Using online health communities to deliver patient-centered care to people with chronic conditions

Innovative Applications of Telemedicine and Other Digital Health Solutions in Pain Management: A Literature Review

Since the COVID-19 pandemic, healthcare systems are facing extraordinary challenges. Our approaches to medicine have changed and created a whole new generation of people who have chronic pain. Various medical services were postponed. The pandemic significantly impacted the bio-psychosocial model of pain and the management of chronic pain. These new challenges affected millions of patients worldwide, with more burden on patients with chronic pain. Telemedicine and digital health rather than traditional office visits have become essential tools for communications, resulting in an unmatched surge in telehealth adoption. This new approach facilitated the remote treatment and follow-up of patients who have difficulty to access the healthcare services, particularly patients with chronic pain and those who were receiving regular controlled medications. An extensive computer search was conducted, during the period (from January 2014 to March 2024), and included literature from PubMed, Scopus, MEDLINE, and Google scholar. According to preset inclusion and exclusion criteria, a total of 38 articles have been included in this review article. This literature review focuses on the innovation of telemedicine and digital health in pain management, especially in the context of the challenges posed by the COVID-19 pandemic. The manuscript provides a comprehensive overview of telemedicine and digital communications, their evolution, and their significance in healthcare. It also emphasizes the benefits, challenges, limitations, and the ethical concerns of telemedicine in pain management after the COVID-19 pandemic. Furthermore, the document explores the different modes of the telecommunications and discusses the future directions of the digital health technology.

Information Seeking and Receiving of Older Adults with Diabetes in the Online Health Community: An Information Need Contextualization Perspective

Online health communities (OHCs) are important online health communication channels for older adults with diabetes to access health information. When seeking health information, they often disclose a variety of contextual information (e.g., socio-economic situations) in their questions. Selective contextual information disclosure is a type of communication strategy for users in OHCs to elicit replies from others. In this study, we adopted text analysis to investigate what contextual information older adults with diabetes disclose to articulate their information needs and used the fixed-effect Poisson model to examine the relationships between different types of contextual information disclosure and informational support receipt. Our analyses were based on a dataset of 4,505 questions and corresponding replies from an online diabetes community. The results showed that cognitive information is the most frequently disclosed contextual information, while older adults tend to disclose demographic information in their questions less. Providing demographic and situational details in questions can enhance informational support receiving, resulting in an increased number of informational supports. However, disclosing cognitive, affective, informational channels, or support information does not significantly affect the informational support receiving. These findings can contribute to extending our existing understanding of information seekers' communication strategies in OHCs.

"Can Anyone Tell Me…". Online Health Communities in Diabetes Self-Management in Poland and Italy

This paper contributes to the debate about the role of Online Health Communities (OHCs) in the healthcare system by concentrating on the kind of information sought and shared by their members. The paper focuses on OHCs for diabetes and discusses the main findings of a qualitative study conducted in Italy and Poland. The Uses and Gratifications approach informed the study, while content analysis was used to perform the analysis. The findings show that OHCs' role goes beyond information and emotional support, which relies on expertise by experience. Indeed, the lack of basic knowledge constituting the essential diabetes literacy for self-management was partially compensated by peer exchange in the OHCs. This raises at least two problems: quality and reliability of the information shared online, and consequences in terms of the equity that a healthcare system provides.

Willingness to reduce alcohol consumption predicted by short-form video exposure, media involvement, psychological bias, and cognitive factor

Introduction

Through previous studies, Chinese college students are known to be prone to alcohol consumption, which can lead to health-risk behaviors such as high blood pressure, heart disease, stroke, liver disease, and digestive problems. However, little is known about how popular social media platforms (e.g., short-form video applications) can positively impact their willingness to reduce alcohol consumption. This study was guided by the theory of optimistic bias; we investigated the direct, mediated, and moderating effects of exposure to anti-alcohol consumption short-form videos and short-form video involvement on Chinese college students' willingness to reduce their alcohol consumption.

Methods

The current study has an empirical cross-sectional design and employed an online survey from September 1st, 2022, to November 1st, 2022. The survey specifically targeted Chinese college students, who are the most common users of short-form video applications. The accumulated data underwent rigorous examination, including hierarchical regression, mediation, and moderation analyses, all conducted using the PROCESS macro 4.0 within SPSS version 22.

Results

A total of 434 participants, aged 18-24 years, were included in this study. There were mediating effects regarding Chinese college students' exposure to anti-alcohol consumption short-form videos (β = 0.35, p < 0.01, 95% CI [0.17, 0.63]) and short-form video involvement (β = 0.44, p < 0.001, 95% CI [0.20, 0.65]) on their willingness to reduce alcohol consumption via reversed optimistic bias. Moreover, perceived prevention of heavy drinking control (β = 0.05, p < 0.001, 95% CI [0.01, 0.09]) played mediating roles in the relationship between exposure to anti-alcohol consumption short-form videos and willingness to reduce alcohol consumption.

Conclusion

This study is one of the earliest studies to examine the intricate effects of exposure to anti-alcohol consumption short-form videos and short-form video involvement on the willingness to reduce alcohol consumption among Chinese college students. In addition, this study confirms that regardless of whether Chinese college students are conscientious, exposure to anti-alcohol consumption short-form videos did not increase their level of reversed optimistic bias. The empirical findings of this study are critical and can provide practical insights for Chinese health departments that encourage Chinese college students to minimize alcohol consumption.

Protocol for a scoping review of how people with ME/CFS use the internet

INTRODUCTION

Myalgic encephalomyelitis (ME) is a chronic neurological illness affecting many bodily systems, commonly the nervous and immune systems. Also known as chronic fatigue syndrome (CFS), key symptoms are extreme fatigue, post-exertional malaise, cognitive problems and sleep disturbance. With reported higher levels of online activity for people with ME/CFS than other patient groups (Westerby 2013 cited in Ytre-Arne) it is crucial to gain more knowledge of usage characteristics and experience of online use, and its integration into everyday life. This scoping review protocol details the proposed methods for gaining insight into this little known phenomenon.

METHODS AND ANALYSIS

This review uses the methodological framework for conducting a scoping review by Arksey and O'Malley, with further guidance by Levac et al, and the Joanna Briggs Institute. It also refers to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. The following bibliographic databases will be searched: Embase, Medline, PsychINFO, Cinahl, AMED, and ASSIA, plus Web of Science, ProQuest Dissertations and Theses Global, Scopus, and Google Scholar for grey literature. Reference lists of included papers will be studied. Two reviewers will independently screen title abstracts, and then full text of studies against inclusion criteria. Remaining studies will be quality assessed using appropriate critical appraisal tools. Findings will be charted and mapped to gain in-depth knowledge of the use of the internet in people with ME/CFS.

ETHICS AND DISSEMINATION

The findings from this review will be disseminated through peer-reviewed publication and a report for leading charities of ME/CFS. The review will collect secondary data only and therefore does not need ethical approval.

Self-Expression and Sharing around Chronic Illness on TikTok

While prior work has investigated the benefits of online health communities and general-purpose social media used for health-related purposes, little work examines the use of TikTok, an emerging social media platform with a substantial user base. The platform's multimodal capabilities foster creative self-expression, while the content-driven network allows users to reach new audiences beyond their personal connections. To investigate users' challenges and motivations, we analyzed 160 TikTok videos that center on users' firsthand experiences living with chronic illness. We found that users struggled with a loss of normalcy and stigmatization in daily life. To contend with these challenges, they publicly shared their experiences to raise awareness, seek support from peers, and normalize chronic illness experiences. Based on our findings, we discuss the modalities of TikTok that facilitate self-expression around stigmatized topics and provide implications for the design of online health communities that better support adolescents and young adults.

Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients

Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.

Design of the STEPS trial: a phase II randomized controlled trial evaluating eHealth-supported motor-cognitive home training for Parkinson's disease

BACKGROUND

Electronic health (eHealth) technology offers the potential to support and motivate physical activity for symptom management in Parkinson's disease (PD). It is also recommended that motor exercise in PD be complemented with cognitive training aimed at attentional or executive functions. This paper describes the protocol for a double-blind randomized controlled trial to evaluate the effects of motor-cognitive training in the home environment, supported by eHealth.

METHODS/DESIGN

The Support for home Training using Ehealth in Parkinsons diseaSe (STEPS) is a double-blind single center randomized controlled trial. Two parallel groups will include in total 120 participants with mild to moderate PD who will receive either (i) the intervention (a progressive 10-week individualized motor-cognitive eHealth training with cognitive behavioral elements to increase physical activity levels) or (ii) an active control group (an individualized 10-week paper-based home exercise program). The active control group will not receive motor-cognitive exercises or cognitive behavioral approaches to increase physical activity level. The primary outcome is walking capacity assessed by the six-minute walk test (6MWT). Secondary outcomes will include gait performance during single and dual task conditions, gait speed, functional mobility and lower limb strength, balance, physical activity behavior and a range of patient reported outcome measures relevant in PD.

DISCUSSION

The STEPS trial will answer the question whether 10 weeks of eHealth supported motor-cognitive exercise in the home environment can improve walking capacity in PD when compared to a standard paper exercise program. Findings from this study will also strengthen the evidence concerning the efficacy of PD-specific eHealth interventions with a view meeting future health care demands by addressing issues of inaccessibility to specialized neurological rehabilitation in PD.

TRIAL REGISTRATION

ClinicalTrials.gov August 2022, NCT05510739.

Online dialogue with medical professionals: An empirical study of an online "Ask the Doctor" platform

BACKGROUND

Accessing medical resources has been a challenging issue in China, particularly for people who do not live in big cities. Online "Ask the doctor" (AtD) services are gaining popularity rapidly. On AtDs, patients or their caregivers can ask questions to medical professionals and receive medical advice without going through the hassles of visiting local hospitals or doctors' offices. However, the communication patterns and remaining challenges of this tool are understudied.

OBJECTIVE

The purpose of this study was to (1) explore the dialogue patterns between the patients and the doctors on an AtD service in China, (2) identify issues and remaining challenges in this new form of communication.

METHODS

We conducted an exploratory study to analyze the dialogues between patients and doctors as well as patients' reviews. To analyze the dialogue data, we took inspiration from the discourse analysis and focus on the various components of the dialogues. We also used thematic analysis to discover the underlying themes embedded in each dialogue, and identify themes from patient complaints.

RESULTS

We identified four stages in the dialogues between the patients and doctors, including the initiating stage, continuing stage, ending stage, and following up stage. We also summarized the common patterns in the first three stages and reasons for sending follow-up messages. Moreover, we identified 6 unique challenges of the AtD service, including (1) inefficient communication in the initial stage, (2) unfinished conversation in the ending stage, (3) communication is perceived as real-time by the patients, not by the doctors, (4) drawbacks of voice messages, (5) verge of the illegal behaviors, and (6) consultation is not worth the payment.

CONCLUSIONS

The AtD service provides the follow-up communication pattern which is considered as a good supplement of Chinese traditional health care. However, several barriers, such as ethical problems, mismatched perceptions and expectations, cost-effectiveness issue still need further investigation.

Classification of reviews of e-healthcare services to improve patient satisfaction: Insights from an emerging economy

The COVID-19 pandemic has brought in many unique challenges and opportunities for patient care, and one is online healthcare practices. Patient satisfaction with online consultation is primary importance as online healthcare practices are evolving with time. Although previous research has examined how patient satisfaction with online doctor services can be further improved, there has been scant research on the satisfaction with online doctor services concerning Indian patients. Within the framework of service science theories, this study examines satisfaction and sentiments of Indian patients with online doctor services from multiple perspectives. A total of 38019 patient online feedback for 343 doctors was used for understanding patient sentiments. The sentiment analysis classified the reviews of the patients on online doctor consultation services. The finding suggests that healthcare service providers consider a systemic approach that includes core health services along with technical and marketing factors to proactively improve online patient satisfaction.

Configuration Path Study of Influencing Factors on Health Information-Sharing Behavior among Users of Online Health Communities: Based on SEM and fsQCA Methods

This study examines the determinants that drive the behavior of sharing health information within online health communities. Leveraging the Theory of Planned Behavior, the Technology Acceptance Model, and the "Knowledge-Attitude-Practice" theory, a comprehensive model elucidating the key elements that sway the health information-sharing behavior among users of online health communities is designed. This model is validated through Structural Equation Modeling (SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA). Findings derived from the SEM suggest that perceived ease of use, perceived usefulness, perceived trust, and perceived behavioral control exert a significant positive impact on attitudes towards health information sharing, the intention to share health information, and the actual health information-sharing behavior. The fsQCA unfolds two unique configuration path models that lead to the emergence of health information-sharing behavior: one predicated on perceived trust and sharing intention, and the other on perceived usefulness, behavioral control, and sharing attitude. This research provides invaluable insights, fostering a deeper comprehension of the dynamics involved in health information sharing within online communities, thereby directing the design of more effective health platforms to augment user engagement and enable informed health decisions.

How to communicate with patients in written asynchronous online conversations: an intervention study with undergraduate medical students in a cross-over design

Introduction

The patient-physician encounter is the core element in the treatment of patients and the diagnosis of disease. In these times of digitalization, patient-physician communication is increasingly taking place online: patients embrace new possibilities offered digitally, and physicians are encouraged to adapt accordingly. Since a huge part of online communication is written, this study aims to investigate how medical students communicate with patients online by focusing on their written competencies and whether an intervention might improve their competencies.

Methods

This study was performed in an explanatory cross-sectional manner with a cross-over design. Second-year medical students participated. An intervention was developed on how to formulate an appropriate written response to a patient's request and integrated a longitudinal communication class. The intervention consists of education on general set-up (e.g., greetings), syntax, spelling, content and kind of communication (e.g., appreciative attitude). After meeting a patient in a simulated role play medical students received the patient's request via a digital platform. The control group had the same simulated role play and the same task but they received the intervention on communication afterwards. Intervention and control group were statistically compared based on a checklist.

Results

Twenty-nine medical students took part in the study. The results showed that the medical students had basic competencies in dealing with written communication independent if they received the intervention (CG: M = 3.86 ± 1.23 vs. IG: M = 4.07 ± 1.03; p = 0.625). Similar results were also for the emotional competency ratings (M_CG = 3.36 ± 1.08; M_IG = 3.67 ± 0.98; p = 0.425).The intervention was able to lead to a more appreciative response toward patient.

Discussion

Intervention on basic competencies such as simple language and clear presentation might not be needed as an integral part in medical education. However, medical students should learn how to present empathic and authentic behavior in written online communication.

Switching from offline to online health consultation in the post-pandemic era: the role of perceived pandemic risk

Introduction

Due to its effectiveness and various benefits, the use of online health consultation (OHC) has dramatically increased in recent years, especially since the outbreak of the COVID-19 pandemic. However, underlying mechanism whereby the pandemic impacted OHC usage is still unclear.

Methods

Via an online survey (N=318), the present paper measures the users' perceptions towards both offline and online services, their intention to switch to OHC, and the perceived pandemic risks. The relationships among these factors are conceptualized by the push-pull-mooring framework, and tested via structural equation modelling.

Results

Dissatisfaction with offline service (process inefficiency and consultation anxiety), the attractiveness of OHC (perceived benefits and perceived ease of use), and users' behavioral inertia (switching cost and habit) jointly influence the intention to switching to OHC. The significant role of the perceived pandemic risk of going to medical facilities is particularly addressed. On the one hand, the perceived pandemic risk is found with an indirect impact on the switching intention by enlarging the dissatisfaction with offline service and the attractiveness of OHC. On the other hand, a high perceived pandemic risk induces more actual switching behavior and also amplifies the transition from switching intention to behavior.

Discussion

The study provides novel insights into the understanding of OHC usage in the post-pandemic era, and also informs medical facilities, OHC platforms, and policymakers on managing and balancing the online and offline healthcare provision.

A Study of Factors Influencing the Volume of Responses to Posts in Physician Online Community

Today's diverse health needs place greater demands on physicians. However, individual doctors have limited capabilities and may encounter many unsolvable medical problems. The physician online community provides a platform for physicians to communicate with each other and help each other. Physicians can post for help about problems they encounter at work. The number of responses to physicians' posts is critical to whether or not the problem is resolved. This study collected information on 13,226 posts from a well-known physician online community in China to analyze the factors that influence the number of post replies. In the analysis of the post content of the physician online community, this study innovatively introduces word usage features in the medical field. TextMind was used to extract the rate of several types of words in posts that frequently appear when describing medical information. Ultimately, we found that the rate of time words, visual words, auditory words, and physiological process words used in posts had a positive and significant effect on the number of post responses. A series of new post features has been found to have an impact on the number of post replies in physician online communities. This finding is beneficial for physicians to quickly obtain peer assistance through online platforms, increasing the likelihood of solving workplace challenges and improving physician care, as well as the success of physician online communities.

"We the BE": An educational mobile health application for children and families affected by bladder exstrophy-epispadias-cloacal exstrophy complex

GOALS

Despite the proliferation of over 45 000 smartphone mobile health applications (MHAs), as far as we know, there is no MHA for those living with rare diseases such as Bladder Exstrophy-Epispadias-Cloacal Exstrophy complex (BEEC). We hypothesized that an MHA could provide similar "on-demand" information and connectivity within health communities for patients with BEEC as they do for more common diseases. Thus, our primary goal was to create an MHA for patients and families affected by BEEC to provide them with important information about the condition and a format for them to connect with other affected patients and families. A secondary goal was to develop an adaptable MHA template for other rare diseases in the future.

METHODS

We began our app development by examining existing common-disease MHAs for thematic structure. We conducted an extensive literature search of PubMed and Google scholar for MHA development and existing MHAs related to BEEC, utilizing these search terms: mobile health applications, rare diseases, bladder exstrophy, and online health communities. Our app development team began with our clinical multidisciplinary team of pediatric urologists; a child psychiatrist; a patient/family mental health therapist; and a certified nurse practitioner. We hired a website engineer and a production team. All clinical members have extensive experience caring for children and families affected by BEEC. Additionally, clinical team members compiled lists of themes deemed relevant from these reviews and themes gleaned from their clinical experience that appear with some frequency or urgency and from the myriad of themes discussed within the literature for MHAs.

RESULTS

We found no existing rare disease MHAs in the literature or our search of app stores online. However, we derived basic app categories from existing MHA formats and the thematic content of all sources reviewed. These categories aligned with the groupings of our lists of clinical themes. Thus, we could subsume diverse themes within a broad categorical format: for example, child development (as "Psychological Development" in the app) or various clinical care options (as "Treatment"). This app structure became nine sections, as shown in. This format allows diverse information to be retrieved efficiently from broader categories. This app is being offered to affected families, healthcare providers, and individuals unrelated to where care is offered.

CONCLUSION

"We the BE" is the first MHA developed for a rare disease, BEEC. It has been published in a downloadable format for the general public at no cost. Further research is required to determine its efficacy for the BEEC community members; preliminary, unsolicited feedback from multiple users has been positive.

Chronic pain experience through COVID-19: a comparison of reports prior and during the early stages of the pandemic

ABSTRACT

The impacts of COVID-19 and imposed restrictions on individuals with chronic noncancer pain continue to emerge, varying across countries. More recent research (including with longitudinal designs) suggests that the pandemic may not have such a disproportionate effect on chronic noncancer pain and its management as first thought. This longitudinal study, with assessments before the pandemic (2019) and early during the pandemic (May-July 2020), examined changes in validated measures of pain severity, pain interference, prescription opioid misuse, and mental health symptoms. Patients (N = 236) self-reported significant improvements in pain severity, pain interference, pain self-efficacy, pain catastrophizing, prescription opioid misuse, depression, and anxiety symptoms over time. Approximately 30% and 33% of patients achieved minimally important reductions (10% change) in pain severity and pain interference, respectively. In follow-up exploratory analyses, prepandemic sociodemographic and psychological factors predictive of 10% improved (vs 10% worse) pain severity and interference were investigated in logistic regressions. Reduction in pain interference was predicted by current employment, older age, and higher pain self-efficacy. There were no significant predictors of reduction in pain severity. The impact of COVID-19 on patients' pain experience and mental health was negligible in the early stages of the pandemic, and findings suggest improvements through the period. Targeted interventions that promote the protective factor of pain self-efficacy and build resilience may buffer patients' future response to the pandemic because it evolves as a part of our new normal. Targeted social determinants of health interventions that direct resources toward maintaining employment could also be important.

The never-ending patient journey of chronically ill patients: A qualitative case study on touchpoints in relation to patient-centered care

BACKGROUND

Healthcare professionals caring for chronically ill patients increasingly want to provide patient-centered care (PCC). By understanding each individual patient journey, they can significantly improve the quality of PCC. A patient journey consists of patient interactions, so-called touchpoints, with healthcare professionals distributed over three periods: pre-service, service, and post-service period. The aim of this study was to ascertain chronically ill patients' needs for digital alternatives for touchpoints. Specifically, we aimed to explore which digital alternatives patients would like to see implemented into their patient journey to help healthcare professionals providing PCC.

METHODS

Eight semi-structured interviews were conducted either face-to-face or via Zoom. Participants were included if they had visited the department of internal medicine and had received treatment for either arteriosclerosis, diabetes, HIV, or kidney failure. The interviews were analyzed utilizing a thematic analysis approach.

RESULTS

The results suggest that the patient journey of chronically ill patients is a continuous cycle. Furthermore, the results showed that chronically ill patients would like to see digital alternatives for touchpoints implemented into their patient journey. These digital alternatives consisted of video calls, digitally checking in before a physical appointment, digitally self-monitoring one's medical condition and personally uploading monitoring results into the patient portal, and viewing their own medical status in a digital format. Particularly, patients who were familiar with their healthcare professional(s) and were in a stable condition mostly opted for digital alternatives.

CONCLUSION

In the cyclical patient journey, digitalization can help put the wishes and needs of the chronically ill patients at the center of care. It is recommended that healthcare professionals implement digital alternatives for touchpoints. Most chronically ill patients consider digital alternatives to lead to more efficient interactions with their healthcare professionals. Furthermore, digital alternatives support patients to be better informed about the progress of their chronical illness.

Knowledge, community and care: Digital biocitizenship in gestational diabetes

Online patient communities have proliferated rapidly, as has literature exploring the role such communities play in allowing patients to share knowledge, offer support to one another, and advocate for better medical care. Yet there has been limited scholarly engagement with patient community in gestational diabetes (GDM). Drawing on a grounded theory analysis of 18 semi-structured interviews with women with GDM, I explore how participating in an online GDM support community shaped these women's experiences of pregnancy and illness. Women's interactions with one another prompted them to appraise, contest, and co-create knowledge claims about GDM. Those in the community supported each other through the difficulties of GDM, but also held each other accountable to their regimes of self-management, often to a greater extent than their health professionals. The networks of peer support within the community engendered new ethics of care and responsibility, reframing GDM as a condition worthy of more personalised treatment and increased medical attention. These findings attest to the emergence of patient-led biocitizenship in GDM, although a caveat is given that these participants all had access to resources that facilitated their engagement with self-care practices. Further research should explore GDM patient community in marginalised populations.

The Effects of Information Continuity and Interpersonal Continuity on Physician Services Online: Cross-sectional Study

BACKGROUND

Web-based medical services have become an effective supplement to traditional services in hospitals and an essential part of medical services. Studies have shown that web-based medical services are useful for shortening the delayed admission time and for enhancing the treatment effect from the service continuity perspective. However, the specific measures that patients and physicians should take to improve service continuity remain unknown.

OBJECTIVE

Based on the information richness theory and continuity of care, this study investigates the dynamic effects of information continuity and interpersonal continuity on physician services online.

METHODS

Data of 7200 patients with 360 physicians covering complete interaction records were collected from a professional web-based platform in China. Content analysis was performed to recognize matching patients and physicians, and least square regression analysis was performed to obtain all empirical results.

RESULTS

Empirical results showed that in the short term, information continuity (including offline experience, medical records, and detailed information) influences physicians' web-based services, and their influences show heterogeneity. Moreover, if a patient's online physician is the same physician who he/she has visited offline, we find that interpersonal continuity is important for service. In the long term, information continuity and interpersonal continuity positively improve service continuity by facilitating repeat purchases.

CONCLUSIONS

Overall, our findings not only shed new light on patient behavior online and cross-channel behavior but also provide practical insights into improving the continuity of care in online health communities.

User Engagement and User Loyalty Under Different Online Healthcare Community Incentives: An Experimental Study

The online healthcare community (OHC) has attained rapid development in recent years in which users are facilitated to exchange disease information and seek medical treatment. However, users’ motivation of participation in OHCs is still under investigation. Taking the perspective of user perceived value, this paper examined the impacts of different incentive levels including identity incentive, privilege incentive, and material incentive on user perceived value, user engagement, and user loyalty. To test the proposed hypotheses, the study adopted the methods of the between-subjects experiment and questionnaire. Based on the data analysis by ANOVA and structural equation model, the results show there are significant differences in the impacts of different incentive levels on users’ perceived value. Most of the incentive measures exert significant effects on simple user hedonic value and community identity value. Accordingly, the research findings suggest that affective support value and self-health management value demonstrate more importance for user engagement and user loyalty. Therefore, OHCs should try to improve users’ affective support value and self-health management value which are the ultimate aims of the OHCs. Our study sheds some light on profoundly understanding the design of incentive mechanism of OHC and contributes to the research of OHC services.

Continuance Intention of Online Healthcare Communities- The Mediation Mechanism of Social Interaction Ties

The purpose of this research is to evaluate the continuance usage intention on online healthcare community (OHC) platform for patients and examine the "doctor-OHC-patient" relationship. The proposed model attempted to integrate social interaction ties, shared value, trust with the indirect effects on the relationship between the determinants and continuous usage intention of the OHC platform. The empirical results showed that perceived critical mass, social identity, and para-social interaction would strengthen continuance intention via the social interaction ties. In addition, this study found that the shared values and trust increase users' willingness to continue usage of OHC. This study provides OHC platform managers with an in-depth understanding of the "doctor-OHC-patient" online social interaction. The results of this study may also help hospitals, health policy makers, and related healthcare practitioners to improve the way they use the web for advocacy and guidance, and provide insight into the intent of promoting the ongoing use of OHC platforms.

Comparative Analysis of Social Support in Online Health Communities Using a Word Co-Occurrence Network Analysis Approach

Online health communities (OHCs) have become a major source of social support for people with health problems. Members of OHCs interact online with others facing similar health problems and receive multiple types of social support, including but not limited to informational support, emotional support, and companionship. The aim of this study is to examine the differences in social support communication among people with different types of cancers. A novel approach is developed to better understand the types of social support embedded in OHC posts. Our approach, based on the word co-occurrence network analysis, preserves the semantic structures of the texts. Information extraction from the semantic structures is supported by the interplay of quantitative and qualitative analyses of the network structures. Our analysis shows that significant differences in social support exist across cancer types, and evidence for the differences across diseases in terms of communication preferences and language use is also identified. Overall, this study can establish a new venue for extracting and analyzing information, so as to inform social support for clinical care.

Come for Information, Stay for Support: Harnessing the Power of Online Health Communities for Social Connectedness during the COVID-19 Pandemic

The COVID-19 pandemic created a globally shared stressor that saw a rise in the emphasis on mental and emotional wellbeing. However, historically, these topics were not openly discussed, leaving those struggling without professional support. One powerful tool to bridge the gap and facilitate connectedness during times of isolation is online health communities (OHCs). This study surveyed Health Union OHC members during the pandemic to determine the degree of COVID-19 concern, social isolation, and mental health distress they are facing, as well as to assess where they are receiving information about COVID-19 and what sources of support they desire. The survey was completed in six independent waves between March 2020 and April 2021, and garnered 10,177 total responses. In the United States, OHCs were utilized significantly more during peak lockdown times, and the desire for emotional and/or mental health support increased over time. Open-ended responses demonstrated a strong desire for connection and validation, which are quintessential characteristics of OHCs. Through active moderation utilizing trained moderators, OHCs can provide a powerful, intermediate and safe space where conversations about mental and emotional wellbeing can be normalized and those in need are encouraged to seek additional assistance from healthcare professionals if warranted.

Integrating online community support into outpatient breast cancer care: Mayo Clinic Connect online platform

Introduction

Mayo Clinic Connect is an online community of over 100,000 members who support each other through sharing lived experience when facing and managing new diagnoses. The community is moderated by Mayo Clinic staff and volunteer patient mentors.

Methods

Mayo Clinic breast clinic patients undergoing evaluation received a binder of support resources including a brochure about Mayo Clinic Connect at visits between January and May of 2019. Surveys were distributed at subsequent visits between May and December of 2019 to assess patient awareness about the online resource, participation frequency, purpose of use, and benefits for members, as well as reasons for not joining (non-members). The primary aim was to assess patient resilience, coping, and self-management after joining the online community.

Results

Nine hundred surveys were distributed, and 102 participants completed surveys between May and December 2019. Forty-five percent (n = 46) had heard about Mayo Clinic Connect; 34% (n = 15) through a brochure. The remainder heard about the community from a Mayo Clinic provider (43%; n = 19) or other resources (22%, n = 10; no response n = 2). Twenty percent (n = 20) of survey participants registered as Breast Cancer group members, and most of this subgroup (55%; n = 11) reported understanding diagnosis, treatment plans, and finding peer support as reasons for joining. Seventy-five percent of Mayo Clinic Connect participants (n = 15) reported the community met or exceeded expectations.

Conclusion

This pilot study reveals the potential positive impact of introducing an online peer support group into clinical care plans for patients coping with a new and anxiety-provoking cancer diagnosis.

Use of Face-to-Face Assessment Methods in E-Learning-An Example of an Objective Structured Clinical Examination (OSCE) Test

The spread of COVID-19 and social-distancing rules have increased the need for alternative learning environments with a focus on e-learning platforms. The objective of this study was to assess whether and to what extent the transition from traditional learning and assessment environment to the e-setting impacts the knowledge and skills acquired by students and their satisfaction with new e-solutions of taking the OSCE test. The study compared the results of three face-to-face (2018-2019) and one electronically conducted (2021) OSCE tests, as well as students' feedback on the content and organization of the tests. For data analysis the one-way ANOVA test and post hoc multiple comparisons were used. The results demonstrated the feasibility and effectiveness of and students' satisfaction with OSCE tests in the Zoom environment. However, more focus on communication techniques is required in a remote communication environment to better cover all patient health-related and drug communication aspects. There were identified differences between undergraduate students and practicing assistant pharmacists in assessing patients' health problems and providing corresponding counseling. This result points to the need to implement the continuous development of patient-centered counseling techniques in the lifelong learning of pharmacists and the need to use innovative digital solutions, if applicable.

Application of natural language processing techniques to identify off-label drug usage from various online health communities

Objective

Outcomes mentioned on online health communities (OHCs) by patients can serve as a source of evidence for off-label drug usage evaluation, but identifying these outcomes manually is tedious work. We have built a natural language processing model to identify off-label usage of drugs mentioned in these patient posts.

Materials and Methods

Single patient posts from 4 major OHCs were considered for this study. A text classification model was built to classify the posts as either relevant or not relevant based on patient experience. The relevant posts were passed through a spelling correction tool, CSpell, and then medications and indications from these posts were identified using cTAKES (clinical Text Analysis and Knowledge Extraction System), a named entity recognition tool. Drug and indication pairs were identified using a dependency parser. Finally, if the paired indication was not mentioned on the label of the drug approved by U.S. Food and Drug Administration, it was tagged as off-label use of that drug.

Results

Using this algorithm, we identified 289 off-label indications, achieving a recall of 76%.

Conclusions

The method designed in this study identifies and extracts the semantic relationship between drugs and indications from demotic posts in OHCs. The results demonstrate the feasibility of using natural language processing techniques in identifying off-label drug usage across online health forums for a variety of drugs. Understanding patients’ off-label use of drugs may be able to help manufacturers innovate to better address patients’ needs and assist doctors’ prescribing decisions.

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

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

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.

Influence of Online Social Support on the Public's Belief in Overcoming COVID-19

The sudden outbreak of coronavirus disease 2019 (COVID-19) in early 2020 has dramatically changed people's lives. Some countries have taken mass home quarantine to control the virus. However, the side effects of quarantine have rarely been interrogated by current COVID-19 research. This study thus investigates the effects of online social support on the public's beliefs in overcoming COVID-19 by embracing their cognition and emotion during the epidemic. First, by crawling and content analysis of the messages posted on "Baidu COVID-19 bar", this study identified 5 types of online social support given or received by the public during COVID-19. On this basis, a model explaining the public's beliefs was developed from the perspectives of online social support, cognition and emotion. 334 valid online questionnaires were collected to examine the proposed model and hypotheses. The results show that cognition has a direct effect on the belief, while emotion affects the belief via a full mediating effect of cognition. Tangible support and esteem support can directly affect the public's beliefs, and educational level significantly moderates these effects. In addition, the public's cognition is influenced by informational support, however, emotion is not influenced by social support but by other factors (e.g., information disclosure, material supplies and frustration caused by the epidemic). These research results provide a deep insight into how to reduce the negative effects of quarantine, consolidate the theoretical basis of the public's beliefs, and have important practical implications for individuals and the government in dealing with such emergencies.

Cognitive mechanisms underlying interaction and contribution in online health communities: the perspectives of doctors and patients

Purpose

Active interaction and knowledge contribution are vital yet challenging elements of the sustainable development of online health communities (OHCs). To investigate the cognitive mechanisms underlying these behaviours in doctors' and patients' use of OHCs, this study develops a theoretical model to examine the relationships among cognitive modes, patterns of interaction, perceived usefulness, and contribution behaviour and the impact of user identity on these relationships.

Design/methodology/approach

To test the research hypotheses, structural equation modelling and multiple-group analysis were used to analyse survey data from 207 doctors and 213 patients.

Findings

The results indicate that dual processes and perceived usefulness are the key cognitive antecedents of interaction and knowledge contribution, respectively. However, the correlation of the rational mode and instrumental interaction is significantly stronger in the doctors' group than in the patients' group, while a stronger correlation between the experiential mode and instrumental interaction is observed in the patients' group.

Practical implications

These findings support the development of information and system strategies to support the operation of dual processes underlying doctors' and patients' instrumental and affective interactions, facilitate evaluation and sense-making of interaction activities, and motivate knowledge contribution.

Originality/value

This study uncovers the invariance and variability in the relationships between salient cognitive activities and behavioural responses in doctors' and patients' use of OHCs and the impact of user identity on variability.

Not just for the money? An examination of the motives behind physicians’ sharing of paid health information

Online platforms make it possible for physicians to share online information with the public, however, few studies have explored the underlying mechanism of physicians’ sharing of paid health information. Drawing on motivation theory, this study developed a theoretical framework to explore the effects of extrinsic motivation, enjoyment, and professional motivation on the sharing of paid information, as well as the contingent role of income ratio (online to offline) and online reputation. The model was tested with both objective and subjective data, which contain responses from 298 physicians. The results show that extrinsic motivation, enjoyment, and professional motivation play significant roles in inducing physicians to share paid information. Furthermore, income ratio can moderate the effects of motives on paid information sharing. Besides, the effect of professional motivation can be more effective in certain situations (low-level income ratio or high online reputation). This study contributes to the literature on knowledge sharing, online health behaviour, and motivation theory, and provides implications for practitioners.

Use and preferences regarding internet-based health care delivery in patients with chronic kidney disease

Background and objectives

Internet-based technologies play an increasingly important role in the management and outcome of patients with chronic kidney disease (CKD). The healthcare system is currently flooded with digital innovations and internet-based technologies as a consequence of the coronavirus disease 2019 (COVID-19) pandemic. However, information about the attitude of German CKD-patients with access to online tools towards the use of remote, internet-based interactions such as video conferencing, email, electronic medical records and apps in general and for health issues in particular, are missing.

Design, setting, participants, and measurements

To address the use, habits and willingness of CKD patients in handling internet-based technologies we conducted a nationwide cross-sectional questionnaire survey in adults with CKD.

Results

We used 380 questionnaires from adult CKD patients (47.6% on dialysis, 43.7% transplanted and 8.7% CKD before renal replacement therapy) for analysis. Of these 18.9% denied using the internet at all (nonusers). Nonusers were significantly older (74.4 years, SD 11.4) than users (54.5 years, SD 14.5, p < 0.001), had a lower educational level than users (≥ 12 years: 6.9% versus 47.1%, p < 0.001) and were more often on dialysis. Within the group of internet users only a minority (2.6%) was using video conferencing with their physician, only 11.7% stated that they were using email to report symptoms and 26.6% were using the internet to schedule appointments. Slightly more than one-third of internet users (35.1%) are concerned that their personal medical data are not safe when submitted via the internet.

Conclusions

Within our group of German CKD-patients we found that almost one out of five patients, especially older patients and patients with a lower educational level, did not use the internet at all. The majority of internet users reported in our survey that they have not used internet-based technologies within a medical context so far, but are willing to consider it. Therefore, it seems to be important to introduce and teach motivated CKD-patients the use and benefits of simple and safe internet-based health care technologies.

Online health community experiences of sexual minority women with cancer

OBJECTIVE

The study sought to explore online health communities (OHCs) for sexual minority women (SMW) with cancer by conducting computational text analysis on posts.

MATERIALS AND METHODS

Eight moderated OHCs were hosted by the National LGBT Cancer Network from 2013 to 2015. Forty-six SMW wrote a total of 885 posts across the OHCs, which were analyzed using Linguistic Inquiry and Word Count and latent Dirichlet allocation. Pearson correlation was calculated between Linguistic Inquiry and Word Count word categories and participant engagement in the OHCs. Latent Dirichlet allocation was used to derive main topics.

RESULTS

Participants (average age 46 years; 89% white/non-Hispanic) who used more sadness, female-reference, drives, and religion-related words were more likely to post in the OHCs. Ten topics emerged: coping, holidays and vacation, cancer diagnosis and treatment, structure of day-to-day life, self-care, loved ones, physical recovery, support systems, body image, and symptom management. Coping was the most common topic; symptom management was the least common topic.

DISCUSSION

Highly engaged SMW in the OHCs connected to others via their shared female gender identity. Topics discussed in these OHCs were similar to OHCs for heterosexual women, and sexual identity was not a dominant topic. The presence of OHC moderators may have driven participation. Formal comparison between sexual minority and heterosexual women's OHCs are needed.

CONCLUSIONS

Our findings contribute to a better understanding of the experiences of SMW cancer survivors and can inform the development of tailored OHC-based interventions for SMW who are survivors of cancer.

Opinions on rehabilitation care of young adults with transversal upper limb reduction deficiency in their transition to adulthood

PURPOSE

Young adults with transversal upper limb reduction deficiency experience limitations regarding education, employment and obtaining a driver's license. Contribution of rehabilitation care within these domains has been reported to be inadequate. This study evaluates the needs and suggestions of participants in rehabilitation care.

METHODS

Two online focus groups with young adults and parents met during 4 consecutive days. Health care professionals joined a face-to-face focus group. Data analysis was based on framework analysis.

RESULTS

The rehabilitation team was mainly consulted for problems with residual limb or for prostheses. Young adults and their parents were mostly unaware of resources regarding education, job selection or obtaining a driver's license. Professionals stated that these subjects were addressed during periodic appointments. Young adults didn't always attend these appointments due to limited perceived benefit. To improve rehabilitation care, participants suggested methods for providing relevant information, facilitating peer contact and offering dedicated training programs to practice work-related tasks, prepare for job interviews or enhance self-confidence.

CONCLUSION

Periodic appointments do not fulfil needs of young adults with transversal upper limb reduction deficiency. To improve care, rehabilitation teams should offer age-relevant information, share peer stories, and create dedicated training programs.

From clinical reasoning to ehealth interventions; a study on how nurses asses care and ehealth in home care

The assessment of care in homecare today is complex. Nurses have to decide on care for clients with multiple health problems. Technological innovations promise solutions for support of self-management of older people. We do not know, however, how and when nurses assess eHealth. A qualitative study design was used, in which 43 homecare nurses participated in focus groups and think aloud interviews. The study shows that nurses believe a trusting relationship necessary in order to suggest eHealth interventions. Nurses say they need home visits for the assessment of eHealth. Nurses also have some strong opinions on eHealth, like the notion that eHealth isn't a fitting option for frail older people. It becomes clear that nurses need to see eHealth interventions fit for clients in a person-centred way and in close connection to health problems they've prioritised in order to assess it. Implications for practice and further research are to focus on how nurses can be convinced to assess and use eHealth in a person-centred way and how to discuss this with their clients. Next to that training and a tool that provides up to date information linked to frequently seen health problems are recommended.

Influencing Factors of Continuous Use of Web-Based Diagnosis and Treatment by Patients With Diabetes: Model Development and Data Analysis

Background

The internet has become a major source of health care information for patients and has enabled them to obtain continuous diagnosis and treatment services. However, the quality of web-based health care information is mixed, which raises concerns about the credibility of physician advice obtained on the internet and markedly affects patients’ choices and decision-making behavior with regard to web-based diagnosis and treatment. Therefore, it is important to identify the influencing factors of continuous use of web-based diagnosis and treatment from the perspective of trust.

Objective

The objective of our study was to investigate the influencing factors of patients’ continuous use of web-based diagnosis and treatment based on the elaboration likelihood model and on trust theory in the face of a decline in physiological conditions and the lack of convenient long-term professional guidance.

Methods

Data on patients with diabetes in China who used an online health community twice or more from January 2018 to June 2019 were collected by developing a web crawler. A total of 2437 valid data records were obtained and then analyzed using correlation factor analysis and regression analysis to validate our research model and hypotheses.

Results

The timely response rate (under the central route), the reference group (under the peripheral route), and the number of thank-you letters and patients’ ratings that measure physicians’ electronic word of mouth are all positively related with the continuous use of web-based diagnosis and treatment by patients with diabetes. Moreover, the physician’s professional title and hospital’s ranking level had weak effects on the continuous use of web-based diagnosis and treatment by patients with diabetes, and the effect size of the physician’s professional title was greater than that of the hospital’s ranking level.

Conclusions

From the patient's perspective, among all indicators that measure physicians’ service quality, the effect size of a timely response rate is much greater than those of effect satisfaction and attitude satisfaction; thus, the former plays an essential role in influencing the patients’ behavior of continuous use of web-based diagnosis and treatment services. In addition, the effect size of electronic word of mouth was greater than that of the physician’s offline reputation. Physicians who provide web-based services should seek clues to patients’ needs and preferences for receiving health information during web-based physician-patient interactions and make full use of their professionalism and service reliability to communicate effectively with patients. Furthermore, the platform should improve its electronic word of mouth mechanism to realize its full potential in trust transmission and motivation, ultimately promoting the patient’s information-sharing behavior and continuous use of web-based diagnosis and treatment.

A multi-stakeholder perspective on sustainable healthcare: From 2030 onwards

Over the past years, the interest in sustainable healthcare has been growing globally and the transition toward environmentally, economically and socially viable health systems is perceived as inevitable and necessary. All the approaches to this emerging field are mainly focusing on short-term specific issues and involving a limited number of stakeholders. This study aimed to address the topic of the possible futures of sustainable healthcare from a multi-stakeholder perspective, in order to define a long-term scenario and the key strategies to enhance this transition. A series of workshops have involved a representative selection of stakeholders based in Nordic countries and concerned with sustainable healthcare (health industries, health providers, managing authorities, universities and research centres, clusters, NGOs and healthcare networks, professional consortia) through a collaborative foresight process. A design-based approach has been adopted to investigate the current scenario and deepen foresight outcomes. The results highlighted three different horizons and the drivers to reshape the roles of individual stakeholders, enhancing the socio-technical transition towards a desirable scenario based on collaboration between distributed dynamic networks. The identified transition strategies move from the local to the international level, focusing on innovation, information and collaboration between stakeholders. This study provides the framework for future studies to deepen the transition process towards sustainable healthcare and its implications at Nordics, European and international levels.

Assessment of Adaptive Engagement and Support Model for People With Chronic Health Conditions in Online Health Communities: Combined Content Analysis

Background

With the pervasiveness of social media, online health communities (OHCs) are an important tool for facilitating information sharing and support among people with chronic health conditions. Importantly, OHCs offer insight into conversations about the lived experiences of people with particular health conditions. Little is known about the aspects of OHCs that are important to maintain safe and productive conversations that support health.

Objective

This study aimed to assess the provision of social support and the role of active moderation in OHCs developed in accordance with and managed by an adaptive engagement model. This study also aimed to identify key elements of the model that are central to the development, maintenance, and adaptation of OHCs for people with chronic health conditions.

Methods

This study used combined content analysis, a mixed methods approach, to analyze sampled Facebook post comments from 6 OHCs to understand how key aspects of the adaptive engagement model facilitate different types of social support. OHCs included in this study are for people living with multiple sclerosis, migraine, irritable bowel syndrome, rheumatoid arthritis, lung cancer, and prostate cancer. An exploratory approach was used in the analysis, and initial codes were grouped into thematic categories and then confirmed through thematic network analysis using the Dedoose qualitative analysis software tool. Thematic categories were compared for similarities and differences for each of the 6 OHCs and by topic discussed.

Results

Data on the reach and engagement of the Facebook posts and the analysis of the sample of 5881 comments demonstrate that people with chronic health conditions want to engage on the web and find value in supporting and sharing their experiences with others. Most comments made in these Facebook posts were expressions of social support for others living with the same health condition (3405/5881, 57.89%). Among the comments with an element of support, those where community members validated the knowledge or experiences of others were most frequent (1587/3405, 46.61%), followed by the expression of empathy and understanding (1089/3405, 31.98%). Even among posts with more factual content, such as insurance coverage issues, user comments still had frequent expressions of support for others (80/213, 37.5%).

Conclusions

The analysis of this OHC adaptive engagement model in action shows that the foundational elements—social support, engagement, and moderation—can effectively be used to provide a rich and dynamic community experience for individuals with chronic health conditions. Social support is demonstrated in a variety of ways, including sharing information or validating information shared by others, expressions of empathy, and sharing encouraging statements with others.

Diabetes Self-Management in the Age of Social Media: Large-Scale Analysis of Peer Interactions Using Semiautomated Methods

BACKGROUND

Online communities have been gaining popularity as support venues for chronic disease management. User engagement, information exposure, and social influence mechanisms can play a significant role in the utility of these platforms.

OBJECTIVE

In this paper, we characterize peer interactions in an online community for chronic disease management. Our objective is to identify key communications and study their prevalence in online social interactions.

METHODS

The American Diabetes Association Online community is an online social network for diabetes self-management. We analyzed 80,481 randomly selected deidentified peer-to-peer messages from 1212 members, posted between June 1, 2012, and May 30, 2019. Our mixed methods approach comprised qualitative coding and automated text analysis to identify, visualize, and analyze content-specific communication patterns underlying diabetes self-management.

RESULTS

Qualitative analysis revealed that "social support" was the most prevalent theme (84.9%), followed by "readiness to change" (18.8%), "teachable moments" (14.7%), "pharmacotherapy" (13.7%), and "progress" (13.3%). The support vector machine classifier resulted in reasonable accuracy with a recall of 0.76 and precision 0.78 and allowed us to extend our thematic codes to the entire data set.

CONCLUSIONS

Modeling health-related communication through high throughput methods can enable the identification of specific content related to sustainable chronic disease management, which facilitates targeted health promotion.

Superusers' Engagement in Asthma Online Communities: Asynchronous Web-Based Interview Study

BACKGROUND

Superusers, defined as the 1% of users who write a large number of posts, play critical roles in online health communities (OHCs), catalyzing engagement and influencing other users' self-care. Their unique online behavior is key to sustaining activity in OHCs and making them flourish. Our previous work showed the presence of 20 to 30 superusers active on a weekly basis among 3345 users in the nationwide Asthma UK OHC and that the community would disintegrate if superusers were removed. Recruiting these highly skilled individuals for research purposes can be challenging, and little is known about superusers.

OBJECTIVE

This study aimed to explore superusers' motivation to actively engage in OHCs, the difficulties they may face, and their interactions with health care professionals (HCPs).

METHODS

An asynchronous web-based structured interview study was conducted. Superusers of the Asthma UK OHC and Facebook groups were recruited through Asthma UK staff to pilot and subsequently complete the questionnaire. Open-ended questions were analyzed using content analysis.

RESULTS

There were 17 superusers recruited for the study (14 patients with asthma and 3 carers); the majority were female (15/17). The age range of participants was 18 to 75 years. They were active in OHCs for 1 to 6 years and spent between 1 and 20 hours per week reading and 1 and 3 hours per week writing posts. Superusers' participation in OHCs was prompted by curiosity about asthma and its medical treatment and by the availability of spare time when they were off work due to asthma exacerbations or retired. Their engagement increased over time as participants furthered their familiarity with the OHCs and their knowledge of asthma and its self-management. Financial or social recognition of the superuser role was not important; their reward came from helping and interacting with others. According to the replies provided, they showed careful judgment to distinguish what can be dealt with through peer advice and what needs input from HCPs. Difficulties were encountered when dealing with misunderstandings about asthma and its treatment, patients not seeking advice from HCPs when needed, and miracle cures or dangerous ideas. Out of 17 participants, only 3 stated that their HCPs were aware of their engagement with OHCs. All superusers thought that HCPs should direct patients to OHCs, provided they are trusted and moderated. In addition, 9 users felt that HCPs themselves should take part in OHCs.

CONCLUSIONS

Superusers from a UK-wide online community are highly motivated, altruistic, and mostly female individuals who exhibit judgment about the complexity of coping with asthma and the limits of their advice. Engagement with OHCs satisfies their psychosocial needs. Future research should explore how to address their unmet needs, their interactions with HCPs, and the potential integration of OHCs in traditional healthcare.

Communication that changes lives: an exploratory research on a Chinese online hypertension community

Purpose

Online health communities (OHCs) are attracting more and more healthy consumers, including patients, their families, caregivers and the general public. This paper aims to explore the themes and characteristics of patient-generated content (PGC) in Chinese OHCs.

Design/methodology/approach

Baidu Tieba for hypertension was selected as the research site. Online ethnography (netnography) approach was utilized to explore the PGC and health communication in the online hypertension community. The final database included 300 randomly sampled threads and their 3,187 reply posts and was further analyzed from three perspectives: health information needs, attitudes and psychological reactions to hypertension and social support exchange.

Findings

The members' health information needs were mainly concentrated on five aspects: causes, symptoms, measuring instrument, tests and diagnosis and treatment. Their attitudes and psychological reactions to hypertension varied with the context, for example, disease stage, health condition. Within the health communication, three types of social support – information support, emotional support and network support – were generated, transmitted and exchanged among members.

Practical implications

OHCs are able to serve as important source of health information and tool for health education. The implications and suggestions for health promotion of individuals, health information services optimization of OHCs and national health strategy plans were also discussed.

Originality/value

This is the first netnography study in information field on Chinese online hypertension community. This study provides a new perspective to explore the needs, attitudes and social support behaviors of Chinese hypertension population and also enables the Chinese experience of using OHCs to reduce health disparities to come to the world.

Chronic patients' satisfaction and priorities regarding medical care, information and services and quality of life: a French online patient community survey

BACKGROUND

The French healthcare system is evolving to meet the challenges of an aging population, the growing prevalence of chronic diseases, the development of new technologies and the increasing involvement of patients in the management of their disease. The aim of this study is to assess the satisfaction and priorities of chronic patients regarding medical care, information and services and their quality of life.

METHODS

A cross-sectional study was conducted from February to March 2018 via the French Carenity platform. Adult patients enrolled in type 1 diabetes, heart failure or obesity communities were invited to answer an online questionnaire. A numeric scale from 0 (meaning not satisfied) to 5 was used to evaluate patients' satisfaction. Patients' priorities were assessed using a ranking question. Patients' satisfaction and priorities have been combined in a matrix to identify patients' expectations.

RESULTS

Sixty-seven respondents of each condition answered a questionnaire. The most important and least satisfactory items about medical care are availability and active listening from healthcare providers, as well as access to coordinated and multidisciplinary care. Regarding information and services, respondents mostly expect connected medical devices, in addition to lifestyle and dietary measures. As for the quality of life, respondents fear that their chronic condition will keep impacting their daily mood and ability to do physical activities.

CONCLUSIONS

This study shows that chronic patients want to be more actively involved in their care pathway. Patient training and therapeutic patient education programs could help them manage their chronic conditions within a patient-centred healthcare system.

Using Intervention Mapping to Develop a Digital Self-Management Program for People With Type 2 Diabetes: Tutorial on MyDESMOND

Digital health interventions (DHIs) are increasingly becoming integrated into diabetes self-management to improve behavior. Despite DHIs becoming available to people with chronic conditions, the development strategies and processes undertaken are often not well described. With theoretical frameworks available in current literature, it is vital that DHIs follow a shared language and communicate a robust development process in a comprehensive way. This paper aims to bring a unique perspective to digital development, as it describes the systematic process of developing a digital self-management program for people with type 2 diabetes, MyDESMOND. We provide a step-by-step guide, based on the intervention mapping (IM) framework to illustrate the process of adapting an existing face-to-face self-management program (diabetes education and self- management for ongoing and newly diagnosed, DESMOND) and translating it to a digital platform (MyDESMOND). Overall, this paper describes the 4 IM steps that were followed to develop MyDESMOND—step 1 to establish a planning group and a patient and public involvement group to describe the context of the intervention and program goals, step 2 to identify objectives and determinants at early design stages to maintain a focus on the strategies adopted, step 3 to generate the program components underpinned by appropriate psychological theories and models, and step 4 to develop the program content and describe the iterative process of refining the content and format of the digital program for implementation. This paper concludes with a number of key learnings collated throughout our development process, which we hope other researchers may find useful when developing DHIs for chronic conditions.

COllaborative open platform E-cohorts for research acceleration in trials and epidemiology

BACKGROUND

The current clinical research system relies on a "one-off" project-by-project model involving a costly and time-wasting permanent construction and deconstruction of the research infrastructure. We propose a new model of research relying on collaborative principles: the COllaborative Open Platform (COOP') e-cohort.

DEVELOPMENT

The COOP' e-cohort aims at building a large community of patients willing to participate in research by contributing to the generation of a large database of patient-reported data, passively enriched, at the individual level, by linkage with routinely collected care and/or medico-administrative data. Approved teams can use the platform and benefit from already enrolled participants or collected data or add new online questionnaires to perform observational or interventional studies to answer a broad range of research questions.

APPLICATION

The Community of Patients for Research (ComPaRe) is a proof-of-concept COOP' e-cohort in the field of chronic conditions that was launched in 2017. As of April 2020, 36,000 patients have joined the project and contributed to more than 4 million data points. Patient-reported data will be enriched by linkage with the French national health system databases and with hospital data for patients receiving care in the Paris region. Since 2017, 150 researchers have used the platform for research projects. Three clinical trials nested in ComPaRe have been funded.

CONCLUSION

By moving from myriad independent studies to a large collaborative infrastructure of research, COOP' e-cohorts will accelerate the research process by avoiding the redundancy of many steps common to all research projects and by limiting waste of research.

Improving the Theoretical Understanding Toward Patient-Driven Health Care Innovation Through Online Value Cocreation: Systematic Review

Background

Patient participation in the health care domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven service innovation has both potential and challenges for health care organizations. Over the last 5 years, articles have surfaced that focus on value cocreation in health care services and the importance of engaging patients and other actors in service delivery. However, a theoretical understanding of how to use OHCs for this purpose is still underdeveloped within the health care service ecosystem.

Objective

This paper aimed to introduce a theoretical discussion for better understanding of the potential of OHCs for health care organizations, in particular, for patient empowerment.

Methods

This literature review study involved a comprehensive search using 12 electronic databases (EMBASE, PsycINFO, Web of Science, Scopus, ScienceDirect, Medical Literature Analysis and Retrieval System Online, PubMed, Elton B Stephens Co [academic], Cumulative Index of Nursing and Allied Health Literature, Accelerated Information Sharing for Law Enforcement, Association for Computing Machinery, and Google Scholar) from 2013 to 2019. A total of 1388 studies were identified from the database search. After removing duplicates and applying inclusion criteria, we thematically analyzed 56 articles using the Braun and Clarke thematic analysis approach.

Results

We identified a list of 5 salient themes: communication extension, improved health literacy for patients and health care organizations, communication transparency with patients, informational and social support for patients, and patient empowerment in self-management. The most frequent theme was communication extension, which covers 39% (22/56) of the literature. This theme reported that an extension of communication between patients, caregivers, and physicians and organizations led to new opportunities to create value with minimal time and cost restrictions. Improved health literacy and communication transparency with patients were the second and third most frequent themes, respectively, covering 26% (15/56) and 25% (14/56) of the literature, respectively. The frequency of these themes indicated that the use of OHCs to generate new knowledge from patients’ interactions helped health care organizations to customize treatment plans and establish transparent and effective communication between health care organizations and patients. Furthermore, of the 56 studies, 13 (23%) and 10 (17%) studies contended the opportunity of using OHCs in terms of informational and emotional support and empowering patients in their self-management of diseases.

Conclusions

This review enables better understanding of the current state of the art of the online value cocreation and its potential for health care organizations. This study found that the opportunities for health care organizations through enhancement of patient participation and their cocreation of value in digital health platforms have been rapidly increasing. The identified gaps and opportunities in this study would identify avenues for future directions in modernized and more effective value-oriented health care informatics research.

Study on Differences between Patients with Physiological and Psychological Diseases in Online Health Communities: Topic Analysis and Sentiment Analysis

The development of online social platforms has promoted the improvement of online health communities (OHCs). However, OHCs often ignore differences in user discussions caused by the characteristics of diseases. The purpose of this research was to study differences in the topics and emotions of patients with physiological and psychological diseases by mining the text that they posted in OHCs as well as to discuss how to satisfy these differences. The data came from Baidu Post Bar, the world's biggest Chinese forum. We collected 50,230 posts from heart disease, hypertension, depression and obsessive-compulsive bars. Then, we used topic modeling and sentiment analysis techniques on these posts. The results indicate that there are significant differences in the preferences of discussion and emotion between patients with physiological and psychological diseases. First, people with physiological diseases are more likely to discuss treatment of their illness, while people with psychological diseases are more likely to discuss feelings and living conditions. Second, psychological disease patients' posts included more extreme and negative emotions than those of physiological disease patients. These results are helpful for society to provide accurate medical assistance based on disease type to different patients, perfecting the national medical service system.