicated that pro-vaccine and anti-vaccine comments were dominated by personal stories. Comments promoting misinformation about the HPV vaccine were often countered through peer-to-peer dialogue. Findings suggest that creating opportunities for the target audience to engage with campaign messages effectively corrected misinformation.

Use of bot and content flags to limit the spread of misinformation among social networks: a behavior and attitude survey

The COVID-19 infodemic is driven partially by Twitter bots. Flagging bot accounts and the misinformation they share could provide one strategy for preventing the spread of false information online. This article reports on an experiment (N = 299) conducted with participants in the USA to see whether flagging tweets as coming from bot accounts and as containing misinformation can lower participants’ self-reported engagement and attitudes about the tweets. This experiment also showed participants tweets that aligned with their previously held beliefs to determine how flags affect their overall opinions. Results showed that flagging tweets lowered participants’ attitudes about them, though this effect was less pronounced in participants who frequently used social media or consumed more news, especially from Facebook or Fox News. Some participants also changed their opinions after seeing the flagged tweets. The results suggest that social media companies can flag suspicious or inaccurate content as a way to fight misinformation. Flagging could be built into future automated fact-checking systems and other misinformation abatement strategies of the social network analysis and mining community.

Article-Level Metrics

In the era of digitization and Open Access, article-level metrics are increasingly employed to distinguish influential research works and adjust research management strategies. Tagging individual articles with digital object identifiers allows exposing them to numerous channels of scholarly communication and quantifying related activities. The aim of this article was to overview currently available article-level metrics and highlight their advantages and limitations. Article views and downloads, citations, and social media metrics are increasingly employed by publishers to move away from the dominance and inappropriate use of journal metrics. Quantitative article metrics are complementary to one another and often require qualitative expert evaluations. Expert evaluations may help to avoid manipulations with indiscriminate social media activities that artificially boost altmetrics. Values of article metrics should be interpreted in view of confounders such as patterns of citation and social media activities across countries and academic disciplines.

Association of social participation, perception of neighborhood social cohesion, and social media use with happiness: Evidence of trade-off (JCOP-20-277)

Social participation and neighborhood social cohesion are positively associated with health and wellbeing. Given that in-person social interactions have generally dwindled over the past several decades at least in Western countries and social media use has become more common, in this study, we examined whether and how social media use interacts with social participation and neighborhood social cohesion in influencing happiness. Data were gathered from a representative sample of adults in Massachusetts, USA. General linear model was used to estimate the main and interaction effects of social participation, perception of neighborhood social cohesion and social media use on happiness, controlling for sociodemographics, marital status, employment, and self-rated health. Results indicated that both social participation and perception of neighborhood social cohesion were positively associated with happiness whereas social media use was not. However, there was a significant interaction effect of social media use and perception of neighborhood social cohesion on happiness. Compared with people with a high perception of neighborhood social cohesion, those with low perception were more likely to be happy as their social media use increased, suggesting that social media use may be helpful to promote happiness among people who perceive their neighborhoods as less supportive, trustworthy, and close-knit.

Access to Vaccination Information and Confidence/Hesitancy Towards Childhood Vaccination: A Cross-Sectional Survey in China

Access to vaccination information could influence public attitudes towards vaccination. This study investigated the number and types of vaccination-related information sources, and estimated their associations with vaccine confidence and hesitancy in China. In January 2019, we conducted a cross-sectional survey in China, and 2122 caregivers with children <6 years completed self-administered questionnaires. Logistic regressions were used to assess associations between caregivers’ primary information sources and vaccine confidence/hesitancy. A majority (72%) of caregivers had multiple sources of vaccination-related information. The proportions of caregivers reporting professional sources, media, and peers as primary information sources were 81%, 63%, and 26%. Internal migrants were less likely to get information from professional sources; more educated and wealthier caregivers reported more information sources and were more likely to get information from media and peers. Caregivers who reported professional information sources had significantly higher odds of being confident about the safety of vaccines and lower odds of being hesitant toward vaccination than those who did not. Caregivers who reported the media as a primary information source had significantly higher odds of being hesitant toward vaccination than those who did not. To address vaccine hesitancy, it is essential to promote universal access to professional vaccination-related information sources, and to use the media to disseminate evidence-based information and clarify misinformation. Health communication should target internal migrants, and more educated and wealthier caregivers.

How German health insurance providers use social online networks to promote healthy lifestyles: a content analysis of Facebook® accounts

Background

Social networking sites such as Facebook® can contribute to health promotion and behaviour change activities, but are currently underused for this purpose. In Germany, health insurance companies are relevant public health agencies that are responsible for health promotion, primary prevention, and health education. We intended to analyse the Facebook® accounts of health insurance providers to explore the range of prevention topics addressed, identify the communication formats used, and analyse user activity stimulated by prevention-related posts.

Methods

We performed a quantitative content analysis of text and picture data on Facebook® accounts (9 months in retrospect) in a cross-sectional study design. 64/159 German health insurance providers hosted a Facebook® page, 25/64 posted ≥ 10 posts/months. Among those 25, we selected 17 health insurance companies (12 public, 5 private) for analysis. All posts were categorized according to domains in the classification system that was developed for this study, and the number of likes and comments was counted. The data were analysed using descriptive statistics.

Results

We collected 3,763 Facebook® posts, 32% of which had a focus on prevention. The frequency of prevention-related posts varied among health insurance providers (1–25 per month). The behaviours addressed most frequently were healthy nutrition, physical activity, and stress/anxiety relief, often in combination with each other. All these topics yielded a moderate user engagement (30–120 likes, 2–10 comments per post). User engagement was highest when a competition or quiz were posted (11% of posts). The predominant communication pattern was health education, often supplemented by photos or links, or information about offline events (e.g. a public run). Some providers regularly engaged in two-side communication with users, inviting tips, stories or recipes, or responding to individual comments. Still, the interactive potential offered by Facebook® was only partly exploited.

Conclusions

Those few health insurace companies that regularly post content about prevention or healthy lifestyles on their Facebook® accounts comply with suggestions given for social media communication. Still, many health insurance providers fail to actively interact with wider audiences. Whether health communication on Facebook® can actually increase health literacy and lead to behaviour changes still needs to be evaluated.

Prevalence of Health Misinformation on Social Media: Systematic Review

Background

Although at present there is broad agreement among researchers, health professionals, and policy makers on the need to control and combat health misinformation, the magnitude of this problem is still unknown. Consequently, it is fundamental to discover both the most prevalent health topics and the social media platforms from which these topics are initially framed and subsequently disseminated.

Objective

This systematic review aimed to identify the main health misinformation topics and their prevalence on different social media platforms, focusing on methodological quality and the diverse solutions that are being implemented to address this public health concern.

Methods

We searched PubMed, MEDLINE, Scopus, and Web of Science for articles published in English before March 2019, with a focus on the study of health misinformation in social media. We defined health misinformation as a health-related claim that is based on anecdotal evidence, false, or misleading owing to the lack of existing scientific knowledge. We included (1) articles that focused on health misinformation in social media, including those in which the authors discussed the consequences or purposes of health misinformation and (2) studies that described empirical findings regarding the measurement of health misinformation on these platforms.

Results

A total of 69 studies were identified as eligible, and they covered a wide range of health topics and social media platforms. The topics were articulated around the following six principal categories: vaccines (32%), drugs or smoking (22%), noncommunicable diseases (19%), pandemics (10%), eating disorders (9%), and medical treatments (7%). Studies were mainly based on the following five methodological approaches: social network analysis (28%), evaluating content (26%), evaluating quality (24%), content/text analysis (16%), and sentiment analysis (6%). Health misinformation was most prevalent in studies related to smoking products and drugs such as opioids and marijuana. Posts with misinformation reached 87% in some studies. Health misinformation about vaccines was also very common (43%), with the human papilloma virus vaccine being the most affected. Health misinformation related to diets or pro–eating disorder arguments were moderate in comparison to the aforementioned topics (36%). Studies focused on diseases (ie, noncommunicable diseases and pandemics) also reported moderate misinformation rates (40%), especially in the case of cancer. Finally, the lowest levels of health misinformation were related to medical treatments (30%).

Conclusions

The prevalence of health misinformation was the highest on Twitter and on issues related to smoking products and drugs. However, misinformation on major public health issues, such as vaccines and diseases, was also high. Our study offers a comprehensive characterization of the dominant health misinformation topics and a comprehensive description of their prevalence on different social media platforms, which can guide future studies and help in the development of evidence-based digital policy action plans.

Sorting the Healthy Diet Signal from the Social Media Expert Noise: Preliminary Evidence from the Healthy Diet Discourse on Twitter

Over 2.8 million people die each year from being overweight or obese, a largely preventable disease. Social media has fundamentally changed the way we communicate, collaborate, consume, and create content. The ease with which content can be shared has resulted in a rapid increase in the number of individuals or organisations that seek to influence opinion and the volume of content that they generate. The nutrition and diet domain is not immune to this phenomenon. Unfortunately, from a public health perspective, many of these 'influencers' may be poorly qualified in order to provide nutritional or dietary guidance, and advice given may be without accepted scientific evidence and contrary to public health policy. In this preliminary study, we analyse the 'healthy diet' discourse on Twitter. While using a multi-component analytical approach, we analyse more than 1.2 million English language tweets over a 16-month period in order to identify and characterise the influential actors and discover topics of interest in the discourse. Our analysis suggests that the discourse is dominated by non-health professionals. There is widespread use of bots that pollute the discourse and seek to create a false equivalence on the efficacy of a particular nutritional strategy or diet. Topic modelling suggests a significant focus on diet, nutrition, exercise, weight, disease, and quality of life. Public health policy makers and professional nutritionists need to consider what interventions can be taken in order to counteract the influence of non-professional and bad actors on social media.

Use of Social Media to Promote Cancer Screening and Early Diagnosis: Scoping Review

BACKGROUND

Social media is commonly used in public health interventions to promote cancer screening and early diagnosis, as it can rapidly deliver targeted public health messages to large numbers of people. However, there is currently little understanding of the breadth of social media interventions and evaluations, whether they are effective, and how they might improve outcomes.

OBJECTIVE

This scoping review aimed to map the evidence for social media interventions to improve cancer screening and early diagnosis, including their impact on behavior change and how they facilitate behavior change.

METHODS

Five databases and the grey literature were searched to identify qualitative and quantitative evaluations of social media interventions targeting cancer screening and early diagnosis. Two reviewers independently reviewed each abstract. Data extraction was carried out by one author and verified by a second author. Data on engagement was extracted using an adapted version of the key performance indicators and metrics related to social media use in health promotion. Insights, exposure, reach, and differing levels of engagement, including behavior change, were measured. The behavior change technique taxonomy was used to identify how interventions facilitated behavior change.

RESULTS

Of the 23 publications and reports included, the majority (16/23, 70%) evaluated national cancer awareness campaigns (eg, breast cancer awareness month). Most interventions delivered information via Twitter (13/23, 57%), targeted breast cancer (12/23, 52%), and measured exposure, reach, and low- to medium-level user engagement, such as number of likes (9/23, 39%). There were fewer articles about colorectal and lung cancer than about breast and prostate cancer campaigns. One study found that interventions had less reach and engagement from ethnic minority groups. A small number of articles (5/23, 22%) suggested that some types of social media interventions might improve high-level engagement, such as intended and actual uptake of screening. Behavior change techniques, such as providing social support and emphasizing the consequences of cancer, were used to engage users. Many national campaigns delivered fundraising messages rather than actionable health messages.

CONCLUSIONS

The limited evidence suggests that social media interventions may improve cancer screening and early diagnosis. Use of evaluation frameworks for social media interventions could help researchers plan more robust evaluations that measure behavior change. We need a greater understanding of who engages with these interventions to know whether social media can be used to reduce some health inequalities in cancer screening and early diagnosis.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2019-033592.

A graph-based approach for population health analysis using Geo-tagged tweets

We propose in this work a graph-based approach for automatic public health analysis using social media. In our approach, graphs are created to model the interactions between features and between tweets in social media. We investigated different graph properties and methods in constructing graph-based representations for population health analysis. The proposed approach is applied in two case studies: (1) estimating health indices, and (2) classifying health situation of counties in the US. We evaluate our approach on a dataset including more than one billion tweets collected in three years 2014, 2015, and 2016, and the health surveys from the Behavioral Risk Factor Surveillance System. We conducted realistic and large-scale experiments on various textual features and graph-based representations. Experimental results verified the robustness of the proposed approach and its superiority over existing ones in both case studies, confirming the potential of graph-based approach for modeling interactions in social networks for population health analysis.

Antivaccine Messages on Facebook: Preliminary Audit

Background

The World Health Organization lists vaccine hesitancy as one of 10 threats to global health. The antivaccine movement uses Facebook to promote messages on the alleged dangers and consequences of vaccinating, leading to a reluctance to immunize against preventable communicable diseases.

Objective

We would like to know more about the messages these websites are sharing via social media that can influence readers and consumers. What messages is the public receiving on Facebook about immunization? What content (news articles, testimonials, videos, scientific studies) is being promoted?

Methods

We proposed using a social media audit tool and 3 categorical lists to capture information on websites and posts, respectively. The keywords “vaccine,” “vaccine truth,” and “anti-vax” were entered in the Facebook search bar. A Facebook page was examined if it had between 2500 and 150,000 likes. Data about beliefs, calls to action, and testimonials were recorded from posts and listed under the categories Myths, Truths, and Consequences. Website data were entered in a social media audit template.

Results

Users’ posts reflected fear and vaccine hesitancy resulting from the alleged dangers of immunization featured on the website links. Vaccines were blamed for afflictions such as autism, cancer, and infertility. Mothers shared testimonies on alleged consequences their children suffered due to immunization, which have influenced other parents to not vaccinate their children. Users denied the current measles outbreaks in the United States to be true, retaliating against the government in protests for fabricating news.

Conclusions

Some Facebook messages encourage prevailing myths about the safety and consequences of vaccines and likely contribute to parents’ vaccine hesitancy. Deeply concerning is the mistrust social media has the potential to cast upon the relationship between health care providers and the public. A grasp of common misconceptions can help support health care provider practice.

Factors Associated With Influential Health-Promoting Messages on Social Media: Content Analysis of Sina Weibo

Background

Social media is a powerful tool for the dissemination of health messages. However, few studies have focused on the factors that improve the influence of health messages on social media.

Objective

To explore the influence of goal-framing effects, information organizing, and the use of pictures or videos in health-promoting messages, we conducted a case study of Sina Weibo, a popular social media platform in China.

Methods

Literature review and expert discussion were used to determine the health themes of childhood obesity, smoking, and cancer. Web crawler technology was employed to capture data on health-promoting messages. We used the number of retweets, comments, and likes to evaluate the influence of a message. Statistical analysis was then conducted after manual coding. Specifically, binary logistic regression was used for the data analyses.

Results

We crawled 20,799 Sina Weibo messages and selected 389 health-promoting messages for this study. Results indicated that the use of gain-framed messages could improve the influence of messages regarding childhood obesity (P<.001), smoking (P=.03), and cancer (P<.001). Statistical expressions could improve the influence of messages about childhood obesity (P=.02), smoking (P=.002), and cancer (P<.001). However, the use of videos significantly improved the influence of health-promoting messages only for the smoking-related messages (P=.009).

Conclusions

The findings suggested that gain-framed messages and statistical expressions can be successful strategies to improve the influence of messages. Moreover, appropriate pictures and videos should be added as much as possible when generating health-promoting messages.

Influence of Social Media Platforms on Public Health Protection Against the COVID-19 Pandemic via the Mediating Effects of Public Health Awareness and Behavioral Changes: Integrated Model

Background

Despite the growing body of literature examining social media in health contexts, including public health communication, promotion, and surveillance, limited insight has been provided into how the utility of social media may vary depending on the particular public health objectives governing an intervention. For example, the extent to which social media platforms contribute to enhancing public health awareness and prevention during epidemic disease transmission is currently unknown. Doubtlessly, coronavirus disease (COVID-19) represents a great challenge at the global level, aggressively affecting large cities and public gatherings and thereby having substantial impacts on many health care systems worldwide as a result of its rapid spread. Each country has its capacity and reacts according to its perception of threat, economy, health care policy, and the health care system structure. Furthermore, we noted a lack of research focusing on the role of social media campaigns in public health awareness and public protection against the COVID-19 pandemic in Jordan as a developing country.

Objective

The purpose of this study was to examine the influence of social media platforms on public health protection against the COVID-19 pandemic via public health awareness and public health behavioral changes as mediating factors in Jordan.

Methods

A quantitative approach and several social media platforms were used to collect data via web questionnaires in Jordan, and a total of 2555 social media users were sampled. This study used structural equation modeling to analyze and verify the study variables.

Results

The main findings revealed that the use of social media platforms had a significant positive influence on public health protection against COVID-19 as a pandemic. Public health awareness and public health behavioral changes significantly acted as partial mediators in this relationship. Therefore, a better understanding of the effects of the use of social media interventions on public health protection against COVID-19 while taking public health awareness and behavioral changes into account as mediators should be helpful when developing any health promotion strategy plan.

Conclusions

Our findings suggest that the use of social media platforms can positively influence awareness of public health behavioral changes and public protection against COVID-19. Public health authorities may use social media platforms as an effective tool to increase public health awareness through dissemination of brief messages to targeted populations. However, more research is needed to validate how social media channels can be used to improve health knowledge and adoption of healthy behaviors in a cross-cultural context.