Social media shaping autism perception and identity

LAY ABSTRACT

This study suggested that social media can provide important information about autism to autistic people. We interviewed 12 autistic adults (aged 18-49 years) and talked to them about the use of social media to find both general information and content specifically about autism, autism identity and online autistic communities. There is little research exploring how autistic people find information about autism on social media and how that makes them feel. Therefore, it is important to ask autistic people about their experiences with using social media to obtain content about autism. The 12 participants explained that when they searched for information about autism on the official health pages, they often felt that the information they found was insufficient and could not answer their questions. In addition, they searched on social media platforms for information about autism despite that they perceived social media as an unreliable source. On the social media platforms, many found content that was positive in relation to their autistic identities. The participants also found comfort in some of the forums and social media groups and received helpful advice. Nevertheless, some of the discussions were aggressive and the participants felt alienated, which did not provide a sense of community online. The findings from the study may advice on what is missing in the official pages about autism, and highlight the need to involve the autistic community in writing the content on such platforms.

Digital Interventions and Their Unexpected Outcomes - Time for Digitalovigilance?

The application of digital interventions in healthcare beyond research has been translated in the development of software as a medical device. Along with corresponding regulations for medical devices, there is a need for assessing adverse events to conduct post-market surveillance and to appropriately label digital health interventions to ensure proper use and patient safety. To date unexpected consequences of digital health interventions are neglected or ignored, or at least remain undescribed in literature. This paper is intended to raise awareness across the research community about these upcoming challenges. We recommend that - together with developing a new research field of digitalovigilance - a systematic assessment and monitoring of adverse events and unexpected interactions be included in clinical trials, along with the reporting of such events and the conduct of meta-analyses on critical aspects.

Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review

BACKGROUND

Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs.

OBJECTIVE

This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children.

METHODS

The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12).

CONCLUSIONS

The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination.

Assessing the Potential Risks of Digital Therapeutics (DTX): The DTX Risk Assessment Canvas

MOTIVATION

Digital therapeutics (DTX), i.e., health interventions that are provided through digital means, are increasingly available for use; in some countries, physicians can even prescribe selected DTX following a reimbursement by health insurances. This results in an increasing need for methodologies to consider and monitor DTX's negative consequences, their risks to patient safety, and possible adverse events. However, it is completely unknown which aspects should be subject to surveillance given the missing experiences with the tools and their negative impacts.

OBJECTIVE

Our aim is to develop a tool-the DTX Risk Assessment Canvas-that enables researchers, developers, and practitioners to reflect on the negative consequences of DTX in a participatory process.

METHOD

Taking the well-established business model canvas as a starting point, we identified relevant aspects to be considered in a risk assessment of a DTX. The aspects or building blocks of the canvas were constructed in a two-way process: first, we defined the aspects relevant for discussing and reflecting on how a DTX might bring negative consequences and risks for its users by considering ISO/TS 82304-2, the scientific literature, and by reviewing existing DTX and their listed adverse effects. The resulting aspects were grouped into thematic blocks and the canvas was created. Second, six experts in health informatics and mental health provided feedback and tested the understandability of the initial canvas by individually applying it to a DTX of their choice. Based on their feedback, the canvas was modified.

RESULTS

The DTX Risk Assessment Canvas is organized into 15 thematic blocks which are in turn grouped into three thematic groups considering the DTX itself, the users of the DTX, and the effects of the DTX. For each thematic block, questions have been formulated to guide the user of the canvas in reflecting on the single aspects. Conclusions: The DTX Risk Assessment Canvas is a tool to reflect the negative consequences and risks of a DTX by discussing different thematic blocks that together constitute a comprehensive interpretation of a DTX regarding possible risks. Applied during the DTX design and development phase, it can help in implementing countermeasures for mitigation or means for their monitoring.

Personalized Digital Solutions for Mental Health

INTRODUCTION

Mental health is one of the major global concerns in the field of healthcare. The emergence of digital solutions is proving to be a great aid for individuals suffering from mental health disorders. These solutions are particularly useful and effective when they are personalized. The objective of this paper is to understand the personalization factors and the methods that have been used to collect information to personalize the digital mental health solutions.

METHODS

This paper builds on a previous review that analyzed the personalization of digital solutions in mHealth, and expands on the extracted information for the specific case of mental health.

RESULTS

Ten mental health digital solutions have been analyzed. The paper focuses on targeted conditions, personalization factors and the methods used for collecting personalization factors.

DISCUSSION

The analyzed mental health digital solutions cover a wide range of health conditions. It is remarkable that most articles do not explicitly mention the factors used to personalize the solution. Among the solutions that mention them, there is a great diversity of factors utilized, such as age, gender, user preferences, and subjective behavior. The authors point out the methods for obtaining data to personalize the solutions, including in-app questionnaires, self-reports, and usage data of the solutions.

CONCLUSIONS

The analysis of current mental health digital solutions emphasizes the need to create guidelines for designing personalized digital solutions for mental health.

Designing personalised mHealth solutions: An overview

INTRODUCTION

Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation.

MATERIALS AND METHODS

We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques.

RESULTS

Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self-management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed.

DISCUSSION

Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it.

CONCLUSIONS

Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques.

Defining and Scoping Participatory Health Informatics: An eDelphi Study

BACKGROUND

Health care has evolved to support the involvement of individuals in decision making by, for example, using mobile apps and wearables that may help empower people to actively participate in their treatment and health monitoring. While the term "participatory health informatics" (PHI) has emerged in literature to describe these activities, along with the use of social media for health purposes, the scope of the research field of PHI is not yet well defined.

OBJECTIVE

This article proposes a preliminary definition of PHI and defines the scope of the field.

METHODS

We used an adapted Delphi study design to gain consensus from participants on a definition developed from a previous review of literature. From the literature we derived a set of attributes describing PHI as comprising 18 characteristics, 14 aims, and 4 relations. We invited researchers, health professionals, and health informaticians to score these characteristics and aims of PHI and their relations to other fields over three survey rounds. In the first round participants were able to offer additional attributes for voting.

RESULTS

The first round had 44 participants, with 28 participants participating in all three rounds. These 28 participants were gender-balanced and comprised participants from industry, academia, and health sectors from all continents. Consensus was reached on 16 characteristics, 9 aims, and 6 related fields.

DISCUSSION

The consensus reached on attributes of PHI describe PHI as a multidisciplinary field that uses information technology and delivers tools with a focus on individual-centered care. It studies various effects of the use of such tools and technology. Its aims address the individuals in the role of patients, but also the health of a society as a whole. There are relationships to the fields of health informatics, digital health, medical informatics, and consumer health informatics.

CONCLUSION

We have proposed a preliminary definition, aims, and relationships of PHI based on literature and expert consensus. These can begin to be used to support development of research priorities and outcomes measurements.

Exploring the Evolution of Social Media in Mental Health Interventions: A Mapping Review

BACKGROUND

With the rise of social media, social media use for delivering mental health interventions has become increasingly popular. However, there is no comprehensive overview available on how this field developed over time.

OBJECTIVES

The objective of this paper is to provide an overview over time of the use of social media for delivering mental health interventions. Specifically, we examine which mental health conditions and target groups have been targeted, and which social media channels or tools have been used since this topic first appeared in research.

METHODS

To provide an overview of the use of social media for mental health interventions, we conducted a search for studies in four databases (PubMed; ACM Digital Library; PsycInfo; and CINAHL) and two trial registries (Clinicaltrials.gov; and Cochranelibrary.com). A sample of representative keywords related to mental health and social media was used for that search. Automatic text analysis methods (e.g., BERTopic analysis, word clouds) were applied to identify topics, and to extract target groups and types of social media.

RESULTS

A total of 458 studies were included in this review (n=228 articles, and n=230 registries). Anxiety and depression were the most frequently mentioned conditions in titles of both articles and registries. BERTopic analysis identified depression and anxiety as the main topics, as well as several addictions (including gambling, alcohol, and smoking). Mental health and women's research were highlighted as the main targeted topics of these studies. The most frequently targeted groups were "adults" (39.5%) and "parents" (33.4%). Facebook, WhatsApp, messenger platforms in general, Instagram, and forums were the most frequently mentioned tools in these interventions.

CONCLUSIONS

We learned that research interest in social media-based interventions in mental health is increasing, particularly in the last two years. A variety of tools have been studied, and trends towards forums and Facebook show that tools allowing for more content are preferred for mental health interventions. Future research should assess which social media tools are best suited in terms of clinical outcomes. Additionally, we conclude that natural language processing tools can help in studying trends in research on a particular topic.

How Participatory Health Informatics Catalyzes One Digital Health

OBJECTIVE

To identify links between Participatory Health Informatics (PHI) and the One Digital Health framework (ODH) and to show how PHI could be used as a catalyst or contributor to ODH.

METHODS

We have analyzed the addressed topics within the ODH framework in previous IMIA Yearbook contributions from our working group during the last 10 years. We have matched main themes with the ODH's framework three perspectives (individual health and wellbeing, population and society, and ecosystem).

RESULTS

PHI catalysts ODH individual health and wellbeing perspective by providing a more comprehensive view on human health, attitudes, and relations between human health and animal health. Integration of specific behavior change techniques or gamification strategies in digital solutions are effective to change behaviors which address the P5 paradigm. PHI supports the population and society perspective through the engagement of the various stakeholders in healthcare. At the same time, PHI might increase a risk for health inequities due to technologies inaccessible to all equally and challenges associated with this. PHI is a catalyst for the ecosystem perspective by contributing data into the digital health data ecosystem allowing for analysis of interrelations between the various data which in turn might provide links among all components of the healthcare ecosystem.

CONCLUSION

Our results suggest that PHI can and will involve topics relating to ODH. As the ODH concept crystalizes and becomes increasingly influential, its themes will permeate and become embedded in PHI even more. We look forward to these developments and co-evolution of the two frameworks.

What Do Autistic People Discuss on Twitter? An Approach Using BERTopic Modelling

Social media provide easy ways to autistic individuals to communicate and to make their voices heard. The objective of this paper is to identify the main themes that are being discussed by autistic people on Twitter. We collected a sample of tweets containing the hashtag #ActuallyAutistic during the period 10/02/2022 and 14/09/2022. To identify the most discussed topics, BERTopic modelling was applied. We manually grouped the detected topics into 6 major themes using inductive content analysis: 1) General aspects of autism and experiences of autistic individuals; 2) Autism awareness, pride and funding; 3) Interventions, mostly related to Applied Behavior Analysis; 4) Reactions and expressions; 5) Everyday life as an autistic (lifelong condition, work, housing…); and 6) Symbols and characteristics. The majority of tweets were presenting general aspects and experiences as autistic individuals; raising awareness; and about their dissatisfaction with some interventions. The identification of autistic individuals' main discussion themes could help to develop meaningful public health agendas and research involving and addressed to autistic individuals.

Exploring Obese Adults' Preferences for a Physical Activity Chatbot: Qualitative Study

Social media chatbots could help increase obese adults' physical activity behaviour. The study aims to explore obese adults' preferences for a physical activity chatbot. Individual- and focus group interviews will be conducted in 2023. Identified preferences will inform the development of a chatbot that motivates obese adults to increase their physical activity. The interview guide was tested in a pilot interview.

Social media interventions for autistic individuals: Systematic review

Background

Research on the use of digital technologies for delivering behavioral interventions has shown mixed evidence on their efficacy for improving both autistic symptoms and co-occurring psychiatric disorders. Little knowledge exists on the specific use or efficacy of using social media in interventions aimed at autistic individuals.

Objective

To review and describe the current existing evidence-based research on the use of social media in interventions aimed at autistic individuals.

Methods

A search was conducted across 8 databases (PubMed; EMBASE; Cochrane Library; PsycInfo; ERIC; Education Source; Web of Science; and IEEE Xplore). We included primary studies and reviews that dealt with autism spectrum disorder (ASD); described interventions that use social media; and reported results from the intervention. The quality of the evidence of the included primary studies was graded according to the GRADE criteria, and the risk of bias in systematic reviews was assessed by drawing on the AMSTAR guidelines. Results were synthesized and sorted by quality of evidence.

Results

A total of nine articles were included in this review: eight primary studies (five non-randomized interventions and three randomized interventions) and one systematic review. The total number of participants with an ASD-diagnosis in the included studies was 164 (aged 5 to 22 years old). Studies weighted as being of moderate quality of evidence have reported significant positive effects in the groups that received the social media interventions: increased social engagement and participation in life situations; increased physical activity level; increased improvement on occupational performance, specified goals, and behavioral problems; and decreased plaque scores coupled with parent reports of intervention success. None of the studies have reported any negative effects linked to social media interventions.

Conclusion

There is very little evidence of good quality on the use of social media in interventions aimed at autistic individuals. While there is a need for more high-quality studies, all the included studies, with one exception found positive results of the interventions. These findings are encouraging, suggesting that social media-based interventions may in fact be useful for supporting behavioral changes in autistic individuals.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=337185, identifier CRD42022337185.

Social Media, Digital Health Literacy, and Digital Ethics in the Light of Health Equity

OBJECTIVE

Social media is used in the context of healthcare, for example in interventions for promoting health. Since social media are easily accessible they have potential to promote health equity. This paper studies relevant factors impacting on health equity considered in social media interventions.

METHODS

We searched for literature to identify potential relevant factors impacting on health equity considered in social media interventions. We included studies that reported examples of health interventions using social media, focused on health equity, and analyzed health equity factors of social media. We identified Information about health equity factors and targeted groups.

RESULTS

We found 17 relevant articles. Factors impacting on health equity reported in the included papers were extracted and grouped into three categories: digital health literacy, digital ethics, and acceptability.

CONCLUSIONS

Literature shows that it is likely that digital technologies will increase health inequities associated with increased age, lower level of educational attainment, and lower socio-economic status. To address this challenge development of social media interventions should consider participatory design principles, visualization, and theories of social sciences.

Telemedicine for Diabetes in Norway

Telemedicine can be useful for diabetes patients living remotely, especially during pandemic times. We aimed to identify current knowledge of the use of telemedicine for diabetes in Norway by conducting a review of the literature. Telemedicine is mostly beneficial, and it seems that it can be adopted into the usual diabetes care in Norway as a low-cost alternative.

Misinformation about Covid-19 Vaccines on Social Media: Rapid Review

Background

The development of COVID-19 vaccines has been crucial in fighting the pandemic. However, misinformation about the COVID-19 pandemic and vaccines is spread on social media platforms at a rate that has made the World Health Organization coin the phrase infodemic. False claims about adverse vaccine side effects, such as vaccines being the cause of autism, were already considered a threat to global health before the outbreak of COVID-19.

Objective

We aimed to synthesize the existing research on misinformation about COVID-19 vaccines spread on social media platforms and its effects. The secondary aim was to gain insight and gather knowledge about whether misinformation about autism and COVID-19 vaccines is being spread on social media platforms.

Methods

We performed a literature search on September 9, 2021, and searched PubMed, PsycINFO, ERIC, EMBASE, Cochrane Library, and the Cochrane COVID-19 Study Register. We included publications in peer-reviewed journals that fulfilled the following criteria: original empirical studies, studies that assessed social media and misinformation, and studies about COVID-19 vaccines. Thematic analysis was used to identify the patterns (themes) of misinformation. Narrative qualitative synthesis was undertaken with the guidance of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Statement and the Synthesis Without Meta-analysis reporting guideline. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Ratings of the certainty of evidence were based on recommendations from the Grading of Recommendations Assessment, Development and Evaluation Working Group.

Results

The search yielded 757 records, with 45 articles selected for this review. We identified 3 main themes of misinformation: medical misinformation, vaccine development, and conspiracies. Twitter was the most studied social media platform, followed by Facebook, YouTube, and Instagram. A vast majority of studies were from industrialized Western countries. We identified 19 studies in which the effect of social media misinformation on vaccine hesitancy was measured or discussed. These studies implied that the misinformation spread on social media had a negative effect on vaccine hesitancy and uptake. Only 1 study contained misinformation about autism as a side effect of COVID-19 vaccines.

Conclusions

To prevent these misconceptions from taking hold, health authorities should openly address and discuss these false claims with both cultural and religious awareness in mind. Our review showed that there is a need to examine the effect of social media misinformation on vaccine hesitancy with a more robust experimental design. Furthermore, this review also demonstrated that more studies are needed from the Global South and on social media platforms other than the major platforms such as Twitter and Facebook.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021277524; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021277524

International Registered Report Identifier (IRRID)

RR2-10.31219/osf.io/tyevj

Usability Testing of a Social Media Chatbot for Increasing Physical Activity Behavior

Digital interventions for increasing physical activity behavior have shown great potential, especially those with social media. Chatbots, also known as conversational agents, have emerged in healthcare in relation to digital interventions and have proven effective in promoting physical activity among adults. The study’s objective is to explore users’ experiences with a social media chatbot. The concept and the prototype development of the social media chatbot MYA were realized in three steps: requirement analysis, concept development, and implementation. MYA’s design includes behavior change techniques effective in increasing physical activity through digital interventions. Participants in a usability study answered a survey with the Chatbot Usability Questionnaire (CUQ), which is comparable to the Systems Usability Scale. The mean CUQ score was below 68, the benchmark for average usability. The highest mean CUQ score was 64.5 for participants who thought MYA could help increase their physical activity behavior. The lowest mean CUQ score was 40.6 for participants aged between 50 and 69 years. Generally, MYA was considered to be welcoming, very easy to use, realistic, engaging, and informative. However, some technical issues were identified. A good and diversified user experience promotes prolonged chatbot use. Addressing identified issues will enhance users’ interaction with MYA.

Discussions of Asperger Syndrome on Social Media: Content and Sentiment Analysis on Twitter

Background

On May 8, 2021, Elon Musk, a well-recognized entrepreneur and business magnate, revealed on a popular television show that he has Asperger syndrome. Research has shown that people’s perceptions of a condition are modified when influential individuals in society publicly disclose their diagnoses. It was anticipated that Musk's disclosure would contribute to discussions on the internet about the syndrome, and also to a potential change in the perception of this condition.

Objective

The objective of this study was to compare the types of information contained in popular tweets about Asperger syndrome as well as their engagement and sentiment before and after Musk’s disclosure.

Methods

We extracted tweets that were published 1 week before and after Musk's disclosure that had received >30 likes and included the terms “Aspergers” or “Aspie.” The content of each post was classified by 2 independent coders as to whether the information provided was valid, contained misinformation, or was neutral. Furthermore, we analyzed the engagement on these posts and the expressed sentiment by using the AFINN sentiment analysis tool.

Results

We extracted a total of 227 popular tweets (34 posted the week before Musk’s announcement and 193 posted the week after). We classified 210 (92.5%) of the tweets as neutral, 13 (5.7%) tweets as informative, and 4 (1.8%) as containing misinformation. Both informative and misinformative tweets were posted after Musk’s disclosure. Popular tweets posted before Musk’s disclosure were significantly more engaging (received more comments, retweets, and likes) than the tweets posted the week after. We did not find a significant difference in the sentiment expressed in the tweets posted before and after the announcement.

Conclusions

The use of social media platforms by health authorities, autism associations, and other stakeholders has the potential to increase the awareness and acceptance of knowledge about autism and Asperger syndrome. When prominent figures disclose their diagnoses, the number of posts about their particular condition tends to increase and thus promote a potential opportunity for greater outreach to the general public about that condition.

Designing Depression Screening Chatbots

Advances in voice recognition, natural language processing, and artificial intelligence have led to the increasing availability and use of conversational agents (chatbots) in different settings. Chatbots are systems that mimic human dialogue interaction through text or voice. This paper describes a series of design considerations for integrating chatbots interfaces with health services. The present paper is part of ongoing work that explores the overall implementation of chatbots in the healthcare context. The findings have been created using a research through design process, combining (1) literature survey of existing body of knowledge on designing chatbots, (2) analysis on state-of-the-practice in using chatbots as service interfaces, and (3) generative process of designing a chatbot interface for depression screening. In this paper we describe considerations that would be useful for the design of a chatbot for a healthcare context.

Social Media Chatbot for Increasing Physical Activity: Usability Study

Fully automated self-help interventions integrated with social media chatbots could serve as highly cost-effective physical activity promotion tools for a large population. We have developed MYA, a Telegram-based chatbot for increasing physical activity. The objective of this study was to assess the usability of MYA. To identify usability issues, we recruited volunteers and asked them to interact with MYA and to answer the Chatbot Usability Questionnaire. Thirty volunteers participated in the study, 83.3% agreed MYA was welcoming during initial setup and 63.3% agreed MYA was very easy to use. MYA was perceived as realistic and engaging, easy to navigate, and its responses were useful, appropriate, and informative (all 53.3%). However, 63.3% of respondents agreed MYA failed to recognize most of their inputs, and 43.3% claimed it would be easy to get confused when using MYA. Although the results are encouraging, it remains unclear if a social media chatbot can motivate people to increase their physical activity. MYA has the potential to do that, with improvements in functionalities like challenge personalization. The efficacy of these approaches should be studied in a clinical trial.

Defining participatory health informatics - a scoping review

Healthcare has been shifting toward individuals participating in decision-making and empowered to be active in their treatment, and health monitoring. The term "participatory health informatics" (PHI) started to appear in literature. A clear definition of PHI is missing, and facets of PHI still have to be shaped. The objective of this paper is to offer a definition of PHI considering themes and technologies that make healthcare participatory. We searched Pubmed, ACM Digital Library, IEEE Xplore, EMBASE, and conference proceedings for articles that reported about use of information technology or informatics in the context of PHI. We performed qualitative synthesis and reported summary statistics. 39 studies were eligible after screening 382 titles and abstracts and reviewing 82 full texts. The top 5 person-centered key themes related to PHI included empowerment, decision-making, informed patient, collaboration, and disease management. Finally, we propose to define PHI as multidisciplinary field that uses information technology as provided through the web, smartphones, or wearables to increase participation of individuals in their care process and to enable them in self-care and shared decision-making. Goals to be achieved through PHI include maintaining health and well-being; improving the healthcare system and health outcomes; sharing experiences; achieving life goals; and self-education.

Role of Participatory Health Informatics in Detecting and Managing Pandemics: Literature Review

OBJECTIVES

Using participatory health informatics (PHI) to detect disease outbreaks or learn about pandemics has gained interest in recent years. However, the role of PHI in understanding and managing pandemics, citizens' role in this context, and which methods are relevant for collecting and processing data are still unclear, as is which types of data are relevant. This paper aims to clarify these issues and explore the role of PHI in managing and detecting pandemics.

METHODS

Through a literature review we identified studies that explore the role of PHI in detecting and managing pandemics. Studies from five databases were screened: PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), IEEE Xplore, ACM (Association for Computing Machinery) Digital Library, and Cochrane Library. Data from studies fulfilling the eligibility criteria were extracted and synthesized narratively.

RESULTS

Out of 417 citations retrieved, 53 studies were included in this review. Most research focused on influenza-like illnesses or COVID-19 with at least three papers on other epidemics (Ebola, Zika or measles). The geographic scope ranged from global to concentrating on specific countries. Multiple processing and analysis methods were reported, although often missing relevant information. The majority of outcomes are reported for two application areas: crisis communication and detection of disease outbreaks.

CONCLUSIONS

For most diseases, the small number of studies prevented reaching firm conclusions about the utility of PHI in detecting and monitoring these disease outbreaks. For others, e.g., COVID-19, social media and online search patterns corresponded to disease patterns, and detected disease outbreak earlier than conventional public health methods, thereby suggesting that PHI can contribute to disease and pandemic monitoring.

Engaging Social Media Users with Health Education and Physical Activity Promotion

Health-dedicated groups on social media provide different contents and social support to their peers. Our objective is to analyze users' engagement with health education and physical activity promotion posts according to the expressed social support and social media. All health education and physical activity promotion posts on Facebook, Twitter, and Instagram during 2017-2019 by a diabetes association were extracted. We identified the type of social support within these posts; and analysed the users' engagement with these posts according to the type of social support and social media channel. A total of 260 posts dealing with health education (n=200) and physical activity promotion (n=60) were published. Posts promoting physical activity received 54% more likes than posts on health education (p<0.05), but they were 69% less likely to receive comments and be shared (both p<0.01). Posts expressing tangible assistance received 6 times more likes (p<0.001), and the ones indicating network support almost 11 times more shares (p<0.05). Posts expressing two or more types of social support were the most engaging (3 times more likes, 2 times more comments, and over 6 times more shares, all p<0.001). Health-dedicated social media groups can be effective channels for providing health education and for promoting physical activity among individuals with diabetes. Our findings suggest that engagement with health education and physical activity promotion posts can be increased by providing tangible assistance, network support, or expressing two or more types of social support; and by posting on Facebook and Instagram.

Criteria for Assessing and Recommending Digital Diabetes Tools: A Delphi Study

Diabetes self-management, an integral part of diabetes care, can be improved with the help of digital self-management tools such as apps, sensors, websites, and social media. The study objective was to reach a consensus on the criteria required to assess and recommend digital diabetes self-management tools targeting those with diabetes in Norway. Healthcare professionals working with diabetes care from all health regions in Norway were recruited to participate in a three-round Delphi study. In all rounds, the panellists rated criteria identified in a systematic review and interviews on a scale from 0-10, with the option to provide comments. On a scale of 0:not important to 10:extremely important, the highest rated criteria for assessing and recommending digital diabetes self-management tools were "Usability" and "Information quality", respectively. For assessing apps, "Security and privacy" was one of the lowest rated criteria. Having access to a list of criteria for assessing and recommending digital self-management tools can help diabetes care stakeholders to make informed choices in recommending and choosing suitable apps, websites, and social media for self-management. Future work on quality assessment of digital health tools should place emphasis on security and privacy compliance, to enable diabetes care stakeholders focus on other relevant criteria to recommend or choose and use such tools.

Evidence-Based Health Informatics as the Foundation for the COVID-19 Response: A Joint Call for Action

Background  As a major public health crisis, the novel coronavirus disease 2019 (COVID-19) pandemic demonstrates the urgent need for safe, effective, and evidence-based implementations of digital health. The urgency stems from the frequent tendency to focus attention on seemingly high promising digital health interventions despite being poorly validated in times of crisis.

Aim  In this paper, we describe a joint call for action to use and leverage evidence-based health informatics as the foundation for the COVID-19 response and public health interventions. Tangible examples are provided for how the working groups and special interest groups of the International Medical Informatics Association (IMIA) are helping to build an evidence-based response to this crisis.

Methods  Leaders of working and special interest groups of the IMIA, a total of 26 groups, were contacted via e-mail to provide a summary of the scientific-based efforts taken to combat COVID-19 pandemic and participate in the discussion toward the creation of this manuscript. A total of 13 groups participated in this manuscript.

Results  Various efforts were exerted by members of IMIA including (1) developing evidence-based guidelines for the design and deployment of digital health solutions during COVID-19; (2) surveying clinical informaticians internationally about key digital solutions deployed to combat COVID-19 and the challenges faced when implementing and using them; and (3) offering necessary resources for clinicians about the use of digital tools in clinical practice, education, and research during COVID-19.

Discussion  Rigor and evidence need to be taken into consideration when designing, implementing, and using digital tools to combat COVID-19 to avoid delays and unforeseen negative consequences. It is paramount to employ a multidisciplinary approach for the development and implementation of digital health tools that have been rapidly deployed in response to the pandemic bearing in mind human factors, ethics, data privacy, and the diversity of context at the local, national, and international levels. The training and capacity building of front-line workers is crucial and must be linked to a clear strategy for evaluation of ongoing experiences.

Online Attitudes and Information-Seeking Behavior on Autism, Asperger Syndrome, and Greta Thunberg

The purpose of this study was to examine Internet trends data and sentiment in tweets mentioning autism, Asperger syndrome, and Greta Thunberg during 2019. We used mixed methods in analyzing sentiment and attitudes in viral tweets and collected 1074 viral tweets on autism that were published in 2019 (tweets that got more than 100 likes). The sample from Twitter was compared with search patterns on Google. In 2019, Asperger syndrome was closely connected to Greta Thunberg, as of the tweets specifically mentioning Asperger (from the total sample of viral tweets mentioning autism), 83% also mentioned Thunberg. In the sample of tweets about Thunberg, the positive sentiment expressed that Greta Thunberg was a role model, whereas the tweets that expressed the most negativity used her diagnosis against her and could be considered as cyberbullying. The Google Trends data also showed that Thunberg was closely connected to search patterns on Asperger syndrome in 2019. The study showed that being open about health information while being an active participant in controversial debates might be used against you but also help break stigmas and stereotypes.

COVID-19-related misinformation on social media: a systematic review

Objective

To review misinformation related to coronavirus disease 2019 (COVID-19) on social media during the first phase of the pandemic and to discuss ways of countering misinformation.

Methods

We searched PubMed®, Scopus, Embase®, PsycInfo and Google Scholar databases on 5 May 2020 and 1 June 2020 for publications related to COVID-19 and social media which dealt with misinformation and which were primary empirical studies. We followed the preferred reporting items for systematic reviews and meta-analyses and the guidelines for using a measurement tool to assess systematic reviews. Evidence quality and the risk of bias of included studies were classified using the grading of recommendations assessment, development and evaluation approach. The review is registered in the international prospective register of systematic reviews (PROSPERO; CRD42020182154).

Findings

We identified 22 studies for inclusion in the qualitative synthesis. The proportion of COVID-19 misinformation on social media ranged from 0.2% (413/212 846) to 28.8% (194/673) of posts. Of the 22 studies, 11 did not categorize the type of COVID-19-related misinformation, nine described specific misinformation myths and two reported sarcasm or humour related to COVID-19. Only four studies addressed the possible consequences of COVID-19-related misinformation: all reported that it led to fear or panic.

Conclusion

Social media play an increasingly important role in spreading both accurate information and misinformation. The findings of this review may help health-care organizations prepare their responses to subsequent phases in the COVID–19 infodemic and to future infodemics in general.

Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregression

OBJECTIVE

To determine the effectiveness of physical activity interventions involving mobile applications (apps) or trackers with automated and continuous self-monitoring and feedback.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed and seven additional databases, from 2007 to 2020.

STUDY SELECTION

Randomised controlled trials in adults (18-65 years old) without chronic illness, testing a mobile app or an activity tracker, with any comparison, where the main outcome was a physical activity measure. Independent screening was conducted.

DATA EXTRACTION AND SYNTHESIS

We conducted random effects meta-analysis and all effect sizes were transformed into standardised difference in means (SDM). We conducted exploratory metaregression with continuous and discrete moderators identified as statistically significant in subgroup analyses.

MAIN OUTCOME MEASURES

Physical activity: daily step counts, min/week of moderate-to-vigorous physical activity, weekly days exercised, min/week of total physical activity, metabolic equivalents.

RESULTS

Thirty-five studies met inclusion criteria and 28 were included in the meta-analysis (n=7454 participants, 28% women). The meta-analysis showed a small-to-moderate positive effect on physical activity measures (SDM 0.350, 95% CI 0.236 to 0.465, I²=69%, T ²=0.051) corresponding to 1850 steps per day (95% CI 1247 to 2457). Interventions including text-messaging and personalisation features were significantly more effective in subgroup analyses and metaregression.

CONCLUSION

Interventions using apps or trackers seem to be effective in promoting physical activity. Longer studies are needed to assess the impact of different intervention components on long-term engagement and effectiveness.

Factors Engaging Users of Diabetes Social Media Channels on Facebook, Twitter, and Instagram: Observational Study

Background

Diabetes patient associations and diabetes-specific patient groups around the world are present on social media. Although active participation and engagement in these diabetes social media groups has been mostly linked to positive effects, very little is known about the content that is shared on these channels or the post features that engage their users the most.

Objective

The objective of this study was to analyze (1) the content and features of posts shared over a 3-year period on 3 diabetes social media channels (Facebook, Twitter, and Instagram) of a diabetes association, and (2) users’ engagement with these posts (likes, comments, and shares).

Methods

All social media posts published from the Norwegian Diabetes Association between January 1, 2017, and December 31, 2019, were extracted. Two independent reviewers classified the posts into 7 categories based on their content. The interrater reliability was calculated using Cohen kappa. Regression analyses were carried out to analyze the effects of content topic, social media channel, and post features on users’ engagement (likes, comments, and shares).

Results

A total of 1449 messages were posted. Posts of interviews and personal stories received 111% more likes, 106% more comments, and 112% more shares than miscellaneous posts (all P<.001). Messages posted about awareness days and other celebrations were 41% more likely to receive likes than miscellaneous posts (P<.001). Conversely, posts on research and innovation received 31% less likes (P<.001), 35% less comments (P=.02), and 25% less shares (P=.03) than miscellaneous posts. Health education posts received 38% less comments (P=.003) but were shared 39% more than miscellaneous posts (P=.007). With regard to social media channel, Facebook and Instagram posts were both 35 times more likely than Twitter posts to receive likes, and 60 times and almost 10 times more likely to receive comments, respectively (P<.001). Compared to text-only posts, those with videos had 3 times greater chance of receiving likes, almost 4 times greater chance of receiving comments, and 2.5 times greater chance of being shared (all P<.001). Including both videos and emoji in posts increased the chances of receiving likes by almost 7 times (P<.001). Adding an emoji to posts increased their chances of receiving likes and being shared by 71% and 144%, respectively (P<.001).

Conclusions

Diabetes social media users seem to be least engaged in posts with content topics that a priori could be linked to greater empowerment: research and innovation on diabetes, and health education. Diabetes social media groups, public health authorities, and other stakeholders interested in sharing research and innovation content and promoting health education on social media should consider including videos and emoji in their posts, and publish on popular and visual-based social media channels, such as Facebook and Instagram, to increase user engagement.

International Registered Report Identifier (IRRID)

RR2-10.1186/s12913-018-3178-7

What Do We Know About the Use of Chatbots for Public Health?

BACKGROUND AND OBJECTIVE

The number of publications on the use of chatbots for health is recently increasing, however to our knowledge, there are no publications summarizing what is known about using chatbots for public health yet. The objective of this work is to provide an overview of the existing scientific literature on the use of chatbots for public health, for which purpose have chatbots been used, and whether health-related outcomes have been reported.

METHODS

We carried out a literature review on this topic across 5 databases: Pubmed, EMBASE, PsychINFO, SCOPUS, and IEEE Xplore. Identified papers were classified according to their underlying technology, application area, and study design.

RESULTS

A total of 15 relevant papers were identified: eight of these papers were developmental studies that tested the feasibility or usability of a chatbot, and seven were interventional studies. All the interventional studies reported positive health- related outcomes associated with the chatbot use.

DISCUSSION

The first studies testing chatbots for public health seem very promising; however, there are various aspects that should be improved, including the chatbots' designs, studies' methods, and analysis and reporting of results. More high-quality studies and improved reporting of chatbots' use are needed.

Analysing Sentiment and Topics Related to Multiple Sclerosis on Twitter

BACKGROUND AND OBJECTIVE

Social media could be valuable tools to support people with multiple sclerosis (MS). There is little evidence on the MS-related topics that are discussed on social media, and the sentiment linked to these topics. The objective of this work is to identify the MS-related main topics discussed on Twitter, and the sentiment linked to them.

METHODS

Tweets dealing with MS in the English language were extracted. Latent-Dirilecht Allocation (LDA) was used to identify the main topics discussed in these tweets. Iterative inductive process was used to group the tweets into recurrent topics. The sentiment analysis of these tweets was performed using SentiStrength.

RESULTS

LDA' identified topics were grouped into 4 categories, tweets dealing with: related chronic conditions; condition burden; disease-modifying drugs; and awareness-raising. Tweets on condition burden and related chronic conditions were the most negative (p<0.001). A significant lower positive sentiment was found for both tweets dealing with disease-modifying drugs, condition burden, and related chronic conditions (p<0.001). Only tweets on awareness-raising were most positive than the average (p<0.001).

DISCUSSION

The use of both tools to identify the main discussed topics on social media and to analyse the sentiment of these topics, increases the knowledge of the themes that could represent the bigger burden for persons affected with MS. This knowledge can help to improve support and therapeutic approaches addressed to them.

Methods and Evaluation Criteria for Apps and Digital Interventions for Diabetes Self-Management: Systematic Review

BACKGROUND

There is growing evidence that apps and digital interventions have a positive impact on diabetes self-management. Standard self-management for patients with diabetes could therefore be supplemented by apps and digital interventions to increase patients' skills. Several initiatives, models, and frameworks suggest how health apps and digital interventions could be evaluated, but there are few standards for this. And although there are many methods for evaluating apps and digital interventions, a more specific approach might be needed for assessing digital diabetes self-management interventions.

OBJECTIVE

This review aims to identify which methods and criteria are used to evaluate apps and digital interventions for diabetes self-management, and to describe how patients were involved in these evaluations.

METHODS

We searched CINAHL, EMBASE, MEDLINE, and Web of Science for articles published from 2015 that referred to the evaluation of apps and digital interventions for diabetes self-management and involved patients in the evaluation. We then conducted a narrative qualitative synthesis of the findings, structured around the included studies' quality, methods of evaluation, and evaluation criteria.

RESULTS

Of 1681 articles identified, 31 fulfilled the inclusion criteria. A total of 7 articles were considered of high confidence in the evidence. Apps were the most commonly used platform for diabetes self-management (18/31, 58%), and type 2 diabetes (T2D) was the targeted health condition most studies focused on (12/31, 38%). Questionnaires, interviews, and user-group meetings were the most common methods of evaluation. Furthermore, the most evaluated criteria for apps and digital diabetes self-management interventions were cognitive impact, clinical impact, and usability. Feasibility and security and privacy were not evaluated by studies considered of high confidence in the evidence.

CONCLUSIONS

There were few studies with high confidence in the evidence that involved patients in the evaluation of apps and digital interventions for diabetes self-management. Additional evaluation criteria, such as sustainability and interoperability, should be focused on more in future studies to provide a better understanding of the effects and potential of apps and digital interventions for diabetes self-management.

Methods and Measures Used to Evaluate Patient-Operated Mobile Health Interventions: Scoping Literature Review

BACKGROUND

Despite the prevalence of mobile health (mHealth) technologies and observations of their impacts on patients' health, there is still no consensus on how best to evaluate these tools for patient self-management of chronic conditions. Researchers currently do not have guidelines on which qualitative or quantitative factors to measure or how to gather these reliable data.

OBJECTIVE

This study aimed to document the methods and both qualitative and quantitative measures used to assess mHealth apps and systems intended for use by patients for the self-management of chronic noncommunicable diseases.

METHODS

A scoping review was performed, and PubMed, MEDLINE, Google Scholar, and ProQuest Research Library were searched for literature published in English between January 1, 2015, and January 18, 2019. Search terms included combinations of the description of the intention of the intervention (eg, self-efficacy and self-management) and description of the intervention platform (eg, mobile app and sensor). Article selection was based on whether the intervention described a patient with a chronic noncommunicable disease as the primary user of a tool or system that would always be available for self-management. The extracted data included study design, health conditions, participants, intervention type (app or system), methods used, and measured qualitative and quantitative data.

RESULTS

A total of 31 studies met the eligibility criteria. Studies were classified as either those that evaluated mHealth apps (ie, single devices; n=15) or mHealth systems (ie, more than one tool; n=17), and one study evaluated both apps and systems. App interventions mainly targeted mental health conditions (including Post-Traumatic Stress Disorder), followed by diabetes and cardiovascular and heart diseases; among the 17 studies that described mHealth systems, most involved patients diagnosed with cardiovascular and heart disease, followed by diabetes, respiratory disease, mental health conditions, cancer, and multiple illnesses. The most common evaluation method was collection of usage logs (n=21), followed by standardized questionnaires (n=18) and ad-hoc questionnaires (n=13). The most common measure was app interaction (n=19), followed by usability/feasibility (n=17) and patient-reported health data via the app (n=15).

CONCLUSIONS

This review demonstrates that health intervention studies are taking advantage of the additional resources that mHealth technologies provide. As mHealth technologies become more prevalent, the call for evidence includes the impacts on patients' self-efficacy and engagement, in addition to traditional measures. However, considering the unstructured data forms, diverse use, and various platforms of mHealth, it can be challenging to select the right methods and measures to evaluate mHealth technologies. The inclusion of app usage logs, patient-involved methods, and other approaches to determine the impact of mHealth is an important step forward in health intervention research. We hope that this overview will become a catalogue of the possible ways in which mHealth has been and can be integrated into research practice.

Diabetes on Twitter: A Sentiment Analysis

BACKGROUND

Contents published on social media have an impact on individuals and on their decision making. Knowing the sentiment toward diabetes is fundamental to understanding the impact that such information could have on people affected with this health condition and their family members. The objective of this study is to analyze the sentiment expressed in messages on diabetes posted on Twitter.

METHOD

Tweets including one of the terms "diabetes," "t1d," and/or "t2d" were extracted for one week using the Twitter standard API. Only the text message and the number of followers of the users were extracted. The sentiment analysis was performed by using SentiStrength.

RESULTS

A total of 67 421 tweets were automatically extracted, of those 3.7% specifically referred to T1D; and 6.8% specifically mentioned T2D. One or more emojis were included in 7.0% of the posts. Tweets specifically mentioning T2D and that did not include emojis were significantly more negative than the tweets that included emojis (-2.22 vs -1.48, P < .001). Tweets on T1D and that included emojis were both significantly more positive and also less negative than tweets without emojis (1.71 vs 1.49 and -1.31 vs -1.50, respectively; P < .005). The number of followers had a negative association with positive sentiment strength ( r = -.023, P < .001) and a positive association with negative sentiment ( r = .016, P < .001).

CONCLUSION

The use of sentiment analysis techniques on social media could increase our knowledge of how social media impact people with diabetes and their families and could help to improve public health strategies.

Artificial Intelligence for Participatory Health: Applications, Impact, and Future Implications

Objective : Artificial intelligence (AI) provides people and professionals working in the field of participatory health informatics an opportunity to derive robust insights from a variety of online sources. The objective of this paper is to identify current state of the art and application areas of AI in the context of participatory health.

Methods : A search was conducted across seven databases (PubMed, Embase, CINAHL, PsychInfo, ACM Digital Library, IEEExplore, and SCOPUS), covering articles published since 2013. Additionally, clinical trials involving AI in participatory health contexts registered at clinicaltrials.gov were collected and analyzed.

Results : Twenty-two articles and 12 trials were selected for review. The most common application of AI in participatory health was the secondary analysis of social media data: self-reported data including patient experiences with healthcare facilities, reports of adverse drug reactions, safety and efficacy concerns about over-the-counter medications, and other perspectives on medications. Other application areas included determining which online forum threads required moderator assistance, identifying users who were likely to drop out from a forum, extracting terms used in an online forum to learn its vocabulary, highlighting contextual information that is missing from online questions and answers, and paraphrasing technical medical terms for consumers.

Conclusions : While AI for supporting participatory health is still in its infancy, there are a number of important research priorities that should be considered for the advancement of the field. Further research evaluating the impact of AI in participatory health informatics on the psychosocial wellbeing of individuals would help in facilitating the wider acceptance of AI into the healthcare ecosystem.

What Are Diabetes Patients Versus Health Care Personnel Discussing on Social Media?

BACKGROUND

Use of social media is increasing rapidly, also in health care and diabetes. However, patients, health care personnel, and patient organizations discuss diabetes on social media very differently. This has led to a lack of common ground when these stakeholders communicate about diabetes and a gap in understanding one another's point of view. Social media have a potential for improved communication if each stakeholder group knows about, acknowledges, and accepts one another's perspective.

METHOD

We extracted and analyzed posts from three Norwegian Facebook groups representing patients, patients' organization, and health care personnel. Qualitative content analysis was done to find the distribution of main categories, followed by a thematic analysis of subcategories that were posted and discussed.

RESULTS

The patient organization's posts are the most equally distributed over the four main identified categories: scientific content, health care services, self-management, and diabetes awareness. The closed patient group's posts were dominated by self-management; the open diabetes nurses' group was dominated by diabetes awareness. The three social media groups differed substantially in what and how they posted and discussed within the main topics. The nurses' open group had percentage-wise both the most liked and commented post, and the posts on self-management had the highest average number of comments.

CONCLUSIONS

There is a big discrepancy in posted information and discussions on social media, between patient closed group, patient organization open group, and health care personnel open group. To reach the aim of using social media for better health, there is a need for more information of what is posted and discussed in the other groups, to harmonize and ensure safe and accurate dissemination of information.

Social Media Use in Interventions for Diabetes: Rapid Evidence-Based Review

Background

Health authorities recommend educating diabetic patients and their families and initiating measures aimed at improving self-management, promoting a positive behavior change, and reducing the risk of complications. Social media could provide valid channel to intervene in and deliver diabetes education. However, it is not well known whether the use of these channels in such interventions can help improve the patients’ outcomes.

Objective

The objective of our study was to review and describe the current existing evidence on the use of social media in interventions targeting people affected with diabetes.

Methods

A search was conducted across 4 databases (PubMed, Scopus, EMBASE, and Cochrane Library).The quality of the evidence of the included primary studies was graded according to the Grading of Recommendations Assessment, Development and Evaluation criteria, and the risk of bias of systematic reviews was assessed by drawing on AMSTAR (A MeaSurement Tool to Assess systematic Reviews) guidelines. The outcomes reported by these studies were extracted and analyzed.

Results

We included 20 moderate- and high-quality studies in the review: 17 primary studies and 3 systematic reviews. Of the 16 publications evaluating the effect on glycated hemoglobin (HbA_1c) of the interventions using social media, 13 reported significant reductions in HbA_1c values. The 5 studies that measured satisfaction with the interventions using social media found positive effects. We found mixed evidence regarding the effect of interventions using social media on health-related quality of life (2 publications found positive effects and 3 found no differences) and on diabetes knowledge or empowerment (2 studies reported improvements and 2 reported no significant changes).

Conclusions

There is very little good-quality evidence on the use of social media in interventions aimed at helping people with diabetes. However, the use of these channels is mostly linked to benefits on patients’ outcomes. Public health institutions, clinicians, and other stakeholders who aim at improving the knowledge of diabetic patients could consider the use of social media in their interventions.

Social media for health promotion in diabetes: study protocol for a participatory public health intervention design

BACKGROUND

Participatory health approaches are increasingly drawing attention among the scientific community, and could be used for health promotion programmes on diabetes through social media. The main aim of this project is to research how to best use social media to promote healthy lifestyles with and within the Norwegian population.

METHODS

The design of the health promotion intervention (HPI) will be participatory, and will involve both a panel of healthcare experts and social media users following the Norwegian Diabetes Association. The panel of experts will agree on the contents by following the Delphi method, and social media users will participate in the definition of the HPI by expressing their opinions through an adhoc online questionnaire. The agreed contents between both parties to be used in the HPI will be posted on three social media channels (Facebook, Twitter and Instagram) along 24 months. The 3 months before starting the HPI, and the 3 months after the HPI will be used as control data. The effect of the HPI will be assessed by comparing formats, frequency, and reactions to the published HPI messages, as well as comparing potential changes in five support-intended communication behaviours expressed on social media, and variations in sentiment analysis before vs during and after the HPI. The HPI's effect on social media users' health-related lifestyles, online health behaviours, and satisfaction with the intervention will be assessed every 6 months through online questionnaires. A separate questionnaire will be used to assess the panel of experts' satisfaction and perceptions of the benefits for health professionals of a HPI as this one.

DISCUSSION

The time constraints of today's medical practice combined with the piling demand of chronic conditions such as diabetes make any additional request of extra time used by health care professionals a challenge. Social media channels provide efficient, ubiquitous and user-friendly platforms that can encourage participation, engagement and action necessary from both those who receive and provide care to make health promotion interventions successful.

Preferences and interests of diabetes social media users regarding a health-promotion intervention

BACKGROUND

Nowadays, rapid and accessible participatory research on diabetes can be carried out using social media platforms. The objective of this study was to identify preferences and interests of diabetic social media users regarding a health-promotion intervention targeting them.

METHODS

Social media followers of the Norwegian Diabetes Association were invited to participate in the creation of a health-promotion intervention on diabetes by expressing their opinions through an online questionnaire posted on Facebook, Twitter, and Instagram. The questionnaire asked participants about their demographics and preferences regarding type of health content: format, frequency, and channels to deliver content. Questions regarding the perceived quality of diabetes-related information and satisfaction with content on social media were also included.

RESULTS

The questionnaire was answered by 346 participants: 332 (96%) of those were reached via Facebook, 66.5% of respondents (n=230) identified themselves as women, 54% (n=187) as individuals diagnosed with type 1 diabetes, and 71% (n=235) were aged 30-64 years. The preferred type of content was "research and innovation on diabetes", selected by 78.0% of the respondents. "Text format" was the choice for 93.4%, and 97.3% would prefer to find health-promotion content on Facebook. There was heterogeneity in the desired frequency of this content. In a scale ranging from 0 to 100, the perceived quality of diabetes-related information on social media was 62.0±1.2 and satisfaction with such content 61.9±1.3.

CONCLUSION

The approach used in this study was successful in reaching and involving participants quickly, and could also potentially increase diabetes patients' engagement and satisfaction with health-promotion interventions, enhance their sense of community, and thus help people attain healthier lifestyles. It is a limitation that our sample might not have been fully representative, as the most interested social media users might have chosen to participate.

Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review

Background

Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients’ quality of life (QoL) and well-being.

Objective

The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients’ user experience with them.

Methods

We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores.

Results

The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found.

Conclusions

Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients’ disease management.

Trial Registration

PROSPERO CRD42017073069; https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID= CRD42017073069 (Archived by WebCite at http://www.webcitation.org/6v38Clb9T)

Combining multivariate statistics and the think-aloud protocol to assess Human-Computer Interaction barriers in symptom checkers

Symptom checkers are software tools that allow users to submit a set of symptoms and receive advice related to them in the form of a diagnosis list, health information or triage. The heterogeneity of their potential users and the number of different components in their user interfaces can make testing with end-users unaffordable. We designed and executed a two-phase method to test the respiratory diseases module of the symptom checker Erdusyk. Phase I consisted of an online test with a large sample of users (n=53). In Phase I, users evaluated the system remotely and completed a questionnaire based on the Technology Acceptance Model. Principal Component Analysis was used to correlate each section of the interface with the questionnaire responses, thus identifying which areas of the user interface presented significant contributions to the technology acceptance. In the second phase, the think-aloud procedure was executed with a small number of samples (n=15), focusing on the areas with significant contributions to analyze the reasons for such contributions. Our method was used effectively to optimize the testing of symptom checker user interfaces. The method allowed kept the cost of testing at reasonable levels by restricting the use of the think-aloud procedure while still assuring a high amount of coverage. The main barriers detected in Erdusyk were related to problems understanding time repetition patterns, the selection of levels in scales to record intensities, navigation, the quantification of some symptom attributes, and the characteristics of the symptoms.

Lessons learnt from a MOOC about social media for digital health literacy

Nowadays, the Internet and social media represent prime channels for health information seeking and peer support. However, benefits of health social media can be reduced by low digital health literacy. We designed a massive open online course (MOOC) course about health social media to increase the students' digital health literacy. In this course, we wanted to explore the difficulties confronted by the MOOC users in relation to accessing quality online health information and to propose methods to overcome the issues. An online survey was carried out to assess the students' digital health literacy. This survey was one of the activities for the enrolled learners in an online course entitled "Social Media in Health Care" on "FutureLearn", one of the popular MOOC platforms. The course was hosted by Taipei Medical University, Taiwan. Data from a total of 300 respondents were collected through the online survey from 14 December 2015 to 10 January 2016. Most participants (61%) considered finding online health information is easy or very easy, while 39% were unsure or found it difficult to retrieve online health information. Most (63%) were not sure about judging whether available information can be used for making health decisions. This study indicates a demand for more training to increase skills to improve the capability of health consumers to identify trustworthy, useful health information. More research to understand the health information seeking process will be crucial in identifying the skillsets that need to be further developed. MOOCs about digital health can be a great source of knowledge when it comes to studying patients' needs.

Ethical Issues of Social Media Usage in Healthcare

OBJECTIVE

Social media, web and mobile technologies are increasingly used in healthcare and directly support patientcentered care. Patients benefit from disease self-management tools, contact to others, and closer monitoring. Researchers study drug efficiency, or recruit patients for clinical studies via these technologies. However, low communication barriers in socialmedia, limited privacy and security issues lead to problems from an ethical perspective. This paper summarizes the ethical issues to be considered when social media is exploited in healthcare contexts.

METHODS

Starting from our experiences in social-media research, we collected ethical issues for selected social-media use cases in the context of patient-centered care. Results were enriched by collecting and analyzing relevant literature and were discussed and interpreted by members of the IMIA Social Media Working Group.

RESULTS

Most relevant issues in social-media applications are confidence and privacy that need to be carefully preserved. The patient-physician relationship can suffer from the new information gain on both sides since private information of both healthcare provider and consumer may be accessible through the Internet. Physicians need to ensure they keep the borders between private and professional intact. Beyond, preserving patient anonymity when citing Internet content is crucial for research studies.

CONCLUSION

Exploiting medical social-media in healthcare applications requires a careful reflection of roles and responsibilities. Availability of data and information can be useful in many settings, but the abuse of data needs to be prevented. Preserving privacy and confidentiality of online users is a main issue, as well as providing means for patients or Internet users to express concerns on data usage.

Impact of Facebook Ads for Sexual Health Promotion Via an Educational Web App

Background: The authors present a case study of a public health campaign, including social media, and aiming at maximizing the use of web app on sexual health. Objective: To analyze the impact of a Facebook fan page, Facebook advertisements, and posters to maximize the number of visits to the educational web app. Methods: The campaign is assessed for 1 year, using data tracked through Facebook statistics and Google Analytics. Results: The site had 3670 visits (10.1 visitors/day, 95%CI 8.7-11.4). During the one-month Facebook Ads campaign, the site received 1263 visits (42.1 visitors/day, 95%CI 37.3-46.9), multiplying by over four the average number of visitors/day. 34.4% of all the participants were recruited during the one-month Facebook ads campaign. Conclusions: Facebook advertisements seem to be a good tool to promote an educational web app on sexual health targeting youth, and to reach a huge number of users rapidly and at a low cost.

Use of social media for sexual health promotion: a scoping review

BACKGROUND

In order to prevent sexually transmitted infections (STIs), the World Health Organization recommends educating people on sexual health. With more than 2 billion active users worldwide, online social media potentially represent powerful channels for health promotion, including sexual health.

OBJECTIVE

To review the scientific literature on the use of online social media for sexual health promotion.

DESIGN

A search was conducted of scientific and medical databases, and grey literature was also included. The selected publications were classified according to their study designs, sexual health promotion main subject, target audience age, and social media use.

RESULTS

Fifty-one publications were included; 4 publications presenting randomized intervention studies, 39 non-randomized intervention studies, and 8 observational studies. In 29 publications (56.9%), the main subject of the sexual health promotion was 'general' or to increase STI testing. Thirty publications (58.8%) specifically focused on youth or young people (aged 11-29 years). Fourteen publications that used social media either as unique channels for sexual health promotion interventions or as a tool supporting the sexual health promotion reported an effect on behavior (27%), and two of those studies found a reduction in the number of positive chlamydia and gonorrhea cases linked to social media intervention. Forty-four publications (86.3%) involved Facebook in some way.

CONCLUSIONS

Although billions of people worldwide actively use social media, we identified only 51 publications on the use of social media for promoting sexual health. About a quarter of the publications have identified promising results, and the evidence for positive effects of social media interventions for promoting sexual health is increasing. There is a need for more studies that explicitly discuss their theoretical framework, and that have strong research designs, in order to further increase the evidence base of the field.

Weekly Pattern for Online Information Seeking on HIV - A Multi-Language Study

Studies have demonstrated that there are weekly patterns of information-seeking activities on sexual health topics in some selected languages. However, it is not known if this weekly pattern is found across the ten most commonly-used languages on the Internet, and whether international public events might have an impact on these information-seeking patterns. The objective of this study is to examine sexual health information-seeking patterns for searches performed in several languages, and also to analyze the potential impact of public events on these information-seeking rates. We extracted the number of hits on the HIV article on Wikipedia for the ten most used languages on the Internet for all of the year 2015. The results confirm the existence of a weekly pattern for the searches performed in English, Spanish, Portuguese, Japanese, Russian, French, and German. But the weekly pattern was not found for searches in Mandarin Chinese, Arabic, and Malay. The number of HIV queries increased significantly during two public events, the World AIDS Day, and the announcement regarding the HIV-positive condition of the celebrity actor Charlie Sheen. The existence of higher peaks in searching rates at the beginning of the week for some languages, and the increase in queries related to public events could represent valuable opportunities for public campaigns promoting sexual health.

Is There a Weekly Pattern for Health Searches on Wikipedia and Is the Pattern Unique to Health Topics?

BACKGROUND

Online health information-seeking behaviors have been reported to be more common at the beginning of the workweek. This behavior pattern has been interpreted as a kind of "healthy new start" or "fresh start" due to regrets or attempts to compensate for unhealthy behavior or poor choices made during the weekend. However, the observations regarding the most common health information-seeking day were based only on the analyses of users' behaviors with websites on health or on online health-related searches. We wanted to confirm if this pattern could be found in searches of Wikipedia on health-related topics and also if this search pattern was unique to health-related topics or if it could represent a more general pattern of online information searching--which could be of relevance even beyond the health sector.

OBJECTIVE

The aim was to examine the degree to which the search pattern described previously was specific to health-related information seeking or whether similar patterns could be found in other types of information-seeking behavior.

METHODS

We extracted the number of searches performed on Wikipedia in the Norwegian language for 911 days for the most common sexually transmitted diseases (chlamydia, gonorrhea, herpes, human immunodeficiency virus [HIV], and acquired immune deficiency syndrome [AIDS]), other health-related topics (influenza, diabetes, and menopause), and 2 nonhealth-related topics (footballer Lionel Messi and pop singer Justin Bieber). The search dates were classified according to the day of the week and ANOVA tests were used to compare the average number of hits per day of the week.

RESULTS

The ANOVA tests showed that the sexually transmitted disease queries had their highest peaks on Tuesdays (P<.001) and the fewest searches on Saturdays. The other health topics also showed a weekly pattern, with the highest peaks early in the week and lower numbers on Saturdays (P<.001). Footballer Lionel Messi had the highest mean number of hits on Tuesdays and Wednesdays, whereas pop singer Justin Bieber had the most hits on Tuesdays. Both these tracked search queries also showed significantly lower numbers on Saturdays (P<.001).

CONCLUSIONS

Our study supports prior studies finding an increase in health information searching at the beginning of the workweek. However, we also found a similar pattern for 2 randomly chosen nonhealth-related terms, which may suggest that the search pattern is not unique to health-related searches. The results are potentially relevant beyond the field of health and our preliminary findings need to be further explored in future studies involving a broader range of nonhealth-related searches.

Randomized trial of a novel game-based appointment system for a university hospital venereology unit: study protocol

Background

Chlamydia is the most common reportable sexually transmitted disease (STD) in Norway, and its incidence in the two northernmost counties has been disclosed to be nearly the double of the Norwegian average. The latest publicly available rates showed that 85.6% of the new cases were diagnosed in people under 29 years old.

The information and communication technologies are among the most powerful influences in the lives of young people. The Internet can potentially represent a way to educate on sexual health and encourage young people, and especially youth, to be tested for STDs. If hospital websites include an easy and anonymous system for scheduling appointments with the clinic, it is possible that this could lead to an increase in the number of people tested for STDs.

Methods

The purpose of the study is to assess the impact of a game-based appointment system on the frequency of consultations at a venereology unit and on the use of an educational web app. An A/B testing methodology is used. Users from the city of Tromsø, in North Norway, will be randomized to one of the two versions of the game-style web app on sexual health at www.sjekkdeg.no. Group A will have access to educational content only, while group B will have, in addition, access to a game-based appointment system with automatic prioritization. After one year of the trial, it will be analyzed if the game-based appointment system increases the number of consultations at the venereology unit and if health professionals deem the system useful.

Discussion

This study will explore if facilitating the access to health services for youth through the use of a game-based appointment system integrated in a game-style web app on sexual health education can have an impact on appointment rates.

Trial registration

The trial is registered at clinicaltrials.org under the identifier ClinicalTrials.gov NCT:02128620

Type 1 Diabetes in Twitter: Who All Listen To?

Knowing what the conversation on Twitter regarding type 1 diabetes (T1D) is about can help in understanding the kind of information relevant to the individuals affected by the disease. The profile of Twitter users posting on T1D was collected and classified. The number of re-tweets was also registered. The tweets posted by non-governmental organizations (NGOs), communication media, and individuals affected by T1D had higher number of potential readers. More than a half of the tweets were posted by individuals affected by T1D, and their tweets were the most re-tweeted. The next most active users were NGOs and healthcare professionals. However, while tweets soliciting for research funds posted by the NGOs were the next most re-tweeted messages, tweets posted by healthcare professionals were the least re-tweeted. Twitter could be used more actively by healthcare professionals to disseminate correct information about T1D.