The conceptual and practical ethical dilemmas of using health discussion board posts as research data

Reporting of Ethical Considerations in Qualitative Research Utilizing Social Media Data on Public Health Care: Scoping Review

BACKGROUND

The internet community has become a significant source for researchers to conduct qualitative studies analyzing users' views, attitudes, and experiences about public health. However, few studies have assessed the ethical issues in qualitative research using social media data.

OBJECTIVE

This study aims to review the reportage of ethical considerations in qualitative research utilizing social media data on public health care.

METHODS

We performed a scoping review of studies mining text from internet communities and published in peer-reviewed journals from 2010 to May 31, 2023. These studies, limited to the English language, were retrieved to evaluate the rates of reporting ethical approval, informed consent, and privacy issues. We searched 5 databases, that is, PubMed, Web of Science, CINAHL, Cochrane, and Embase. Gray literature was supplemented from Google Scholar and OpenGrey websites. Studies using qualitative methods mining text from the internet community focusing on health care topics were deemed eligible. Data extraction was performed using a standardized data extraction spreadsheet. Findings were reported using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines.

RESULTS

After 4674 titles, abstracts, and full texts were screened, 108 studies on mining text from the internet community were included. Nearly half of the studies were published in the United States, with more studies from 2019 to 2022. Only 59.3% (64/108) of the studies sought ethical approval, 45.3% (49/108) mentioned informed consent, and only 12.9% (14/108) of the studies explicitly obtained informed consent. Approximately 86% (12/14) of the studies that reported informed consent obtained digital informed consent from participants/administrators, while 14% (2/14) did not describe the method used to obtain informed consent. Notably, 70.3% (76/108) of the studies contained users' written content or posts: 68% (52/76) contained verbatim quotes, while 32% (24/76) paraphrased the quotes to prevent traceability. However, 16% (4/24) of the studies that paraphrased the quotes did not report the paraphrasing methods. Moreover, 18.5% (20/108) of the studies used aggregated data analysis to protect users' privacy. Furthermore, the rates of reporting ethical approval were different between different countries (P=.02) and between papers that contained users' written content (both direct and paraphrased quotes) and papers that did not contain users' written content (P<.001).

CONCLUSIONS

Our scoping review demonstrates that the reporting of ethical considerations is widely neglected in qualitative research studies using social media data; such studies should be more cautious in citing user quotes to maintain user privacy. Further, our review reveals the need for detailed information on the precautions of obtaining informed consent and paraphrasing to reduce the potential bias. A national consensus of ethical considerations such as ethical approval, informed consent, and privacy issues is needed for qualitative research of health care using social media data of internet communities.

Patient listening on social media for patient-focused drug development: a synthesis of considerations from patients, industry and regulators

Patients, life science industry and regulatory authorities are united in their goal to reduce the disease burden of patients by closing remaining unmet needs. Patients have, however, not always been systematically and consistently involved in the drug development process. Recognizing this gap, regulatory bodies worldwide have initiated patient-focused drug development (PFDD) initiatives to foster a more systematic involvement of patients in the drug development process and to ensure that outcomes measured in clinical trials are truly relevant to patients and represent significant improvements to their quality of life. As a source of real-world evidence (RWE), social media has been consistently shown to capture the first-hand, spontaneous and unfiltered disease and treatment experience of patients and is acknowledged as a valid method for generating patient experience data by the Food and Drug Administration (FDA). While social media listening (SML) methods are increasingly applied to many diseases and use cases, a significant piece of uncertainty remains on how evidence derived from social media can be used in the drug development process and how it can impact regulatory decision making, including legal and ethical aspects. In this policy paper, we review the perspectives of three key stakeholder groups on the role of SML in drug development, namely patients, life science companies and regulators. We also carry out a systematic review of current practices and use cases for SML and, in particular, highlight benefits and drawbacks for the use of SML as a way to identify unmet needs of patients. While we find that the stakeholders are strongly aligned regarding the potential of social media for PFDD, we identify key areas in which regulatory guidance is needed to reduce uncertainty regarding the impact of SML as a source of patient experience data that has impact on regulatory decision making.

Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review

BACKGROUND

International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses.

OBJECTIVE

This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses.

METHODS

A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach.

RESULTS

Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level.

CONCLUSIONS

There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.

Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care

Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics.

Ethical considerations and methodological uses of Facebook data in public health research: A systematic review

OBJECTIVE

Since 2016, around seven in 10 adults in the United States (U.S.) actively use Facebook. While much Facebook data is publicly available for research, many users may not understand how their data are being used. We sought to examine to what extent research ethical practices were employed and the research methods being used with Facebook data in public health research.

METHODS

We conducted a systematic review (PROSPERO registration CRD42020148170) of social media-based public health research focused on Facebook published in peer-reviewed journals in English between January 1, 2006 and October 31, 2019. We extracted data on ethical practices, methodology, and data analytic approaches. For studies that included verbatim user content, we attempted to locate users/posts within a timed 10-min period.

RESULTS

Sixty-one studies met eligibility criteria. Just under half (48%, n = 29) sought IRB approval and six (10%) sought and obtained informed consent from Facebook users. Users' written content appeared in 39 (64%) papers, of which 36 presented verbatim quotes. We were able to locate users/posts within 10 min for half (50%, n = 18) of the 36 studies containing verbatim content. Identifiable posts included content about sensitive health topics. We identified six categories of analytic approaches to using these data: network analysis, utility (i.e., usefulness of Facebook as a tool for surveillance, public health dissemination, or attitudes), associational studies of users' behavior and health outcomes, predictive model development, and two types of content analysis (thematic analysis and sentiment analysis). Associational studies were the most likely to seek IRB review (5/6, 83%), while those of utility (0/4, 0%) and prediction (1/4, 25%) were the least likely to do so.

CONCLUSIONS

Stronger guidance on research ethics for using Facebook data, especially the use of personal identifiers, is needed.

Attitudes of Swedish Language Twitter Users Toward COVID-19 Vaccination: Exploratory Qualitative Study

Background

Social media have played an important role in shaping COVID-19 vaccine choices during the pandemic. Understanding people’s attitudes toward the vaccine as expressed on social media can help address the concerns of vaccine-hesitant individuals.

Objective

The aim of this study was to understand the attitudes of Swedish-speaking Twitter users toward COVID-19 vaccines.

Methods

This was an exploratory qualitative study that used a social media–listening approach. Between January and March 2022, a total of 2877 publicly available tweets in Swedish were systematically extracted from Twitter. A deductive thematic analysis was conducted using the World Health Organization’s 3C model (confidence, complacency, and convenience).

Results

Confidence in the safety and effectiveness of the COVID-19 vaccine appeared to be a major concern expressed on Twitter. Unclear governmental strategies in managing the pandemic in Sweden and the belief in conspiracy theories have further influenced negative attitudes toward vaccines. Complacency—the perceived risk of COVID-19 was low and booster vaccination was unnecessary; many expressed trust in natural immunity. Convenience—in terms of accessing the right information and the vaccine—highlighted a knowledge gap about the benefits and necessity of the vaccine, as well as complaints about the quality of vaccination services.

Conclusions

Swedish-speaking Twitter users in this study had negative attitudes toward COVID-19 vaccines, particularly booster vaccines. We identified attitudes toward vaccines and misinformation, indicating that social media monitoring can help policy makers respond by developing proactive health communication interventions.

Use of Online Health Forums by People Living With Breast Cancer During the COVID-19 Pandemic: Thematic Analysis

BACKGROUND

At the time of the UK COVID-19 lockdowns, online health forums (OHFs) were one of the relatively few remaining accessible sources of peer support for people living with breast cancer. Cancer services were heavily affected by the pandemic in many ways, including the closure of many of the customary support services. Previous studies indicate that loneliness, anxiety, distress, and depression caused by COVID-19 were common among people living with breast cancer, and this suggests that the role of OHFs in providing users with support, information, and empathy could have been of increased importance at that time.

OBJECTIVE

This study aimed to examine how people living with breast cancer shared information, experiences, and emotions in an OHF during the COVID-19 pandemic.

METHODS

This qualitative study thematically analyzed posts from the discussion forums of an OHF provided by the UK charity, Breast Cancer Now. We selected 1053 posts from the time of 2 UK lockdowns: March 16, 2020, to June 15, 2020 (lockdown 1), and January 6, 2021, to March 8, 2021 (lockdown 3), for analysis, from 2 of the forum's boards (for recently diagnosed people and for those undergoing chemotherapy). We analyzed the data using the original 6 steps for thematic analysis by Braun and Clarke but by following a codebook approach. Descriptive statistics for posts were also derived.

RESULTS

We found that COVID-19 amplified the forum's value to its users. As patients with cancer, participants were in a situation that was "bad enough already," and the COVID-19 pandemic heightened this difficult situation. The forum's value, which was already high for the information and peer support it provided, increased because COVID-19 caused some special information needs that forum users were uniquely well placed to fulfill as people experiencing the combined effects of having breast cancer during the pandemic. The forum also met the emotional needs generated by the COVID-19 pandemic and was valued as a place where loneliness during the pandemic may be relieved and users' spirits lifted in a variety of ways specific to this period. We found some differences in use between the 2 periods and the 2 boards-most noticeable was the great fear and anxiety expressed at the beginning of lockdown 1. Both the beginning and end of lockdown periods were particularly difficult for participants, with the ends seen as potentially increasing isolation.

CONCLUSIONS

The forums were an important source of support and information to their users, with their value increasing during the lockdowns for a variety of reasons. Our findings will be helpful to organizations offering OHFs and to health care workers advising people living with breast cancer about sources of support.

Breaking up with my idol: A qualitative study of the psychological adaptation process of renouncing fanship

Introduction

This study aimed to explore the psychological adaptation process of renouncing fanship due to para-loveshock in the context of fandom culture.

Methods

We adopted netnography to explore social media platforms used by fans in China (Weibo, WeChat, and Douban) as research fields for 3 years.

Results

(1) The process of "breaking up with" or renouncing an idol can be divided into three phases: the resistance phase with acute stress, the negotiation phase with bargaining, and the recovery phase with attachment reconstruction. In the resistance phase, fans displayed acute stress responses due to loveshock in psychological, physical, and behavioral aspects. In the negotiation phase, fans faced four barriers to renouncement: cognitive dissonance, emotional attachment, behavioral dependence, and social threat. They bargained within the three types of cognitive framework before deciding to "leave" or "re-follow" their idol. In the recovery phase, fans adopted two types of strategies to promote recovery: healing the past and facing the future. Healing the past involved public outcry, sharing their breakup plans, cognitive reconstruction, and seeking closure to the fan role. Facing the future involved switching environments, seeking new interests, and inhibiting the re-intrusion of trauma cues. (2) Internal factors affecting the psychological adaptation process of renouncement include the level of initiative, attribution styles, experience, attachment status and core belief systems, and alternative lifestyles; external factors include social support, peer pressure from the fan community, life stressors, and types and impact of traumatic events. (3) Based on the two dimensions of orientation and commitment, fans were classified into four types: short-term rational, short-term passionate, bounded loyal, and unconditionally loyal, corresponding to non-traumatic, stressful, accumulated, and traumatic breakup processes, respectively. (4) The post-renouncement growth of fans mainly manifested in the development of mental modes, coping skills toward trauma, emotional adaptation experience, and behavior patterns.

Implications

This investigation of the recovery process from para-loveshock after renouncement of fanship can provide theoretical and practical insights into the development of psychological resilience for fans, reduction of the psychological distress and negative outcomes, and public governance on social media platform and cyber pop culture industry.

Lifestyle medicine pillars as predictors of psychological flourishing

Positive Psychology Interventions (PPI) are widely applied to improving wellbeing and helping individuals flourish. At the same time, Lifestyle Medicine (LM) offers an opportunity to boost PPI and psychological research, by expanding its capacity beyond psychology, to include the body and social environment. However, little is known about the relationship between LM and positive psychology flourishing models. Flourishing is as a stage of optimal human functioning that goes beyond moderate wellbeing. The objective of this cross-sectional study was to, (1) identify which of the six LM pillars (sleep, physical exercise, eating well, alcohol intake, social engagement, stress management) best-predicted flourishing; (2) examine the relationship between the number of LM pillars used by individuals and flourishing; and (3) determine the odds of using LM pillars by flourishers. A total of 1,112 participants, mostly female professionals (73%), aged 40-59 (77%), based in Ireland, completed an online survey. Regression analysis showed that all six LM pillars predicted flourishing as measured by the PERMA Profiler (including the Physical Health component) and the Mental Health Continuum (MHC). Moreover, the chi-square and odds ratio analysis showed that those who flourished were three times more likely to use 3-6 LM pillars than those who were moderately well; and nine times more likely than languishers. The results are discussed in the context of their contribution to enhancing the population's health and wellbeing.

'As Long as It's Used for Beneficial Things': An Investigation of non-Māori, Māori and Young People's Perceptions Regarding the Research use of the Aotearoa New Zealand Integrated Data Infrastructure (IDI)

The Aotearoa New Zealand Integrated Data Infrastructure (IDI) is a national database containing a wide range of data about people and households. There is limited information about public views regarding its use for research.A qualitative study was undertaken to examine the views of forty individuals attending a large hospital in Auckland, including those of Māori ethnicity and young people. Semi-structured interview data were analysed using Braun and Clarke's method of thematic analysis.Seven key themes emerged: 1) Limited knowledge about medical data held in national databases; 2) Conditional support for the use of the IDI, including for research; 3) Concerns regarding the misuse of IDI data; 4) The importance of privacy; 5) Different views regarding consent for use of data for research; 6) Desire for access to personal data and the results of research; and 7) Concerns regarding third party and commercial use. Young people and those of Māori ethnicity were more wary of data misuse than others.Although there is reasonable support for the secondary use of public administrative data in the IDI for research, there is more work to be done to ensure ethical and culturally appropriate use of this data via improved consent privacy management processes and researcher training.

Toward an Ethical Framework for the Text Mining of Social Media for Health Research: A Systematic Review

Background: Text-mining techniques are advancing all the time and vast corpora of social media text can be analyzed for users' views and experiences related to their health. There is great promise for new insights into health issues such as drug side effects and spread of disease, as well as patient experiences of health conditions and health care. However, this emerging field lacks ethical consensus and guidance. We aimed to bring together a comprehensive body of opinion, views, and recommendations in this area so that academic researchers new to the field can understand relevant ethical issues. Methods: After registration of a protocol in PROSPERO, three parallel systematic searches were conducted, to identify academic articles comprising commentaries, opinion, and recommendations on ethical practice in social media text mining for health research and gray literature guidelines and recommendations. These were integrated with social media users' views from qualitative studies. Papers and reports that met the inclusion criteria were analyzed thematically to identify key themes, and an overarching set of themes was deduced. Results: A total of 47 reports and articles were reviewed, and eight themes were identified. Commentators suggested that publicly posted social media data could be used without consent and formal research ethics approval, provided that the anonymity of users is ensured, although we note that privacy settings are difficult for users to navigate on some sites. Even without the need for formal approvals, we note ethical issues: to actively identify and minimize possible harms, to conduct research for public benefit rather than private gain, to ensure transparency and quality of data access and analysis methods, and to abide by the law and terms and conditions of social media sites. Conclusion: Although social media text mining can often legally and reasonably proceed without formal ethics approvals, we recommend improving ethical standards in health-related research by increasing transparency of the purpose of research, data access, and analysis methods; consultation with social media users and target groups to identify and mitigate against potential harms that could arise; and ensuring the anonymity of social media users.

Factors influencing research data communication on Zika virus: a grounded theory

Purpose

The purpose of this paper is to propose a theoretical model to illustrate factors influencing research data communication on diseases caused by the Zika virus.

Design/methodology/approach

The grounded theory methodology was adopted. For data collection, interviews were conducted with 13 Brazilian researchers involved with the Zika virus theme. Data analysis was performed using the open, axial and selective coding processes, according to the principles of the grounded theory.

Findings

Based on data collection and analysis, seven theoretical categories representing intervening factors in Zika virus research data communication were identified. The emerging theory showed the centrality of researchers’ expectations for acknowledgment and reward, influenced by the aspects of research funding and academic culture. Three factors involved in the macro processes of research data communication: data use, data production and data sharing. In the use and production processes, factors related to collaboration figured most strongly. In the production and sharing processes, the factors regarding data processing and the use of research data repositories were more pronounced. Finally, data sharing, and the possibility of reusing data are directly affected by the social context of Zika virus disease as an emerging disease.

Originality/value

The study presents a theory developed systematically to explain the phenomenon of communication of research data on Zika virus. The theory presents a set of intervening factors of the process of communication of research data and discusses the factors in light of the fundamentals of information science.

Bi-submodular Optimization (BSMO) for Detecting Drug-Drug Interactions (DDIs) from On-line Health Forums

Online health discussion forums as information exchange repository are used by different patient groups for sharing experience and seeking advice. Their accessibility is tremendously expanded in the last decade with the rapid growth of mobile internet. Among many popular topics, "drug-drug interactions" (DDIs) forum embeds a large number of DDIs hazards patient experienced however not published. In this paper, we intend to uncover the potential DDIs from the online forums and formulate the task as a sub-graph detection problem, such that co-mentioned drugs and symptoms are modeled as vertices, along with the occurrences are modeled as weighted edges. Therefore, a connected sub-graph consisting of both symptoms and drug vertices reveals DDIs occurrence. We then propose a novel bi-submodular function to characterize the likelihood of DDI occurrence within a connected sub-graph and apply an approximated algorithm to resolve the bi-submodular optimization (BSMO). The complexity of the algorithm is nearly linear. Our extensive experiments demonstrate the effectiveness and efficiency of the proposed approach.

Genetic testing for Huntington’s disease: A thematic analysis of online support community messages

Huntington’s disease is a fatal late-onset genetic illness that causes motor, cognitive and psychiatric disorders. Individuals considering genetic testing may benefit from online social support. This study investigates how genetic testing is discussed within health forums. A total of 337 messages written by 58 individuals were analysed using deductive thematic analysis. Discussions examined three themes: deciding to be tested (enquiring about symptoms and starting a new family), preparing for the test (information seeking and attending appointments) and receiving the results (positive and negative results). Forums can reduce the uncertainty of ambiguous symptoms and provide ongoing personalised support before, during and after a genetic test.

Is It Time to Re-Evaluate the Ethics Governance of Social Media Research?

This article reports on a U.K. workshop on social media research ethics held in May 2018. There were 10 expert speakers and an audience of researchers, research ethics committee members, and research institution representatives. Participants reviewed the current state of social media ethics, discussing well-rehearsed questions such as what needs consent in social media research, and how the public/private divide differs between virtual and real-life environments. The lack of answers to such questions was noted, along with the difficulties posed for ethical governance structures in general and the work of research ethics committees in particular. Discussions of these issues enabled the creation of two recommendations. The first is for research ethics committees and journal editors to add the category of ‘data subject research’ to the existing categories of ‘text research’ and ‘human subject research’. This would reflect the fact that social media research does not fall into either of the existing categories and so needs a category of its own. The second is that ethical issues should be considered at all stages of social media research, up to and including aftercare. This acknowledges that social media research throws up a large number of ethical issues throughout the process which, under current arrangements for ethical research governance, risks remaining unaddressed.

An ethical assessment model for digital disease detection technologies

Digital epidemiology, also referred to as digital disease detection (DDD), successfully provided methods and strategies for using information technology to support infectious disease monitoring and surveillance or understand attitudes and concerns about infectious diseases. However, Internet-based research and social media usage in epidemiology and healthcare pose new technical, functional and formal challenges. The focus of this paper is on the ethical issues to be considered when integrating digital epidemiology with existing practices. Taking existing ethical guidelines and the results from the EU project M-Eco and SORMAS as starting point, we develop an ethical assessment model aiming at providing support in identifying relevant ethical concerns in future DDD projects. The assessment model has four dimensions: user, application area, data source and methodology. The model supports in becoming aware, identifying and describing the ethical dimensions of DDD technology or use case and in identifying the ethical issues on the technology use from different perspectives. It can be applied in an interdisciplinary meeting to collect different viewpoints on a DDD system even before the implementation starts and aims at triggering discussions and finding solutions for risks that might not be acceptable even in the development phase. From the answers, ethical issues concerning confidence, privacy, data and patient security or justice may be judged and weighted.

Ethical Issues of Social Media Usage in Healthcare

OBJECTIVE

Social media, web and mobile technologies are increasingly used in healthcare and directly support patientcentered care. Patients benefit from disease self-management tools, contact to others, and closer monitoring. Researchers study drug efficiency, or recruit patients for clinical studies via these technologies. However, low communication barriers in socialmedia, limited privacy and security issues lead to problems from an ethical perspective. This paper summarizes the ethical issues to be considered when social media is exploited in healthcare contexts.

METHODS

Starting from our experiences in social-media research, we collected ethical issues for selected social-media use cases in the context of patient-centered care. Results were enriched by collecting and analyzing relevant literature and were discussed and interpreted by members of the IMIA Social Media Working Group.

RESULTS

Most relevant issues in social-media applications are confidence and privacy that need to be carefully preserved. The patient-physician relationship can suffer from the new information gain on both sides since private information of both healthcare provider and consumer may be accessible through the Internet. Physicians need to ensure they keep the borders between private and professional intact. Beyond, preserving patient anonymity when citing Internet content is crucial for research studies.

CONCLUSION

Exploiting medical social-media in healthcare applications requires a careful reflection of roles and responsibilities. Availability of data and information can be useful in many settings, but the abuse of data needs to be prevented. Preserving privacy and confidentiality of online users is a main issue, as well as providing means for patients or Internet users to express concerns on data usage.

Attitudes Toward the Ethics of Research Using Social Media: A Systematic Review

BACKGROUND

Although primarily used for social networking and often used for social support and dissemination, data on social media platforms are increasingly being used to facilitate research. However, the ethical challenges in conducting social media research remain of great concern. Although much debated in the literature, it is the views of the public that are most pertinent to inform future practice.

OBJECTIVE

The aim of our study was to ascertain attitudes on the ethical considerations of using social media as a data source for research as expressed by social media users and researchers.

METHODS

A systematic review was conducted, wherein 16 databases and 2 Internet search engines were searched in addition to handsearching, reference checking, citation searching, and contacting authors and experts. Studies that conducted any qualitative methods to collect data on attitudes on the ethical implications of research using social media were included. Quality assessment was conducted using the quality of reporting tool (QuaRT) and findings analyzed using inductive thematic synthesis.

RESULTS

In total, 17 studies met the inclusion criteria. Attitudes varied from overly positive with people expressing the views about the essential nature of such research for the public good, to very concerned with views that social media research should not happen. Underlying reasons for this variation related to issues such as the purpose and quality of the research, the researcher affiliation, and the potential harms. The methods used to conduct the research were also important. Many respondents were positive about social media research while adding caveats such as the need for informed consent or use restricted to public platforms only.

CONCLUSIONS

Many conflicting issues contribute to the complexity of good ethical practice in social media research. However, this should not deter researchers from conducting social media research. Each Internet research project requires an individual assessment of its own ethical issues. Guidelines on ethical conduct should be based on current evidence and standardized to avoid discrepancies between, and duplication across, different institutions, taking into consideration different jurisdictions.

Ethics and Privacy Implications of Using the Internet and Social Media to Recruit Participants for Health Research: A Privacy-by-Design Framework for Online Recruitment

Background

The Internet and social media offer promising ways to improve the reach, efficiency, and effectiveness of recruitment efforts at a reasonable cost, but raise unique ethical dilemmas. We describe how we used social media to recruit cancer patients and family caregivers for a research study, the ethical issues we encountered, and the strategies we developed to address them.

Objective

Drawing on the principles of Privacy by Design (PbD), a globally recognized standard for privacy protection, we aimed to develop a PbD framework for online health research recruitment.

Methods

We proposed a focus group study on the dietary behaviors of cancer patients and their families, and the role of Web-based dietary self-management tools. Using an established blog on our hospital website, we proposed publishing a recruitment post and sharing the link on our Twitter and Facebook pages. The Research Ethics Board (REB) raised concern about the privacy risks associated with our recruitment strategy; by clicking on a recruitment post, an individual could inadvertently disclose personal health information to third-party companies engaged in tracking online behavior. The REB asked us to revise our social media recruitment strategy with the following questions in mind: (1) How will you inform users about the potential for privacy breaches and their implications? and (2) How will you protect users from privacy breaches or inadvertently sharing potentially identifying information about themselves?

Results

Ethical guidelines recommend a proportionate approach to ethics assessment, which advocates for risk mitigation strategies that are proportional to the magnitude and probability of risks. We revised our social media recruitment strategy to inform users about privacy risks and to protect their privacy, while at the same time meeting our recruitment objectives. We provide a critical reflection of the perceived privacy risks associated with our social media recruitment strategy and the appropriateness of the risk mitigation strategies that we employed by assessing their alignment with PbD and by discussing the following: (1) What are the potential risks and who is at risk? (2) Is cancer considered “sensitive” personal information? (3) What is the probability of online disclosure of a cancer diagnosis in everyday life? and (4) What are the public’s expectations for privacy online and their views about online tracking, profiling, and targeting? We conclude with a PbD framework for online health research recruitment.

Conclusions

Researchers, REBs, ethicists, students, and potential study participants are often unaware of the privacy risks of social media research recruitment and there is no official guidance. Our PbD framework for online health research recruitment is a resource for these wide audiences.

How a moderated online discussion forum facilitates support for young people with eating disorders

INTRODUCTION

Young people with eating disorders are at risk of harm to their social, emotional and physical development and life chances. Although they can be reluctant to seek help, they may access social media for information, advice or support. The relationship between social media and youth well-being is an emotive subject, but not clearly understood. This qualitative study aimed to explore how young people used a youth-orientated, moderated, online, eating disorders discussion forum, run by an eating disorders charity.

METHODS

We applied a netnographic approach involving downloading and thematically analysing over 400 messages posted August-November 2012.

RESULTS

Data analysis generated five themes: Taking on the role of mentor; the online discussion forum as a safe space; Friendship within the online forum; Flexible help; and Peer support for recovery and relapse prevention. Forum moderation may have influenced the forum culture.

DISCUSSION

Our findings are consistent with literature about youth preferences for mental health self-care support. A young person's decision to use this discussion forum can be construed as pro-active self-care. A moderated online discussion forum can make a positive contribution to support for youth with eating disorders, countering negative media perceptions of online groups.

CONCLUSION

This study adds to knowledge about how young people access support via social media. Online discussion forums can be safe and acceptable spaces for youth to access help. Further research could provide insights into the impact of forum moderation.

"I Always Vet Things": Navigating Privacy and the Presentation of Self on Health Discussion Boards Among Individuals with Long-Term Conditions

Background

The ethics of research into online communities is a long-debated issue, with many researchers arguing that open-access discussion groups are publically accessible data and do not require informed consent from participants for their use for research purposes. However, it has been suggested that there is a discrepancy between the perceived and actual privacy of user-generated online content by community members.

Objective

There has been very little research regarding how privacy is experienced and enacted online. The objective of this study is to address this gap by qualitatively exploring the expectations of privacy on Internet forums among individuals with long-term conditions.

Methods

Semistructured interviews were conducted with 20 participants with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and 21 participants with type 1 and 2 diabetes mellitus, and were analyzed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups.

Results

The findings indicate that privacy online is a nebulous concept. Rather than individuals drawing a clear-cut distinction between what they would and would not be comfortable sharing online, it was evident that these situations were contextually dependent and related to a number of unique and individual factors.

Conclusions

Interviewees were seen to carefully manage how they presented themselves on forums, filtering and selecting the information that they shared about themselves in order to develop and maintain a particular online persona, while maintaining and preserving an acceptable level of privacy.

Online Drug Scenes and Harm Reduction From Below as Phronesis

This article presents a theoretical critique of the notion of harm reduction on the basis of an empirical investigation of a variety of online manifestations of drug culture. Taking a multicase study approach to drug use–related forums, blogs, and “story sites” focused on novel psychoactive substances/“legal high” use and nonmedicinal prescription drug use, our analysis leads us to describe the culture of “harm reduction from below” in terms of the Aristotelian concept of phronesis. We argue that the peer-to-peer co-creation of knowledge, sharing, and support constitutes an emergent and constantly evolving form of “practical wisdom” with respect to drugs. Drawing on Flyvbjerg’s accounts of phronetic social science as a practice, which proposes a permeable boundary between theoretical and practical inquiry, and Stenger’s account of the “collective voice from below” as always embedded within an “ecology of practices,” we offer an interpretation of the online dimension of drug taking in terms of drug users’ shared aim of “doing drugs well.” The investigation of online life in terms of the multiple contexts of drug-related communicative exchange thus allows us to identify harm reduction from below as an ethical practice inherent in a variety of online drug scenes.

The Impact of Personality Factors and Preceding User Comments on the Processing of Research Findings on Deep Brain Stimulation: A Randomized Controlled Experiment in a Simulated Online Forum

Background

Laypeople frequently discuss medical research findings on Web-based platforms, but little is known about whether they grasp the tentativeness that is inherent in these findings. Potential influential factors involved in understanding medical tentativeness have hardly been assessed to date.

Objective

The research presented here aimed to examine the effects of personality factors and of other users’ previous contributions in a Web-based forum on laypeople’s understanding of the tentativeness of medical research findings, using the example of research on deep brain stimulation.

Methods

We presented 70 university students with an online news article that reported findings on applying deep brain stimulation as a novel therapeutic method for depression, which participants were unfamiliar with. In a randomized controlled experiment, we manipulated the forum such that the article was either accompanied by user comments that addressed the issue of tentativeness, by comments that did not address this issue, or the article was accompanied by no comments at all. Participants were instructed to write their own individual user comments. Their scientific literacy, epistemological beliefs, and academic self-efficacy were measured. The outcomes measured were perceived tentativeness and tentativeness addressed in the participants’ own comments.

Results

More sophisticated epistemological beliefs enhanced the perception of tentativeness (standardized β=.26, P=.034). Greater scientific literacy (stand. β=.25, P=.025) and greater academic self-efficacy (stand. β=.31, P=.007) were both predictors of a more extensive discussion of tentativeness in participants’ comments. When forum posts presented in the experiment addressed the issue of tentativeness, participants’ subsequent behavior tended to be consistent with what they had read in the forum, F_2,63=3.66; P=.049, η_p²=.092.

Conclusions

Students’ understanding of the tentativeness of research findings on deep brain stimulation in an online forum is influenced by a number of character traits and by the previous comments that were contributed to the forum by other users. There is potential for targeted modification of traits such as scientific literacy, epistemological beliefs, and academic self-efficacy to foster critical thinking in laypeople who take part in online discussions of medical research findings.

Could Blood Pressure Phobia Go Beyond the White Coat Effect?

BACKGROUND

While it is known that excessive anxiety surrounding the measuring of blood pressure may preclude an accurate measurement, it is not known whether it could also lead to phobic avoidance behavior.

METHODS

Self-reported information was collected on 125 individuals who made postings on 5 internet-based medical forums.

RESULTS

Qualitative thematic analysis revealed that these individuals reported experiencing intense fear associated with the measuring of blood pressure, that was excessive or irrational and which contributed to avoidance of medical treatment and interference with life decisions.

CONCLUSIONS

Based on these preliminary observations, we are speculating that these symptoms could be considered consistent with a diagnosis of a Specific Phobia. Investigations using quantitative methods, representative samples, and standardized clinical instruments need to be conducted before definitive conclusions can be reached.

Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions

Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson’s disease. In this viewpoint paper, we use Parkinson’s disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders.

Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum

Background

The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions.

Objective

We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience.

Methods

By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion.

Results

There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the “downfall of the professional knowledge providers” and (2) the “rise of the nonprofessional treasure trove of experience.” The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions “trust in evidence-based knowledge,” “trust in experience-based knowledge,” and “subjectivity” (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement).

Conclusions

By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information.

Would you tell everyone this? Facebook conversations as health promotion interventions

Background

Health promotion interventions on social networking sites can communicate individually tailored content to a large audience. User-generated content helps to maximize engagement, but health promotion websites have had variable success in supporting user engagement.

Objective

The aim of our study was to examine which elements of moderator and participant behavior stimulated and maintained interaction with a sexual health promotion site on Facebook.

Methods

We examined the pattern and content of posts on a Facebook page. Google analytics was used to describe the number of people using the page and viewing patterns. A qualitative, thematic approach was used to analyze content.

Results

During the study period (January 18, 2010, to June 27, 2010), 576 users interacted 888 times with the site through 508 posts and 380 comments with 93% of content generated by users. The user-generated conversation continued while new participants were driven to the site by advertising, but interaction with the site ceased rapidly after the advertising stopped. Conversations covered key issues on chlamydia and chlamydia testing. Users endorsed testing, celebrated their negative results, and modified and questioned key messages. There was variation in user approach to the site from sharing of personal experience and requesting help to joking about sexually transmitted infection. The moderator voice was reactive, unengaged, tolerant, simplistic, and was professional in tone. There was no change in the moderator approach throughout the period studied.

Conclusions

Our findings suggest this health promotion site provided a space for single user posts but not a self-sustaining conversation. Possible explanations for this include little new content from the moderator, a definition of content too narrow to hold the interest of participants, and limited responsiveness to user needs. Implications for health promotion practice include the need to consider a life cycle approach to online community development for health promotion and the need for a developing moderator strategy to reflect this. This strategy should reflect two facets of moderation for online health promotion interventions: (1) unengaged and professional oversight to provide a safe space for discussion and to maintain information quality, and (2) a more engaged and interactive presence designed to maintain interest that generates new material for discussion and is responsive to user requests.

Innovative uses of electronic health records and social media for public health surveillance

Electronic health records (EHRs) and social media have the potential to enrich public health surveillance of diabetes. Clinical and patient-facing data sources for diabetes surveillance are needed given its profound public health impact, opportunity for primary and secondary prevention, persistent disparities, and requirement for self-management. Initiatives to employ data from EHRs and social media for diabetes surveillance are in their infancy. With their transformative potential come practical limitations and ethical considerations. We explore applications of EHR and social media for diabetes surveillance, limitations to approaches, and steps for moving forward in this partnership between patients, health systems, and public health.