The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study

Navigating the Maze of Social Media Disinformation on Psychiatric Illness and Charting Paths to Reliable Information for Mental Health Professionals : An Observational Analysis

BACKGROUND

Disinformation on social media can seriously affect mental health by spreading false information, increasing anxiety, stress, and confusion in vulnerable individuals as well as perpetuating stigma. This flood of misleading content can undermine trust in reliable sources and heighten feelings of isolation and helplessness among users.

OBJECTIVE

This study aimed to explore the phenomenon of disinformation about mental health on social media and provide recommendations to mental health professionals that would use social media platforms to create educational videos about mental health topics.

METHODS

A comprehensive analysis conducted on 1000 TikTok videos from over 16 countries, available in English, French, and Spanish, covering 26 mental health topics. The data collection was conducted using a framework on disinformation and social media. A multilayered perceptron algorithm was used to identify factors predicting disinformation. Recommendations to health professionals about the creation of informative mental health videos were designed as per the data collected.

RESULTS

Disinformation was predominantly found in videos about neurodevelopment, mental health, personality disorders, suicide, psychotic disorders, and treatment. A machine learning model identified weak predictors of disinformation, such as an initial perceived intent to disinform and content aimed at the general public rather than a specific audience. Other factors, including content presented by licensed professionals like a counseling resident, an ear-nose-throat surgeon, or a therapist, and country-specific variables from Ireland, Colombia, and the Philippines, as well as topics like adjustment disorder, addiction, eating disorders, and impulse control disorders, showed a weak negative association with disinformation. In terms of engagement, only the number of favorites was significantly associated with a reduction in disinformation. Five recommendations were made to enhance the quality of educational videos about mental health on social media platforms.

CONCLUSIONS

This study is the first to provide specific, data-driven recommendations to mental health providers globally, addressing the current state of disinformation on social media. Further research is needed to assess the implementation of these recommendations by health professionals, their impact on patient health, and the quality of mental health information on social networks.

CLINICALTRIAL

Social media strategies used to translate knowledge and disseminate clinical neuroscience information to healthcare users: A systematic review

Social media can be an important source of clinical neuroscience information for healthcare users (e.g., patients, healthcare providers, the general public). This systematic review synthesized evidence on the effectiveness of social media strategies in translating knowledge and disseminating clinical neuroscience information to healthcare users. A systematic review of six electronic databases up to July 29, 2024 was conducted. Original, peer-reviewed articles examining the effectiveness of YouTube, Facebook, LinkedIn, Twitter, social media messaging apps, or a combination of these platforms in translating clinical neuroscience information to healthcare users (e.g., patients, healthcare providers, caregivers, and the general public) were eligible for inclusion. Several proxies (e.g., change in uptake of research, change in awareness, change in knowledge, change in understanding, behaviour change, and/or change in social media metrics) were considered as outcomes of knowledge translation (KT) effectiveness. Two independent reviewers screened articles and assessed risk of bias. The protocol was registered on PROSPERO (ID: CRD42021269034). A total of six studies were included in this review. The included studies used YouTube, Facebook, Twitter, or a combination of social media platforms aimed at healthcare users. Most social media strategies used to disseminate clinical neuroscience information in the included studies (N = 5/6) resulted in improved indicators of KT. However, due to the high risk of bias among the included studies, these results must be interpreted with caution. Disseminating clinical neuroscience information via Facebook, Twitter, YouTube, or a combination of these platforms may achieve the goals of KT. However, there is currently a gap in the literature about clinical neuroscience KT via social media, both in the quantity of studies and quality of evidence. Future research should aim to minimize the risk of bias by controlling for important confounding factors and use objective measures of KT to complement subjective measures.

Stimulating implementation of clinical practice guidelines in hospital care from a central guideline organization perspective: A systematic review

BACKGROUND

The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts.

METHODS

We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics.

RESULTS

Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals' time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements.

CONCLUSION

Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.

Examining the Effectiveness of Social Media for the Dissemination of Research Evidence for Health and Social Care Practitioners: Systematic Review and Meta-Analysis

BACKGROUND

Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners.

OBJECTIVE

This study aims to quantitatively synthesize evidence of the between- and within-group effectiveness of social media for dissemination of research evidence to health and social care practitioners. It also compared effectiveness between different social media platforms, formats, and strategies.

METHODS

We searched electronic databases for articles in English that were published between January 1, 2010, and January 10, 2023, and that evaluated social media interventions for disseminating research evidence to qualified, postregistration health and social care practitioners in measures of reach, engagement, direct dissemination, or impact. Screening, data extraction, and risk of bias assessments were carried out by at least 2 independent reviewers. Meta-analyses of standardized pooled effects were carried out for between- and within-group effectiveness of social media and comparisons between platforms, formats, and strategies. Certainty of evidence for outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework.

RESULTS

In total, 50 mixed-quality articles that were heterogeneous in design and outcome were included (n=9, 18% were randomized controlled trials [RCTs]). Reach (measured in number of practitioners, impressions, or post views) was reported in 26 studies. Engagement (measured in likes or post interactions) was evaluated in 21 studies. Direct dissemination (measured in link clicks, article views, downloads, or altmetric attention score) was analyzed in 23 studies (8 RCTs). Impact (measured in citations or measures of thinking and practice) was reported in 13 studies. Included studies almost universally indicated effects in favor of social media interventions, although effect sizes varied. Cumulative evidence indicated moderate certainty of large and moderate between-group effects of social media interventions on direct dissemination (standardized mean difference [SMD] 0.88; P=.02) and impact (SMD 0.76; P<.001). After social media interventions, cumulative evidence showed moderate certainty of large within-group effects on reach (SMD 1.99; P<.001), engagement (SMD 3.74; P<.001), and direct dissemination (SMD 0.82; P=.004) and low certainty of a small within-group effect on impacting thinking or practice (SMD 0.45; P=.02). There was also evidence for the effectiveness of using multiple social media platforms (including Twitter, subsequently rebranded X; and Facebook), images (particularly infographics), and intensive social media strategies with frequent, daily posts and involving influential others. No included studies tested the dissemination of research evidence to social care practitioners.

CONCLUSIONS

Social media was effective for disseminating research evidence to health care practitioners. More intense social media campaigns using specific platforms, formats, and strategies may be more effective than less intense interventions. Implications include recommendations for effective dissemination of research evidence to health care practitioners and further RCTs in this field, particularly investigating the dissemination of social care research.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022378793; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378793.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/45684.

Working with patients' treatment expectations - what we can learn from homeopathy

The usual homeopathic remedy, "globules," does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients' treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.

Understanding How and Under What Circumstances Social Media Supports Health Care Providers' Knowledge Use in Clinical Practice: A Realist Review

Background: Although theoretical frameworks exist to guide social media interventions, few of them make it explicit how social media is supposed to work to improve the knowledge use by health care providers. This study aimed to synthesize literature to understand how and under what circumstances social media supports knowledge use by health care providers in clinical practice. Methods: We followed the realist review methodology described by Pawson et al. It involved six iterative steps: (1) develop an initial program theory; (2) search for evidence; (3) select and appraise studies; (4) extract data; (5) synthesize data; and (6) draw conclusions. Results: Of the 7,175 citations retrieved, 32 documents were prioritized for synthesis. We identified two causal explanations of how social media could support health care providers' knowledge use, each underpinned by distinct context-mechanism-outcome (CMO) configurations. We defined these causal explanations as: (1) the rationality-driven approach that primarily uses open social media platforms (n = 8 CMOs) such as Twitter, and (2) the relationality-driven approach that primarily uses closed social media platforms (n = 6 CMOs) such as an online community of practice. Key mechanisms of the rationality-driven approach included social media content developers capabilities and capacities, in addition to recipients' access to, perceptions of, engagement with, and intentions to use the messages, and ability to function autonomously within their full scope of practice. However, the relationality-driven approach encompassed platform receptivity, a sense of common goals, belonging, trust and ownership, accessibility to expertise, and the fulfillment of needs as key mechanisms. Conclusion: Social media has the potential to support knowledge use by health care providers. Future research is necessary to refine the two causal explanations and investigate their potential synergistic effects on practice change.

COVID-19 Intensive Care—Evaluation of Public Information Sources and Current Standards of Care in German Intensive Care Units: A Cross Sectional Online Survey on Intensive Care Staff in Germany

Backround: In February 2021, the first formal evidence and consensus-based (S3) guidelines for the inpatient treatment of patients with COVID-19 were published in Germany and have been updated twice during 2021. The aim of the present study is to re-evaluate the dissemination pathways and strategies for ICU staff (first evaluation in December 2020 when previous versions of consensus-based guidelines (S2k) were published) and question selected aspects of guideline adherence of standard care for patients with COVID-19 in the ICU. Methods: We conducted an anonymous online survey among German intensive care staff from 11 October 2021 to 11 November 2021. We distributed the survey via e-mail in intensive care facilities and requested redirection to additional intensive care staff (snowball sampling). Results: There was a difference between the professional groups in the number, selection and qualitative assessment of information sources about COVID-19. Standard operating procedures were most frequently used by all occupational groups and received a high quality rating. Physicians preferred sources for active information search (e.g., medical journals), while nurses predominantly used passive consumable sources (e.g., every-day media). Despite differences in usage behaviour, the sources were rated similarly in terms of the quality of the information on COVID-19. The trusted organizations have not changed over time. The use of guidelines was frequently stated and highly recommended. The majority of the participants reported guideline-compliant treatment. Nevertheless, there were certain variations in the use of medication as well as the criteria chosen for discontinuing non-invasive ventilation (NIV) compared to guideline recommendations. Conclusions: An adequate external source of information for nursing staff is lacking, the usual sources of physicians are only appropriate for the minority of nursing staff. The self-reported use of guidelines is high.

The use of social media as a tool for patient blood management and transfusion medicine education

BACKGROUND AND OBJECTIVES

Transfusion is one of the most performed medical procedures. Wrong indications are common and are probably related to the scarcity of transfusion teaching during medical education. The development of a new way to improve transfusion education is paramount. Social media has the potential to reach larger audiences for rapid communication of medical content. The use of social media for transfusion education in Brazil has not been published. The aim of this article is to describe a new tool to improve transfusion learning.

MATERIALS AND METHODS

Evidence-based cards were created. Initially, these cards were sent by WhatsApp. Later, Instagram and Facebook pages were created. EducaSangue, as this e-learning project was called, is a tool for the spreading of transfusion knowledge that permits the exchange of experiences.

RESULTS

By April 2021, Facebook and Instagram pages had 8300 and 5100 followers, respectively. Cards about single red blood cell (RBC) unit, alternatives to transfusion, transfusion reactions and pre-transfusion tests were published. Doctors and other health professionals follow EducaSangue. RBC transfusions reduced in Ceara and single-unit RBC increased by 28%, although not statistically significant. In Brazil, the minority of medical schools have transfusion as a discipline. The scarcity of transfusion education is related to the poorer care of the patient. Technological innovation has been used for educational changes and is an alternative to formal education.

CONCLUSION

Social media is an interesting tool to provide quality to medical services, since they can reach a broader public, especially where personal contact is difficult.

Multifaceted intervention including Facebook-groups to improve guideline-adherence in ICU: A quasi-experimental interrupted time series study

BACKGROUND

The impact of social media, with its speed, reach and accessibility, in interventions aimed to improve adherence to guidelines such as assessment of Pain, Agitation/Sedation and Delirium (PAD) in intensive care is not described. Therefore, the primary objective of this quality improvement study was to evaluate the impact of a multifaceted intervention including audit and feedback of quality indicators (QI) via Facebook-groups, educational events and engagement of opinion leaders on adherence to PAD-guidelines in four ICUs.

METHODS

A quasi-experimental interrupted time series study with eight monthly data points in the two phases Before and Intervention was designed. Proportion of nursing shifts with documented PAD-assessment (PAD-QIs) were retrieved from the electronical medical chart from included adult ICU patient-stays in four participating ICUs. Difference between the two time periods was assessed using generalised mixed model for repeated measures with unstructured covariance matrix, and presented as Beta (B) with 95% confidence interval (CI).

RESULTS

Finally, 1049 ICU patient-stays were analysed; 534 in Before and 515 in Intervention. All three PAD-QIs significantly increased in Intervention by 31% (B = 30.7, 95%CI [25.7 to 35.8]), 26% (B = 25.8, 95%CI [19.4 to 32.2]) and 34% (B = 33.9, 95%CI [28.4 to 39.4]) in pain, agitation/sedation and delirium, respectively.

CONCLUSION

A multifaceted intervention including use of Facebook-groups was associated with improved guideline-adherence in four ICUs, as measured with process PAD-QIs of PAD assessment. Further research on use of social media to improve guideline adherence is warranted, particularly as social distancing impacts clinical education and training and new approaches are needed.

[COVID-19 pandemic: preferences and barriers for dissemination of evidence syntheses : Survey of intensive care personnel in Germany]

Hintergrund

Das COVID-19-Evidenz-Ökosystem (CEOsys) identifiziert, bewertet und fasst Ergebnisse wissenschaftlicher Studien in Evidenzsynthesen im Kontext von COVID-19 zusammen. Diese Evidenzsynthesen werden genutzt, um konkrete Handlungsempfehlungen abzuleiten und Leitlinien zu erstellen.

Zielsetzung

Vorbereitung der am besten geeigneten Verteilung von Evidenzsynthesen im Rahmen der Aufgaben des CEOsys-Projekts.

Methode

Für Deutschland wurde eine Befragung hinsichtlich des intensivmedizinischen Personals priorisierter Themenbereiche, Wünschen zu Layout, Plattform der Bekanntmachung von Evidenzsynthesen und Vertrauenswürdigkeit von Institutionen mit kategorialen Antwortmöglichkeiten durchgeführt. Die Umfrage erfolgte online und wurde per E‑Mail lokal und über die DIVI verteilt.

Ergebnisse

Von 317 Befragten, die die Umfrage starteten, vervollständigten 200 den Fragebogen. Knappe Zeit und fehlender Zugriff, unzureichende Erfahrung bzw. Unsicherheit im Umgang mit Evidenzsynthesen wurden als Barriere für Wissenserwerb benannt. Das aktive Herantragen von Informationen wird bevorzugt („Push-Strategie“). Als Format werden Kurzversion, Übersichten mit Algorithmen und Webinare prioritär gewünscht. Webseiten öffentlicher Einrichtungen, Fachjournalartikel und E‑Mail-Newsletter sollen auf neue Evidenz aufmerksam machen. Fachgesellschaften und dem Robert Koch Institut werden in der Pandemie mehrheitlich Vertrauen geschenkt. Priorisierte Themen der Befragten sind Langzeitfolgen der Erkrankung, Schutz des medizinischen Personals und Invasivität der Beatmungstherapie.

Schlussfolgerung

Evidenzsynthesen sollten aktiv an Zielgruppen herangetragen werden. Inhalte sollten übersichtlich, kurz (Algorithmen, Kurzversion, Webinare) und frei verfügbar sein. Webseiten, E‑Mail-Newsletter und medizinische Journale, aber auch Fachgesellschaften und das Robert Koch-Institut sollten auf Evidenzsynthesen hinweisen.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00101-021-01037-z) enthalten.

Online Search Trends Influencing Anticoagulation in Patients With COVID-19: Observational Study

Background

Early evidence of COVID-19–associated coagulopathy disseminated rapidly online during the first months of 2020, followed by clinical debate about how best to manage thrombotic risks in these patients. The rapid online spread of case reports was followed by online interim guidelines, discussions, and worldwide online searches for further information. The impact of global online search trends and online discussion on local approaches to coagulopathy in patients with COVID-19 has not been studied.

Objective

The goal of this study was to investigate the relationship between online search trends using Google Trends and the rate of appropriate venous thromboembolism (VTE) prophylaxis and anticoagulation therapy in a cohort of patients with COVID-19 admitted to a tertiary hospital in Ireland.

Methods

A retrospective audit of anticoagulation therapy and VTE prophylaxis among patients with COVID-19 who were admitted to a tertiary hospital was conducted between February 29 and May 31, 2020. Worldwide Google search trends of the term “COVID-19” and anticoagulation synonyms during this time period were determined and correlated against one another using a Spearman correlation. A P value of <.05 was considered significant, and analysis was completed using Prism, version 8 (GraphPad).

Results

A statistically significant Spearman correlation (P<.001, r=0.71) was found between the two data sets, showing an increase in VTE prophylaxis in patients with COVID-19 with increasing online searches worldwide. This represents a proxy for online searches and discussion, dissemination of information, and Google search trends relating to COVID-19 and clotting risk, in particular, which correlated with an increasing trend of providing thromboprophylaxis and anticoagulation therapy to patients with COVID-19 in our tertiary center.

Conclusions

We described a correlation of local change in clinical practice with worldwide online dialogue and digital search trends that influenced individual clinicians, prior to the publication of formal guidelines or a local quality-improvement intervention.

Using technology-based educational interventions to improve knowledge about clinical practice guidelines

OBJECTIVE

To describe the best evidence on the effectiveness of technology-based learning tools designed to improve knowledge of health care providers about clinical practice guidelines (CPGs).

METHODS

We conducted a systematic review, searching MEDLINE, Embase, and CINAHL from inception to July 2018. Included studies investigated the effectiveness of any technology-based learning tools developed to improve knowledge of health care providers about CPGs. We used a 2-phase screening process to determine eligibility. Pairs of reviewers critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network checklist for randomized controlled trials or the National Institutes of Health checklist for pre- and postintervention trials. Evidence from internally valid studies was described using a best-evidence summary. We conducted a sensitivity analysis to determine whether results varied according to methodological quality.

RESULTS

Twenty-five of 8321 articles met our selection criteria. Six studies had a low risk of bias and were included in this review. Spaced education was associated with improvement in knowledge; however, its effectiveness relative to other interventions is unknown. Module-based online educational interventions were associated with improvement in knowledge of CPGs; however, they may not be more effective than paper-based self-learning or in-person workshops. The sensitivity analysis determined that the evidence was similar between the high and low risk of bias studies.

CONCLUSION

Module-based- and spaced-education interventions may be beneficial for improving health care providers' knowledge of CPGs; however, much of the evidence toward their use is preliminary.

Surgical Residents in the Battle Against COVID-19

In times of public health crises, medical residency program leaders are responsible to maintain the wellbeing of their residents and ensure uninterrupted training. COVID-19 caused significant impact on healthcare industry, depleting resources and manpower, which led to disruption to graduate medical education and residency training. Surgical residents were affected by the pandemic both by reduced operative opportunities in most training centers and inducing stress and concerns about safety and wellbeing among residents. Spread of the SARS-Cov-2 was naturally accompanied with a gradual decrease in numbers of healthcare personnel which consequently increased the burden on residents. During these times of crisis and uncertainty, it is crucial that residency programs find alternative learning opportunities and deploy pre-designed, dynamic operational strategies to ensure high quality surgical services while optimizing resident safety and wellbeing. The COVID-19 crisis was a natural call for the essential need to add another dimension to residency competencies, which is Crisis-based learning and practice. Times of public health crisis are opportunities to reflect on the medical practice from an interdisciplinary and interprofessional perspective and train the residents to function as part of a larger, globally responsible team. It also calls upon adopting innovative instructional and learning strategies such as utilizing digital and online learning tools to complement learning. A holistic approach to the crisis was taken by the surgical residency program at the University of Illinois in Chicago, which addressed the issue from a resident, hospital, and public health standpoints. An operational strategy was introduced to optimize resident safety, maximize learning opportunities, support other non-surgical services, and promote online teaching and learning. This strategy is meant to serve as a dynamic reference for surgical residency programs and as an infrastructure for dealing with this and any upcoming healthcare crises in an efficient and resident-centered way.

A Systematic Review of the Use of Social Media for Dissemination of Clinical Practice Guidelines

CONTEXT

Clinical practice guideline (CPG) uptake does not occur spontaneously and requires active implementation, especially for long-term implementation. Social media (SoMe) with its power of rapid and global information exchange among physicians, patients, organizations, and stakeholders in the medical field can open up unprecedented opportunities for CPG dissemination.

OBJECTIVE

The aim of this review was to assess the current use of SoMe in CPG dissemination across different medical specialties.

EVIDENCE ACQUISITION

A systematic review (SR) of the literature was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, Embase, and Cochrane databases and the general platform Google were searched for all relevant publications (no limitation for publication time and no language restrictions). The search revealed 1881 citations; following title and abstract review, 22 studies were identified; and five studies were finally included after full-text review.

EVIDENCE SYNTHESIS

All included studies were published in the past 5 yr; there was a significant improvement in knowledge, awareness, compliance, and positive behavior toward CPGs with the use of SoMe dissemination compared with traditional methods. A large audience (healthcare professionals and patients) viewed and engaged with the SoMe process of CPG dissemination, and expressed an intent to engage in this method in the future. The studies included in the SR reported variable methods of SoMe use and similarly variable methods of analyzing the outcomes.

CONCLUSIONS

Owing to the recent application of SoMe in the context of CPG dissemination, there is no standardized format for its use, and the data available are variable and limited. However, encouraging preliminary results have been reported using SoMe for CPG dissemination in multiple fields, and we have provided a pragmatic method of SoMe usage in CPG dissemination based on the review. It is vital to ensure a uniform method of application and assessment of SoMe use in CPG dissemination and implementation going forward.

PATIENT SUMMARY

Social media (SoMe) plays an important role in rapid and global information exchange among physicians, patients, organizations, and stakeholders in the medical field, and its power can be harnessed in the dissemination of evidence-based clinical practice guidelines (CPGs) that guide clinicians in practice. Our review reveals that SoMe use for CPG dissemination is a relatively new concept published approximately 5 yr ago, and it has led to significant improvement in knowledge, awareness, compliance, and positive behavior with respect to the CPGs compared with traditional methods. A large audience (healthcare professionals and patients) viewed and engaged with the SoMe process. We have produced a pragmatic method of using SoMe in CPG dissemination. Considering the importance of CPGs in practice and the ever increasing role of SoMe in the medical profession, a new role for SoMe in CPG dissemination could be established.

Implementation: The Next Giant Hurdle to Clinical Transformation With Digital Health

Clinical implementation of digital health is a major hurdle to overcome in the coming years. Considering the role of the Journal of Medical Internet Research in the past 20 years and looking toward the journal’s future, this viewpoint acknowledges the vision of medicine and the role that digital health plays in that vision. It also highlights barriers to implementation of digital health as an obstacle to achieving that vision. In particular, this paper focuses on how digital health research must start looking toward implementation as an area of inquiry and the role that the Journal of Medical Internet Research and its' sister journals from JMIR Publications can play in this process.

Assessing the Adoption of Recommended Standards, Novel Approaches, and Best Practices for Animal Health Surveillance by Decision Makers in Europe

Animal health surveillance is an important tool for disease mitigation and helps to promote animal health and welfare, protect human health, support efficient animal production, and enable trade. This study aimed to assess adoption of recommended standards and best practice for surveillance (including risk-based approaches) in Europe. It included scoping interviews with surveillance experts in Denmark, the Netherlands, Norway, and Switzerland to gather information on knowledge acquisition, decisions and implementation of surveillance, and perceptions. This was followed by an online survey among animal health and food safety surveillance users in EU, EEA, and Schengen countries. A total of 166 responses were collected from 27 countries; 111 were eligible for analysis. A strong preference for legislation and established standards was observed, with peer-reviewed publications, conferences, symposia, and workshops to be major sources of information. The majority of respondents indicated a need for international evaluation for surveillance and implied that considerations of cost-effectiveness were essential when making a decision to adopt new surveillance standards. However, most of the respondents did not use a formal evaluation to inform the adoption of new standards or only conducted a descriptive assessment before their implementation or adaptation. Only a few respondents reported a quantitative economic evaluation despite economic efficiency being considered as a highly relevant criterion for surveillance implementation. Constraints mentioned in the adoption of new surveillance standards included insufficient time, financial and human resources, and lack of competency. Researchers aiming to achieve impact by their surveillance work are advised to consider ways of influencing binding standards and to disseminate their work pro-actively using varied channels of engagement tailored to relevant target audiences and their needs. Generally, a more formal linkage between surveillance information and disease mitigation decisions-for example, by using systematic evaluation-could help increase the economic value of surveillance efforts. Finally, a collaborative, international platform for exchange and learning on surveillance as well as co-design and dissemination of surveillance standards is recommended.

Knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers - a cross-sectional study

BACKGROUND

Antibiotic resistance is a global health threat. Public knowledge is considered a prerequisite for appropriate use of antibiotics and limited spread of antibiotic resistance. Our aim was to examine the level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, and to assess to which degree beliefs, attitudes and sociodemographic factors are associated with this knowledge.

METHODS

A questionnaire based, cross-sectional study was conducted among pharmacy customers in three Norwegian cities. The questionnaire covered 1) knowledge of antibiotics (13 statements) and antibiotic resistance (10 statements), 2) the general beliefs about medicines questionnaire (BMQ general) (three subdomains, four statements each), 3) attitudes toward antibiotic use (four statements), and 4) sociodemographic factors, life style and health. High knowledge level was defined as > 66% of maximum score. Factors associated with knowledge of antibiotics and antibiotic resistance were investigated through univariate and multiple linear regression. Hierarchical model regression was used to estimate a population average knowledge score weighted for age, gender and level of education.

RESULTS

Among 877 participants, 57% had high knowledge of antibiotics in general and 71% had high knowledge of antibiotic resistance. More than 90% knew that bacteria can become resistant against antibiotics and that unnecessary use of antibiotics can make them less effective. Simultaneously, more than 30% erroneously stated that antibiotics are effective against viruses, colds or influenza. Factors positively associated with antibiotic knowledge were health professional background, high education level, and a positive view on the value of medications in general. Male gender, a less restrictive attitude toward antibiotic use, and young age were negatively associated with antibiotic knowledge. The mean overall antibiotic knowledge score was relatively high (15.6 out of maximum 23 with estimated weighted population score at 14.8).

CONCLUSIONS

Despite a high level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, there are obvious knowledge gaps. We suggest that action is taken to increase the knowledge level, and particularly target people in vocational, male dominated occupations outside the health service, and primary/secondary school curricula.

Effectiveness of knowledge translation and knowledge appropriation of clinical practice guidelines for patients and communities, a systematic review

Introduction: Knowledge translation and knowledge appropriation social interventions apply knowledge to improve health services and outcomes. These interventions can be implemented routinely to improve patient adherence to clinical practice guidelines. Objective: To assess the effectiveness of knowledge translation interventions to improve patient and community adherence to clinical practice guidelines. Materials and methods: We performed a systematic review of these interventions compared with classical interventions for patients and/or communities. We searched the following electronic databases up to April 2017: Medline (Ovid), Embase, Scopus, Central (Ovid), Web of Science, LILACS, Academic Search, and Scielo. Two independent raters qualified the relevance, risk of bias, and quality of included studies. Results: Eight studies were included. Patient adherence to recommendations was observed in two studies. There was high heterogeneity due to the variability of the population, types of guidelines, and types of measurement tools. The risk of bias was high: a 60% risk of performance bias, 50% risk of attrition bias, 25% risk of selection and reporting bias, and 15% risk of detection bias. The quality of evidence was moderate for the outcomes of adherence and mortality. The interventions that used a combination of strategies, such as with the group of health professionals, could improve some clinical outcomes in the patients (Average deviation: -3.00; 95% IC: -6.08-0.08). Conclusions: Knowledge translation interventions might have a slight positive effect on patient adherence and some short-term clinical outcomes, particularly within mixed interventions (patients and health professionals). However, future studies with less heterogeneity are necessary to confirm these results.

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.

Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Patient Education

A diagnosis of multiple sclerosis (MS) is life-altering. Because the course of MS is heterogeneous, patients may face uncertainty in terms of long-term physical and cognitive challenges, potential loss of employment, and the risk of social isolation. Patients often turn to the Internet and social media for information about MS and its management, and to seek out fellow patients and support groups. Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient education. We consider the access that these conduits provide not only to other patients with MS but also to a wealth of disease-related information online. These themes are further illustrated with first-hand experiences of the patient author and her physician. We also explore the impact of the Internet and social media on the education and support of patients with MS from the healthcare professional’s (HCP’s) perspective, including opportunities for HCPs to promote disease education among their patients, and the advantages that arise from patients being better informed about their disease. The rise of the Internet and social media has changed the patient experience, helping patients to support each other, to educate themselves proactively about their condition, and to participate more actively in decisions relating to disease management than perhaps was the case historically.

Funding Novartis Pharmaceuticals Corporation.

Getting Started: A Social Media Primer

Social media use has increased both in the general public and in the surgical profession. A variety of social media platforms have been used, with Twitter being one of the most common and interactive platforms. Common uses by surgeons and scientists for social media include dissemination of information, information exchange, education, research recruitment, community consultation for clinical trials, and hospital or surgeon ratings. As social media use increases, a new language as well as metrics has been developed to track impact and reach of research incorporating social media platforms. All surgeons should be encouraged to familiarize themselves with social media, regardless of whether or not they choose to actively engage in it.

"We make choices we think are going to save us": Debate and stance identification for online breast cancer CAM discussions

Patients discuss complementary and alternative medicine (CAM) in online health communities. Sometimes, patients' conflicting opinions toward CAM-related issues trigger debates in the community. The objectives of this paper are to identify such debates, identify controversial CAM therapies in a popular online breast cancer community, as well as patients' stances towards them. To scale our analysis, we trained a set of classifiers. We first constructed a supervised classifier based on a long short-term memory neural network (LSTM) stacked over a convolutional neural network (CNN) to detect automatically CAM-related debates from a popular breast cancer forum. Members' stances in these debates were also identified by a CNN-based classifier. Finally, posts automatically flagged as debates by the classifier were analyzed to explore which specific CAM therapies trigger debates more often than others. Our methods are able to detect CAM debates with F score of 77%, and identify stances with F score of 70%. The debate classifier identified about 1/6 of all CAM-related posts as debate. About 60% of CAM-related debate posts represent the supportive stance toward CAM usage. Qualitative analysis shows that some specific therapies, such as Gerson therapy and usage of laetrile, trigger debates frequently among members of the breast cancer community. This study demonstrates that neural networks can effectively locate debates on usage and effectiveness of controversial CAM therapies, and can help make sense of patients' opinions on such issues under dispute. As to CAM for breast cancer, perceptions of their effectiveness vary among patients. Many of the specific therapies trigger debates frequently and are worth more exploration in future work.

Public Funding and Open Access to Research: A Review of Canadian Multiple Sclerosis Research

Background

Multiple sclerosis (MS), a progressive demyelinating disease of the brain and spinal cord, is the leading cause of nontraumatic neurological damage in young adults. Canada has one of the highest reported incidents of MS, with estimates between 55 and 240 per 100,000 individuals. Between 2009 and 2014, the MS Society of Canada provided over Can $90 million to researchers and, since 2013, has encouraged researchers to make both current and previous research products openly available.

Objective

The goal of the study was to determine the open access (OA) cost implications and repository policies of journals frequently used by a sample of MS researchers. This study benchmarked current publishing preferences by MS Society of Canada researchers by examining the OA full-text availability of journal articles written by researchers funded between 2009 and 2014.

Methods

Researchers were identified from the 2009 to 2014 annual MS Society of Canada Research Summaries. Articles were identified through searches in Web of Science, Scopus, Medline and Embase (both via OVID). Journal level analysis included comparison of OA policies, including article processing charges (APCs) and repository policies. Data were analyzed using descriptive statistics.

Results

There were 758 articles analyzed in this study, of which 288 (38.0%) were OA articles. The majority of authors were still relying on journal policies for deposit in PubMed Central or availability on publisher websites for OA. Gold OA journals accounted for 10.2% of the journals in this study and were associated with significantly lower APCs (US $1900) than in hybrid journals (US $3000). Review of the journal self-archiving options highlighted the complexity of stipulations that authors would have to navigate to legally deposit a version of their article.

Conclusions

This study found that there are currently researcher- and publisher-imposed barriers to both the gold and green roads to OA. These results provide a current benchmark against which efforts to enhance openness can be measured and can serve as a reference point in future assessments of the impact of OA policies within this field. With funding agencies worldwide releasing OA mandates, future success in compliance will require changes to how researchers and publishers approach production and dissemination of research.

Leveraging Social Media to Promote Evidence-Based Continuing Medical Education

IMPORTANCE

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).

OBJECTIVE

To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.

DESIGN

We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians.

SETTING

The National Physicians Alliance (NPA) membership.

PARTICIPANTS

NPA e-mail recipients, Facebook followers and friends, and Twitter followers.

MAIN OUTCOMES AND MEASURES

Clicks to the NPA's CME landing site.

RESULTS

On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p<0.001). Twitter posts (p = 0.13) and paid Facebook posts (p = 0.06) were not statistically different from e-mail in generating clicks to the landing site. Use of different hooks to engage physicians had no impact on clicks to the landing site. Interviews with physicians suggested that social media might not be a preferred vehicle for disseminating CME.

CONCLUSIONS

Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.

Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study

Background

Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF).

Objectives

The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients.

Methods

The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals’ attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented.

Results

The sample included 294 original tweets with the hashtag “#heartfailure.” The most frequent message content codes were “HF awareness” (166/294, 56.5%) and “patient support” (97/294, 33.0%). The most frequent source codes were “professional, government, patient advocacy organization, or charity” (112/277, 40.4%) and “patient or family” (105/277, 37.9%). The most frequent target audience codes were “unable to identify” (111/277, 40.1%) and “other” (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being “HF research” (P=.049). Tweets with the source code “professional, government, patient advocacy organizations, or charities” were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology.

Conclusions

Existing Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users.

Identifying Complementary and Alternative Medicine Usage Information from Internet Resources. A Systematic Review

OBJECTIVES

Identify and highlight research issues and methods used in studying Complementary and Alternative Medicine (CAM) information needs, access, and exchange over the Internet.

METHODS

A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from PubMed to identify articles that have studied Internet use in the CAM context. Additional searches were conducted at Nature.com and Google Scholar.

RESULTS

The Internet provides a major medium for attaining CAM information and can also serve as an avenue for conducting CAM related surveys. Based on the literature analyzed in this review, there seems to be significant interest in developing methodologies for identifying CAM treatments, including the analysis of search query data and social media platform discussions. Several studies have also underscored the challenges in developing approaches for identifying the reliability of CAM-related information on the Internet, which may not be supported with reliable sources. The overall findings of this review suggest that there are opportunities for developing approaches for making available accurate information and developing ways to restrict the spread and sale of potentially harmful CAM products and information.

CONCLUSIONS

Advances in Internet research are yet to be used in context of understanding CAM prevalence and perspectives. Such approaches may provide valuable insights into the current trends and needs in context of CAM use and spread.

Randomized Controlled Trial of Social Media: Effect of Increased Intensity of the Intervention

Background

A prior randomized controlled trial of social media exposure at Circulation determined that social media did not increase 30‐day page views. Whether insufficient social media intensity contributed to these results is uncertain.

Methods and Results

Original article manuscripts were randomized to social media exposure compared with no social media exposure (control) at Circulation beginning in January 2015. Social media exposure consisted of Facebook and Twitter posts on the journal's accounts. To increase social media intensity, a larger base of followers was built using advertising and organic growth, and posts were presented in triplicate and boosted on Facebook and retweeted on Twitter. The primary outcome was 30‐day page views. Stopping rules were established at the point that 50% of the manuscripts were randomized and had 30‐day follow‐up to compare groups on 30‐day page views. The trial was stopped for futility on September 26, 2015. Overall, 74 manuscripts were randomized to receive social media exposure, and 78 manuscripts were randomized to the control arm. The intervention and control arms were similar based on article type (P=0.85), geographic location of the corresponding author (P=0.33), and whether the manuscript had an editorial (P=0.80). Median number of 30‐day page views was 499.5 in the social media arm and 450.5 in the control arm; there was no evidence of a treatment effect (P=0.38). There were no statistically significant interactions of treatment by manuscript type (P=0.86), by corresponding author (P=0.35), by trimester of publication date (P=0.34), or by editorial status (P=0.79).

Conclusions

A more intensive social media strategy did not result in increased 30‐day page views of original research.

Agenda Setting for Health Promotion: Exploring an Adapted Model for the Social Media Era

Background

The foundation of best practice in health promotion is a robust theoretical base that informs design, implementation, and evaluation of interventions that promote the public’s health. This study provides a novel contribution to health promotion through the adaptation of the agenda-setting approach in response to the contribution of social media. This exploration and proposed adaptation is derived from a study that examined the effectiveness of Twitter in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia.

Objective

The proposed adaptations to the agenda-setting model to be explored reflect two levels of engagement: agenda setting within the social media sphere and the position of social media within classic agenda setting. This exploratory research aims to assess the veracity of the proposed adaptations on the basis of the hypotheses developed to test these two levels of engagement.

Methods

To validate the hypotheses, we collected and analyzed data from two primary sources: Twitter activities and Saudi national newspapers. Keyword mentions served as indicators of agenda promotion; for Twitter, interactions were used to measure the process of agenda setting within the platform. The Twitter final dataset comprised 59,046 tweets and 38,066 users who contributed by tweeting, replying, or retweeting. Variables were collected for each tweet and user. In addition, 518 keyword mentions were recorded from six popular Saudi national newspapers.

Results

The results showed significant ratification of the study hypotheses at both levels of engagement that framed the proposed adaptions. The results indicate that social media facilitates the contribution of individuals in influencing agendas (individual users accounted for 76.29%, 67.79%, and 96.16% of retweet impressions, total impressions, and amplification multipliers, respectively), a component missing from traditional constructions of agenda-setting models. The influence of organizations on agenda setting is also highlighted (in the data of user interactions, organizational accounts registered 17% and 14.74% as source and target of interactions, respectively). In addition, 13 striking similarities showed the relationship between newspapers and Twitter on the mentions trends line.

Conclusions

The effective use of social media platforms in health promotion intervention programs requires new strategies that consider the limitations of traditional communication channels. Conducting research is vital to establishing a strong basis for modifying, designing, and developing new health promotion strategies and approaches.

Knowledge seeking behaviours of pre interns and early career doctors in Sri Lanka: a cross sectional study

BACKGROUND

Use of reference sources for medical knowledge has changed dramatically over the last two decades with the introduction of online sources of information. This study analyses the medical knowledge seeking behaviours of pre interns and early career doctors in Sri Lanka.

METHODS

This cross sectional survey with a convenience sample was conducted at two sites targeting two groups; pre-intern doctors graduated from the Faculty of Medicine, University of Colombo and early career doctors following a postgraduate course at the National Hospital of Sri Lanka. The data collection tool was an online self-administered questionnaire (paper based questionnaires used on request) that probed the patterns of using reference sources for medical knowledge.

RESULTS AND DISCUSSION

The respondents comprised of 52 pre-interns and 34 early career doctors. A majority (98 %) had internet access. Early career doctors preferred online resources significantly more than the pre-interns. However, the utilization of online resources for evidence synthesis and planning research was unsatisfactory in both groups. A significant proportion (35 %) responded that they had never read a systematic review. Only one person in the entire sample had co-authored a review article.

CONCLUSION

The use of online resources by participants seems to be satisfactory with a majority shifting to reliable online resources as a reference point for medical knowledge. However, a closer look at the usage patterns reveal that online resources that can be used for more innovative tasks such as evidence synthesis are grossly under-utilized.