Enabling community through social media

The Portrayal of Cesarean Section on Instagram: Mixed Methods Social Media Analysis

BACKGROUND

Cesarean section (CS) rates in Indonesia are rapidly increasing for both sociocultural and medical reasons. However, there is limited understanding of the role that social media plays in influencing preferences regarding mode of birth (vaginal or CS). Social media provides a platform for users to seek and exchange information, including information on the mode of birth, which may help unpack social influences on health behavior.

OBJECTIVE

This study aims to explore how CS is portrayed on Instagram in Indonesia.

METHODS

We downloaded public Instagram posts from Indonesia containing CS hashtags and extracted their attributes (image, caption, hashtags, and objects and texts within images). Posts were divided into 2 periods-before COVID-19 and during COVID-19-to examine changes in CS portrayal during the pandemic. We used a mixed methods approach to analysis using text mining, descriptive statistics, and qualitative content analysis.

RESULTS

A total of 9978 posts were analyzed quantitatively, and 720 (7.22%) posts were sampled and analyzed qualitatively. The use of text (527/5913, 8.91% vs 242/4065, 5.95%; P<.001) and advertisement materials (411/5913, 6.95% vs 83/4065, 2.04%; P<.001) increased during the COVID-19 pandemic compared to before the pandemic, indicating growth of information sharing on CS over time. Posts with CS hashtags primarily promoted herbal medicine for faster recovery and services for choosing auspicious childbirth dates, encouraging elective CS. Some private health facilities offered discounts on CS for special events such as Mother's Day and promoted techniques such as enhanced recovery after CS for comfortable, painless birth, and faster recovery after CS. Hashtags related to comfortable or painless birth (2358/5913, 39.88% vs 278/4065, 6.84%; P<.001), enhanced recovery after CS (124/5913, 2.1% vs 0%; P<.001), feng shui services (110/5913, 1.86% vs 56/4065, 1.38%; P=.03), names of health care providers (2974/5913, 50.3% vs 304/4065, 7.48%; P<.001), and names of hospitals (1460/5913, 24.69% vs 917/4065, 22.56%; P=.007) were more prominent during compared to before the pandemic.

CONCLUSIONS

This study highlights the necessity of enforcing advertisement regulations regarding birth-related medical services in the commercial and private sectors. Enhanced health promotion efforts are crucial to ensure that women receive accurate, balanced, and appropriate information about birth options. Continuous and proactive health information dissemination from government organizations is essential to counteract biases favoring CS over vaginal birth.

Development and Maturation of the Human Brain, from Infancy to Adolescence

This chapter describes basic principles and key findings regarding the development and maturation of the human brain, the former referring to the pre-natal and early post-natal periods and the latter concerning childhood and adolescence. In both cases, we focus on brain structure as revealed in vivo with multi-modal magnetic resonance imaging (MRI). We begin with a few numbers about the human brain and its cellular composition and a brief overview of a number of MRI-based metrics used to characterize age-related variations in grey and white matter. We then proceed with synthesizing current knowledge about developmental and maturational changes in the cerebral cortex (its thickness, surface area, and intra-cortical myelination) and the underlying white matter (volume and structural properties). To facilitate biological interpretations of MRI-derived metrics, we introduce the concept of virtual histology. We conclude the chapter with a few notes about future directions in the study of factors shaping the human brain from conception onwards.

"One community at a time": promoting community resilience in the face of natural hazards and public health challenges

BACKGROUND

Resilience is vital for facing natural disasters and public health challenges. Despite the significance of resilience-building activities, there is a scarcity of locally-tailored planning and response strategies, leaving communities incapable of addressing the unique challenges posed by natural disasters and public health crises. This study aims to explore how the "One Community at a Time" approach enhances community resilience in facing natural hazards and public health challenges.

METHODS

A systematic review was conducted over journal articles published from January 2001 to April 2023 through PRISMA approach. Multiple databases such as Web of Science and Scopus were thoroughly searched. We used independent screening by two researchers and painstaking data extraction using standardized forms. This approach was adopted to assure the reliability, validity, and precision of our study selection and analysis. The included studies' quality was evaluated by the Mixed Methods Appraisal Tool.

RESULTS

In the evaluation, 35 studies were deemed eligible for inclusion and underwent in-depth examination. Several major components of "One Community at a Time" have been identified, including social capital and networks, local knowledge and learning, effective governance and leadership, preparedness and response capacity, and adaptive infrastructure and resources. This framework highlights the significance of individualized approaches to resilience-building initiatives, recognizing that each community has specific strengths, needs, and challenges.

CONCLUSION

Relevant stakeholders can adapt suitable resilient strategies to help prepare and recover from natural hazards and public health challenges. By adopting a localized strategy, stakeholders can collaborate to develop a culture of readiness and resilience, ultimately leading to more sustainable and resilient communities. This framework advises community-based groups, local government, and other stakeholders on prioritizing partnerships, preparedness planning, community participation, and leadership as essential components of creating and maintaining resilience. "One Community at a Time" framework offers practical guidance for community-based organizations, local government, and other stakeholders to prioritize partnerships, preparedness planning, community participation, and leadership as essential components of creating and sustaining resilience.

Exploring public sentiment and vaccination uptake of COVID-19 vaccines in England: a spatiotemporal and sociodemographic analysis of Twitter data

Objectives

Vaccination is widely regarded as the paramount approach for safeguarding individuals against the repercussions of COVID-19. Nonetheless, concerns surrounding the efficacy and potential adverse effects of these vaccines have become prevalent among the public. To date, there has been a paucity of research investigating public perceptions and the adoption of COVID-19 vaccines. Therefore, the present study endeavours to address this lacuna by undertaking a spatiotemporal analysis of sentiments towards vaccination and its uptake in England at the local authority level, while concurrently examining the sociodemographic attributes at the national level.

Methods

A sentiment analysis of Twitter data was undertaken to delineate the distribution of positive sentiments and their demographic correlates. Positive sentiments were categorized into clusters to streamline comparison across different age and gender demographics. The relationship between positive sentiment and vaccination uptake was evaluated using Spearman's correlation coefficient. Additionally, a bivariate analysis was carried out to further probe public sentiment towards COVID-19 vaccines and their local adoption rates.

Result

The results indicated that the majority of positive tweets were posted by males, although females expressed higher levels of positive sentiment. The age group over 40 dominated the positive tweets and exhibited the highest sentiment polarity. Additionally, vaccination uptake was positively correlated with the number of positive tweets and the age group at the local authority level.

Conclusion

Overall, public opinions on COVID-19 vaccines are predominantly positive. The number of individuals receiving vaccinations at the local authority level is positively correlated with the prevalence of positive attitudes towards vaccines, particularly among the population aged over 40. These findings suggest that targeted efforts to increase vaccination uptake among younger populations, particularly males, are necessary to achieve widespread vaccination coverage.

Social media use of adolescents who died by suicide: lessons from a psychological autopsy study

BACKGROUND

while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress.

METHODS

data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents.

RESULTS

young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths' closedness.

CONCLUSIONS

based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models.

"Social media perceptions of hip fractures: A two-year cross-sectional analysis"

BACKGROUND

The outcomes of hip fracture rely heavily on subjective pain relief, and social media provides a remarkable lens to examine the patient experience.

METHODS

A search of public posts on Instagram and Twitter was performed over a 2 -year period, selected through use of the following hashtags: #hipfracture, #hipfracturerecovery, and #hipfracturerepair. A categorical classification system was used for media format (picture or video), perspective, timing, tone, and content. Post-popularity (number of likes) and geographic location were also recorded.

RESULTS

Of the Instagram posts analyzed, 50.6% were made by patients. The most common content included in Instagram posts was rehabilitation and or educational posts on hip fracture. Amongst the Twitter posts analyzed, 66% of posts were made by professional organizations. Frequently referenced themes included education, and posts produced by the hospital or surgeon. Of Facebook posts analyzed, 62.8% of posts were produced by businesses.

CONCLUSION

Social media analysis is a powerful tool for evaluating characteristics important to patients. Instagram was used more by patients and focused on rehabilitation. Twitter posts were more frequently made by professional organizations and tended to be educational. Lastly, Facebook posts were made primarily by businesses and focused on marketing.

Cues Disseminated by Professional Associations That Represent 5 Health Care Professions Across 5 Nations: Lexical Analysis of Tweets

BACKGROUND

Collaboration across health care professions is critical in efficiently and effectively managing complex and chronic health conditions, yet interprofessional care does not happen automatically. Professional associations have a key role in setting a profession's agenda, maintaining professional identity, and establishing priorities. The associations' external communication is commonly undertaken through social media platforms, such as Twitter. Despite the valuable insights potentially available into professional associations through such communication, to date, their messaging has not been examined.

OBJECTIVE

This study aimed to identify the cues disseminated by professional associations that represent 5 health care professions spanning 5 nations.

METHODS

Using a back-iterative application programming interface methodology, public tweets were sourced from professional associations that represent 5 health care professions that have key roles in community-based health care: general practice, nursing, pharmacy, physiotherapy, and social work. Furthermore, the professional associations spanned Australia, Canada, New Zealand, the United Kingdom, and the United States. A lexical analysis was conducted of the tweets using Leximancer (Leximancer Pty Ltd) to clarify relationships within the discourse.

RESULTS

After completing a lexical analysis of 50,638 tweets, 7 key findings were identified. First, the discourse was largely devoid of references to interprofessional care. Second, there was no explicit discourse pertaining to physiotherapists. Third, although all the professions represented in this study support patients, discourse pertaining to general practitioners was most likely to be connected with that pertaining to patients. Fourth, tweets pertaining to pharmacists were most likely to be connected with discourse pertaining to latest and research. Fifth, tweets about social workers were unlikely to be connected with discourse pertaining to health or care. Sixth, notwithstanding a few exceptions, the findings across the different nations were generally similar, suggesting their generality. Seventh and last, tweets pertaining to physiotherapists were most likely to refer to discourse pertaining to profession.

CONCLUSIONS

The findings indicate that health care professional associations do not use Twitter to disseminate cues that reinforce the importance of interprofessional care. Instead, they largely use this platform to emphasize what they individually deem to be important and advance the interests of their respective professions. Therefore, there is considerable opportunity for professional associations to assert how the profession they represent complements other health care professions and how the professionals they represent can enact interprofessional care for the benefit of patients and carers.

Exploring the sociotechnical system of Chinese internet literature online forums: a social network analytical approach

Purpose

Chinese internet literature (CIL) platforms afford freedom for creative expression and opportunities for direct interactions between writers and fans and among fans. Enabled by these platforms' technological and commercial arrangement, a new form of literary production and consumption has emerged, the most significant of which is the role of fans participation. A social network analysis of the interaction patterns in online fan communities was conducted to investigate fan communication activities at scale. Of particular interest is how the socio-technical system of the site influences its network topology.

Design/methodology/approach

Online forums for 10 popular fiction titles in Qidian, the leading CIL platform, were analyzed. Social networks were constructed based on a post–reply–reply threaded discussion structure. Various aspects of fan interactions were analyzed, including number of replies per post, post length and emerging network patterns.

Findings

Similarities in network topology shared by CIL fan forums and other online communities, such as small-world and scale properties, were discovered; however, distinct network dynamics were also identified. Consistent with previous findings, writers and moderators, along with a few highly ranked fans, occupied the central positions in the network. This was due to their social roles and the nature of their posts rather than, as the conventional explanation goes, preferential attachment.

Originality/value

The findings demonstrate how community-specific circumstances and norms influence interaction patterns and the resultant network structure. It was revealed that in the CIL sites, the users adopted the technologies in unexpected ways. And the resulting network topology can be attributed to the interplay between the sites' official arrangement and users' adaptive tactics.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-11-2021-0596.

Virtual Engagement in a Social Media Community of Mothers With Substance Use Disorders: Content Analysis

BACKGROUND

Co-occurring substance use disorder is common among pregnant and parenting women with mental illness, but their engagement with and utilization of relevant services and treatment is low. Social media has the potential to convey benefits and facilitate engagement among this target group.

OBJECTIVE

This study aimed to explore the reach and engagement of specific social media posts among pregnant women and mothers with substance use disorders.

METHODS

Eighteen posts providing content related to substance use (cannabis, opioids, or alcohol), varying in type of content (informational or experiential) and target (policy-, practice-, or perception-related), were posted in a closed Facebook community page comprising over 33,000 pregnant women and mothers between May 2019 and October 2019.

RESULTS

The overall level of reach of these Facebook posts ranged from 453 to 3045 community members. Engagement levels, measured via the number of likes, comments, or posts shared, varied based on the type of post content (ie, informational or experiential).

CONCLUSIONS

Participation in a virtual community via social media platforms can facilitate engagement among pregnant women and mothers with mental illness by communicating relevant information about substance use, as well as potentially promoting awareness of, access to, and engagement with treatment services.

Representations of Psychoactive Drugs' Use in Mass Culture and Their Impact on Audiences

Drug use has been increasing worldwide over recent decades. Apart from the determinants of drug initiation established in numerous studies, the authors wish to draw attention to other equally important factors, which may contribute to augmenting this phenomenon. The article aims to draw attention to the content of mass culture, especially representations of drug use in mass media, which may influence the liberalization of attitudes towards drugs and their use. The role of mass culture and its impact on the audience is discussed. It presents an overview of drug representations in the content of mass culture, e.g., in film, music, literature, and the occurrence of drug references in everyday products, e.g., food, clothes, and cosmetics. Attention was drawn to liberal attitudes of celebrities and their admissions to drug use, particularly to the impact of the presented positions on the attitudes of the audience, especially young people for whom musicians, actors, and celebrities are regarded as authorities. Indications for further preventive actions were also presented. Attention was drawn to the need to take appropriate action due to the time of the COVID-19 pandemic when many people staying at home (due to lockdown or quarantine) have the possibility of much more frequent contact with mass culture content, which may distort the image of drugs.

Mapping out Violence Against Women of Influence on Twitter Using the Cyber-Lifestyle Routine Activity Theory

The study applies and expands the routine activity theory to examine the dynamics of online harassment and violence against women on Twitter in India. We collected 931,363 public tweets (original posts and replies) over a period of 1 month that mentioned at least one of 101 influential women in India. By undertaking both manual and automated text analysis of "hateful" tweets, we identified three broad types of violence experienced by women of influence on Twitter: dismissive insults, ethnoreligious slurs, and gendered sexual harassment. The analysis also revealed different types of individually motivated offenders: "news junkies," "Bollywood fanatics," and "lone-wolves", who do not characteristically engage in direct targeted attacks against a single person. Finally, we question the effectiveness of Twitter's form of "guardianship" against online violence against women, as we found that a year after our initial data collection in 2017, only 22% of hostile posts with explicit forms of harassment have been deleted. We conclude that in the social media age, online and offline public spheres overlap and intertwine, requiring improved regulatory approaches, policies, and moderation tools of "capable" guardianship that empower women to actively participate in public life.

Mental health, quality of life, wellbeing, loneliness and use of social media in a time of social distancing during the COVID-19 outbreak. A cross-country comparative study

BACKGROUND

The COVID-19 outbreak raised questions about how people experience their mental health, quality of life (QoL), wellbeing and loneliness in the context of social distancing, and the use of social media during this time.

AIMS

To examine the experience of mental health, QoL, wellbeing and loneliness and use of social media among people living in Norway, USA, UK and Australia.

METHODS

A cross-country comparative survey of people living in Norway, USA, UK and Australia. Relevant statistical analyses were used to examine differences between the countries and to explore associations between demographic, mental health and psychosocial variables and use of social media.

RESULTS

There were 3810 respondents from four countries, of which 50 - 74% showed a high level of emotional distress. The Norwegian population reported significantly better mental health, QoL and wellbeing and lower levels of loneliness compared to the other countries. High-frequent use of social media after the COVID-19 outbreak was associated with poorer mental- and psychosocial health.

CONCLUSIONS

The results suggest that the COVID-19 outbreak took a toll on people's experience of mental health, QoL, wellbeing and experienced loneliness, and high-frequent use of social media was associated with these factors.

Feasibility of a virtual Facebook community platform for engagement on health research

INTRODUCTION

Community engagement is important for advancing Clinical and Translational Science (CTS), but face-to-face engagement has limited reach and scale. We examined the feasibility of a novel virtual Facebook community platform for public engagement on health research statewide in Minnesota.

METHODS

The Facebook platform, MN Research Link, was evaluated from June 19, 2019 to June 30, 2020. Facebook advertisements and boosts were used to recruit followers. Content, based on prior formative work, included health research information and interactive postings (e.g., live interviews with researchers). Standard metrics obtained from Facebook analytics included participation (followers), content reach (views), and engagement (likes, shares, comments, clicks).

RESULTS

During the 12-month period, we acquired 1406 followers (31% rural residents), with a retention of followers of 99.7%. Mean number of views per month was 9379.83 (Mdn = 2791, range 724-41,510). Engagement metrics indicated a mean of 535.2 likes, shares, comments, and/or clicks per month (Mdn = 296.5, range 55-1535). The page continued to acquire new followers, but a slight decrease in engagement was observed in the final months after state COVID-19 mitigation strategies were implemented.

CONCLUSION

As the complexity of CTS continues to grow, along with social distancing measures resulting from the COVID-19 pandemic, the availability of virtual digital platforms to reach and engage community stakeholders in conversations about health and research has increasing importance. Preliminary findings from this program evaluation indicate that a Facebook community platform is feasible to engage Minnesota residents in conversations around health and research topics. Future work will evaluate its potential for reach, scale, and sustainability.

Coding and Classifying Knowledge Exchange on Social Media: a Comparative Analysis of the #Twitterstorians and AskHistorians Communities

As social media become a staple for knowledge discovery and sharing, questions arise about how self-organizing communities manage learning outside the domain of organized, authority-led institutions. Yet examination of such communities is challenged by the quantity of posts and variety of media now used for learning. This paper addresses the challenges of identifying (1) what information, communication, and discursive practices support successful online communities, (2) whether such practices are similar on Twitter and Reddit, and (3) whether machine learning classifiers can be successfully used to analyze larger datasets of learning exchanges. This paper builds on earlier work that used manual coding of learning and exchange in Reddit 'Ask' communities to derive a coding schema we refer to as 'learning in the wild'. This schema of eight categories: explanation with disagreement, agreement, or neutral presentation; socializing with negative, or positive intent; information seeking; providing resources; and comments about forum rules and norms. To compare across media, results from coding Reddit's AskHistorians are compared to results from coding a sample of #Twitterstorians tweets (n = 594). High agreement between coders affirmed the applicability of the coding schema to this different medium. LIWC lexicon-based text analysis was used to build machine learning classifiers and apply these to code a larger dataset of tweets (n = 69,101). This research shows that the 'learning in the wild' coding schema holds across at least two different platforms, and is partially scalable to study larger online learning communities.

Antivaccine Messages on Facebook: Preliminary Audit

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

An Instagram-Based Study to Understand Betel Nut Use Culture in Micronesia: Exploratory Content Analysis

BACKGROUND

A 2012 World Health Organization report recognizes betel nut use as an urgent public health threat faced by the Western Pacific region. However, compared with other addictive substances, little is known about how betel nuts are depicted on social media platforms. In particular, image-based social media platforms can be powerful tools for health communication. Studying the content of substance use on visual social media may provide valuable insights into public health interventions.

OBJECTIVE

This study aimed to explore and document the ways that betel nut is portrayed on the photo-sharing site Instagram. The analysis focuses on the hashtag #pugua, which refers to the local term for betel nut in Guam and other parts of Micronesia.

METHODS

An exploratory content analysis of 242 Instagram posts tagged #pugua was conducted based on previous research on substance use and Instagram and betel nut practices in Micronesia. In addition, the study examined the social engagement of betel nut content on the image-based platform.

RESULTS

The study findings revealed content themes referencing the betel nut or betel nut tree, betel nut preparation practices, and the unique social and cultural context surrounding betel nut activity in Guam and Micronesia. In addition, certain practices and cultural themes encouraged social engagement on Instagram.

CONCLUSIONS

The findings from this study emphasize the cultural relevance of betel nut use in Micronesia. These findings provide a basis for empirically testing hypotheses related to the etiological roles of cultural identity and pride in shaping betel nut use behavior among Micronesians, particularly youths and young adults. Such research is likely to inform the development of culturally relevant betel nut prevention and cessation programs.

Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial

BACKGROUND

Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes.

OBJECTIVE

This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia.

METHODS

Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs.

RESULTS

Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6).

CONCLUSIONS

The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants' knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings.

Identifying New Frontiers for Social Media Engagement in Global Surgery: An Observational Study

Background

The purpose of this observational study is to characterize the use of social media content pertaining to global surgery.

Methods

A search for public posts on social media related to global surgery was performed over a 3-month window, from January 1st, 2019, to March 31st, 2019. Two public domains were included in the search: Instagram and Twitter. Posts were selected by filtering for one hashtag: #GlobalSurgery. A binary scoring system was used for media format, perspective of the poster, timing of the post, tone, and post content. Data were analyzed using Chi-squared tests with significance set to p < 0.05.

Results

Overall, 2633 posts with the hashtag #GlobalSurgery were publicly shared on these two social media platforms over the 3-month period. Of these, 2272 (86.3%) referenced content related to global surgery and were original posts. Physicians and other health professionals authored a majority (60.5%, 1083/1788) of posts on Twitter, whereas organizations comprised a majority of the posts on Instagram (59.9%, 290/484). Posts either had a positive (50.2%, 1140/2272) or neutral (49.6%, 1126/2272) tone, with only 0.3% or 6/2272 of posts being explicitly negative. The content of the posts varied, but most frequently (43.4%, 986/2272) focused on promoting communication and engagement within the community, followed by educational content (21.3%, 486/2272), advertisements (18.8%, 427/2272), and published research (13.2%, 299/2272). The majority of global surgery posts originated from the USA, UK, or Canada (67.6%, 1537/2272), followed by international organizations (11.5%, 261/2272). Chi-squared analysis comparing Instagram with Twitter performed examining media content, tone, perspective, and content, finding statistically significant differences (p < 0.001) the two platforms for each of the categories.

Conclusion

The online social media community with respect to global surgery engagement is predominantly composed of surgeons and health care professionals, focused primarily on promoting dialogue within the online community. Social media platforms may provide a scalable tool that can augment engagement between global surgeons, with remaining opportunity to foster global collaboration, community engagement, education and awareness.

Effects of user behaviors on accumulation of social capital in an online social network

The use of social network sites helps people to make and maintain social ties accumulating social capital, which is increasingly important for individual success. There is a wide variation in the amount and structure of online ties, and to some extent this variation is contingent on specific online user behaviors which are to date under-researched. In this work, we examine an entire city-bounded friendship network (N = 194,601) extracted from VK social network site to explore how specific online user behaviors are related to structural social capital in a network of geographically proximate ties. Social network analysis was used to evaluate individual social capital as a network asset, and multiple regression analysis–to determine and estimate the effects of online user behaviors on social capital. The analysis reveals that the graph is both clustered and highly centralized which suggests the presence of a hierarchical structure: a set of sub-communities united by city-level hubs. Against this background, membership in more online groups is positively associated with user’s brokerage in the location-bounded network. Additionally, the share of local friends, the number of received likes and the duration of SNS use are associated with social capital indicators. This contributes to the literature on the formation of online social capital, examined at the level of a large and geographically localized population.

The Use of Web-Based Support Groups Versus Usual Quit-Smoking Care for Men and Women Aged 21-59 Years: Protocol for a Randomized Controlled Trial

Background

Existing smoking cessation treatments are challenged by low engagement and high relapse rates, suggesting the need for more innovative, accessible, and interactive treatment strategies. Twitter is a Web-based platform that allows people to communicate with each other throughout the day using their phone.

Objective

This study aims to leverage the social media platform of Twitter for fostering peer-to-peer support to decrease relapse with quitting smoking. Furthermore, the study will compare the effects of coed versus women-only groups on women’s success with quitting smoking.

Methods

The study design is a Web-based, three-arm randomized controlled trial with two treatment arms (a coed or women-only Twitter support group) and a control arm. Participants are recruited online and are randomized to one of the conditions. All participants will receive 8 weeks of combination nicotine replacement therapy (patches plus their choice of gum or lozenges), serial emails with links to Smokefree.gov quit guides, and instructions to record their quit date online (and to quit smoking on that date) on a date falling within a week of initiation of the study. Participants randomized to a treatment arm are placed in a fully automated Twitter support group (coed or women-only), paired with a buddy (matched on age, gender, location, and education), and encouraged to communicate with the group and buddy via daily tweeted discussion topics and daily automated feedback texts (a positive tweet if they tweet and an encouraging tweet if they miss tweeting). Recruited online from across the continental United States, the sample consists of 215 male and 745 female current cigarette smokers wanting to quit, aged between 21 and 59 years. Self-assessed follow-up surveys are completed online at 1, 3, and 6 months after the date they selected to quit smoking, with salivary cotinine validation at 3 and 6 months. The primary outcome is sustained biochemically confirmed abstinence at the 6-month follow-up.

Results

From November 2016 to September 2018, 960 participants in 36 groups were recruited for the randomized controlled trial, in addition to 20 participants in an initial pilot group. Data analysis will commence soon for the randomized controlled trial based on data from 896 of the 960 participants (93.3%), with 56 participants lost to follow-up and 8 dropouts.

Conclusions

This study combines the mobile platform of Twitter with a support group for quitting smoking. Findings will inform the efficacy of virtual peer-to-peer support groups for quitting smoking and potentially elucidate gender differences in quit rates found in prior research.

Trial Registration

ClinicalTrials.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028

International Registered Report Identifier (IRRID)

DERR1-10.2196/16417

The Antecedents and Consequences of Health Care Professional-Patient Online Interactions: Systematic Review

Background

Online health care services effectively supplement traditional medical treatment. The development of online health care services depends on sustained interactions between health care professionals (HCPs) and patients. Therefore, it is necessary to understand the demands and gains of health care stakeholders in HCP-patient online interactions and determine an agenda for future work.

Objective

This study aims to present a systematic review of the antecedents and consequences of HCP-patient online interactions. It seeks to reach a better understanding of why HCPs and patients are willing to interact with each other online and what the consequences of HCP-patient online interactions are for health care stakeholders. Based on this, we intend to identify the gaps in existing studies and make recommendations for future research.

Methods

In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic retrieval was carried out from the Web of Science, PubMed, and Scopus electronic databases. The search results were confined to those papers published in English between January 1, 2000 and June 30, 2018. Selected studies were then evaluated for quality; studies that did not meet quality criteria were excluded from further analysis. Findings of the reviewed studies related to our research questions were extracted and synthesized through inductive thematic analysis.

Results

A total of 8440 records were found after the initial search, 28 papers of which were selected for analysis. Accessibility to HCPs, self-management, and unmet needs were the main triggers for patients to participate in online interaction. For HCPs, patient education, career needs, and self-promotion were the major reasons why they took the online approach. There were several aspects of the consequences of HCP-patient online interactions on health care stakeholders. Consequences for patients included patient empowerment, health promotion, and acquisition of uncertain answers. Consequences for HCPs included social and economic returns, lack of control over their role, and gaining more appointments. HCP-patient online interactions also improved communication efficiency in offline settings and helped managers of online health care settings get a better understanding of patients’ needs. Health care stakeholders have also encountered ethical and legal issues during online interaction.

Conclusions

Through a systematic review, we sought out the antecedents and consequences of HCP-patient online interactions to understand the triggers for HCPs and patients to participate and the consequences of participating. Potential future research topics are the influences on the chain of online interaction, specifications and principles of privacy design within online health care settings, and roles that sociodemographic and psychological characteristics play. Longitudinal studies and the adoption of text-mining method are worth encouraging. This paper is expected to contribute to the sustained progress of online health care settings.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

#Hookahlife: The Rise of Waterpipe Promotion on Instagram

Introduction. Hookah smoking is becoming increasingly popular worldwide, especially among young adults. The growth of social media has also enabled sharing of opinions, experiences, and marketing related to hookah via user-generated content. Aim. To evaluate the portrayal and promotion of hookah on Instagram and to highlight public health challenges created by this content. Method. A qualitative content analysis was performed on a sample of 301 Instagram posts made with the hashtags #hookah or #shisha in October 2016. Results. Of the 301 coded posts, 279 were relevant to hookah. These posts were most commonly made by hookah lounges/bars (29.2%) and individual users (27.6%). Posters were most commonly from Russia (38.5%), the United States (18.6%), and Germany (10.7%). A total of 63.8% of the posts were promotional in nature; 19.7% of posts contained hashtags that expressed hookah identity or community (e.g., #hookahlife); 35.5% of posts associated nightlife activities with hookah smoking and 33.0% portrayed hookah smoking as a social activity. Only one post (0.4%) mentioned that hookah might have negative health effects. Likes were more common on posts depicting novel rather than traditional hookah designs ( p = .027). Conclusions. Images from Instagram may help in understanding health behaviors such as hookah smoking. Our results suggest that domestic and international hookah promotion is common on Instagram. Instagram posts cast hookah in an overwhelmingly positive light and may normalize hookah use through associations with nightlife, community, and hookah identity. Policy makers and researchers should explore approaches for reducing the volume of promotional posts and tailoring counter-marketing to the specific themes presented on social media.

Investigating Patterns of Participation in an Online Support Group for Problem Drinking: a Social Network Analysis

PURPOSE

This study contributes to emerging literature on online health networks by modeling communication patterns between members of a moderated online support group for problem drinking. Using social network analysis, we described members' patterns of joint participation in threads, parsing out the role of site moderators, and explored differences in member characteristics by network position.

METHODS

Posts made to the online support group of Alcohol Help Centre during 2013 were structured as a two-mode network of members (n = 205) connected via threads (n = 506). Metrics included degree centrality, clique membership, and tie strength.

RESULTS

The network consisted of one component and no cliques of members, although most made few posts and a small number communicated only with the site's moderators. Highly active members were older and tended to have started posting prior to 2013. The distribution of members across threads varied from threads containing posts by one member to others that connected multiple members. Moderators accounted for sizable proportions of the connectivity between both members and threads.

CONCLUSIONS

After 5 years of operation, the AHC online support group appears to be fairly cohesive and stable, in the sense that there were no isolated subnetworks comprised of specific types of members or devoted to specific topics. Participation and connectedness at the member-level was varied, however, and tended to be low on average. The moderators were among the most central in the network, although there were also members who emerged as central and dedicated contributors to the online discussions across topics. Study findings highlight a number of areas for consideration by online support group developers and managers.

Social Media Engagement and the Critical Care Medicine Community

Over the last decade, social media has transformed how we communicate in the medical community. Microblogging through platforms such as Twitter has made social media a vehicle for succinct, targeted, and innovative dissemination of content in critical care medicine. Common uses of social media in medicine include dissemination of information, knowledge acquisition, professional networking, and patient advocacy. Social media engagement at conferences represents all of these categories and is often the first time health-care providers are introduced to Twitter. Most of the major critical care medicine conferences, journals, and societies leverage social media for education, research, and advocacy, and social media users can tailor the inflow of content based on their own interests. From these interactions, networks and communities are built within critical care medicine and beyond, overcoming the barriers of physical proximity. In this review, we summarize the history and current status of health-care social media as it relates to critical care medicine and provide a primer for those new to health-care social media with a focus on Twitter, one of the most popular microblogging platforms.

Use of Social Network Sites for Communication Among Health Professionals: Systematic Review

BACKGROUND

Although much research has been done investigating the roles of social network sites (SNSs) in linking patients and health professionals, there is a lack of information about their uses, benefits, and limitations in connecting health professions only for professional communication.

OBJECTIVE

This review aimed to examine the utilization of SNSs for communication among health professionals in (1) frontline clinical practice, (2) professional networks, and (3) education and training to identify areas for future health communication research.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A systematic search of the literature published in the last 10 years (January 1, 2007, to March 1, 2017) was performed in March 2017, using the following electronic databases: MEDLINE via OvidSP, EMBASE, CINAHL Complete, and InfoSci-Journals. The searches were conducted using the following defined search terms: "social media" OR "social network" OR "social network site" OR "Facebook" OR "Twitter" OR "Linkedin" OR "Instagram" OR "Weibo" OR "Whatsapp" OR "Telegram" OR "WeChat" AND "health" OR "health profession."

RESULTS

Of the 6977 papers retrieved, a total of 33 studies were included in this review. They were exploratory in nature, and the majority used surveys (n=25) and interviews (n=6). All retrieved studies stated that SNSs enhanced effective communication and information sharing. SNSs were used for supporting delivering of clinical services, making referrals, and sharing information. They were beneficial to network building and professional collaboration. SNSs were novel tools to enhance educational interactions among peers, students, instructors, and preceptors. The application of SNSs came with restraints in technical knowledge, concerns on data protection, privacy and liability, issues in professionalism, and data protection.

CONCLUSIONS

SNSs provide platforms facilitating efficient communication, interactions, and connections among health professionals in frontline clinical practice, professional networks, education, and training with limitations identified as technical knowledge, professionalism, and risks of data protection. The evolving use of SNSs necessitates robust research to explore the full potential and the relative effectiveness of SNSs in professional communication.

Engagement as a Driver of Growth of Online Health Forums: Observational Study

Background

The emerging research on nurturing the growth of online communities posits that it is in part attributed to network effects, wherein every increase in the volume of user-generated content increases the value of the community in the eyes of its potential new members. The recently introduced metric engagement capacity offers a means of quantitatively assessing the ability of online platform users to engage each other into generating content; meanwhile, the quantity engagement value is useful for quantifying communication-based platform use. If the claim that higher engagement leads to accelerated growth holds true for online health forums (OHFs), then engagement tracking should become an important tool in the arsenal of OHF managers. Indeed, it might allow for quantifying the ability of an OHF to exploit network effects, thus predicting the OHF’s future success.

Objective

This study aimed to empirically analyze the relationship between internal OHF use (quantified using engagement measurement), and external growth.

Methods

We collected data from 7 OHFs posted between the years 1999 and 2016. Longitudinal analyses were conducted by evaluating engagement in the OHFs over time. We analyzed 2-way causality effects between the engagement value and metrics evaluating OHF growth using Granger causality tests. User activity metrics per week were correlated with engagement metrics, followed by linear regression analyses.

Results

Observational data showed a 1-way causal relationship between the OHF engagement value and reach (P=.02). We detected a 2-way causal relationship between the engagement value and delurking, with further analysis indicating that the engagement value was more likely to cause delurking (P<.001 with lag 2; for the reverse hypothesis, P=.01 with lag 2). Users who engaged each other more were more likely (up to 14 times, depending on how much one user engaged another) to develop personal connections. Finally, we found that the more engaging an OHF user was in a given week, the more likely (up to 2 times, depending on their ability to engage others) they were to remain active in the OHF in the following week.

Conclusions

This study supports the claim that network effects play an important role in accelerating OHF growth, opening the door to exploiting these effects in calculated ways. In such efforts, engagement metrics can be used to monitor the “health” of an OHF and to identify the users most important to its success.

Patient Participation at Health Care Conferences: Engaged Patients Increase Information Flow, Expand Propagation, and Deepen Engagement in the Conversation of Tweets Compared to Physicians or Researchers

BACKGROUND

Health care conferences present a unique opportunity to network, spark innovation, and disseminate novel information to a large audience, but the dissemination of information typically stays within very specific networks. Social network analysis can be adopted to understand the flow of information between virtual social communities and the role of patients within the network.

OBJECTIVE

The purpose of this study is to examine the impact engaged patients bring to health care conference social media information flow and how they expand dissemination and distribution of tweets compared to other health care conference stakeholders such as physicians and researchers.

METHODS

From January 2014 through December 2016, 7,644,549 tweets were analyzed from 1672 health care conferences with at least 1000 tweets who had registered in Symplur's Health Care Hashtag Project from 2014 to 2016. The tweet content was analyzed to create a list of the top 100 influencers by mention from each conference, who were then subsequently categorized by stakeholder group. Multivariate linear regression models were created using stepwise function building to identify factors explaining variability as predictor variables for the model in which conference tweets were taken as the dependent variable.

RESULTS

Inclusion of engaged patients in health care conference social media was low compared to that of physicians and has not significantly changed over the last 3 years. When engaged patient voices are included in health care conferences, they greatly increase information flow as measured by total tweet volume (beta=301.6) compared to physicians (beta=137.3, P<.001), expand propagation of information tweeted during a conference as measured by social media impressions created (beta=1,700,000) compared to physicians (beta=270,000, P<.001), and deepen engagement in the tweet conversation as measured by replies to their tweets (beta=24.4) compared to physicians (beta=5.5, P<.001). Social network analysis of hubs and authorities revealed that patients had statistically significant higher hub scores (mean 8.26×10-4, SD 2.96×10-4) compared to other stakeholder groups' Twitter accounts (mean 7.19×10-4, SD 3.81×10-4; t273.84=4.302, P<.001).

CONCLUSIONS

Although engaged patients are powerful accelerators of information flow, expanders of tweet propagation, and greatly deepen engagement in conversation of tweets on social media of health care conferences compared to physicians, they represent only 1.4% of the stakeholder mix of the top 100 influencers in the conversation. Health care conferences that fail to engage patients in their proceedings may risk limiting their engagement with the public, disseminating scientific information to a narrow community and slowing flow of information across social media channels.

Effects of a weight management program delivered by social media on weight and metabolic syndrome risk factors in overweight and obese adults: A randomised controlled trial

Introduction

The aim of this project was to evaluate the effectiveness of using social media to augment the delivery of, and provide support for, a weight management program delivered to overweight and obese individuals during a twenty four week intervention.

Methods

Participants randomly divided into either one of two intervention groups or a control group. The two intervention groups were instructed to follow identical weight-management program. One group received the program within a Facebook group, along with a support network with the group, and the other intervention group received the same program in a booklet. The control group was given standard care. Participants’ weight and other metabolic syndrome risk factors were measured at baseline and at weeks 6, 12, 18 and 24.

Results

The Facebook Group reported a 4.8% reduction in initial weight, significant compared to the CG only (p = 0.01), as well as numerically greater improvements in body mass index, waist circumference, fat mass, lean mass, and energy intake compared to the Pamphlet Group and the Control Group.

Conclusions

These results demonstrate the potential of social media to assist overweight and obese individuals with respect to dietary and physical activity modifications for weight management, and justify further research into the inclusion of social media in clinical weight management programs. It is anticipated that social media will provide an invaluable resource for health professionals, as a low maintenance vehicle for communicating with patients, as well as a source of social support and information sharing for individuals undergoing lifestyle modifications.

Randomised controlled trial evaluation of Tweet2Quit: a social network quit-smoking intervention

BACKGROUND

We evaluated a novel Twitter-delivered intervention for smoking cessation, Tweet2Quit, which sends daily, automated communications to small, private, self-help groups to encourage high-quality, online, peer-to-peer discussions.

DESIGN

A 2-group randomised controlled trial assessed the net benefit of adding a Tweet2Quit support group to a usual care control condition of nicotine patches and a cessation website.

PARTICIPANTS

Participants were 160 smokers (4 cohorts of 40/cohort), aged 18-59 years, who intended to quit smoking, used Facebook daily, texted weekly, and had mobile phones with unlimited texting.

INTERVENTION

All participants received 56 days of nicotine patches, emails with links to the smokefree.gov cessation website, and instructions to set a quit date within 7 days. Additionally, Tweet2Quit participants were enrolled in 20-person, 100-day Twitter groups, and received daily discussion topics via Twitter, and daily engagement feedback via text.

MEASURES

The primary outcome was sustained abstinence at 7, 30 and 60 days post-quit date.

RESULTS

Participants (mean age 35.7 years, 26.3% male, 31.2% college degree, 88.7% Caucasian) averaged 18.0 (SD=8.2) cigarettes per day and 16.8 (SD=9.8) years of smoking. Participants randomised to Tweet2Quit averaged 58.8 tweets/participant and the average tweeting duration was 47.4 days/participant. Tweet2Quit doubled sustained abstinence out to 60 days follow-up (40.0%, 26/65) versus control (20.0%, 14/70), OR=2.67, CI 1.19 to 5.99, p=0.017. Tweeting via phone predicted tweet volume, and tweet volume predicted sustained abstinence (p<0.001). The daily autocommunications caused tweeting spikes accounting for 24.0% of tweets.

CONCLUSIONS

Tweet2Quit was engaging and doubled sustained abstinence. Its low cost and scalability makes it viable as a global cessation treatment.

TRIAL REGISTRATION NUMBER

NCT01602536.

Community-based participatory research through virtual communities

Background

Over the last quarter century many new cyberspace platforms have emerged that facilitate communication across time, geographical distance and now even language. Whereas brick-and-mortar communities are defined by geographically local characteristics, a virtual community is an online community of individuals who socialize and connect around a common interest or theme using the Internet. Community-based participatory research (CBPR) is a public health approach that requires equitable partnerships between community members and researchers. Virtual communities abound on the Internet today, yet their application to CBPR is rarely considered.

Methods

We examine three case studies to explore the advantages and challenges of virtual communities for CBPR, as well as several of the online tools CBPR practitioners can use to facilitate virtual community participation.

Results

There is a potential utility of virtual communities in supporting CBPR efforts as they reduce the effects of geographical barriers, maximize the growth potential of the community, and provide portable and affordable channels forreal-time communication. Some caveats indicated in our case studies are: technological challenges, difficulty in crediting members' contributions and determining ownership of content, no face-to-face interaction may hinder relationship formation, cohesion, and trust resulting in lower engagement.

Conclusions

The paper concludes with recommendations for the use of virtual communities in CBPR projects, such as in the coordination of statewide health care policy initiatives and in the dissemination of best public health practices.

Use of Web 2.0 Social Media Platforms to Promote Community-Engaged Research Dialogs: A Preliminary Program Evaluation

Background

Community-engaged research is defined by the Institute of Medicine as the process of working collaboratively with groups of people affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being. Traditional face-to-face community-engaged research is limited by geographic location, limited in resources, and/or uses one-way communications. Web 2.0 technologies including social media are novel communication channels for community-engaged research because these tools can reach a broader audience while promoting bidirectional dialogs.

Objective

This paper reports on a preliminary program evaluation of the use of social media platforms for promoting engagement of researchers and community representatives in dialogs about community-engaged research.

Methods

For this pilot program evaluation, the Clinical and Translational Science Office for Community Engagement in Research partnered with the Social Media Network at our institution to create a WordPress blog and Twitter account. Both social media platforms were facilitated by a social media manager. We used descriptive analytics for measuring engagement with WordPress and Twitter over an 18-month implementation period during 2014-2016. For the blog, we examined type of user (researcher, community representative, other) and used content analysis to generate the major themes from blog postings. For use of Twitter, we examined selected demographics and impressions among followers.

Results

There were 76 blog postings observed from researchers (48/76, 64%), community representatives (23/76, 32%) and funders (5/76, 8%). The predominant themes of the blog content were research awareness and dissemination of community-engaged research (35/76, 46%) and best practices (23/76, 30%). For Twitter, we obtained 411 followers at the end of the 18-month evaluation period, with an increase of 42% (from 280 to 411) over the final 6 months. Followers reported varied geographic location (321/411, 78%, resided in the United States); 99% (407/411) spoke English; and about half (218/411, 53%) were female. Followers produced 132,000 Twitter impressions.

Conclusions

Researchers and community stakeholders use social medial platforms for dialogs related to community-engaged research. This preliminary work is novel because we used Web 2.0 social media platforms to engage these stakeholders whereas prior work used face-to-face formats. Future research is needed to explore additional social media platforms; expanded reach to other diverse stakeholders including patients, providers, and payers; and additional outcomes related to engagement.

Community Structure of a Mental Health Internet Support Group: Modularity in User Thread Participation

BACKGROUND

Little is known about the community structure of mental health Internet support groups, quantitatively. A greater understanding of the factors, which lead to user interaction, is needed to explain the design information of these services and future research concerning their utility.

OBJECTIVE

A study was conducted to determine the characteristics of users associated with the subgroup community structure of an Internet support group for mental health issues.

METHODS

A social network analysis of the Internet support group BlueBoard (blueboard.anu.edu.au) was performed to determine the modularity of the community using the Louvain method. Demographic characteristics age, gender, residential location, type of user (consumer, carer, or other), registration date, and posting frequency in subforums (depression, generalized anxiety, social anxiety, panic disorder, bipolar disorder, obsessive compulsive disorder, borderline personality disorder, eating disorders, carers, general (eg, "chit chat"), and suggestions box) of the BlueBoard users were assessed as potential predictors of the resulting subgroup structure.

RESULTS

The analysis of modularity identified five main subgroups in the BlueBoard community. Registration date was found to be the largest contributor to the modularity outcome as observed by multinomial logistic regression. The addition of this variable to the final model containing all other factors improved its classification accuracy by 46.3%, that is, from 37.9% to 84.2%. Further investigation of this variable revealed that the most active and central users registered significantly earlier than the median registration time in each group.

CONCLUSIONS

The five subgroups resembled five generations of BlueBoard in distinct eras that transcended discussion about different mental health issues. This finding may be due to the activity of highly engaged and central users who communicate with many other users. Future research should seek to determine the generalizability of this finding and investigate the role that highly active and central users may play in the formation of this phenomenon.

Toward a Mixed-Methods Research Approach to Content Analysis in The Digital Age: The Combined Content-Analysis Model and its Applications to Health Care Twitter Feeds

Background

Twitter’s 140-character microblog posts are increasingly used to access information and facilitate discussions among health care professionals and between patients with chronic conditions and their caregivers. Recently, efforts have emerged to investigate the content of health care-related posts on Twitter. This marks a new area for researchers to investigate and apply content analysis (CA). In current infodemiology, infoveillance and digital disease detection research initiatives, quantitative and qualitative Twitter data are often combined, and there are no clear guidelines for researchers to follow when collecting and evaluating Twitter-driven content.

Objective

The aim of this study was to identify studies on health care and social media that used Twitter feeds as a primary data source and CA as an analysis technique. We evaluated the resulting 18 studies based on a narrative review of previous methodological studies and textbooks to determine the criteria and main features of quantitative and qualitative CA. We then used the key features of CA and mixed-methods research designs to propose the combined content-analysis (CCA) model as a solid research framework for designing, conducting, and evaluating investigations of Twitter-driven content.

Methods

We conducted a PubMed search to collect studies published between 2010 and 2014 that used CA to analyze health care-related tweets. The PubMed search and reference list checks of selected papers identified 21 papers. We excluded 3 papers and further analyzed 18.

Results

Results suggest that the methods used in these studies were not purely quantitative or qualitative, and the mixed-methods design was not explicitly chosen for data collection and analysis. A solid research framework is needed for researchers who intend to analyze Twitter data through the use of CA.

Conclusions

We propose the CCA model as a useful framework that provides a straightforward approach to guide Twitter-driven studies and that adds rigor to health care social media investigations. We provide suggestions for the use of the CCA model in elder care-related contexts.

A Group-Based Mobile Application to Increase Adherence in Exercise and Nutrition Programs: A Factorial Design Feasibility Study

Background

Novel methods of promoting self-monitoring and social support are needed to ensure long-term maintenance of behavior change. In this paper, we directly investigate the effects of group support in an exercise and nutrition program delivered by an mHealth application called Fittle.

Objective

Our first specific study aim was to explore whether social support improved adherence in wellness programs. Our second specific study aim was to assess whether media types (ePaper vs mobile) were associated with different levels of compliance and adherence to wellness programs. The third aim was to assess whether the use of an mHealth application led to positive changes to participants’ eating behavior, physical activity, and stress level, compared to traditional paper-based programs.

Methods

A 2 × 2 (eg, Media: Mobile vs ePaper × Group Type: Team vs Solo) factorial design feasibility study was conducted. A sample of 124 volunteers who were interested in improving eating behavior, increasing physical activity, or reducing stress participated in this study. The study duration was 8 weeks. All groups were self-directed with no ongoing human input from the research team.

Results

Participants in ePaper conditions had higher attrition rates compared to participants in Mobile conditions, χ₃²=9.96, P=.02 (N=124). Participants in Mobile conditions reported their compliance with a much higher frequency closer to the time of challenge activity completion (2-sample Kolmogorov-Smirnov test comparing distributions was highly significant—KS=0.33, P<.001 [N=63]). Participants in ePaper conditions had a much higher frequency of guessing while reporting as compared with those in Mobile conditions—χ₁²=25.25, P<.001 (N=63). Together, these findings suggest that the mobile app allowed a more accurate method to report and track health behaviors over a longer period than traditional ePaper-based diaries or log books. There was a significant difference in the overall compliance score for Mobile-Solo (Mean [SD] 0.30 [0.39]) and Mobile-Team (Mean [SD] 0.49 [0.35]) conditions (t_50.82=1.94, P=.05). This suggests that working in a team increased participants’ overall compliance within Fittle. Survival analysis showed that participants assigned to Team conditions are 66% more likely to engage longer with mHealth app-based intervention than those assigned to the Solo condition. Overall, participants across all groups reported some positive changes in eating behavior, physical activity, and stress level; however, participants in the Mobile-Solo condition reported higher perceived stress levels at the end of the study.

Conclusions

The team-based Fittle app is an acceptable and feasible wellness behavior change intervention and a full randomized controlled trial to investigate the efficacy of such an intervention is warranted.

From Help-Seekers to Influential Users: A Systematic Review of Participation Styles in Online Health Communities

BACKGROUND

Understanding how people participate in and contribute to online health communities (OHCs) is useful knowledge in multiple domains. It is helpful for community managers in developing strategies for building community, for organizations in disseminating information about health interventions, and for researchers in understanding the social dynamics of peer support.

OBJECTIVE

We sought to determine if any patterns were apparent in the nature of user participation across online health communities.

METHODS

The current study involved a systematic review of all studies that have investigated the nature of participation in an online health community and have provided a quantifiable method for categorizing a person based on their participation style. A systematic search yielded 20 papers.

RESULTS

Participatory styles were classified as either multidimensional (based on multiple metrics) or unidimensional (based on one metric). With respect to the multidimensional category, a total of 41 different participation styles were identified ranging from Influential Users who were leaders on the board to Topic-Focused Responders who focused on a specific topic and tended to respond to rather than initiate posts. However, there was little overlap in participation styles identified both across OHCs for different health conditions and within OHCs for specific health conditions. Five of the 41 styles emerged in more than one study (Hubs, Authorities, Facilitators, Prime Givers, and Discussants), but the remainder were reported in only one study. The focus of the unidimensional studies was on level of engagement and particularly on high-engaged users. Eight different metrics were used to evaluate level of engagement with the greatest focus on frequency of posts.

CONCLUSIONS

With the exception of high-engaged users based on high post frequency, the current review found little evidence for consistent participatory styles across different health communities. However, this area of research is in its infancy, with most of the studies included in the review being published in the last 2 years. Nevertheless, the review delivers a nomenclature for OHC participation styles and metrics and discusses important methodological issues that will provide a basis for future comparative research in the area. Further studies are required to systematically investigate a range of participatory styles, to investigate their association with different types of online health communities and to determine the contribution of different participatory styles within and across online health communities.

eHealth, Participatory Medicine, and Ethical Care: A Focus Group Study of Patients' and Health Care Providers' Use of Health-Related Internet Information

Background

The rapid explosion in online digital health resources is seen as transformational, accelerating the shift from traditionally passive patients to patients as partners and altering the patient–health care professional (HCP) relationship. Patients with chronic conditions are increasingly engaged, enabled, and empowered to be partners in their care and encouraged to take responsibility for managing their conditions with HCP support.

Objective

In this paper, we focus on patients’ and HCPs’ use of health-related Internet information and how it influences the patient-HCP relationship. In particular, we examine the challenges emerging in medical encounters as roles and relationships shift and apply a conceptual framework of relational ethics to examine explicit and nuanced ethical dimensions emerging in patient-HCP interactions as both parties make increased use of health-related Internet information.

Methods

We purposively sampled patients and HCPs in British Columbia, Canada, to participate in focus groups. To be eligible, patients self-reported a diagnosis of arthritis and at least one other chronic health condition; HCPs reported a caseload with >25% of patients with arthritis and multimorbidity. We used a semistructured, but flexible, discussion guide. All discussions were audiotaped and transcribed verbatim. Elements of grounded theory guided our constant comparison thematic analytic approach. Analysis was iterative. A relational ethics conceptual lens was applied to the data.

Results

We recruited 32 participants (18 patients, 14 HCPs). They attended seven focus groups: four with patients and three with rehabilitation professionals and physicians. Predominant themes to emerge were how use of health-related Internet information fostered (1) changing roles, (2) patient-HCP partnerships, and (3) tensions and burdens for patients and HCPs.

Conclusions

Relational aspects such as mutual trust, uncertainty, and vulnerability are illuminated in patient-HCP interactions around health-related Internet information and the negotiated space of clinical encounters. New roles and associated responsibilities have key ethical dimensions that make clear the changes are fundamental and important to understand in ethical care. When faced with tensions and burdens around incorporating health-related Internet information as a resource in clinical encounters, participants described a particular ambivalence illustrating the fundamental changes being negotiated by both patients and HCPs.

Social media and medical education: Exploring the potential of Twitter as a learning tool

This study set out to explore the ways in which social media can facilitate learning in medical education. In particular we were interested in determining whether the use of Twitter during an academic conference can promote learning for participants. The Twitter transcript from the annual International Conference on Residency Education (ICRE) 2013 was qualitatively analysed for evidence of the three overarching cognitive themes: (1) preconceptions, (2) frameworks, and (3) metacognition/refl ection in regard to the National Research Council ’ s (NRC) How People Learn framework . Content analysis of the Twitter transcript revealed evidence of the three cognitive themes as related to how people learn. Twitter appears to be most effective at stimulating individuals ’ preconceptions, thereby engaging them with the new material acquired during a medical education conference. The study of social media data, such as the Twitter data used in this study, is in its infancy. Having established that Twitter does hold signifi cant potential as a learning tool during an academic conference, we are now in a better position to more closely examine the spread, depth, and sustainability of such learning during medical education meetings.

One Health in social networks and social media

In the rapidly evolving world of social media, social networks, mobile applications and citizen science, online communities can develop organically and separately from larger or more established organisations. The One Health online community is experiencing expansion from both the bottom up and the top down. In this paper, the authors review social media's strengths and weaknesses, earlier work examining Internet resources for One Health, the current state of One Health in social media (e.g. Facebook, Twitter, YouTube) and online social networking sites (e.g. LinkedIn and ResearchGate), as well as social media in One Health-related citizen science projects. While One Health has a fairly strong presence on websites, its social media presence is more limited and has an uneven geographic distribution. In work following the Stone Mountain Meeting,the One Health Global Network Task Force Report recommended the creation of an online community of practice. Professional social networks as well as the strategic use of social media should be employed in this effort. Finally, One Health-related research projects using volunteers (citizen science) often use social media to enhance their recruitment. Including these researchers in a community of practitioners would take full advantage of their existing social media presence. In conclusion, the interactive nature of social media, combined with increasing global Internet access, provides the One Health community with opportunities to meaningfully expand their community and promote their message.

Development of a Twitter-based intervention for smoking cessation that encourages high-quality social media interactions via automessages

BACKGROUND

The medical field seeks to use social media to deliver health interventions, for example, to provide low-cost, self-directed, online self-help groups. However, engagement in online groups is often low and the informational content may be poor.

OBJECTIVE

The specific study aims were to explore if sending automessages to online self-help groups encouraged engagement and to see if overall or specific types of engagement related to abstinence.

METHODS

We conducted a Stage I Early Therapy Development Trial of a novel social media intervention for smoking cessation called Tweet2Quit that was delivered online over closed, 20-person quit-smoking groups on Twitter in 100 days. Social media such as Twitter traditionally involves non-directed peer-to-peer exchanges, but our hybrid social media intervention sought to increase and direct such exchanges by sending out two types of autocommunications daily: (1) an "automessage" that encouraged group discussion on an evidence-based cessation-related or community-building topic, and (2) individualized "autofeedback" to each participant on their past 24-hour tweeting. The intervention was purposefully designed without an expert group facilitator and with full automation to ensure low cost, easy implementation, and broad scalability. This purely Web-based trial examined two online quit-smoking groups with 20 members each. Participants were adult smokers who were interested in quitting and were recruited using Google AdWords. Participants' tweets were counted and content coded, distinguishing between responses to the intervention's automessages and spontaneous tweets. In addition, smoking abstinence was assessed at 7 days, 30 days, and 60 days post quit date. Statistical models assessed how tweeting related to abstinence.

RESULTS

Combining the two groups, 78% (31/40) of the members sent at least one tweet; and on average, each member sent 72 tweets during the 100-day period. The automessage-suggested discussion topics and participants' responses to those daily automessages were related in terms of their content (r=.75, P=.012). Responses to automessages contributed 22.78% (653/2867) of the total tweets; 77.22% (2214/2867) were spontaneous. Overall tweeting related only marginally to abstinence (OR 1.03, P=.086). However, specific tweet content related to abstinence including tweets about setting of a quit date or use of nicotine patches (OR 1.52, P=.024), countering of roadblocks to quitting (OR 1.76, P=.008) and expressions of confidence about quitting (OR 1.71, SE 0.42, P=.032). Questionable, that is, non-evidence-based, information about quitting did not relate to abstinence (OR 1.12, P=.278).

CONCLUSIONS

A hybrid social media intervention that combines traditional online social support with daily automessages appears to hold promise for smoking cessation. This hybrid approach capitalizes on social media's spontaneous real-time peer-to-peer exchanges but supplements this with daily automessages that group members respond to, bolstering and sustaining the social network and directing the information content. Highly engaging, this approach should be studied further.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01602536; https://clinicaltrials.gov/ct2/show/NCT01602536 (Archived by WebCite at http://www.webcitation.org/6WGbt0o1K).

Mapping physician Twitter networks: describing how they work as a first step in understanding connectivity, information flow, and message diffusion

Background

Twitter is becoming an important tool in medicine, but there is little information on Twitter metrics. In order to recommend best practices for information dissemination and diffusion, it is important to first study and analyze the networks.

Objective

This study describes the characteristics of four medical networks, analyzes their theoretical dissemination potential, their actual dissemination, and the propagation and distribution of tweets.

Methods

Open Twitter data was used to characterize four networks: the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American College of Physicians (ACP). Data were collected between July 2012 and September 2012. Visualization was used to understand the follower overlap between the groups. Actual flow of the tweets for each group was assessed. Tweets were examined using Topsy, a Twitter data aggregator.

Results

The theoretical information dissemination potential for the groups is large. A collective community is emerging, where large percentages of individuals are following more than one of the groups. The overlap across groups is small, indicating a limited amount of community cohesion and cross-fertilization. The AMA followers’ network is not as active as the other networks. The AMA posted the largest number of tweets while the AAP posted the fewest. The number of retweets for each organization was low indicating dissemination that is far below its potential.

Conclusions

To increase the dissemination potential, medical groups should develop a more cohesive community of shared followers. Tweet content must be engaging to provide a hook for retweeting and reaching potential audience. Next steps call for content analysis, assessment of the behavior and actions of the messengers and the recipients, and a larger-scale study that considers other medical groups using Twitter.

Harnessing the social web for health and wellness: issues for research and knowledge translation

Social media is a powerful, rapid, and popular way of communication amongst people around the world. How can health professionals and patients use this strategy to achieve optimal disease management and prevention and attainment of wellness? An interdisciplinary group at University of British Columbia, supported by a grant from UBC Peter Wall Institute of Advanced Studies, conducted a research workshop in February 2013 to explore what is known and yet to be researched in using social media for nurturing the growth of virtual communities of people for health and wellness. This two and a half day workshop brought together a group of 30 multidisciplinary experts in closed discussions to reflect on five research themes in detail: (1) individual information acquisition and application, (2) community genesis and sustainability, (3) technological design issues, (4) knowledge management, dissemination, and renewal, and (5) research designs. In addition, a public forum for the general public, which attracted over 195 live participants, over 100 participants via Web casting, 1004 tweets, and 1,124,886 impressions following the #HCSMForum hash tag on Twitter, demonstrated the keen interest of the general public in this topic. Key concepts were captured in JMIR publications in this issue, and future directions, including research, knowledge translation approaches, and strategic partnerships of interdisciplinary researchers with policy makers and industries emerged from the workshop proceedings.