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Jung SY, Moon KJ. Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study. JMIR Serious Games 2024; 12:e53165. [PMID: 38913417 DOI: 10.2196/53165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations. OBJECTIVE We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences. METHODS PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim. RESULTS The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management. CONCLUSIONS The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.
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Affiliation(s)
- Soo Youn Jung
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Kyoung Ja Moon
- College of Nursing, Keimyung University, Daegu, Republic of Korea
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Schoultz M, Mcgrogan C, Carolan C, Macaden L, Beattie M. Exploring barriers to care home research recruitment during the COVID-19 pandemic: The influence of social media recruitment posts and public sentiment. PLoS One 2024; 19:e0303609. [PMID: 38905189 PMCID: PMC11192410 DOI: 10.1371/journal.pone.0303609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/28/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Recruitment of care home staff to research studies is recognised as challenging. This was further exacerbated by the COVID-19 pandemic and the associated negative media portrayal of care home workers. Social media use has surged since the onset of COVID-19 lockdowns, offering a plausible approach to understanding the barriers to care home research recruitment and gaining insight into public perceptions of care home workers. AIM To utilise comments from two Facebook recruitment posts to: 1) gain an understanding of potential barriers to recruitment of healthcare workers (HCWs) in UK care homes, and 2) explore public sentiment towards care home research and care homes in the context of the COVID-19 pandemic. METHODS This cross-sectional study analysed comments from two Facebook posts (available June-October 2021) advertising a separate study on psychological support for care staff during the pandemic. This study was situated within a larger investigation into the mental health and wellbeing of care home staff and employed both qualitative analysis and quantitative methods (word count and correlations between words used and between posts). RESULTS Three themes were identified from the qualitative analysis: support, mistrust and blame. There was a greater use of words associated with support and negative emotive words in post 2. Post 2 comments featured significantly more choice words and first-person singular pronouns than post 1 which indicated a resentful sentiment from those who advocate freedom of choice and control. Discussion of mistrust towards researchers was most prominent in post 1 indicating the importance of relationship building between researchers and HCWs in UK care homes. With attribution to blame, there was a larger range of negative emotion words than positive emotion words. DISCUSSION AND CONCLUSION Taken together our findings offer novel insights into why recruitment to care home research during the pandemic including the use of social media might be problematic. Social media is a useful tool for recruitment but should not be considered as a one-time input. Researchers should pro-actively engage with the study population from the start using co-design with resident and public groups to support recruitment and ensure these populations are accurately represented within research.
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Affiliation(s)
- Mariyana Schoultz
- School of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Claire Mcgrogan
- School of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Clare Carolan
- Centre for Rural Health Sciences, University of the Highlands and Islands, Inverness, United Kingdom
| | - Leah Macaden
- Nursing Studies, School of Health in Social Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle Beattie
- Centre for Rural Health Sciences, University of the Highlands and Islands, Inverness, United Kingdom
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3
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Brassel S, Brunner M, Campbell A, Power E, Togher L. Exploring Discussions About Virtual Reality on Twitter to Inform Brain Injury Rehabilitation: Content and Network Analysis. J Med Internet Res 2024; 26:e45168. [PMID: 38241072 PMCID: PMC10837760 DOI: 10.2196/45168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/06/2023] [Accepted: 10/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Virtual reality (VR) use in brain injury rehabilitation is emerging. Recommendations for VR development in this field encourage end user engagement to determine the benefits and challenges of VR use; however, existing literature on this topic is limited. Data from social networking sites such as Twitter may further inform development and clinical practice related to the use of VR in brain injury rehabilitation. OBJECTIVE This study collected and analyzed VR-related tweets to (1) explore the VR tweeting community to determine topics of conversation and network connections, (2) understand user opinions and experiences of VR, and (3) identify tweets related to VR use in health care and brain injury rehabilitation. METHODS Publicly available tweets containing the hashtags #virtualreality and #VR were collected up to twice weekly during a 6-week period from July 2020 to August 2020 using NCapture (QSR International). The included tweets were analyzed using mixed methods. All tweets were coded using inductive content analysis. Relevant tweets (ie, coded as "VR in health care" or "talking about VR") were further analyzed using Dann's content coding. The biographies of users who sent relevant tweets were examined descriptively. Tweet data networks were visualized using Gephi computational analysis. RESULTS A total of 260,715 tweets were collected, and 70,051 (26.87%) were analyzed following eligibility screening. The sample comprised 33.68% (23,596/70,051) original tweets and 66.32% (46,455/70,051) retweets. Content analysis generated 10 main categories of original tweets related to VR (ie, advertising and promotion, VR content, talking about VR, VR news, general technology, VR industry, VR live streams, VR in health care, VR events, and VR community). Approximately 4.48% (1056/23,596) of original tweets were related to VR use in health care, whereas 0.19% (45/23,596) referred to VR in brain injury rehabilitation. In total, 14.86% (3506/23,596) of original tweets featured commentary on user opinions and experiences of VR applications, equipment, and software. The VR tweeting community comprised a large network of 26,001 unique Twitter users. Users that posted tweets related to "VR in health care" (2124/26,001, 8.17%) did not form an interconnected VR network, whereas many users "talking about VR" (3752/26,001, 14.43%) were connected within a central network. CONCLUSIONS This study provides valuable data on community-based experiences and opinions related to VR. Tweets showcased various VR applications, including in health care, and identified important user-based considerations that can be used to inform VR use in brain injury rehabilitation (eg, technical design, accessibility, and VR sickness). Limited discussions and small user networks related to VR in brain injury rehabilitation reflect the paucity of literature on this topic and the potential underuse of this technology. These findings emphasize that further research is required to understand the specific needs and perspectives of people with brain injuries and clinicians regarding VR use in rehabilitation.
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Affiliation(s)
- Sophie Brassel
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Brunner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Campbell
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Leanne Togher
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District, Sydney, Australia
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Gomez Bergin AD, Allison AM, Hazell CM. Understanding Public Perceptions of Virtual Reality Psychological Therapy Using the Attitudes Towards Virtual Reality Therapy (AVRT) Scale: Mixed Methods Development Study. JMIR Ment Health 2024; 11:e48537. [PMID: 38214958 PMCID: PMC10818238 DOI: 10.2196/48537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/29/2023] [Accepted: 10/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Virtual reality (VR) psychological therapy has the potential to increase access to evidence-based mental health interventions by automating their delivery while maintaining outcomes. However, it is unclear whether these more automated therapies are acceptable to potential users of mental health services. OBJECTIVE The main aim of this study was to develop a new, validated questionnaire to measure public perceptions of VR therapy (VRT) guided by a virtual coach. We also aimed to explore these perceptions in depth and test how aspects such as familiarity with VR and mental health are associated with these perceptions, using both quantitative and qualitative approaches. METHODS We used a cross-sectional mixed methods design and conducted an exploratory factor analysis of a questionnaire that we developed, the Attitudes Towards Virtual Reality Therapy (AVRT) Scale, and a qualitative content analysis of the data collected through free-text responses during completion of the questionnaire. RESULTS We received 295 responses and identified 4 factors within the AVRT Scale, including attitudes toward VRT, expectation of presence, preference for VRT, and cost-effectiveness. We found that being more familiar with VR was correlated with more positive attitudes toward VRT (factor 1), a higher expectation of presence (factor 2), a preference for VRT over face-to-face therapy (factor 3), and a belief that VRT is cost-effective (factor 4). Qualitative data supported the factors we identified and indicated that VRT is acceptable when delivered at home and guided by a virtual coach. CONCLUSIONS This study is the first to validate a scale to explore attitudes toward VRT guided by a virtual coach. Our findings indicate that people are willing to try VRT, particularly because it offers increased access and choice, and that as VR becomes ubiquitous, they will also have positive attitudes toward VRT. Future research should further validate the AVRT Scale.
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Affiliation(s)
- Aislinn D Gomez Bergin
- National Institute of Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- National Institute of Health and Care Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Aoife M Allison
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Cassie M Hazell
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guilford, United Kingdom
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Rosenthal A, Ebrahimi C, Wedemeyer F, Romanczuk-Seiferth N, Beck A. The Treatment of Substance Use Disorders: Recent Developments and New Perspectives. Neuropsychobiology 2022; 81:451-472. [PMID: 35724634 DOI: 10.1159/000525268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Substance-related disorders are complex psychiatric disorders that are characterized by continued consumption in spite of harmful consequences. Addiction affects various brain networks critically involved in learning, reward, and motivation, as well as inhibitory control. Currently applied therapeutic approaches aim at modification of behavior that ultimately leads to decrease of consumption or abstinence in individuals with substance use disorders. However, traditional treatment methods might benefit from recent neurobiological and cognitive neuroscientific research findings. Novel cognitive-behavioral approaches in the treatment of addictive behavior aim at enhancement of strategies to cope with stressful conditions as well as craving-inducing cues and target erroneous learning mechanisms, including cognitive bias modification, reconsolidation-based interventions, mindfulness-based interventions, virtual-reality-based cue exposure therapy as well as pharmacological augmentation strategies. This review discusses therapeutic strategies that target dysregulated neurocognitive processes associated with the development and maintenance of disordered substance use and may hold promise as effective treatments for substance-related disorders.
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Affiliation(s)
- Annika Rosenthal
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Ebrahimi
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Wedemeyer
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Health and Medical University, Campus Potsdam, Faculty of Health, Potsdam, Germany
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Vilela RMM, Goytizolo E, Mendes FF. Immersive virtual reality on a pregnant patient during an elective orthopedic surgery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:839-840. [PMID: 35839935 PMCID: PMC9659981 DOI: 10.1016/j.bjane.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022]
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Dincelli E, Yayla A. Immersive virtual reality in the age of the Metaverse: A hybrid-narrative review based on the technology affordance perspective. JOURNAL OF STRATEGIC INFORMATION SYSTEMS 2022. [DOI: 10.1016/j.jsis.2022.101717] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Trenfield SJ, Awad A, McCoubrey LE, Elbadawi M, Goyanes A, Gaisford S, Basit AW. Advancing pharmacy and healthcare with virtual digital technologies. Adv Drug Deliv Rev 2022; 182:114098. [PMID: 34998901 DOI: 10.1016/j.addr.2021.114098] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023]
Abstract
Digitalisation of the healthcare sector promises to revolutionise patient healthcare globally. From the different technologies, virtual tools including artificial intelligence, blockchain, virtual, and augmented reality, to name but a few, are providing significant benefits to patients and the pharmaceutical sector alike, ranging from improving access to clinicians and medicines, as well as improving real-time diagnoses and treatments. Indeed, it is envisioned that such technologies will communicate together in real-time, as well as with their physical counterparts, to create a large-scale, cyber healthcare system. Despite the significant benefits that virtual-based digital health technologies can bring to patient care, a number of challenges still remain, ranging from data security to acceptance within the healthcare sector. This review provides a timely account of the benefits and challenges of virtual health interventions, as well an outlook on how such technologies can be transitioned from research-focused towards real-world healthcare and pharmaceutical applications to transform treatment pathways for patients worldwide.
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Social network behavior and public opinion manipulation. JOURNAL OF INFORMATION SECURITY AND APPLICATIONS 2022. [DOI: 10.1016/j.jisa.2021.103060] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Gemesi K, Holzmann SL, Hochrein R, Döllinger N, Wienrich C, Weinberger NA, Luck-Sikorski C, Holzapfel C. Attitude of Nutrition Experts Toward Psychotherapy and Virtual Reality as Part of Obesity Treatment-An Online Survey. Front Psychiatry 2022; 13:787832. [PMID: 35546927 PMCID: PMC9082543 DOI: 10.3389/fpsyt.2022.787832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of obesity requires lifestyle-based interventions covering nutrition, physical activity, and behavior. As part of cognitive behavioral therapy (CBT), body image therapy approaches can be used not only by psychotherapists. One tool to conduct behavioral therapy is virtual reality (VR). It is unknown, whether nutrition experts conduct behavioral therapy, and whether they would like to use VR technology as a tool to conduct body image therapy as part of obesity management. OBJECTIVE This survey aimed to collect data from nutrition experts treating people with obesity about the status quo regarding behavioral and body image therapy as part of obesity management, and regarding their attitude toward VR in obesity therapy. METHODS The survey was conducted online in autumn 2020. Participants were recruited digitally through expert and professional associations. The standardized questionnaire included items concerning sociodemographic, professional status, behavioral therapy, body image, and VR. The descriptive analysis was performed with Excel, the subgroup analyses with R. RESULTS Data from 158 nutrition experts was analyzed. Participants were mostly female (98/102, 96.1%) and had a mean age of 45.6 ± 11.3 years (n = 101). Most of the survey participants (93/124, 75.0%) stated to use behavioral treatment methods in case of weight reduction as the primary target. More than half of the participants stated to address body image (99/150, 66.0%). Almost all (111/112, 99.1%) nutrition experts have never used VR-glasses. The suitability and importance of VR technology as part of obesity therapy was estimated as neutral by around 50%. Overall, no statistically significant difference could be shown between age groups regarding attitudes toward VR in obesity treatment. CONCLUSION The results of this non-representative survey indicate that nutrition experts do not use VR technology in nutrition counseling sessions to treat obesity. In addition, survey participants have a positive attitude to VR technology, whereas they are not familiar with this technology. In future, VR technology might support nutrition experts of every age using elements of body image therapy. SURVEY REGISTRATION The German Register of Clinical Studies (Registration Number: DRKS00022853).
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Affiliation(s)
- Kathrin Gemesi
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Sophie Laura Holzmann
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Regine Hochrein
- Research Group "Chronic Diseases and Psychological Health" (COPE), SRH, University of Applied Health Sciences, Gera, Germany
| | - Nina Döllinger
- Human-Technology-Systems, University of Würzburg, Würzburg, Germany
| | - Carolin Wienrich
- Human-Technology-Systems, University of Würzburg, Würzburg, Germany
| | - Natascha-Alexandra Weinberger
- Research Group "Chronic Diseases and Psychological Health" (COPE), SRH, University of Applied Health Sciences, Gera, Germany.,Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University - Medical Center, Leipzig, Germany
| | - Claudia Luck-Sikorski
- Research Group "Chronic Diseases and Psychological Health" (COPE), SRH, University of Applied Health Sciences, Gera, Germany.,Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University - Medical Center, Leipzig, Germany
| | - Christina Holzapfel
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
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Chao YP, Chuang HH, Hsin LJ, Kang CJ, Fang TJ, Li HY, Huang CG, Kuo TBJ, Yang CCH, Shyu HY, Wang SL, Shyu LY, Lee LA. Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial. JMIR Serious Games 2021; 9:e13124. [PMID: 34813485 PMCID: PMC8663656 DOI: 10.2196/13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/02/2020] [Accepted: 09/10/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. OBJECTIVE The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. METHODS This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. RESULTS All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. CONCLUSIONS Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules. TRIAL REGISTRATION ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.
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Affiliation(s)
- Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch & Linkou Main Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Yih Shyu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Educational Technology, Tamkang University, New Taipei, Taiwan
| | - Shu-Ling Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Teacher Education, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Liang-Yu Shyu
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tsamitros N, Sebold M, Gutwinski S, Beck A. Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00377-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Abstract
Purpose
Substance use disorders (SUD) are burdening chronic conditions characterized by high relapse rates despite severe negative consequences. Substance-related cues that elicit craving by means of automatic physiological and behavioural responses have long been suggested to predict relapse. One major mechanism contributing to relapse behaviour are cue-induced behavioural approach tendencies towards the addictive agent. Recently, there has been an emerging interest in virtual reality (VR)-based approaches to assess and modify craving and its related responses. This review aims at elucidating (1) VR techniques applied in the field of SUD, (2) VR as an induction/assessment tool for biopsychological correlates of craving and (3) VR-based therapeutic approaches.
Findings
There is an emerging number of studies focusing on different substances of abuse incorporating VR in craving induction/assessment as well as therapy. Despite some limitations as missing of randomized controlled clinical trials with large samples and missing data on the long-term effects of VR treatment, the VR approach showed consistent results in eliciting and reducing craving across different substances.
Summary
This review suggests virtual reality as a promising tool for the assessment and treatment of craving among individuals with substance use disorders. Because of its ecological validity, VR unifies the benefits of a laboratory setting with the advantages of a realistic environment. Further studies with large samples and randomized controlled clinical trials using more homogenous VR techniques as well as assessment of objective biophysiological craving markers are required.
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El-Awaisi A, O’Carroll V, Koraysh S, Koummich S, Huber M. Perceptions of who is in the healthcare team? A content analysis of social media posts during COVID-19 pandemic. J Interprof Care 2020; 34:622-632. [DOI: 10.1080/13561820.2020.1819779] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alla El-Awaisi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Somaya Koraysh
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Sarra Koummich
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Marion Huber
- ZHAW School of Health Professions, Zurich University of Applied Sciences, Zurich, Switzerland
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Gao S, He L, Chen Y, Li D, Lai K. Public Perception of Artificial Intelligence in Medical Care: Content Analysis of Social Media. J Med Internet Res 2020; 22:e16649. [PMID: 32673231 PMCID: PMC7385634 DOI: 10.2196/16649] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/02/2020] [Accepted: 05/31/2020] [Indexed: 01/22/2023] Open
Abstract
Background High-quality medical resources are in high demand worldwide, and the application of artificial intelligence (AI) in medical care may help alleviate the crisis related to this shortage. The development of the medical AI industry depends to a certain extent on whether industry experts have a comprehensive understanding of the public’s views on medical AI. Currently, the opinions of the general public on this matter remain unclear. Objective The purpose of this study is to explore the public perception of AI in medical care through a content analysis of social media data, including specific topics that the public is concerned about; public attitudes toward AI in medical care and the reasons for them; and public opinion on whether AI can replace human doctors. Methods Through an application programming interface, we collected a data set from the Sina Weibo platform comprising more than 16 million users throughout China by crawling all public posts from January to December 2017. Based on this data set, we identified 2315 posts related to AI in medical care and classified them through content analysis. Results Among the 2315 identified posts, we found three types of AI topics discussed on the platform: (1) technology and application (n=987, 42.63%), (2) industry development (n=706, 30.50%), and (3) impact on society (n=622, 26.87%). Out of 956 posts where public attitudes were expressed, 59.4% (n=568), 34.4% (n=329), and 6.2% (n=59) of the posts expressed positive, neutral, and negative attitudes, respectively. The immaturity of AI technology (27/59, 46%) and a distrust of related companies (n=15, 25%) were the two main reasons for the negative attitudes. Across 200 posts that mentioned public attitudes toward replacing human doctors with AI, 47.5% (n=95) and 32.5% (n=65) of the posts expressed that AI would completely or partially replace human doctors, respectively. In comparison, 20.0% (n=40) of the posts expressed that AI would not replace human doctors. Conclusions Our findings indicate that people are most concerned about AI technology and applications. Generally, the majority of people held positive attitudes and believed that AI doctors would completely or partially replace human ones. Compared with previous studies on medical doctors, the general public has a more positive attitude toward medical AI. Lack of trust in AI and the absence of the humanistic care factor are essential reasons why some people still have a negative attitude toward medical AI. We suggest that practitioners may need to pay more attention to promoting the credibility of technology companies and meeting patients’ emotional needs instead of focusing merely on technical issues.
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Affiliation(s)
- Shuqing Gao
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Lingnan He
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Big Data Analysis and Simulation of Public Opinion, Guangzhou, China
| | - Yue Chen
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China
| | - Dan Li
- School of Journalism and Communication, Jinan University, Guangzhou, China
| | - Kaisheng Lai
- School of Journalism and Communication, Jinan University, Guangzhou, China
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15
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Jung T, Moorhouse N, Shi X, Amin MF. A Virtual Reality-Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study. J Med Internet Res 2020; 22:e14178. [PMID: 32673224 PMCID: PMC7381058 DOI: 10.2196/14178] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. OBJECTIVE This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. METHODS This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. RESULTS In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. CONCLUSIONS Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale.
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Affiliation(s)
- Timothy Jung
- Manchester Metropolitan University, Business School, Manchester, United Kingdom
| | - Natasha Moorhouse
- Manchester Metropolitan University, Business School, Manchester, United Kingdom
| | - Xin Shi
- Manchester Metropolitan University, Business School, Manchester, United Kingdom
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16
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Mavragani A. Infodemiology and Infoveillance: Scoping Review. J Med Internet Res 2020; 22:e16206. [PMID: 32310818 PMCID: PMC7189791 DOI: 10.2196/16206] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/12/2022] Open
Abstract
Background Web-based sources are increasingly employed in the analysis, detection, and forecasting of diseases and epidemics, and in predicting human behavior toward several health topics. This use of the internet has come to be known as infodemiology, a concept introduced by Gunther Eysenbach. Infodemiology and infoveillance studies use web-based data and have become an integral part of health informatics research over the past decade. Objective The aim of this paper is to provide a scoping review of the state-of-the-art in infodemiology along with the background and history of the concept, to identify sources and health categories and topics, to elaborate on the validity of the employed methods, and to discuss the gaps identified in current research. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to extract the publications that fall under the umbrella of infodemiology and infoveillance from the JMIR, PubMed, and Scopus databases. A total of 338 documents were extracted for assessment. Results Of the 338 studies, the vast majority (n=282, 83.4%) were published with JMIR Publications. The Journal of Medical Internet Research features almost half of the publications (n=168, 49.7%), and JMIR Public Health and Surveillance has more than one-fifth of the examined studies (n=74, 21.9%). The interest in the subject has been increasing every year, with 2018 featuring more than one-fourth of the total publications (n=89, 26.3%), and the publications in 2017 and 2018 combined accounted for more than half (n=171, 50.6%) of the total number of publications in the last decade. The most popular source was Twitter with 45.0% (n=152), followed by Google with 24.6% (n=83), websites and platforms with 13.9% (n=47), blogs and forums with 10.1% (n=34), Facebook with 8.9% (n=30), and other search engines with 5.6% (n=19). As for the subjects examined, conditions and diseases with 17.2% (n=58) and epidemics and outbreaks with 15.7% (n=53) were the most popular categories identified in this review, followed by health care (n=39, 11.5%), drugs (n=40, 10.4%), and smoking and alcohol (n=29, 8.6%). Conclusions The field of infodemiology is becoming increasingly popular, employing innovative methods and approaches for health assessment. The use of web-based sources, which provide us with information that would not be accessible otherwise and tackles the issues arising from the time-consuming traditional methods, shows that infodemiology plays an important role in health informatics research.
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Affiliation(s)
- Amaryllis Mavragani
- Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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17
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Pomputius A. Can You Hear Me Now? Social Listening as a Strategy for Understanding User Needs. Med Ref Serv Q 2019; 38:181-186. [PMID: 31173567 DOI: 10.1080/02763869.2019.1588042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maintaining regular engagement with audiences through various forms of social media is becoming more important as library users and the general public increasingly rely on social media for news, updates, and feedback. While large corporations have been monitoring social media for more than a decade, libraries have recently begun to use social listening to stay abreast of trends and assess user needs as voiced directly by their communities. This column will explain what social listening is, explore concerns over its widespread application, consider examples of social media listening software currently available, and offer an overview of its application in library settings.
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Affiliation(s)
- Ariel Pomputius
- a Health Science Center Libraries, University of Florida , Gainesville , Florida , USA
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18
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Franz D, Marsh HE, Chen JI, Teo AR. Using Facebook for Qualitative Research: A Brief Primer. J Med Internet Res 2019; 21:e13544. [PMID: 31411143 PMCID: PMC6711038 DOI: 10.2196/13544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 11/13/2022] Open
Abstract
As Facebook continues to grow its number of active users, the potential to harness data generated by Facebook users also grows. As much of Facebook users’ activity consists of creating (and commenting on) written posts, the potential use of text data for research is enormous. However, conducting a content analysis of text from Facebook users requires adaptation of research methods used for more traditional sources of qualitative data. Furthermore, best practice guidelines to assist researchers interested in conducting qualitative studies using data derived from Facebook are lacking. The purpose of this primer was to identify opportunities, as well as potential pitfalls, of conducting qualitative research with Facebook users and their activity on Facebook and provide potential options to address each of these issues. We begin with an overview of information obtained from a literature review of 23 studies published between 2011 and 2018 and our own research experience to summarize current approaches to conducting qualitative health research using data obtained from Facebook users. We then identify potential strategies to address limitations related to current approaches and propose 5 key considerations for the collection, organization, and analysis of text data from Facebook. Finally, we consider ethical issues around the use and protection of Facebook data obtained from research participants. In this primer, we have identified several key considerations that should aid health researchers in the planning and execution of qualitative studies involving content analysis of text data from Facebook users.
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Affiliation(s)
- Daschel Franz
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States
| | - Heather Elizabeth Marsh
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States
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19
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Jiang X, Jiang W, Cai J, Su Q, Zhou Z, He L, Lai K. Characterizing Media Content and Effects of Organ Donation on a Social Media Platform: Content Analysis. J Med Internet Res 2019; 21:e13058. [PMID: 30860489 PMCID: PMC6434401 DOI: 10.2196/13058] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The lack of organ donors has become a barrier for the development of organ transplantation programs, and many countries are currently facing a severe shortage of deceased organs. Media campaigns on social media have the potential to promote organ donation. However, little is known about what kind of media content is the most appropriate for this purpose. OBJECTIVE This study aimed to analyze media posts regarding organ donation on Weibo, a social media platform, and to identify the media themes that are most advantageous in promoting public awareness and attitudes concerning organ donation. METHODS Based on 16 million social media users' posts randomly extracted from January 1 to December 31, 2017, 1507 reposts of 141 distinct media posts relevant to organ donation were found. We analyzed the media posts' themes and examined their effects in promoting public awareness about organ donation by comparing the number of reposts and comments they prompted. The themes' impact on attitude toward organ donation was gauged using the comments indicating support and intentions for organ donation. RESULTS Overall, 5 major themes were identified from the media posts, among which "organ donation behaviors" constituted the highest proportion (58/141, 41.13%). However, themes of "statistical descriptions of organ donation" and "meaningfulness of donation" were the most influential in promoting awareness on organ donation: approximately 3 of 10 commenters for the former theme and 2 of 10 commenters for the latter expressed intentions to become organ donors. These two themes, along with "meaningfulness of organ donation for society," a subtheme of "meaningfulness of donation," were the most effective for evoking support and intentions for donation. CONCLUSIONS A discrepancy was revealed between the media themes that were the most salient on the media agenda and those that were the most effective in increasing organ donation awareness and intentions on social media. These findings provide guidance for campaigns on organ donation. The results also suggest the potential of campaigns on social media for promoting prosocial health behaviors and highlight the importance of strategic message design for serving this goal.
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Affiliation(s)
- Xiaoya Jiang
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China
| | - Wenshi Jiang
- Intelligence Sharing for Life Science Research Institute, Shenzhen, China
| | - Jiawei Cai
- Intelligence Sharing for Life Science Research Institute, Shenzhen, China
| | - Qingdong Su
- 923 Hospital of Chinese People's Liberation Army, Nanning, China
| | - Zhigang Zhou
- The First People's Hospital of Kunming, Kunming, China
| | - Lingnan He
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Big Data Analysis and Simulation of Public Opinion, Guangzhou, China
| | - Kaisheng Lai
- School of Journalism and Communication, Jinan University, Guangzhou, China
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20
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Keller MS, Mosadeghi S, Cohen ER, Kwan J, Spiegel BMR. Reproductive Health and Medication Concerns for Patients With Inflammatory Bowel Disease: Thematic and Quantitative Analysis Using Social Listening. J Med Internet Res 2018; 20:e206. [PMID: 29891471 PMCID: PMC6018236 DOI: 10.2196/jmir.9870] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) affects many individuals of reproductive age. Most IBD medications are safe to use during pregnancy and breastfeeding; however, observational studies find that women with IBD have higher rates of voluntary childlessness due to fears about medication use during pregnancy. Understanding why and how individuals with IBD make decisions about medication adherence during important reproductive periods can help clinicians address patient fears about medication use. OBJECTIVE The objective of this study was to gain a more thorough understanding of how individuals taking IBD medications during key reproductive periods make decisions about their medication use. METHODS We collected posts from 3000 social media sites posted over a 3-year period and analyzed the posts using qualitative descriptive content analysis. The first level of analysis, open coding, identified individual concepts present in the social media posts. We subsequently created a codebook from significant or frequently occurring codes in the data. After creating the codebook, we reviewed the data and coded using our focused codes. We organized the focused codes into larger thematic categories. RESULTS We identified 7 main themes in 1818 social media posts. Individuals used social media to (1) seek advice about medication use related to reproductive health (13.92%, 252/1818); (2) express beliefs about the safety of IBD therapies (7.43%, 135/1818); (3) discuss personal experiences with medication use (16.72%, 304/1818); (4) articulate fears and anxieties about the safety of IBD therapies (11.55%, 210/1818); (5) discuss physician-patient relationships (3.14%, 57/1818); (6) address concerns around conception, infertility, and IBD medications (17.38%, 316/1818); and (7) talk about IBD symptoms during and after pregnancy and breastfeeding periods (11.33%, 206/1818). CONCLUSIONS Beliefs around medication safety play an important role in whether individuals with IBD decide to take medications during pregnancy and breastfeeding. Having a better understanding about why patients stop or refuse to take certain medications during key reproductive periods may allow clinicians to address specific beliefs and attitudes during office visits.
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Affiliation(s)
- Michelle Sophie Keller
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States.,Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Sasan Mosadeghi
- Department of Medicine, University of Arizona, Phoenix, AZ, United States
| | - Erica R Cohen
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - James Kwan
- Cedars-Sinai Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Brennan Mason Ross Spiegel
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States.,Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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