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

Organizational aspects of tissue engineering clinical translation: insights from a qualitative case study

Background

Tissue engineering is a multidisciplinary field that combines principles from cell biology, bioengineering, material sciences, medicine and surgery to create functional and viable bioproducts that can be used to repair or replace damaged or diseased tissues in the human body. The complexity of tissue engineering can affect the prospects of efficiently translating scientific discoveries in the field into scalable clinical approaches that could benefit patients. Organizational challenges may play a key role in the clinical translation of tissue engineering for the benefit of patients.

Methods

To gain insight into the organizational aspects of tissue engineering that may create impediments to efficient clinical translation, we conducted a retrospective qualitative case study of one tissue engineering multi-site translational project on knee cartilage engineered tissue grafts. We collected qualitative data using a set of different methods: semi-structured interviews, documentary research and audio-visual content analysis.

Results

Our study identified various challenges associated to first-in-human trials in tissue engineering particularly related to: logistics and communication; research participant recruitment; clinician and medical student participation; study management; and regulation.

Conclusions

While not directly generalizable to other types of advanced therapies or to regenerative medicine in general, our results offer valuable insights into organizational barriers that may prevent efficient clinical translation in the field of tissue engineering.

The Use of Social Media to Express and Manage Medical Uncertainty in Dyskeratosis Congenita: Content Analysis

BACKGROUND

Social media has the potential to provide social support for rare disease communities; however, little is known about the use of social media for the expression of medical uncertainty, a common feature of rare diseases.

OBJECTIVE

This study aims to evaluate the expression of medical uncertainty on social media in the context of dyskeratosis congenita, a rare cancer-prone inherited bone marrow failure and telomere biology disorder (TBD).

METHODS

We performed a content analysis of uncertainty-related posts on Facebook and Twitter managed by Team Telomere, a patient advocacy group for this rare disease. We assessed the frequency of uncertainty-related posts, uncertainty sources, issues, and management and associations between uncertainty and social support.

RESULTS

Across all TBD social media platforms, 45.98% (1269/2760) of posts were uncertainty related. Uncertainty-related posts authored by Team Telomere on Twitter focused on scientific (306/434, 70.5%) or personal (230/434, 53%) issues and reflected uncertainty arising from probability, ambiguity, or complexity. Uncertainty-related posts in conversations among patients and caregivers in the Facebook community group focused on scientific (429/511, 84%), personal (157/511, 30.7%), and practical (114/511, 22.3%) issues, many of which were related to prognostic unknowns. Both platforms suggested uncertainty management strategies that focused on information sharing and community building. Posts reflecting response-focused uncertainty management strategies (eg, emotional regulation) were more frequent on Twitter compared with the Facebook community group (χ21=3.9; P=.05), whereas posts reflecting uncertainty-focused management strategies (eg, ordering information) were more frequent in the Facebook community group compared with Twitter (χ21=55.1; P<.001). In the Facebook community group, only 36% (184/511) of members created posts during the study period, and those who created posts did so with a low frequency (median 3, IQR 1-7 posts). Analysis of post creator characteristics suggested that most users of TBD social media are White, female, and parents of patients with dyskeratosis congenita.

CONCLUSIONS

Although uncertainty is a pervasive and multifactorial issue in TBDs, our findings suggest that the discussion of medical uncertainty on TBD social media is largely limited to brief exchanges about scientific, personal, or practical issues rather than ongoing supportive conversation. The nature of uncertainty-related conversations also varied by user group: patients and caregivers used social media primarily to discuss scientific uncertainties (eg, regarding prognosis), form social connections, or exchange advice on accessing and organizing medical care, whereas Team Telomere used social media to express scientific and personal issues of uncertainty and to address the emotional impact of uncertainty. The higher involvement of female parents on TBD social media suggests a potentially greater burden of uncertainty management among mothers compared with other groups. Further research is needed to understand the dynamics of social media engagement to manage medical uncertainty in the TBD community.

Digital Mixed Content Analysis for the Study of Digital Platform Social Data: An Illustration from the Analysis of COVID-19 Risk Perception in the Italian Twittersphere

The explosion of platform social data as digital secondary data, collectable through sophisticated and automatized query systems or algorithms, makes it possible to accumulate huge amounts of dense and miscellaneous data. The challenge for social researchers becomes how to extract meaning and not only trends in a quantitative and in a qualitative manner. Through the application of a digital mixed content analysis design, we present the potentiality of a hybrid digitalized approach to social content applied to a very tricky question: the recognition of risk perception during the first phase of COVID-19 in the Italian Twittersphere. The contribution of our article to mixed methods research consists in the extension of the existing definitions of content analysis as a mixed approach by combining hermeneutic and automated procedures, and by creating a design model with vast application potential, especially when applied to the digital scenario.

Factors influencing community acceptability of mass drug administration for the elimination of onchocerciasis in the Asante Akim South Municipal, Ghana

Introduction

Onchocerciasis is one of the eleven neglected tropical diseases (NTDs) recently targeted by the World Health Organization (WHO) for elimination. Mass drug administration (MDA) of ivermectin has become the main intervention for reducing the burden of onchocerciasis and controlling its transmission. However, despite the considerable gains in the fight against onchocerciasis in Ghana, the infection remains endemic in some communities. This study aimed to ascertain community members’ acceptability levels and factors associated with ivermectin MDA for the elimination of onchocerciasis in the Asante Akim South Municipal in the Ashanti Region of Ghana.

Methods

A cross-sectional, questionnaire-based study was conducted in six communities in the Asante Akim South Municipal from 7th May to 9th July, 2021. The study population comprised all persons aged 18 years and above who had lived in the study communities for more than three months prior to the study. The main outcome variable was the acceptability of ivermectin MDA by the community members. This was measured using a composite acceptability score adapted from the Intervention Rating Profile tool. The explanatory variables were the respondents’ socio-demographic characteristics, self-rated knowledge of onchocerciasis, perceived side effects of ivermectin, and self-reported level of education received on MDA activities.

Results

Out of 450 community members included in the study, 50.4% were male while 49.6% were female. The respondents’ mean age was 39.57±10.64 years. The mean acceptability score for ivermectin MDA was 20.52±2.91 (range, 9–36). Acceptability of ivermectin MDA was positively associated with gender, educational status, employment status, self-rated knowledge of onchocerciasis, and level of education received on MDA; and negatively associated with perceived side effect of ivermectin.

Conclusion

This study provides valuable information to inform policy decisions on planning and implementing MDA programs for the elimination of onchocerciasis in the study area and the country as a whole.

Perception of COVID-19 vaccination among Indian Twitter users: computational approach

Vaccination has been a hot topic in the present COVID-19 context. The government, public health stakeholders and media are all concerned about how to get the people vaccinated. The study was intended to explore the perception and emotions of the Indians citizens toward COVID-19 vaccine from Twitter messages. The tweets were collected for the period of 6 months, from mid-January to June, 2021 using hash-tags and keywords specific to India. Topics and emotions from the tweets were extracted using Latent Dirichlet Allocation (LDA) method and National Research Council (NRC) Lexicon, respectively. Theme, sentiment and emotion wise engagement and reachability metrics were assessed. Hash-tag frequency of COVID-19 vaccine brands were also identified and evaluated. Information regarding 'Co-WIN app and availability of vaccine' was widely discussed and also received highest engagement and reachability among Twitter users. Among the various emotions, trust was expressed the most, which highlights the acceptance of vaccines among the Indian citizens. The hash-tags frequency of vaccine brands shows that Covishield was popular in the month of March 2021, and Covaxin in April 2021. The results from the study will help stakeholders to efficiently use social media to disseminate COVID-19 vaccine information on popular concerns. This in turn will encourage citizens to be vaccinated and achieve herd immunity. Similar methodology can be adopted in future to understand the perceptions and concerns of people in emergency situations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42001-023-00203-0.

Entertainment-Education: What Are Grey's Anatomy and Saving Hope Teaching Us About Death?

In this article, we examine primetime television as a source of entertainment-education on death. Using directed (deductive) and conventional (inductive) approaches to content analysis, we describe how death and dying are being depicted on two primetime medical television series, Grey's Anatomy and Saving Hope. We then discuss what kinds of information viewers may be taking from these series. Our deductive content analysis suggests that much of the messages obtained are fairly representative of what occurs in real hospital settings, with the exception of emotional display. From the inductive analysis, we identified four thematic categories: 'the person dies, but life goes on', 'the tragic death', 'the purposeful death', and 'the well-timed death'. Regardless of category, no rituals are conducted at the moment of death and little space is made for grieving on primetime medical television shows. While death is often present, displays of grief are avoided.

Qualitative content analysis of image interpretation education in UK pre-registration diagnostic radiography programmes

INTRODUCTION

Image interpretation is a required capability for all UK pre-registration programmes in diagnostic radiography to meet the needs of graduate practice. It also provides a potential educational foundation for future advanced clinical practice. The aim of this study was to explore how image interpretation education is designed, delivered, and assessed within contemporary UK pre-registration diagnostic radiography programmes.

METHODS

Qualitative content analysis of open-source image interpretation curriculum data extracted from UK Higher Education Institute (HEI) websites.

RESULTS

Extracted search data was initially coded and three overarching themes emerged, image interpretation education vision, operationalisation, and delivery and assessment.

CONCLUSION

This study identified significant heterogeneity in all aspects of UK pre-registration image interpretation education which may suggest an equal heterogeneity can be expected in the image interpretation knowledge, skill, confidence between newly registered practitioners.

IMPLICATIONS FOR PRACTICE

There may be a need for clearer expectations on HEIs by professional and regulatory bodies to ensure consistency in pre-registration image interpretation education.

Conceptualization in ontology based on Peirce’s triadic model of the sign: a qualitative content analysis

Purpose

This study aims to identify the effective components in object interpretation based on Pierce’s triadic sign model to determine how meaning is created and identify the components affecting conceptualization in ontology.

Design/methodology/approach

A qualitative approach was adopted, and 6320 comments posted on the Instagram pages of five groups forming the research population were analyzed by qualitative content analysis.

Findings

Concepts are dynamic and context-oriented. Over time, a person’s concepts and mental patterns about an object are altered or eliminated. Social, political and economic conditions, governance, technology, interactions, language, environment, culture and social habits contribute to object interpretation and meaning creation.

Practical implications

In designing ontologies, especially in a context-dependent field, attention should be paid to users’ mental preconceptions, mental patterns, context and personal characteristics. Instead of using words, researchers can use visual and multimedia signs. In addition to logic, statistics and computer science, personal and anthropological characteristics should be considered in the ontology design.

Originality/value

This study dealt with conceptualization, which is a principal component of ontology. Using Pierce’s triadic model sign and unstructured Instagram data, ontology was studied from a user and pragmatic viewpoint, independently of technical aspects.

From Hostile to Benevolent Ageism: Polarising Attitudes Towards Older Adults in German COVID-19 Related Tweets

Background and Objectives

Previous studies have linked COVID-19 to a rise in ageism. While a growing body of research examined hostile ageism during the pandemic, benevolent ageism received less attention. Drawing on the stereotype content theory and the classic tripartite model of attitudes, the current study explored how benevolent and hostile ageism are reflected in the cognitive, affective, and behavioural dimensions of attitudes towards older adults in German COVID-19 related tweets. The study examined the most prevalent attitudes as well as changes in prevalence between the first and second lockdown period in Germany.

Research Design and Methods

792 German tweets concerning COVID-19 and ageing were collected and coded using Mayring’s qualitative content analysis with a dominantly inductive approach. Quantitative methods were used to identify the most prevalent subthemes as well as changes in prevalence.

Results

The coding resulted in 21 subthemes. Most tweets (60.73%) contained either hostile or benevolent ageist attitudes, with benevolent ageism being more prevalent. The top 5 subthemes in terms of prevalence and reach contained several opposing attitudes, such as devaluation and opposing devaluation. The chi-square tests revealed a shift from a promotion to an evaluation of COVID-19 related policies between the two lockdowns.

Discussion and Implications

Results highlight social media’s polarising effect and its potential contribution to both hostile and benevolent ageism in the context of COVID-19 in Germany. Results indicate the need to consider the adverse effects of benevolent ageism and use of chronological age as risk factor, when designing COVID-19 related policies.

Spontaneously generated online patient experience data - how and why is it being used in health research: an umbrella scoping review

PURPOSE

Social media has led to fundamental changes in the way that people look for and share health related information. There is increasing interest in using this spontaneously generated patient experience data as a data source for health research. The aim was to summarise the state of the art regarding how and why SGOPE data has been used in health research. We determined the sites and platforms used as data sources, the purposes of the studies, the tools and methods being used, and any identified research gaps.

METHODS

A scoping umbrella review was conducted looking at review papers from 2015 to Jan 2021 that studied the use of SGOPE data for health research. Using keyword searches we identified 1759 papers from which we included 58 relevant studies in our review.

RESULTS

Data was used from many individual general or health specific platforms, although Twitter was the most widely used data source. The most frequent purposes were surveillance based, tracking infectious disease, adverse event identification and mental health triaging. Despite the developments in machine learning the reviews included lots of small qualitative studies. Most NLP used supervised methods for sentiment analysis and classification. Very early days, methods need development. Methods not being explained. Disciplinary differences - accuracy tweaks vs application. There is little evidence of any work that either compares the results in both methods on the same data set or brings the ideas together.

CONCLUSION

Tools, methods, and techniques are still at an early stage of development, but strong consensus exists that this data source will become very important to patient centred health research.

Schizophrenia on Turkish Twitter: an exploratory study investigating misuse, stigmatization and trivialization

PURPOSE

This study aims to investigate use and misuse of the word 'schizophrenia' and its derivatives to assess the prevalence of stigmatizing and trivializing attitudes and the meanings attributed to the condition on Turkish Twitter.

METHODS

Using R programming language, we collected Turkish Twitter posts containing the terms used for schizophrenia in Turkish through Twitter's Search API over a 47-day period between July and June 2019. After removing retweets, we randomly sampled 3000 tweets and manually categorized them in three dimensions: use type (metaphorical/non-metaphorical), topic and attitude. Qualitative analysis on representative tweets were performed and word frequencies were calculated.

RESULTS

In total 44,266 tweets were collected and after removing retweets, 24,529 tweets were obtained. Overwhelming majority of the tweets (91.7%) used the terms metaphorically and the majority displayed stigmatizing (68.3%) and trivializing (23%) attitudes. Politics was the most common topic (58.2%) followed by everyday/social chatter (28.5%). Only a small number of tweets were part of awareness campaigns (0.2%) or displayed a supportive attitude (0.8%). Terms were often used metaphorically in a stigmatizing manner as personal or political insults, while in everyday/social contexts, they were used in a trivializing manner to label eccentricity, oddness, overthinking and suspiciousness. Popularity and reach metrics show that these tweets were extensively retweeted, liked and reached millions of users.

CONCLUSION

This is the first study investigating attitudes towards schizophrenia on Turkish Twitter. Significantly higher rates of stigmatizing attitudes demonstrate the urgent need for public health and social awareness campaigns targeting stigma surrounding schizophrenia in Turkey.

Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review

OBJECTIVE

Explore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients' experience of illness.

DESIGN

Review of qualitative research studies.

DATA SOURCES

CINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020.

ELIGIBILITY CRITERIA

Journal articles in English, reporting qualitative studies on lived experience of CHF.

RESULTS

35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms' interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient's capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients' lives.

CONCLUSIONS

Symptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients' efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients' capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient's agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population.

PROSPERO REGISTRATION NUMBER

CRD42017077487.

Police Enforcement of Sex Work Criminalization Laws in an "End Demand" City: The Persistence of Quality-of-Life Policing and Seller Arrests

The purported goals of commercial sex work criminalization policies in the United States have shifted over the past two decades as local jurisdictions have adopted End Demand reforms. These reforms aim to refocus arrest from individuals who sell sexual services to buyers and facilitators, representing a departure from the quality-of-life, nuisance-focused approach of the late twentieth century. This article presents a case study examining enforcement of commercial sex laws in Chicago, a city that has been heralded as a leader in End Demand reforms. Our case study utilized annualized arrest statistics from 1998 to 2017 and individual arrest reports (n = 575) from 2015 to 2017. Commercial sex arrests by the Chicago Police Department have declined substantially over the past two decades, falling 98.4% from its peak. However, our analysis suggests that sellers of sexual services continue to face the heaviest burden of arrest (80.5%) and officers generally continue to approach commercial sex as a quality-of-life issue. We argue that this divergence between the goals and implementation of End Demand are the result of three institutional factors: street-level bureaucracy, logics of spatial governmentality, and participatory security. Our results suggest that the ideals of End Demand may be incompatible with the institutional realties of urban policing.

Framing clinical and translational science: Examining the strategic social media communications of NCATS-funded CTSAs

INTRODUCTION

Many Clinical and Translational Science Awards (CTSAs) focus their energy on operational aspects of running their hub, but may not devote enough energy and resources toward branding and effective communication. However, CTSAs have an important mission when it comes to communicating effectively with their stakeholders through social media. Using framing theory as the underpinning, the purpose of this content analysis is to investigate the ways in which CTSAs use Twitter to communicate with their various stakeholders, the type of content they post, and the type of engagement their tweets garner.

METHODS

We examined 349 tweets posted from January 2019 to January 2020 from 19 CTSA Twitter accounts (sampled from a total of 35 CTSA accounts). A thematic codebook was generated using tweets randomly chosen from the sample. Content analysis was performed on the entire tweet sample by four coders using the codebook (alpha = 0.89).

RESULTS

CTSAs tweeted the most about events (29.8%), and the least about study recruitment (2.01%). Most tweets included images (59.31%) and hashtags (51.29%), but received little user engagement on the average post (average: 4.38 likes and 1.94 retweets). CTSAs tweeted most from 10 a.m. to 12 p.m. PST and received the most engagement. Most CTSAs had a dedicated person (e.g., manager, coordinator) handling their communications.

DISCUSSION

Our analysis shows multiple opportunities for CTSAs to engage with stakeholders and the public, as well as standardize and improve their Twitter communications to effectively reach a broader audience.

Emergency Medicine Influencers' Twitter Use During the COVID-19 Pandemic: A Mixed-methods Analysis

INTRODUCTION

The objective of this study was to analyze the messages of influential emergency medicine (EM) Twitter users in the United States (US) during the early stages of the coronavirus disease 2019 (COVID-19) global pandemic by characterizing the themes, emotional tones, temporal viewpoints, and depth of engagement with the tweets.

METHODS

We performed a retrospective mixed-methods analysis of publicly available Twitter data derived from the publicly available "Coronavirus Tweet IDs" dataset, March 3, 2020-May 1, 2020. Original tweets and modified retweets in the dataset by 50 influential EM Twitter users in the US were analyzed using linguistic software to report the emotional tone and temporal viewpoint. We qualitatively analyzed a 25% random subsample and report themes.

RESULTS

There were 1315 tweets available in the dataset from 36/50 influential EM Twitter users in the US. The majority of tweets were either positive (455/1315, 34.6%) or neutral (407/1315, 31%) in tone and focused on the present (1009/1315, 76.7%). Qualitative analysis identified six distinct themes, with users most often sharing news or clinical information.

CONCLUSIONS

During the early weeks of the COVID-19 pandemic, influential EM Twitter users in the US delivered mainly positive or neutral messages, most often pertaining to news stories or information directly relating to patient care. The majority of these messages led to engagement by other users. This study underscores how EM influencers can leverage social media in public health outbreaks to bring attention to topics of importance.

Self-reported dental treatment needs during the COVID-19 outbreak in Brazil: an infodemiological study

The aim of the present infodemiological study was to evaluate whether the COVID-19 outbreak has influenced the volume of content related to the dental treatment needs of Brazilian Twitter users to summarize the trends, and to identify the perceptions of the treatment needed. We collected tweets related to dental care needs of individuals exposed to the COVID-19 outbreak scenario between March 23 to May 4, 2020 and of those not exposed to the COVID-19 pandemic (unexposed group) on the same reported days of 2019 using the terms "dentista (dentist), dente (tooth), siso (third molar), and aparelho (orthodontic appliance)." Descriptive analysis was performed to provide summary statistics of the frequencies of tweets related to different dental treatment needs and also the differences in volume content between the years 2019 and 2020. Moreover, the data were analyzed by qualitative analysis using an inductive approach. A total of 1,763 tweets from 2020 and 1,339 tweets from 2019 were screened. Those tweets posted by non-Brazilian users, duplicates, and those unrelated to dental treatment needs were removed and, therefore 1,197 tweets from 2020 and 719 tweets from 2019 were selected. Content volume related to dental treatment needs greatly increased during the COVID-19 outbreak. Findings from the word cloud and content analysis suggest that dental pain, related or not to the third molar, and problems with orthodontic appliances were the topics most commonly related to dental treatment needs discussed during the COVID-19 outbreak, mainly conveying anxiety and distress. The volume of tweets related to dental treatment needs posted by Brazilian users increased during the COVID-19 outbreak and self-reported pain and urgencies were the most popular topics.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Public Engagement and Government Responsiveness in the Communications About COVID-19 During the Early Epidemic Stage in China: Infodemiology Study on Social Media Data

BACKGROUND

Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioral compliance. China has experienced the unprecedented epidemic of the coronavirus disease (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns.

OBJECTIVE

This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on an analysis of data from Sina Weibo, a major social media platform in China.

METHODS

Weibo data relevant to COVID-19 from December 1, 2019, to January 31, 2020, were retrieved. Engagement data (likes, comments, shares, and followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis further explored main content patterns, and chi-square for trend examined how proportions of main content patterns changed by time within the study time frame.

RESULTS

The public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier for Weibo than the government. Online users generally had low engagement with posts relevant to COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situations; general knowledge of the new disease; and policies, guidelines, and official actions. However, personal posts were more likely to show empathy to affected people (χ²₁=13.3, P<.001), attribute blame to other individuals or government (χ²₁=28.9, P<.001), and express worry about the epidemic (χ²₁=32.1, P<.001), while government posts were more likely to share instrumental support (χ²₁=32.5, P<.001) and praise people or organizations (χ²₁=8.7, P=.003). As the epidemic evolved, sharing situation updates (for trend, χ²₁=19.7, P<.001) and policies, guidelines, and official actions (for trend, χ²₁=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (for trend, χ²₁=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising, and empathizing in government posts (for trend, χ²₁=9.0, P=.003).

CONCLUSIONS

The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation updates and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns.

Patients' experiences of radiotherapy: Insights from Twitter

INTRODUCTION

Understanding how patients experience radiotherapy is a key element in improving care. People with cancer are increasingly using social media to share information and discuss healthcare matters. Twitter may provide a rich source of data on how people experience radiotherapy. The aims of this research were to better understand the role of social media in this context and establish what can be learnt about the experience of undergoing radiotherapy from a novel digital data source.

METHODS

A qualitative content analysis was conducted to describe how and why Twitter is being used by patients in relation to radiotherapy. Twitter was queried with "radiotherapy" and a purposive subsample of tweets, authored primarily by patients was collected over one randomly generated composite month in 2016. Thematic analysis was performed to interpret the data.

RESULTS

442 unique tweets authored by patients and their families were sampled and six themes were developed. Three core themes represented the radiotherapy pathway; pre- during- and post-treatment. Underlying themes were emotional and informational support, impact on loved ones and giving thanks.

CONCLUSION

Patients and their loved ones use Twitter to share their experience of radiotherapy. They describe the physical and psychological impact of undergoing treatment and seek informational and emotional support through social media. There is opportunity for greater engagement from radiotherapy professionals and organisations to improve informational support for patients online.

IMPLICATIONS FOR PRACTICE

Increased engagement between radiotherapy professionals and patient communities on Twitter has the potential to build patient-practitioner trust, promote self-management and raise the social profile of radiotherapy and its professions.

What Twitter teaches us about patient-provider communication on pain

The objective of this study was to understand how pain patients and health care providers (HCPs) are engaging on Twitter and what insights this engagement might provide. By identifying how information is spread by and between these audiences, organizations such as patient advocacy groups may be better poised to develop and share materials that facilitate online communication between HCPs and pain patients, with an end goal of improving a shared decision-making process around pain management. We analyzed the Twitter audiences most engaged on pain topics by conducting a Social Network Analysis (SNA) of a large network of connected users on Twitter. The analysis segmented users based on the sources they cited and measured their influence based on who follows them. As a point of comparison, we also conducted an SNA of Twitter audiences most engaged on oncology topics. Oncology was chosen as a comparison due to what was perceived to be a highly developed online network of both patients and physicians. The populations included in this research included 12,086 accounts that were highly engaged on pain-related topics, and 12,617 accounts that were highly engaged on oncology-related topics. Network statistics were generated for variables including: word use, sources cited, retweets, and mentions. We also statistically analyzed the Twitter follow relationships among select HCPs and patient groups within each SNA. The creation of separate pain and oncology SNAs allowed the team to compare relationships and engagement related to these topics. We found that on Twitter, pain patients and providers appear to interact less than oncology patients and providers. Pain patients do not appear to follow medical professionals or share medical or health-related information on Twitter to the same extent as oncology patients. In addition, we found that pain patients do not communicate on Twitter in the same language as HCPs. Our results are important because they underscore that challenges in communication are not just problematic in face-to-face interactions, but also in digital social network (Twitter) interactions, serving as an additional roadblock to what can be shared decision-making opportunities around pain management. Contributing to this roadblock is access to quality information and a potential need for an online, evidence-based resource hub that could benefit the pain patient community in the same way that cancer.gov serves as a source of aggregated materials for oncology patients and HCPs. This study is an illustration of how social media networks like Twitter can be used to better understand the relationships, language gaps, and shared resources between pain patients and providers and offers a template for using digital social network (Twitter) interactions to research other difficult-to-treat or rare disease states.

Reframing healthy food choices: a content analysis of Australian healthy eating blogs

BACKGROUND

Blogs are widely being used by health professionals and consumers to communicate and access nutrition information. There are numerous benefits for dietitians to establish and contribute to healthy eating blogs. In particular, to disseminate evidence-based nutrition information to promote healthier dietary practices. The aim of this study was to explore characteristics of popular healthy eating blogs and inform the provision of healthy eating information in the Australian context.

METHODS

A content analysis approach was used to identify characteristics of popular Australian healthy eating blogs. A purposive and snowball sampling approach was used to identify healthy eating blogs from search engines including Google, Bing and Yahoo. Blogs were deemed eligible if: (1) the author self-identified as a health professional; (2) the blog was written by a single author; (3) the blog was written by an Australian author; (4) the blog had a minimum of one post per month, and (5) the blog focused on communicating healthy eating information to the general adult population.

RESULTS

Five popular blogs were followed over a three-month period (December 2017-March 2018), with 76 blog posts included for analysis. Characteristics of these popular blogs were examined and four main features were identified: (i) clearly conveying the purpose of each post; (ii) developing a strong understanding of the reader base and their preferences; (iii) employing a consistent writing style; use of vocabulary and layout; and (iv) communicating healthy eating information in a practical manner. These findings reveal important insight into the features that promote effective nutrition communication within this context.

CONCLUSION

Findings from this study highlight common characteristics of popular healthy eating blogs. Future research into the development of blog guidelines which incorporate the characteristics identified in this study can support dietitians in establishing or contributing to the successful provision of evidence-based nutritional information through blogs.

What's All the Chatter? A Mixed-Methods Analysis of Emergency Physicians' Tweets

INTRODUCTION

Twitter is growing in popularity and influence among emergency physicians (EP), with over 2200 self-identified EP users. As Twitter's popularity has increased among EPs so too has its influence. While there has been debate about the value of Twitter as an effective educational delivery tool, little attention has been paid to the nature of the conversation occurring on Twitter. We aim to describe how influential EPs use Twitter by characterizing the language, purpose, frequencies, content, and degree of engagement of their tweets.

METHODS

We performed a mixed-methods analysis following a combined content analysis approach. We conducted qualitative and quantitative analyses of a sample of tweets from the 61 most influential EPs on Twitter. We present descriptive tweet characteristics and noteworthy themes.

RESULTS

We analyzed 1375 unique tweets from 57 unique users, representing 93% of the influential Twitter EPs. A majority of tweets (1104/1375, 80%) elicited some response in the form of retweets, likes, or replies, demonstrating community engagement. The qualitative analysis identified 15 distinct categories of tweets.

CONCLUSION

Influential EPs on Twitter were engaged in largely medical conversations in which most messages generated some form of interaction. They shared resources and opinions while also building social rapport in a community of practice. This data can help EPs make informed decisions about social media engagement.

Access to care of frail community-dwelling older adults in Belgium: a qualitative study

Aim

This paper aims to identify barriers that frail community-dwelling older adults experience regarding access to formal care and support services.

Background

Universal access to healthcare has been set by the World Health Organisation (WHO) as a main goal for the post-2015 development agenda. Nevertheless, regarding access to care, particular attention has to be paid to the so-called vulnerable groups, such as (frail) older adults.

Methods

Both inductive and deductive content analyses were performed on 22 individual interviews with frail, community-dwelling older adults who indicated they lacked care and support. The coding scheme was generated from the conceptual framework ‘6A’s of access to care and support’ (referring to work of Penchansky and Thomas, 1981; Wyszewianski, 2002; Saurman, 2016) and applied on the transcripts.

Findings

Results indicate that (despite all policy measures) access to a broad spectrum of care and support services remains a challenge for older people in Belgium. The respondents’ barriers concern: ‘affordability’ referring to a lot of Belgian older adults having limited pensions, ‘accessibility’ going beyond geographical accessibility but also concerning waiting lists, ‘availability’ referring to the lack of having someone around, ‘adequacy’ addressing the insufficiency of motivated staff, the absence of trust in care providers influencing ‘acceptability’, and ‘awareness’ referring to limited health literacy. The discussion develops the argument that in order to make care and support more accessible for people in order to be able to age in place, governments should take measures to overcome these access limitations (eg, by automatic entitlements) and should take into account a broad description of access. Also, a seventh barrier (a seventh A) within the results, namely ‘ageism’, was discovered.

The Tangibility of Personalized 3D-Printed Feedback May Enhance Youths' Physical Activity Awareness, Goal Setting, and Motivation: Intervention Study

BACKGROUND

In the United Kingdom, most youth fail to achieve the government guideline of 60 min of moderate to vigorous physical activity (MVPA) daily. Reasons that are frequently cited for the underachievement of this guideline include (1) a lack of awareness of personal physical activity levels (PALs) and (2) a lack of understanding of what activities and different intensities contribute to daily targets of physical activity (PA). Technological advances have enabled novel ways of representing PA data through personalized tangible three-dimensional (3D) models.

OBJECTIVE

The purpose of this study was to investigate the efficacy of 3D-printed models to enhance youth awareness and understanding of and motivation to engage in PA.

METHODS

A total of 39 primary school children (22 boys; mean age 7.9 [SD 0.3] years) and 58 secondary school adolescents (37 boys; mean age 13.8 [SD 0.3] years) participated in a 7-week fading intervention, whereby participants were given 3D-printed models of their previous week's objectively assessed PALs at 4 time points. Following the receipt of their 3D model, each participant completed a short semistructured video interview (children, 4.5 [SD 1.2] min; adolescents, 2.2 [SD 0.6] min) to assess their PA awareness, understanding, and motivation. Data were transcribed verbatim and thematically analyzed to enable key emergent themes to be further explored and identified.

RESULTS

Analyses revealed that the 3D models enhanced the youths' awareness of and ability to recall and self-evaluate their PA behaviors. By the end of the study, the youths, irrespective of age, were able to correctly identify and relate to the government's PA guideline represented on the models, despite their inability to articulate the government's guideline through time and intensity. Following the fourth 3D model, 72% (71/97) of the youths used the models as a goal-setting strategy, further highlighting such models as a motivational tool to promote PA.

CONCLUSIONS

The results suggest that 3D-printed models of PA enhanced the youths' awareness of their PA levels and provided a motivational tool for goal setting, potentially offering a unique strategy for future PA promotion.

Understanding Youths' Ability to Interpret 3D-Printed Physical Activity Data and Identify Associated Intensity Levels: Mixed-Methods Study

Background

A significant proportion of youth in the United Kingdom fail to meet the recommended 60 minutes of moderate-to-vigorous physical activity every day. One of the major barriers encountered in achieving these physical activity recommendations is the perceived difficulty for youths to interpret physical activity intensity levels and apply them to everyday activities. Personalized physical activity feedback is an important method to educate youths about behaviors and associated outcomes. Recent advances in 3D printing have enabled novel ways of representing physical activity levels through personalized tangible feedback to enhance youths’ understanding of concepts and make data more available in the everyday physical environment rather than on screen.

Objective

The purpose of this research was to elicit youths’ (children and adolescents) interpretations of two age-specific 3D models displaying physical activity and to assess their ability to appropriately align activities to the respective intensity.

Methods

Twelve primary school children (9 boys; mean age 7.8 years; SD 0.4 years) and 12 secondary school adolescents (6 boys; mean age 14.1 years; SD 0.3 years) participated in individual semistructured interviews. Interview questions, in combination with two interactive tasks, focused on youths’ ability to correctly identify physical activity intensities and interpret an age-specific 3D model. Interviews were transcribed verbatim, content was analyzed, and outcomes were represented via tables and diagrammatic pen profiles.

Results

Youths, irrespective of age, demonstrated a poor ability to define moderate-intensity activities. Moreover, children and adolescents demonstrated difficulty in correctly identifying light- and vigorous-intensity activities, respectively. Although youths were able to correctly interpret different components of the age-specific 3D models, children struggled to differentiate physical activity intensities represented in the models.

Conclusions

These findings support the potential use of age-specific 3D models of physical activity to enhance youths’ understanding of the recommended guidelines and associated intensities.

Perceptions of cervical cancer prevention on Twitter uncovered by different sampling strategies

Introduction

Cervical cancer prevention is possible through use of the HPV vaccine and Pap tests, yet the vaccine remains underutilized.

Methods

We obtained publicly-available Twitter data from 2014 using three sampling strategies (top-ranked, simple random sample, and topic model) based on key words related to cervical cancer prevention. We conducted a content analysis of 100 tweets from each of the three samples and examined the extent to which the narratives and frequency of themes differed across samples.

Results

Advocacy-related tweets constituted the most prevalent theme to emerge across all three sample types, and were most frequently found in the top-ranked sample. A random sample detected the same themes as topic modeling, but the relative frequency of themes identified from topic modeling fell in-between top-ranked and random samples.

Discussion

Variations in themes uncovered by different sampling methods suggest it is useful to qualitatively assess the relative frequency of themes to better understand the breadth and depth of social media conversations about health.

Conclusions

Future studies using social media data should consider sampling methods to uncover a wider breadth of conversations about health on social media.

At-a-glance - What can social media tell us about the opioid crisis in Canada?

We explored social media as a potential data source for acquiring realtime information on opioid use and perceptions in Canada. Twitter messages were collected through a social media analytics platform between June 15, 2017, and July 13, 2017, and analyzed to identify recurring topics mentioned in the messages. Messages concerning the medical use of opioids as well as commentary on the Canadian government's current response efforts to the opioid crisis were common. The findings of this study may help to inform public health practice and community stakeholders in their efforts to address the opioid crisis.

Analysis of Content Shared in Online Cancer Communities: Systematic Review

Background

The content that cancer patients and their relatives (ie, posters) share in online cancer communities has been researched in various ways. In the past decade, researchers have used automated analysis methods in addition to manual coding methods. Patients, providers, researchers, and health care professionals can learn from experienced patients, provided that their experience is findable.

Objective

The aim of this study was to systematically review all relevant literature that analyzes user-generated content shared within online cancer communities. We reviewed the quality of available research and the kind of content that posters share with each other on the internet.

Methods

A computerized literature search was performed via PubMed (MEDLINE), PsycINFO (5 and 4 stars), Cochrane Central Register of Controlled Trials, and ScienceDirect. The last search was conducted in July 2017. Papers were selected if they included the following terms: (cancer patient) and (support group or health communities) and (online or internet). We selected 27 papers and then subjected them to a 14-item quality checklist independently scored by 2 investigators.

Results

The methodological quality of the selected studies varied: 16 were of high quality and 11 were of adequate quality. Of those 27 studies, 15 were manually coded, 7 automated, and 5 used a combination of methods. The best results can be seen in the papers that combined both analytical methods. The number of analyzed posts ranged from 200 to 1,500,000; the number of analyzed posters ranged from 75 to 90,000. The studies analyzing large numbers of posts mainly related to breast cancer, whereas those analyzing small numbers were related to other types of cancers. A total of 12 studies involved some or entirely automatic analysis of the user-generated content. All the authors referred to two main content categories: informational support and emotional support. In all, 15 studies reported only on the content, 6 studies explicitly reported on content and social aspects, and 6 studies focused on emotional changes.

Conclusions

In the future, increasing amounts of user-generated content will become available on the internet. The results of content analysis, especially of the larger studies, give detailed insights into patients’ concerns and worries, which can then be used to improve cancer care. To make the results of such analyses as usable as possible, automatic content analysis methods will need to be improved through interdisciplinary collaboration.

Integration of Massage Therapy in Outpatient Cancer Care

BACKGROUND

Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care.

PURPOSE

The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers.

SETTING

This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62).

DESIGN

Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis.

MAIN OUTCOME MEASURE

The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally.

RESULTS

The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all-not even provision of information about massage to patients through the center website.

CONCLUSIONS

The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care.

'It has saved thousands of lives, so why change it?' Content analysis of objections to cervical screening programme changes in Australia

OBJECTIVES

The incidence and mortality of cervical cancer have halved since introduction of the Australian cervical screening programme in 1991, involving 2-yearly Pap smears from ages 18-69 years. In 2017, the programme changed to 5- yearly primary human papillomavirus (HPV) testing for women aged 25-74 years. This study investigated reasons for opposition to the renewed screening programme within the open-ended comments of an online petition, 'Stop May 1st Changes to Pap Smears-Save Women's Lives', opposing the changes, which received over 70 000 signatures and almost 20 000 comments.

METHODS

Content analysis of a random sample of 2000 comments, reflecting 10% of the 19 633 comments posted in February-March 2017.

RESULTS

Nineteen codes were identified, reflecting four themes: (1) valuing women's health and rights, (2) political statements, (3) concerns about healthcare funding cuts and (4) opposition to specific components of the new screening programme. The most prevalent codes were: placing value on women's health (33%), concerns about increasing screening intervals (17%) and opposition to the changes related to personal experiences with cervical cancer or cervical abnormalities (15%). Concern about the key change in technology (HPV testing instead of Pap smears) was expressed in less than 3% of comments, and some opposition to the changes from health professionals was noted.

CONCLUSIONS

Screening changes within this selected group were perceived as threatening women's health, as a political policy created by male decision-makers and as a cost-cutting exercise. Many commenters were concerned about increased screening intervals and later screening onset, but little opposition was expressed regarding the testing technology itself. This analysis may inform public education and communication strategies for future changes to cervical screening programmes internationally, to pre-emptively address specific concerns about the changes.

Attitudes of Crohn's Disease Patients: Infodemiology Case Study and Sentiment Analysis of Facebook and Twitter Posts

BACKGROUND

Data concerning patients originates from a variety of sources on social media.

OBJECTIVE

The aim of this study was to show how methodologies borrowed from different areas including computer science, econometrics, statistics, data mining, and sociology may be used to analyze Facebook data to investigate the patients' perspectives on a given medical prescription.

METHODS

To shed light on patients' behavior and concerns, we focused on Crohn's disease, a chronic inflammatory bowel disease, and the specific therapy with the biological drug Infliximab. To gain information from the basin of big data, we analyzed Facebook posts in the time frame from October 2011 to August 2015. We selected posts from patients affected by Crohn's disease who were experiencing or had previously been treated with the monoclonal antibody drug Infliximab. The selected posts underwent further characterization and sentiment analysis. Finally, an ethnographic review was carried out by experts from different scientific research fields (eg, computer science vs gastroenterology) and by a software system running a sentiment analysis tool. The patient feeling toward the Infliximab treatment was classified as positive, neutral, or negative, and the results from computer science, gastroenterologist, and software tool were compared using the square weighted Cohen's kappa coefficient method.

RESULTS

The first automatic selection process returned 56,000 Facebook posts, 261 of which exhibited a patient opinion concerning Infliximab. The ethnographic analysis of these 261 selected posts gave similar results, with an interrater agreement between the computer science and gastroenterology experts amounting to 87.3% (228/261), a substantial agreement according to the square weighted Cohen's kappa coefficient method (w2K=0.6470). A positive, neutral, and negative feeling was attributed to 36%, 27%, and 37% of posts by the computer science expert and 38%, 30%, and 32% by the gastroenterologist, respectively. Only a slight agreement was found between the experts' opinion and the software tool.

CONCLUSIONS

We show how data posted on Facebook by Crohn's disease patients are a useful dataset to understand the patient's perspective on the specific treatment with Infliximab. The genuine, nonmedically influenced patients' opinion obtained from Facebook pages can be easily reviewed by experts from different research backgrounds, with a substantial agreement on the classification of patients' sentiment. The described method allows a fast collection of big amounts of data, which can be easily analyzed to gain insight into the patients' perspective on a specific medical therapy.

Nature Contact and Human Health: A Research Agenda

BACKGROUND

At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding.

OBJECTIVES

We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions.

DISCUSSION

We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science.

CONCLUSIONS

Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights. https://doi.org/10.1289/EHP1663.

Patterns of Twitter Behavior Among Networks of Cannabis Dispensaries in California

Background

Twitter represents a social media platform through which medical cannabis dispensaries can rapidly promote and advertise a multitude of retail products. Yet, to date, no studies have systematically evaluated Twitter behavior among dispensaries and how these behaviors influence the formation of social networks.

Objectives

This study sought to characterize common cyberbehaviors and shared follower networks among dispensaries operating in two large cannabis markets in California.

Methods

From a targeted sample of 119 dispensaries in the San Francisco Bay Area and Greater Los Angeles, we collected metadata from the dispensary accounts using the Twitter API. For each city, we characterized the network structure of dispensaries based upon shared followers, then empirically derived communities with the Louvain modularity algorithm. Principal components factor analysis was employed to reduce 12 Twitter measures into a more parsimonious set of cyberbehavioral dimensions. Finally, quadratic discriminant analysis was implemented to verify the ability of the extracted dimensions to classify dispensaries into their derived communities.

Results

The modularity algorithm yielded three communities in each city with distinct network structures. The principal components factor analysis reduced the 12 cyberbehaviors into five dimensions that encompassed account age, posting frequency, referencing, hyperlinks, and user engagement among the dispensary accounts. In the quadratic discriminant analysis, the dimensions correctly classified 75% (46/61) of the communities in the San Francisco Bay Area and 71% (41/58) in Greater Los Angeles.

Conclusions

The most centralized and strongly connected dispensaries in both cities had newer accounts, higher daily activity, more frequent user engagement, and increased usage of embedded media, keywords, and hyperlinks. Measures derived from both network structure and cyberbehavioral dimensions can serve as key contextual indicators for the online surveillance of cannabis dispensaries and consumer markets over time.

Utilizing Big Data and Twitter to Discover Emergent Online Communities of Cannabis Users

Large shifts in medical, recreational, and illicit cannabis consumption in the United States have implications for personalizing treatment and prevention programs to a wide variety of populations. As such, considerable research has investigated clinical presentations of cannabis users in clinical and population-based samples. Studies leveraging big data, social media, and social network analysis have emerged as a promising mechanism to generate timely insights that can inform treatment and prevention research. This study extends a novel method called stochastic block modeling to derive communities of cannabis consumers as part of a complex social network on Twitter. A set of examples illustrate how this method can ascertain candidate samples of medical, recreational, and illicit cannabis users. Implications for research planning, intervention design, and public health surveillance are discussed.

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.