Social Media and Multiple Sclerosis in the Posttruth Age

Web-Based Health Information Seeking by People Living With Multiple Sclerosis: Qualitative Investigation of the Multiple Sclerosis Online Course

BACKGROUND

Digital technologies have afforded people living with multiple sclerosis (MS) access to telehealth consultations, diagnostic tools, and monitoring. Although health care professionals remain the most trusted source of information, the internet has emerged as a valuable resource for providing MS-related information, particularly during the COVID-19 pandemic. Notably, people living with MS are increasingly seeking educational content for a range of topics related to the self-management of MS; however, web-based information seeking remains largely underevaluated. To address this gap and ensure that web-based health-related information is accessible and engaging, this study used qualitative methods to analyze the reflections from participants of web-based educational programs for people living with MS.

OBJECTIVE

This study aimed to explore the motivations, behaviors, and expectations of web-based health information seeking for people living with MS.

METHODS

We conducted semistructured interviews for 38 people living with MS 1 month after they completed the novel MS Online Course, which provided information on modifiable lifestyle-related risk factors for people living with MS. Of the 38 participants, 22 (58%) completed the intervention course and 16 (42%) completed the standard care course. Inductive thematic analysis was used within a qualitative paradigm, and 2 authors coded each interview separately and arrived at themes with consensus.

RESULTS

We identified 2 themes: motivation to learn and MS information on the web. The diagnosis of MS was described as a pivotal moment for precipitating web-based information seeking. People living with MS sought lifestyle-related information to facilitate self-management and increase control of their MS. Although social media sites and MS websites were considered useful for providing both support and information, discretion was needed to critically appraise information. Recognizable institutions were frequently accessed because of their trustworthiness.

CONCLUSIONS

This study provided novel insights into the motivations of people living with MS for seeking web-based health information. Furthermore, their preferences for the content and format of the web-based information accessed and their experiences and reactions to this information were explored. These findings may guide educators, researchers, and clinicians involved in MS care to optimize the engagement and processing of web-based health information seeking by people living with MS.

No Evidence of Disease Activity (NEDA) as a Clinical Assessment Tool for Multiple Sclerosis: Clinician and Patient Perspectives [Narrative Review]

The emergence of high-efficacy therapies for multiple sclerosis (MS), which target inflammation more effectively than traditional disease-modifying therapies, has led to a shift in MS management towards achieving the outcome assessment known as no evidence of disease activity (NEDA). The most common NEDA definition, termed NEDA-3, is a composite of three related measures of disease activity: no clinical relapses, no disability progression, and no radiological activity. NEDA has been frequently used as a composite endpoint in clinical trials, but there is growing interest in its use as an assessment tool to help patients and healthcare professionals navigate treatment decisions in the clinic. Raising awareness about NEDA may therefore help patients and clinicians make more informed decisions around MS management and improve overall MS care. This review aims to explore the potential utility of NEDA as a clinical decision-making tool and treatment target by summarizing the literature on its current use in the context of the expanding treatment landscape. We identify current challenges to the use of NEDA in clinical practice and detail the proposed amendments, such as the inclusion of alternative outcomes and biomarkers, to broaden the clinical information captured by NEDA. These themes are further illustrated with the real-life perspectives and experiences of our two patient authors with MS. This review is intended to be an educational resource to support discussions between clinicians and patients on this evolving approach to MS-specialized care.

The effect of Covid-19 in digital media use of Finnish physicians - Four wave longitudinal panel survey

BACKGROUND

Covid-19 pandemic has boosted digitalization in healthcare, as mobility restrictions and social distancing rules have made healthcare providers to adopt digital tools to replace or complement face-to-face interactions.

PURPOSE

We discuss the effects of Covid-19 pandemic on physicians' use of digital media. We examine whether Covid-19 conditions have changed how physicians use internet resources for information search, how they engage in social media, and their attitude towards online events.

BASIC PROCEDURES

The study was done as a longitudinal panel survey in four waves. The sample was a panel including active physicians in Finland. The panel was updated annually. Identical surveys were administered in 2018, 2019, 2020 and 2021. Spring 2020 was the time when Finland executed mobility restrictions and re-organization of healthcare because of pandemic. Comparing results of the survey before and after Covid-19 restrictions gives us a unique opportunity to do comparative analysis of Covid-19 effects.

MAIN FINDINGS

Our results show that the use of digital media for information search stayed relatively stable without statistically significant change during the four-year period covered in the study. The use of social media rose steadily from 2018 to 2021 with no significant difference in the trend. However, there was a significant change in the attitude of Finnish physicians on online events. Year 2021, the attitude remained in this more positive level.

PRINCIPAL CONCLUSIONS

As use of digital media including social media was already high prior Covid-19 in Finland, our results do not show significant change because of special circumstances introduced in 2020. However, our results show that the attitudes towards online events turned more positive during Covid-19 related restrictions. This could indicate that Covid-19 era has triggered a change that might continue also when pandemic related restrictions will be removed.

User concerns regarding information sharing on social networking sites: The user's perspective in the context of national culture

Information sharing via social networking systems (SNS) is a common practice among academics, as well as others, that brings substantial benefits. At the same time, privacy concerns are widespread among SNS users, which may tend to inhibit their maximising the benefit from using the systems. This paper investigates the proposition that SNS user attitudes and behaviour are affected by privacy concerns, and that the effects are subject to significant cultural factors. A broad assessment of the literature provides the context for the study. Working in the context of Saudi Arabia, we apply a mixed-methods approach beginning with in-depth interviews, exposing in detail a range of views and concerns about privacy and SNS use, also allowing us to identify three key factors that bear on SNS usage and users’ concerns. Analysis of these factors in the light of the “theory of reasoned action” derives a structural model predicting several hypotheses relating the factors and users’ attitudes and behaviour. We assess the model through development of a questionnaire, administered to a large pool of academic participants, that allows us to examine how the model responds in general, and via multigroup partial least squares analyses, differentially to gender and to culturally distinct (Arab vs. non-Arab) constituents of the participant group. Results show good support for the hypotheses and clear gender and culture effects. Picking up issues from the interviews, discussion focuses on users’ views about SNS providers’ privacy policies and their inadequacy regarding culturally specific ethical concerns. We argue that these views may reflect different regulatory environments in combination with other cultural factors.

Health co-inquiry in migraine: Online participation and stakeholder experiences before and during the COVID-19 pandemic

A migraine is more than head pain, and chronic migraine can dramatically impact a person and those around her/him/them. To better understand those effects it is important to study the experiences of persons with migraine and their caregivers, family, friends, and health and mental health providers. When they collaborate, stakeholders may improve outcomes for persons with chronic migraine. One type of stakeholder cooperation is Health Co-Inquiry, involving a person-centered approach, activation of persons toward collaboration and improved health, evidence-based practice, and integrated care. The current study investigated Health Co-Inquiry at online forums, blogs, and bulletin boards where people came together to discuss migraine. A "Bifurcated Method" was used to conduct inductive, thematic analyses, quantitize themes, and cross-check themes using a robot program, which crawled the Internet to gather data about stakeholder sites and posts related to migraine. Key themes in the online narratives of migraine stakeholders included seeking and providing advice, help, and information. In addition, giving personal stories and testimonials, selling computer applications and products, and providing misinformation were frequent. Differences in the types of posts by various stakeholder groups were identified and may inform researchers about their varied perspectives and goals. Remarkably, migraine is still migraine-before a pandemic and during it. As such, migraineur concerns remained stable across thematic analyses of blog and forum posts before and during the worldwide COVID-19 pandemic.

Social networks and infectious diseases prevention behavior: A cross-sectional study in people aged 40 years and older

Background

Social networks, i.e., our in-person and online social relations, are key to lifestyle behavior and health, via mechanisms of influence and support from our relations. We assessed associations between various social network aspects and practicing behavior to prevent respiratory infectious diseases.

Methods

We analyzed baseline-data (2019) from the SaNAE-cohort on social networks and health, collected by an online questionnaire in Dutch community-dwelling people aged 40–99 years. Outcome was the number of preventive behaviors in past two months [range 0–4]. Associations between network aspects were tested using ordinal regression analyses, adjusting for confounders.

Results

Of 5,128 participants (mean age 63; 54% male), 94% regularly washed hands with water and soap, 55% used only paper (not cloth) handkerchiefs/tissues; 19% touched their face as little as possible; 39% kept distance from people with respiratory infectious disease symptoms; median score of behaviors was 2. Mean network size was 11 (46% family; 27% friends); six network members were contacted exclusively in-person and two exclusively via phone/internet. Participants received informational, emotional, and practical support from four, six, and two network members, respectively. Independently associated with more preventive behaviors were: ‘strong relationships’, i.e., large share of friends and aspects related to so called ‘weak relationships’, a larger share of distant living network members, higher number of members with whom there was exclusively phone/internet contact, and more network members providing informational support. Club membership and a larger share of same-aged network members were inversely associated.

Conclusion

Friends (‘strong’ relationships) may play an important role in the adoption of infection-preventive behaviors. So may ‘weak relationships’, e.g. geographically more distant network members, who may provide informational support as via non-physical modes of contact. Further steps are to explore employment of these types of relationships when designing infectious diseases control programs aiming to promote infection-preventive behavior in middle aged-and older individuals.

Public Engagement and Neurology: An Update

BACKGROUND

Public engagement (PE) is defined as the involvement of "specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters". The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases.

METHOD

This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson's disease, migraine, neurogenetics, and amyotrophic lateral sclerosis.

RESULTS AND CONCLUSIONS

PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.

Googling for Neurological Disorders: From Seeking Health-Related Information to Patient Empowerment, Advocacy, and Open, Public Self-Disclosure in the Neurology 2.0 Era

Since its introduction, the internet has played a major role in reshaping patient-physician communication and interactions, having fostered a shift from a paternalistic to a patient-centered model. Because of its dynamic nature, the internet has been used as a platform to not only disseminate knowledge—favored by improved access to an increasing wealth of available resources—but also to spread advocacy and awareness, contribute to fund-raising, and facilitate open, public self-disclosure of one’s own disease, thus eliminating any taboo and reducing the stigma associated with it. The era of Medicine 2.0 is characterized by openness, collaboration, participation, and social networking. The current situation is completely different from the time when Lorenzo Odone’s parents, after his diagnosis of adrenoleukodystrophy, decided to attend medical school in order to collect information about a devastating, unknown disease and had to contend with medical authorities at that establishment to convince them of the alleged effectiveness and safety of their discovered therapeutics. Orphan and rare neurological diseases have currently received recognition on web-based resources. However, while the intention is not to ridicule Odone’s family legacy and the “complicated lessons” they have reported, some issues should be carefully addressed by health authorities, such as the reputability, reliability, and accuracy of material available on the internet and prevention of the dissemination of material that could instill illusions and unjustified hopes in individuals seeking medical treatment. Neurologists should be aware of such digital resources, participate in web-based activities, and recommend select high-quality websites to their patients.

"I Will Respect the Autonomy of My Patient": A Scoping Review of Shared Decision Making in Multiple Sclerosis

Background

Patient autonomy is a bioethical principle that was strengthened in the revised Declaration of Geneva. Shared decision making (SDM) is particularly relevant in the management of multiple sclerosis (MS) because many preference-sensitive decisions have to be made during the disease course. We aimed to summarize the available evidence on SDM in the MS field and to inform future research and practice.

Methods

We performed a scoping review by searching MEDLINE (past 5 years). Studies were included if they reported primary/secondary research and focused on SDM related to people with MS. Data were grouped into topics, with results presented in narrative form.

Results

From 865 references, we included 55 studies conducted mostly in Europe. Half of the studies were observational, followed by qualitative (20%), mixed-methods (17%), randomized controlled trials (RCTs, 5%), quasi-experimental (5%), and reviews (4%). Most studies addressed people with relapsing-remitting MS (85%); the remaining addressed health care professionals, patients' significant others, or a combination. We identified five main topics: decisions on disease-modifying drugs, decisions on chronic cerebrospinal venous insufficiency treatment, information provision and patient education, health literacy, and risk knowledge.

Conclusions

The high proportion of included studies on SDM in MS in Europe suggests an earlier adoption of these concepts in this area. Decisions on disease-modifying drugs was the prevalent topic. Only 5% of studies were RCTs, indicating that more research is needed to study the effectiveness of SDM interventions. Studies addressing people with primary and secondary progressive MS are also needed.

The impact of social media use on depression in multiple sclerosis patients

Social media is a powerful tool in providing information and support for minority groups such as patients with chronic diseases. We aimed to assess the link between using online social media and depression in a sample population of Iranian Multiple Sclerosis (MS) patients. In this cross-sectional study, a number of MS patients between 18-55 years were recruited. The Persian-language version of the Beck Depression Inventory-II (BDI-II-Persian) was used to screen MS patients for depression. We selected a cut-off point of 16 to identify depressed MS patients, who answered the self-administered questionnaire designed by the authors (the validity and reliability was confirmed before). Patients, whose interaction with social networks and communication tools was limited to < 1 h/day for < 5 times/month, were allocated as controls. A two-sided p < 0.05 was considered statistically significant. We compared the depression score between patients who used internet and social media (16.38 ± 8.35) with those who did not (25 ± 13.98). We found out there was a significant difference (p = 0.046). However, there were no significant differences between the type (r = 0.098, p = 0.513) and duration (r = - 0.102, p = 0.564) of social media with depression score. Also, based on a cut-off of 3 number of social media there was no significant difference in the status of depression among patients (p = 0.921). Based on the experience of patients, it is helpful to implement a source using online social media to facilitate patients' access to rehabilitation support and establish support groups with standard supervised information delivery.

Multiple sclerosis coverage in the written media of a low prevalence country

BACKGROUND

Awareness in the community is an important factor across a wide range of diseases and the communication media have an important role in its promotion. However, misinformation and misguide may take place heightening the expectations of people affected by chronic conditions such as multiple sclerosis (MS). This study explores media coverage of MS in a low prevalence country.

METHODS

We identified the most important written media at national and local levels and performed a search in their digital archives and social media with the words "Multiple Sclerosis". The articles found were categorized as relevant, and non-relevant. We describe the total number, number of relevant and non-relevant articles published every year, since the earliest found until 2018. We identified the topics covered by the relevant articles and described their distribution and performed a quality evaluation of their content.

RESULTS

We reviewed the archives of 20 sources. A total of 976 articles where MS was mentioned were reviewed (relevant: 143 [14.6%]; non-relevant: 833 [85.4%]). We observed a steady increase in the annual publication rate, from the first in 1991 up to 107 in 2018. The most frequent covered topic was disease modifying therapies and MS itself, and the least documented topic was rehabilitation. Most of the relevant articles had low quality scores.

CONCLUSION

The media coverage of different topics MS has risen steadily since its first appearance in the early nineties. This should be encouraged, but caution should be held so misinformation is not propagated. We call for the public to discuss misleading information with their healthcare providers.

A cross-sectional survey among physicians on internet use for epilepsy-related information

OBJECTIVE

We investigated views towards the Internet in a sample of Italian healthcare specialists involved in epilepsy field, to identify factors associated with the attitude of being influenced by information found on the Internet.

METHODS

This study was a self-administered survey conducted in a group of members of the Italian Chapter of the International League Against Epilepsy (ILAE) in January 2018.

RESULTS

184 questionnaires were analyzed. 97.8 % of responders reported to seek online information on epilepsy. The Internet was most frequently searched to obtain new information (69.9 %) or to confirm a diagnostic or therapeutic decision (37.3 %). The influence of consulting the Internet on clinical practice was associated with registration to social network(s) (OR: 2.94; 95 %CI: 1.28-6.76; p = 0.011), higher frequency of Internet use (OR: 3.66; 95 %CI: 1.56-9.21; p = 0.006) and higher confidence in reliability of online information (OR: 2.61; 95 %CI: 1.09-6.26; p = 0.031). No association was found with age, sex, years in epilepsy practice or easiness to find online information.

CONCLUSION

Internet is frequently used among healthcare professionals involved in the epilepsy to obtain information about this disease. The attitude of being influenced by the Internet for diagnostic and/or therapeutic decisions in epilepsy is independent on age and years of experience in epilepsy, and probably reflects an individual approach towards the Web.

Are Health e-Mavens the New Patient Influencers?

Even though the healthcare industry is usually considered a rather traditional and slowly evolving sector, change is happening. Digitalization is transforming the way of obtaining medical advice and treatment and the Internet has become a key source for the seeking of healthcare information. It has allowed people to turn into more active collaborators in matters of their own health by enabling them to easily search and share information with other patients. Although research points out the growing importance of user-generated content in many sectors and its positive impact on information credibility, trust, engagement, and, ultimately, customer behavior (Malthouse et al., 2016), there is a lack of attention to this topic in healthcare. In this brief review, we address this gap by analyzing the role of health e-mavens, which are a particular type of influencers that possesses both expertise and online social influence. We lastly illustrate possible benefits of their impact on other to the different parties involved and affected by this phenomenon.

Crowdsourcing in medical research: concepts and applications

Crowdsourcing shifts medical research from a closed environment to an open collaboration between the public and researchers. We define crowdsourcing as an approach to problem solving which involves an organization having a large group attempt to solve a problem or part of a problem, then sharing solutions. Crowdsourcing allows large groups of individuals to participate in medical research through innovation challenges, hackathons, and related activities. The purpose of this literature review is to examine the definition, concepts, and applications of crowdsourcing in medicine. This multi-disciplinary review defines crowdsourcing for medicine, identifies conceptual antecedents (collective intelligence and open source models), and explores implications of the approach. Several critiques of crowdsourcing are also examined. Although several crowdsourcing definitions exist, there are two essential elements: (1) having a large group of individuals, including those with skills and those without skills, propose potential solutions; (2) sharing solutions through implementation or open access materials. The public can be a central force in contributing to formative, pre-clinical, and clinical research. A growing evidence base suggests that crowdsourcing in medicine can result in high-quality outcomes, broad community engagement, and more open science.

Mapping tweets to a known disease epidemiology; a case study of Lyme disease in the United Kingdom and Republic of Ireland

BACKGROUND

Analysis of social media is an emerging method with potential as a tool for disease surveillance. Twitter may offer a route for surveillance by using tweeting habits as a proxy for disease incidence. Previous work has focused on temporal patterns and have proven to be successful. However, the identification of geographical patterns has been limited by a combination of Twitter's data collection policies and by exploring diseases that have a high prevalence and high levels of awareness with the public. We propose that, by performing a restricted geographical search strategy on a disease with a relatively low incidence, one may be able to explore spatial patterns. Here, Lyme disease in the United Kingdom and the Republic of Ireland is used as a case example.

OBJECTIVE

To explore whether the tweeting habits of British and Irish Twitter users matched the known spatio-temporal epidemiology of Lyme disease in these respective countries.

METHODS

All Tweets containing the word 'Lyme' were collected between the 1st of July 2017 and the 30th June 2018, restricted by geography (a 375-mile radius around the geographical centre of Great Britain) and by language (English-only tweets). Tweets were removed which referred to locations that included 'Lyme' within their name (e.g. Lyme Regis). Only original tweets were analysed. Daily and monthly time series were created and compared to national Lyme disease surveillance figures. A map of the number of Twitter users tweeting about Lyme disease per 100,000 population per local authority was created. This was formerly compared to national surveillance data for England and Wales using an exploratory spatial data analysis approach.

RESULTS

During the study period, 13,757 original tweets containing the word 'Lyme', and excluding place names relating to Lyme, were collected. The mean number of daily tweets was 38 (range: 12-276). There was strong seasonality with the highest number of tweets in the summer, this matched the known epidemiology of Lyme disease. Of the 5212 of users who tweeted about Lyme disease, 51.8% had a user profile location that could be matched to a local authority in the United Kingdom or Republic of Ireland. The mean number of Twitter users tweeting about Lyme disease per 100,000 population per local authority was 3.7. The areas with the highest incidence were south-west England and the Highlands of Scotland. When comparing these figures to English and Welsh Lyme disease surveillance figures they showed a significant positive spatial correlation (p = 0.002).

CONCLUSIONS

The tempo-spatial pattern of Twitter users tweeting about Lyme disease matches the known disease epidemiology. The degree of geographical concordance between Twitter users' locations and national surveillance reports, indicate that Twitter has the potential to be used in to identify potential disease hotspots based on the levels of social media 'noise'. There is scope for further work to test the robustness of Twitter as an adjunct 'measure of concern' disease surveillance tool. However, caution must be taken as national media stories can skew data and Twitter users may not provide reliable facts in the data that they share on the platform.

Patient Power Revolution in Multiple Sclerosis: Navigating the New Frontier

A debate on shared decision making in multiple sclerosis (MS) was led by a patient advocate and leading neurologists from the MS in the 21st Century Steering Group. Key themes and salient points which emerged from the debate and audience discussions are reported in this article. Arguments against shared decision making included the fact that physicians study and practice for years to reach their level of expertise, and that the level of understanding required to make these decisions may not be possible to communicate to patients within time-limited consultations. Furthermore, unreliable online information, information overload or information with marketing bias may also cloud patients' judgements. Arguments for patient engagement focussed on how ownership of decisions can lead to improved adherence and outcomes, and a strengthening of the physician-patient relationship. Shared decision making requires educating patients to make informed decisions and to understand the risks and consequences of their choices. However, shared decision making may not be the correct option for every patient, and the level of involvement must be driven by the patient. To support patients' engagement and promote responsible management of their condition, physicians need to (1) foster and maintain a positive, ongoing relationship with their patients, and (2) provide patients with timely, accurate, and understandable information. There was broad agreement that the patient voice should be heard more in discussions around the future of MS care. MS in the 21st Century offers a model for patient involvement in partnership with MS healthcare specialists, and the steering group is currently considering these issues and developing tools and solutions to enhance patient-physician communication and relationships. Funding Merck KGaA, Darmstadt, Germany.

Impact of early diagnosis on clinical characteristics of an Italian sample of people with multiple sclerosis recruited online

BACKGROUND

In order to anticipate the diagnosis of Multiple Sclerosis (MS), the diagnostic criteria had been reviewed several times in the last years.

OBJECTIVE

We wanted to understand whether earlier diagnoses of MS have impacted on therapeutic management of the disease.

METHODS

We designed a 22-item survey posted on SMsocialnetwork, a webplatform with a medical supervision, dedicated to Italian MS patients. We collected socio-demographic data, disease and treatment-related information of 1000 patients.

RESULTS

The median age at diagnosis significantly decreased over years. In the last decades the time delay between disease onset and diagnosis reduced, the disease phenotypes at diagnosis shifted from progressive form to relapsing ones and clinically isolated syndrome, the number of early treated patients increased over time.

CONCLUSION

We showed, verifying a large sample of patients in a reallife setting, that the improvement of the diagnostic process allowed the anticipation of MS diagnosis over years and had a huge impact in terms of treatment approach.

e-Health and multiple sclerosis: An update

e-Health (or digital healthcare) is becoming increasingly relevant in multiple sclerosis (MS) clinical management. We aim to review and discuss current status and future perspective of e-health in people with multiple sclerosis (pwMS). The first part of this review describes how information on MS can be conveyed through the Web and digital media. The second part illustrates recent advances in digital technology that can improve clinical management and in motor and cognitive rehabilitation of pwMS. Finally, this review advocates future development of the "digital case manager" as a new figure to coordinate clinical management and care of pwMS. The digital revolution is changing the medical approach to MS in terms of information conveying and sharing, rehabilitation, and healthcare management.