@Article{info:doi/10.2196/69040, author="Hindelang, Michael and Sitaru, Sebastian and Zink, Alexander", title="Tracking Public Interest in Rare Diseases and Eosinophilic Disorders in Germany: Web Search Analysis", journal="JMIR Infodemiology", year="2025", month="May", day="26", volume="5", pages="e69040", keywords="hypereosinophilia", keywords="eosinophilia", keywords="public health informatics", keywords="web search analysis", keywords="rare diseases", abstract="Background: Eosinophilia and hypereosinophilic syndrome (HES) are rare disorders grouped under the term hypereosinophilic disorders. They are diagnosed based on an increased number of eosinophils. They can also cause serious symptoms, including skin, lung, and gastrointestinal problems. These disorders are very rarely recognized due to their rarity and misdiagnosis. Objective: This study analyzes public interest in hypereosinophilic disorders using data on internet search volume in Germany between 2020 and 2023. Objectives include identifying frequently searched terms, evaluating temporal trends, analyzing seasonal patterns, evaluating geographic differences in search behavior, and identifying unmet information needs and frequently searched risk factors. Methods: A retrospective analysis using Google Ads Keyword Planner gathered monthly search volume data for 12 German terms related to hypereosinophilic disorders. These terms were selected based on their medical relevance and common usage identified from medical literature. Data were analyzed descriptively, with trends, seasonal variations, and geographical distributions examined. Chi-square tests and correlation analysis assessed statistical significance. Results: A total of 178 keywords were identified, resulting in a search volume of 1,745,540 queries. The top keyword was ``eosophile,'' a misspelling, followed by ``eosinophilia'' and ``HES.'' The main categories included ``Eosinophilia,'' ``Eosinophils,'' and ``Churg-Strauss syndrome.'' Temporal analysis showed seasonal growth in search volumes, peaking in January 2023, with higher interest during winter. Geographical analysis showed regional variations. Conclusions: This research shows a growing public interest in eosinophilic diseases, reflected by a steadily increasing search volume over time. This is particularly evident in searches for basic definitions and diagnostic criteria, such as ``eosinophils'' or ``symptoms of eosinophilic diseases.'' This increase in search volume, which peaked in January 2023, indicates an increased interest in accurate and readily available information for rare conditions. ", doi="10.2196/69040", url="https://infodemiology.jmir.org/2025/1/e69040" } @Article{info:doi/10.2196/65087, author="Khakban, Iliya and Jain, Shagun and Gallab, Joseph and Dharmaraj, Blossom and Zhou, Fangwen and Lokker, Cynthia and Abdelkader, Wael and Zeraatkar, Dena and Busse, W. Jason", title="Impact of the COVID-19 Pandemic and the 2021 National Institute for Health and Care Excellence Guidelines on Public Perspectives Toward Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Thematic and Sentiment Analysis on Twitter (Rebranded as X)", journal="J Med Internet Res", year="2025", month="May", day="21", volume="27", pages="e65087", keywords="myalgic encephalomyelitis", keywords="chronic fatigue syndrome", keywords="Twitter", keywords="sentiment analysis", keywords="post--COVID-19 condition", keywords="long COVID", abstract="Background: Myalgic encephalomyelitis (ME), also referred to as chronic fatigue syndrome (CFS), is a complex illness that typically presents with disabling fatigue and cognitive and functional impairment. The etiology and management of ME/CFS remain contentious and patients often describe their experiences through social media. Objective: We explored public discourse on Twitter (rebranded as X) to understand the concerns and priorities of individuals living with ME/CFS, with a focus on (1) the COVID-19 pandemic and (2) publication of the 2021 UK National Institute for Health and Care Excellence (NICE) guidelines on the diagnosis and management of ME/CFS. Methods: We used the Twitter application programming interface to collect tweets related to ME/CFS posted between January 1, 2010, and January 30, 2024. Tweets were sorted into 3 chronological periods (pre--COVID-19 pandemic, post--COVID-19 pandemic, and post-UK 2021 NICE Guidelines publication). A Robustly Optimized Bidirectional Embedding Representations from Transformers Pretraining Approach (RoBERTa) language processing model was used to categorize the sentiment of tweets as positive, negative, or neutral. We identified tweets that mentioned COVID-19, the UK NICE guidelines, and key themes identified through latent Dirichlet allocation (ie, fibromyalgia, research, and treatment). We sampled 1000 random tweets from each theme to identify subthemes and representative quotes. Results: We retrieved 906,404 tweets, of which 427,824 (47.2\%) were neutral, 369,371 (40.75\%) were negative, and 109,209 (12.05\%) were positive. Over time, both the proportion of negative and positive tweets increased, and the proportion of neutral tweets decreased (P<.001 for all changes). Tweets mentioning fibromyalgia acknowledged similarities with ME/CFS, stigmatization associated with both disorders, and lack of effective treatments. Treatment-related tweets often described frustration with ME/CFS labeled as mental illness, dismissal of concerns by health care providers, and the need to seek out ``good physicians'' who viewed ME/CFS as a physical disorder. Tweets on research typically praised studies of biomarkers and biomedical therapies, called for greater investment in biomedical research, and expressed frustration with studies suggesting a biopsychosocial etiology for ME/CFS or supporting management with psychotherapy or graduated activity. Tweets about the UK NICE guidelines expressed frustration with the 2007 version that recommended cognitive behavioral therapy and graded exercise therapy, and a prolonged campaign by advocacy organizations to influence subsequent versions. Tweets showed high acceptance of the 2021 UK NICE guidelines, which were seen to validate ME/CFS as a biomedical disease and recommended against graded exercise therapy. Tweets about COVID-19 often noted overlaps between post--COVID-19 condition and ME/CFS, including claims of a common biological pathway, and advised there was no cure for either condition. Conclusions: Our findings suggest research is needed to inform how best to support patients' engagement with evidence-based care. Furthermore, while patient involvement with ME/CFS research is critical, unmanaged intellectual conflicts of interest may threaten the trustworthiness of research efforts. ", doi="10.2196/65087", url="https://www.jmir.org/2025/1/e65087" } @Article{info:doi/10.2196/66845, author="Beatini, Rose Julia and Sun, Yanyi Nora and Coleman, K. Julianna and Haas-Kogan, E. Maetal and Pelletier, Andrea and Bartz, Deborah and Keuroghlian, Sogomon Alex", title="\#GenderAffirmingHormoneTherapy and Health Information on TikTok: Thematic Content Analysis", journal="JMIR Infodemiology", year="2025", month="Apr", day="29", volume="5", pages="e66845", keywords="transgender", keywords="gender diverse", keywords="transgender and gender diverse", keywords="TGD", keywords="gender fluid", keywords="online platform", keywords="social media", keywords="gender affirming", keywords="hormone therapy", keywords="gender-affirming hormone therapy", keywords="GAHT", keywords="social media content", keywords="media information", keywords="social media analysis", keywords="TikTok", keywords="web scraper", keywords="hashtag", keywords="themes", keywords="qualitative content analysis", keywords="patient education materials assessment", keywords="PEMAT", keywords="Currency, Relevance, Authority, Accuracy, and Purpose", keywords="CRAAP", keywords="audiovisual materials", keywords="qualitative", abstract="Background: Transgender and gender diverse people often turn to online platforms for information and support regarding gender-affirming hormone therapy (GAHT); however, analysis of this social media content remains scarce. Objective: We characterized GAHT-related videos on TikTok to highlight the implications relevant to GAHT prescribers. Methods: We used a web scraper to identify TikTok videos posted under the hashtags \#genderaffirminghormonetherapy and \#genderaffirminghormones as of November 2023. We identified recurrent themes via qualitative content analysis and assessed health education videos with the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) scale and a modified Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test. Results: Out of 69 videos extracted, 71\% (49/69) were created by GAHT users, 24.6\% (17/69) were created by health care workers, and 21.7\% (15/69) were created to provide health education. Themes included physical changes on testosterone, GAHT access, and combating misinformation and stigma surrounding GAHT. Health education videos scored highly on PEMAT-A/V items assessing understandability (mean 88.3\%, SD 11.3\%) and lower on actionability (mean 60.0\%, SD 45.8\%). On the CRAAP test, videos scored highly on the relevance, authority, and purpose domains but lower on the currency and accuracy domains. Conclusions: Discussions of GAHT on TikTok build community among transgender and gender diverse users, provide a platform for digital activism and resistance against legislation that limits GAHT access, and foster patient-provider dialogue. Educational videos are highly understandable and are created by reliable sources, but they vary in terms of currency and quality of supporting evidence, and they lack in actionability. ", doi="10.2196/66845", url="https://infodemiology.jmir.org/2025/1/e66845" } @Article{info:doi/10.2196/64792, author="Wang, Jiangkun and Xu, Kai and Wu, Juanjuan and Liang, Wen and Qiu, Weiming and Wang, Song", title="Evaluating the Content and Quality of Videos Related to Hypertrophic Scarring on TikTok in China: Cross-Sectional Study", journal="JMIR Infodemiology", year="2025", month="Apr", day="29", volume="5", pages="e64792", keywords="hypertrophic scars", keywords="health education", keywords="TikTok", keywords="social media", keywords="information quality", abstract="Background: Hypertrophic scars (HTSs) are a predominant condition after burns and trauma, and it causes severe physiological and psychological problems. TikTok (Douyin in Chinese), a popular platform for sharing short videos, has shown the potential to spread health information, including information related to HTSs. Educating the public to obtain correct information is important to reduce the incidence of physiological and psychological problems caused by HTSs. However, the quality and reliability of HTS-related video content on TikTok in mainland China have not been thoroughly studied. Objective: This study aims to evaluate the content and quality of short videos related to HTSs on the Chinese version of TikTok?(Douyin) and explore the factors related to their quality, providing valuable insights for health information dissemination. Methods: We collected a sample of 153 TikTok videos in Chinese related to HTSs and categorized them according to video source and content. We evaluated the video content using a coding schema, and a hexagonal radar schema was used to intuitively display the spotlight and weight of each aspect of the videos. We evaluated quality using 4 standardized tools: the modified DISCERN (mDISCERN) questionnaire, the Journal of the American Medical Association, the Global Quality Scale (GQS), and the Health on the Net Foundation Code of Conduct. We also explored the potential relationship between video quality and characteristics. Results: The analysis showed that health care professionals uploaded all videos about treating HTSs, which matched the hexagonal radar model analysis findings. The quality assessment scores for the Journal of the American Medical Association, GQS, mDISCERN, and the Health on the Net Foundation Code of Conduct had median values of 1 (IQR 1-2), 2 (IQR 2-3), 2 (IQR 2-3), and 3 (IQR 3-4), respectively, indicating a need to improve the quality and reliability of videos on HTSs. In addition, high-quality videos were more popular, based on metrics such as likes, comments, favorites, and shares (P<.001). Interestingly, the time when the videos were uploaded positively correlated with GQS and mDISCERN scores (r=0.393; P<.001 and r=0.273; P<.001), while the video length did not significantly correlate with evaluation scores (P=.78, P=.20, P=.07, and P=.04). Conclusions: The quality of TikTok videos related to HTSs is generally moderate. Users should exercise caution when seeking information on HTSs from TikTok. It is advisable to choose videos uploaded by health care professionals from the burn department and the burn plastic surgery department, and in the Chinese context, those produced in first-tier cities and emerging first-tier cities. ", doi="10.2196/64792", url="https://infodemiology.jmir.org/2025/1/e64792" } @Article{info:doi/10.2196/66010, author="Watkins, Lea Shannon and Snodgrass, Katherine and Fahrion, Lexi and Shaw, Emily", title="Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic (``So Much Contradictory Evidence''): Qualitative Document Analysis of Reddit Forums", journal="J Med Internet Res", year="2025", month="Mar", day="20", volume="27", pages="e66010", keywords="vaping", keywords="nicotine", keywords="tobacco", keywords="health communication", keywords="social media", keywords="new media", abstract="Background: Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use. Objective: This study aims to characterize and contextualize e-cigarette--related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making. Methods: We conducted a qualitative analysis of COVID-19--related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors. Results: e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette--related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media. Conclusions: Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information and discussion on Reddit also informed risk perceptions and decisions during the pandemic. Social media is an effective and important place to communicate public health information, particularly during crisis or disaster situations. Moving forward, transparent, accurate, and specific message development should consider the stress, struggles, and stigma of people who use e-cigarettes and address the roles mistrust and misinformation play in decisions. ", doi="10.2196/66010", url="https://www.jmir.org/2025/1/e66010" } @Article{info:doi/10.2196/62828, author="Holst, Christine and Woloshin, Steven and Oxman, D. Andrew and Rose, Christopher and Rosenbaum, Sarah and Munthe-Kaas, Menzies Heather", title="Alternative Presentations of Overall and Statistical Uncertainty for Adults' Understanding of the Results of a Randomized Trial of a Public Health Intervention: Parallel Web-Based Randomized Trials", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="18", volume="11", pages="e62828", keywords="communication", keywords="Grading of Recommendations Assessment, Development, and Evaluation language", keywords="GRADE language", keywords="statistical uncertainty", keywords="overall uncertainty", keywords="randomized trial", abstract="Background: Well-designed public health messages can help people make informed choices, while poorly designed messages or persuasive messages can confuse, lead to poorly informed decisions, and diminish trust in health authorities and research. Communicating uncertainties to the public about the results of health research is challenging, necessitating research on effective ways to disseminate this important aspect of randomized trials. Objective: This study aimed to evaluate people's understanding of overall and statistical uncertainty when presented with alternative ways of expressing randomized trial results. Methods: Two parallel, web-based, individually randomized trials (3{\texttimes}2 factorial designs) were conducted in the United States and Norway. Participants were randomized to 1 of 6 versions of a text (summary) communicating results from a study examining the effects of wearing glasses to prevent COVID-19 infection. The summaries varied in how overall uncertainty (``Grading of Recommendations Assessment, Development and Evaluation [GRADE] language,'' ``plain language,'' or ``no explicit language'') and statistical uncertainty (whether a margin of error was shown or not) were presented. Participants completed a web-based questionnaire exploring 4 coprimary outcomes: 3 to measure understanding of overall uncertainty (benefits, harms, and sufficiency of evidence), and one to measure statistical uncertainty. Participants were adults who do not wear glasses recruited from web-based research panels in the United States and Norway. Results of the trials were analyzed separately and combined in a meta-analysis. Results: In the US and Norwegian trials, 730 and 497 individuals were randomized, respectively; data for 543 (74.4\%) and 452 (90.9\%) were analyzed. More participants had a correct understanding of uncertainty when presented with plain language (United States: 37/99, 37\% and Norway: 40/76, 53\%) than no explicit language (United States: 18/86, 21\% and Norway: 34/80, 42\%). Similar positive effect was seen for the GRADE language in the United States (26/79, 33\%) but not in Norway (30/71, 42\%). There were only small differences between groups for understanding the uncertainty of harms. Plain language improved correct understanding of evidence sufficiency (odds ratio 2.05, 95\% CI 1.17-3.57), compared to no explicit language. The effect of GRADE language was inconclusive (odds ratio 1.34, 95\% CI 0.79-2.28). The understanding of statistical uncertainty was improved when the participants were shown the margin of error compared to not being shown: Norway: 16/75, 21\% to 24/71, 34\% vs 1/71, 1\% to 2/76, 3\% and the United States: 21/101, 21\% to 32/90, 36\% vs 0/86, 0\% to 3/79, 4\%). Conclusions: Plain language, but not GRADE language, was better than no explicit language in helping people understand overall uncertainty of benefits and harms. Reporting margin of error improved understanding of statistical uncertainty around the effect of wearing glasses, but only for a minority of participants. Trial Registration: ClinicalTrials.gov NCT05642754; https://tinyurl.com/4mhjsm7s ", doi="10.2196/62828", url="https://publichealth.jmir.org/2025/1/e62828" } @Article{info:doi/10.2196/66524, author="Okuhara, Tsuyoshi and Terada, Marina and Okada, Hiroko and Yokota, Rie and Kiuchi, Takahiro", title="Experiences of Public Health Professionals Regarding Crisis Communication During the COVID-19 Pandemic: Systematic Review of Qualitative Studies", journal="JMIR Infodemiology", year="2025", month="Mar", day="14", volume="5", pages="e66524", keywords="COVID-19", keywords="health communication", keywords="infodemic", keywords="misinformation", keywords="social media", keywords="SARS-CoV-2", keywords="pandemic", keywords="infectious", keywords="digital age", keywords="systematic review", keywords="internet", keywords="public health", keywords="government", keywords="health professional", keywords="crisis communication", keywords="qualitative", keywords="disinformation", keywords="eHealth", keywords="digital health", keywords="medical informatics", abstract="Background: The COVID-19 pandemic emerged in the digital age and has been called the first ``data-driven pandemic'' in human history. The global response demonstrated that many countries had failed to effectively prepare for such an event. Learning through experience in a crisis is one way to improve the crisis management process. As the world has returned to normal after the pandemic, questions about crisis management have been raised in several countries and require careful consideration. Objective: This review aimed to collect and organize public health professionals' experiences in crisis communication to the public during the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, and Communication Abstracts in February 2024 to locate English-language articles that qualitatively investigated the difficulties and needs experienced by health professionals in their communication activities during the COVID-19 pandemic. Results: This review included 17 studies. Our analysis identified 7 themes and 20 subthemes. The 7 themes were difficulties in pandemic communication, difficulties caused by the ``infodemic,'' difficulties in partnerships within or outside of public health, difficulties in community engagement, difficulties in effective communication, burnout among communicators, and the need to train communication specialists and establish a permanent organization specializing in communication. Conclusions: This review identified the gaps between existing crisis communication guidelines and real-world crisis communication in the digital environment and clarified the difficulties and needs that arose from these gaps. Crisis communication strategies and guidelines should be updated with reference to the themes revealed in this review to effectively respond to subsequent public health crises. Trial Registration: PROSPERO CRD42024528975; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=528975 International Registered Report Identifier (IRRID): RR2-10.2196/58040 ", doi="10.2196/66524", url="https://infodemiology.jmir.org/2025/1/e66524" } @Article{info:doi/10.2196/68400, author="Gao, Quyige and Liu, Shangbin and Tuerxunjiang, Muzaibaier and Xu, Huifang and Zhang, Jiechen and Xu, Gang and Chen, Jianyu and Cai, Yong and Hu, Fan and Wang, Ying", title="Mpox Prevention Self-Efficacy and Associated Factors Among Men Who Have Sex With Men in China: Large Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="28", volume="11", pages="e68400", keywords="mpox", keywords="self-efficacy", keywords="men who have sex with men", keywords="MSM", keywords="monkeypox", keywords="cross-sectional study", keywords="mpox prevention self-efficacy scale", abstract="Background: Self-efficacy in mpox (formerly known as monkeypox) prevention plays a pivotal role in promoting preventive behaviors by fostering a sense of control and motivation, especially among men who have sex with men (MSM), the population most affected by mpox in many countries. Objective: This study aims to assess the mpox prevention self-efficacy among MSM in China and identify factors influencing it, using a validated mpox prevention self-efficacy scale. Methods: From October 2023 to March 2024, a nationwide cross-sectional study was conducted among MSM (aged ?18 years) across 6 geographic regions in China using a snowball sampling method. The recruited participants (effective response rate=2403/2481, 96.9\%) were asked to complete an anonymous questionnaire designed based on prior knowledge of mpox and social cognitive theory. The mpox prevention self-efficacy scale was evaluated for construct validity using exploratory factor analysis and confirmatory factor analysis, and its reliability was assessed using the Cronbach $\alpha$ coefficient. Univariate and multivariable logistic regression analyses were used to examine the factors associated with mpox prevention self-efficacy among MSM. Results: A total of 2403 MSM participants were included, with a mean age of 29 (IQR 19?39) years. Of these, 1228 (51.1\%) were aged 25?34 years, 1888 (78.6\%) held a college degree or higher, and 2035 (84.7\%) were unmarried. The median mpox prevention self-efficacy score was 23 (IQR 18?28). Exploratory factor analysis retained 6 items of the mpox prevention self-efficacy scale. Confirmatory factor analysis confirmed a strong model fit ($\chi${\texttwosuperior}?=32.1, n=1225; P<.001; comparative fit index=0.991; root mean square error of approximation=0.067; standardized root mean square residual=0.02; goodness-of-fit index=0.992; normed fit index=0.990; incremental fit index=0.991; Tucker-Lewis index=0.974), with all indices within acceptable ranges. The scale demonstrated good internal consistency, with a Cronbach $\alpha$ of 0.859. The positive factors associated with mpox prevention self-efficacy were mpox-related knowledge (OR 1.107, 95\% CI 1.070?1.146), perceived risk awareness (OR 1.338, 95\% CI 1.132?1.583), and mpox risk perception (OR 1.154, 95\% CI 1.066?1.250), while the negative factor was age, with individuals aged 25 years and older exhibiting lower self-efficacy in mpox prevention (25?34 years: OR 0.789, 95\% CI 0.642?0.970; 35?44 years: OR 0.572, 95\% CI 0.444?0.736; 45 years and older: OR 0.569, 95\% CI 0.394?0.823). Conclusions: These findings highlight the critical role of targeted interventions to enhance mpox prevention self-efficacy, particularly through increasing knowledge, perceived risk awareness, and risk perception. Such interventions are especially important for middle-aged and older MSM, who may experience a decline in self-efficacy. Strengthening self-efficacy in these areas is essential for promoting sustained preventive behaviors, improving mental well-being, and contributing to more effective mpox prevention and control within the MSM community. ", doi="10.2196/68400", url="https://publichealth.jmir.org/2025/1/e68400" } @Article{info:doi/10.2196/59101, author="Lin, Bing and Liu, Jiaxiu and Li, Kangjie and Zhong, Xiaoni", title="Predicting the Risk of HIV Infection and Sexually Transmitted Diseases Among Men Who Have Sex With Men: Cross-Sectional Study Using Multiple Machine Learning Approaches", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e59101", keywords="HIV", keywords="sexually transmitted diseases", keywords="men who have sex with men", keywords="machine learning", keywords="web application", keywords="risk stratification", abstract="Background: Men who have sex with men (MSM) are at high risk for HIV infection and sexually transmitted diseases (STDs). However, there is a lack of accurate and convenient tools to assess this risk. Objective: This study aimed to develop machine learning models and tools to predict and assess the risk of HIV infection and STDs among MSM. Methods: We conducted a cross-sectional study that collected individual characteristics of 1999 MSM with negative or unknown HIV serostatus in Western China from 2013 to 2023. MSM self-reported their STD history and were tested for HIV. We compared the accuracy of 6 machine learning methods in predicting the risk of HIV infection and STDs using 7 parameters for a comprehensive assessment, ranking the methods according to their performance in each parameter. We selected data from the Sichuan MSM for external validation. Results: Of the 1999 MSM, 72 (3.6\%) tested positive for HIV and 146 (7.3\%) self-reported a history of previous STD infection. After taking the results of the intersection of the 3 feature screening methods, a total of 7 and 5 predictors were screened for predicting HIV infection and STDs, respectively, and multiple machine learning prediction models were constructed. Extreme gradient boost models performed optimally in predicting the risk of HIV infection and STDs, with area under the curve values of 0.777 (95\% CI 0.639-0.915) and 0.637 (95\% CI 0.541-0.732), respectively, demonstrating stable performance in both internal and external validation. The highest combined predictive performance scores of HIV and STD models were 33 and 39, respectively. Interpretability analysis showed that nonadherence to condom use, low HIV knowledge, multiple male partners, and internet dating were risk factors for HIV infection. Low degree of education, internet dating, and multiple male and female partners were risk factors for STDs. The risk stratification analysis showed that the optimal model effectively distinguished between high- and low-risk MSM. MSM were classified into HIV (predicted risk score <0.506 and ?0.506) and STD (predicted risk score <0.479 and ?0.479) risk groups. In total, 22.8\% (114/500) were in the HIV high-risk group, and 43\% (215/500) were in the STD high-risk group. HIV infection and STDs were significantly higher in the high-risk groups (P<.001 and P=.05, respectively), with higher predicted probabilities (P<.001 for both). The prediction results of the optimal model were displayed in web applications for probability estimation and interactive computation. Conclusions: Machine learning methods have demonstrated strengths in predicting the risk of HIV infection and STDs among MSM. Risk stratification models and web applications can facilitate clinicians in accurately assessing the risk of infection in individuals with high risk, especially MSM with concealed behaviors, and help them to self-monitor their risk for targeted, timely diagnosis and interventions to reduce new infections. ", doi="10.2196/59101", url="https://www.jmir.org/2025/1/e59101" } @Article{info:doi/10.2196/60559, author="Soleymani, Dagmar and Pougheon-Bertrand, Dominique and Gagnayre, R{\'e}mi", title="A Digital Behavior Change Intervention for Health Promotion for Adults in Midlife: Protocol for a Multidimensional Assessment Study", journal="JMIR Res Protoc", year="2025", month="Feb", day="7", volume="14", pages="e60559", keywords="digital behavior change intervention", keywords="assessment protocol", keywords="middle-aged adults", keywords="health promotion", keywords="user account", keywords="mixed assessments", keywords="health information technologies", abstract="Background: To support lifelong health promotion and disease prevention, Sant{\'e} publique France studied the methodology for building a social marketing scheme with a digital intervention targeting middle-aged adults, specifically socioeconomically disadvantaged groups. The digital intervention aims to encourage people aged 40-55 years to look after their health in the short and medium terms by adopting small actions relating to 8 health determinants: nutrition, physical activity, smoking, alcohol, stress, cognitive health, sleep, and environmental health. In the long term, the intervention intends to prevent frailty and reduce the burden of multimorbidities in older age, particularly for lower socioeconomic groups. Objective: This study aims to measure behavior changes among registered users of the future website. The protocol assesses the impact of the website based on users' implementation of small actions relating to the 8 health determinants. Specifically, it intends to evaluate the website's performance in terms of engaging a specific population, triggering behavior change, raising awareness about a multifactorial approach to health, and encouraging user interaction with the website's resources. Methods: The methodology is based on clinical assessments developed alongside the website according to the functionalities offered to registered users in their personalized space. The assessment tool design draws on logic models for digital interventions, and their consistency for digital applications is verified. The target audience is clearly defined from the outset. The protocol sets out a 3-step assessment: upon registration, after 3 weeks of use, and after 10 weeks of use (end of assessment). Users are divided into 2 groups (socioeconomically disadvantaged users and others) to characterize differences and make corrections. The protocol uses a mixed assessment approach based on website traffic and user login data. Specific and identifiable behavior changes are documented by monitoring the same individuals from T0 to T2, using verbatim comments to classify them into profiles and conducting semistructured individual interviews with a sample of users. Results: The protocol creates a multidimensional assessment of digital intervention, showing that during a given timeline, interactions with users can reveal their capabilities, opportunities, and motivations to adopt healthy lifestyles. The protocol's principles were integrated into the development of a personal account to assess users' behavior changes. Given the delayed launch of the website, no recruitment or effects analysis of the protocol took place. Conclusions: As no multidimensional assessment protocol is currently available for digital behavior change interventions, our methods reveal that the different framework stages can strengthen the effect measurement, consolidate the choice of assumptions used within the logic model and steer the digital intervention toward action while reducing the burden of information. The suitability of the assessment protocol remains to be evaluated given the delayed launch of the website. International Registered Report Identifier (IRRID): PRR1-10.2196/60559 ", doi="10.2196/60559", url="https://www.researchprotocols.org/2025/1/e60559" } @Article{info:doi/10.2196/58981, author="Rowley, AK Elizabeth and Mitchell, K. Patrick and Yang, Duck-Hye and Lewis, Ned and Dixon, E. Brian and Vazquez-Benitez, Gabriela and Fadel, F. William and Essien, J. Inih and Naleway, L. Allison and Stenehjem, Edward and Ong, C. Toan and Gaglani, Manjusha and Natarajan, Karthik and Embi, Peter and Wiegand, E. Ryan and Link-Gelles, Ruth and Tenforde, W. Mark and Fireman, Bruce", title="Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e58981", keywords="disease risk score", keywords="propensity score", keywords="vaccine effectiveness", keywords="COVID-19", keywords="simulation study", keywords="usefulness", keywords="comorbidity", keywords="assessment", abstract="Background: Real-world COVID-19 vaccine effectiveness (VE) studies are investigating exposures of increasing complexity accounting for time since vaccination. These studies require methods that adjust for the confounding that arises when morbidities and demographics are associated with vaccination and the risk of outcome events. Methods based on propensity scores (PS) are well-suited to this when the exposure is dichotomous, but present challenges when the exposure is multinomial. Objective: This simulation study aimed to investigate alternative methods to adjust for confounding in VE studies that have a test-negative design. Methods: Adjustment for a disease risk score (DRS) is compared with multivariable logistic regression. Both stratification on the DRS and direct covariate adjustment of the DRS are examined. Multivariable logistic regression with all the covariates and with a limited subset of key covariates is considered. The performance of VE estimators is evaluated across a multinomial vaccination exposure in simulated datasets. Results: Bias in VE estimates from multivariable models ranged from --5.3\% to 6.1\% across 4 levels of vaccination. Standard errors of VE estimates were unbiased, and 95\% coverage probabilities were attained in most scenarios. The lowest coverage in the multivariable scenarios was 93.7\% (95\% CI 92.2\%-95.2\%) and occurred in the multivariable model with key covariates, while the highest coverage in the multivariable scenarios was 95.3\% (95\% CI 94.0\%-96.6\%) and occurred in the multivariable model with all covariates. Bias in VE estimates from DRS-adjusted models was low, ranging from --2.2\% to 4.2\%. However, the DRS-adjusted models underestimated the standard errors of VE estimates, with coverage sometimes below the 95\% level. The lowest coverage in the DRS scenarios was 87.8\% (95\% CI 85.8\%-89.8\%) and occurred in the direct adjustment for the DRS model. The highest coverage in the DRS scenarios was 94.8\% (95\% CI 93.4\%-96.2\%) and occurred in the model that stratified on DRS. Although variation in the performance of VE estimates occurred across modeling strategies, variation in performance was also present across exposure groups. Conclusions: Overall, models using a DRS to adjust for confounding performed adequately but not as well as the multivariable models that adjusted for covariates individually. ", doi="10.2196/58981", url="https://formative.jmir.org/2025/1/e58981" } @Article{info:doi/10.2196/59539, author="Br{\"u}gger, Victoria and Kowatsch, Tobias and Jovanova, Mia", title="Wearables and Smartphones for Tracking Modifiable Risk Factors in Metabolic Health: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="28", volume="13", pages="e59539", keywords="wearable", keywords="smartphone", keywords="mHealth", keywords="metabolic disease", keywords="lifestyle", keywords="physiological", keywords="risk factor", keywords="mobile phone", abstract="Background: Metabolic diseases, such as cardiovascular diseases and diabetes, contribute significantly to global mortality and disability. Wearable devices and smartphones are increasingly used to track and manage modifiable risk factors associated with metabolic diseases. However, no established guidelines exist on how to derive meaningful signals from these devices, often hampering cross-study comparisons. Objective: This study aims to systematically overview the current empirical literature on how wearables and smartphones are used to track modifiable (physiological and lifestyle) risk factors associated with metabolic diseases. Methods: We will conduct a scoping review to overview how wearable and smartphone-based studies measure modifiable risk factors related to metabolic diseases. We will search 5 databases (Scopus, Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and SPORTDiscus) from 2019 to 2024, with search terms related to wearables, smartphones, and modifiable risk factors associated with metabolic diseases. Eligible studies will use smartphones or wearables (worn on the wrist, finger, arm, hip, and chest) to track physiological or lifestyle factors related to metabolic diseases. We will follow the reporting guideline standards from PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) guidance on scoping review methodology. Two reviewers will independently screen articles for inclusion and extract data using a standardized form. The findings will be synthesized and reported qualitatively and quantitatively. Results: Data collection is expected to begin in November 2024; data analysis in the first quarter of 2025; and submission to a peer-reviewed journal by the second quarter of 2025. We expect to identify the degree to which wearable and smartphone-based studies track modifiable risk factors collectively (versus in isolation), and the consistency and variation in how modifiable risk factors are measured across existing studies. Conclusions: Results are expected to inform more standardized guidelines on wearable and smartphone-based measurements, with the goal of aiding cross-study comparison. The final report is planned for submission to a peer-reviewed, indexed journal. This review is among the first to systematically overview the current landscape on how wearables and smartphones measure modifiable risk factors associated with metabolic diseases. International Registered Report Identifier (IRRID): PRR1-10.2196/59539 ", doi="10.2196/59539", url="https://www.researchprotocols.org/2024/1/e59539" } @Article{info:doi/10.2196/63193, author="Sakhuja, Mayank and Friedman, B. Daniela and Macauda, M. Mark and Hebert, R. James and Pednekar, S. Mangesh and Gupta, C. Prakash and Fong, T. Geoffrey and Thrasher, F. James", title="Association Between Cigarette and Bidi Purchase Behavior (Loose vs Pack) and Health Warning Label Exposure: Findings From the Tobacco Control Policy India Survey and In-Depth Interviews With People Who Smoke", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="25", volume="10", pages="e63193", keywords="loose cigarettes", keywords="singles", keywords="health warning labels", keywords="tobacco control", keywords="India", keywords="mixed methods", keywords="purchase behavior", keywords="tobacco users", keywords="cigarette", keywords="qualitative research", keywords="thematic analysis", keywords="prevention", keywords="health promotion", keywords="public health", abstract="Background: The sale of loose cigarettes or bidis can undermine the purpose of requiring health warning labels (HWLs) on cigarette packs and bidi bundles by diminishing their visibility and legibility. Objective: This mixed-methods study aims to examine the association between purchase behavior (loose vs pack or bundle), HWL exposure, and responses to HWLs among Indian adults who smoke. Methods: Data were analyzed from the 2018-2019 India Tobacco Control Policy Survey and from 28 in-depth interviews conducted with Indian adults who smoked in 2022. The Tobacco Control Policy Survey sample included tobacco users who bought cigarettes (n=643) or bidis (n=730), either loose or in packs or bundles at their last purchase. Ordinal regression models were fit separately for cigarettes and bidis, whereby HWL variables (noticing HWLs, reading and looking closely at HWLs, forgoing a cigarette or bidi because of HWLs, thinking about health risks of smoking, and thinking about quitting smoking cigarettes or bidis because of HWLs) were regressed on last purchase (loose vs packs or bundles). In-depth interviews with participants from Delhi and Mumbai who purchased loose cigarettes in the last month were conducted, and thematic analysis was used to analyze the interview data. Results: Survey findings indicated that about 74.3\% (478/643) of cigarette users and 11.8\% (86/730) of bidi users reported having bought loose sticks at their last purchase. Those who purchased loose cigarettes (vs packs) noticed HWLs less often (estimate --0.830, 95\% CI --1.197 to --0.463, P<.001), whereas those who purchased loose bidis (vs bundles) read and looked closely at HWLs (estimate 0.646, 95\% CI 0.013-1.279, P=.046), thought about the harms of bidi smoking (estimate 1.200, 95\% CI 0.597-1.802, P<.001), and thought about quitting bidi smoking (estimate 0.871, 95\% CI 0.282-1.461, P=.004) more often. Interview findings indicated lower exposure to HWLs among those who purchased loose cigarettes, primarily due to vendors distributing loose cigarettes without showing the original cigarette pack, storing them in separate containers, and consumers' preference for foreign-made cigarette brands, which often lack HWLs. While participants were generally aware of the contents of HWLs, many deliberately avoided them when purchasing loose cigarettes. In addition, they believed that loose cigarette purchases reduced the HWLs' potential to deliver consistent reminders about the harmful effects of cigarette smoking due to reduced exposure, an effect more common among those who purchased packs. Participants also noted that vendors, especially small ones, did not display statutory health warnings at their point of sale, further limiting exposure to warning messages. Conclusions: Survey and interview findings indicated that those who purchased loose cigarettes noticed HWLs less often. Loose purchases likely decrease the frequency of exposure to HWLs' reminders about the harmful effects of smoking, potentially reducing the effectiveness of HWLs. ", doi="10.2196/63193", url="https://publichealth.jmir.org/2024/1/e63193", url="http://www.ncbi.nlm.nih.gov/pubmed/39320944" } @Article{info:doi/10.2196/53993, author="van der Mee, M. Frederieke A. and Schaper, Fleur and Jansen, Jesse and Bons, P. Judith A. and Meex, R. Steven J. and Cals, L. Jochen W.", title="Enhancing Patient Understanding of Laboratory Test Results: Systematic Review of Presentation Formats and Their Impact on Perception, Decision, Action, and Memory", journal="J Med Internet Res", year="2024", month="Aug", day="12", volume="26", pages="e53993", keywords="electronic health record", keywords="patient access to records", keywords="patient portal", keywords="laboratory test results", keywords="clinical laboratory information systems", keywords="health communication", keywords="health informatics", keywords="patient engagement", keywords="patient involvement", abstract="Background: Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients' processing of the information. Objective: This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory. Methods: The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool. Results: A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89\%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants' perception. Additionally, horizontal line bars significantly decreased participants' tendency to search for information or to contact their physician, compared with numerical values with reference ranges. Conclusions: In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants' cognitive perception and perception of communication while decreasing participants' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients' information processing. ", doi="10.2196/53993", url="https://www.jmir.org/2024/1/e53993" } @Article{info:doi/10.2196/51094, author="Raber, Margaret and Allen, Haley and Huang, Sophia and Vazquez, Maria and Warner, Echo and Thompson, Debbe", title="Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis", journal="JMIR Form Res", year="2024", month="Jun", day="19", volume="8", pages="e51094", keywords="misinformation", keywords="social media", keywords="Mediterranean Diet", keywords="content analysis", keywords="health communication", keywords="communication", keywords="TikTok", keywords="diet", keywords="cardiometabolic disease", keywords="cardiometabolic", keywords="consumer", keywords="eating", keywords="quality", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="promotion research", keywords="nutrition therapy", keywords="healthy diet", abstract="Background: The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information. Objective: We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living. Methods: The first-appearing 202 TikTok posts that resulted from a search of the hashtag \#mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests. Results: TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1\% vs 2/96, 2.1\%; P=.001), use scientific citations to support claims (26/106, 24.5\% vs 0/96, 0\%; P<.001), and discuss specific nutrients (33/106, 31.1\% vs 6/96, 6.3\%; P<.001) and diseases related to the diet (27/106, 25.5\% vs 5/96, 5.2\%; P<.001) compared to posts created by nonhealth professionals. Conclusions: Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures. ", doi="10.2196/51094", url="https://formative.jmir.org/2024/1/e51094" } @Article{info:doi/10.2196/53417, author="Xu, Huan Richard and Chen, Caiyun", title="Moderating Effect of Coping Strategies on the Association Between the Infodemic-Driven Overuse of Health Care Services and Cyberchondria and Anxiety: Partial Least Squares Structural Equation Modeling Study", journal="J Med Internet Res", year="2024", month="Apr", day="9", volume="26", pages="e53417", keywords="infodemic", keywords="health care", keywords="cyberchondria", keywords="anxiety", keywords="coping", keywords="structural equation modeling", abstract="Background: The COVID-19 pandemic has led to a substantial increase in health information, which has, in turn, caused a significant rise in cyberchondria and anxiety among individuals who search for web-based medical information. To cope with this information overload and safeguard their mental well-being, individuals may adopt various strategies. However, the effectiveness of these strategies in mitigating the negative effects of information overload and promoting overall well-being remains uncertain. Objective: This study aimed to investigate the moderating effect of coping strategies on the relationship between the infodemic-driven misuse of health care and depression and cyberchondria. The findings could add a new dimension to our understanding of the psychological impacts of the infodemic, especially in the context of a global health crisis, and the moderating effect of different coping strategies on the relationship between the overuse of health care and cyberchondria and anxiety. Methods: The data used in this study were obtained from a cross-sectional web-based survey. A professional survey company was contracted to collect the data using its web-based panel. The survey was completed by Chinese individuals aged 18 years or older without cognitive problems. Model parameters of the relationships between infodemic-driven overuse of health care, cyberchondria, and anxiety were analyzed using bootstrapped partial least squares structural equation modeling. Additionally, the moderating effects of coping strategies on the aforementioned relationships were also examined. Results: A total of 986 respondents completed the web-based survey. The mean scores of the Generalized Anxiety Disorder-7 and Cyberchondria Severity Scale-12 were 8.4 (SD 3.8) and 39.7 (SD 7.5), respectively. The mean score of problem-focused coping was higher than those of emotion- and avoidant-focused coping. There was a significantly positive relationship between a high level of infodemic and increased overuse of health care (bootstrapped mean 0.21, SD 0.03; 95\% CI 0.1581-0.271). The overuse of health care resulted in more severe cyberchondria (bootstrapped mean 0.107, SD 0.032) and higher anxiety levels (bootstrapped mean 0.282, SD 0.032) in all the models. Emotion (bootstrapped mean 0.02, SD 0.008 and 0.037, SD 0.015)- and avoidant (bootstrapped mean 0.026, SD 0.009 and 0.049, SD 0.016)-focused coping strategies significantly moderated the relationship between the overuse of health care and cyberchondria and that between the overuse of health care and anxiety, respectively. Regarding the problem-based model, the moderating effect was significant for the relationship between the overuse of health care and anxiety (bootstrapped mean 0.007, SD 0.011; 95\% CI 0.005-0.027). Conclusions: This study provides empirical evidence about the impact of coping strategies on the relationship between infodemic-related overuse of health care services and cyberchondria and anxiety. Future research can build on the findings of this study to further explore these relationships and develop and test interventions aimed at mitigating the negative impact of the infodemic on mental health. ", doi="10.2196/53417", url="https://www.jmir.org/2024/1/e53417", url="http://www.ncbi.nlm.nih.gov/pubmed/38593427" } @Article{info:doi/10.2196/51113, author="Xian, Xuechang and Neuwirth, J. Rostam and Chang, Angela", title="Government-Nongovernmental Organization (NGO) Collaboration in Macao's COVID-19 Vaccine Promotion: Social Media Case Study", journal="JMIR Infodemiology", year="2024", month="Mar", day="19", volume="4", pages="e51113", keywords="COVID-19", keywords="government", keywords="vaccine", keywords="automated content analysis", keywords="Granger causality test", keywords="network agenda setting", keywords="QAP", keywords="social media", abstract="Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao's COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: ``Vaccine importance'' and ``COVID-19 risk'' were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize ``COVID-19 risk'' and ``vaccine effectiveness,'' while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. ", doi="10.2196/51113", url="https://infodemiology.jmir.org/2024/1/e51113", url="http://www.ncbi.nlm.nih.gov/pubmed/38502184" } @Article{info:doi/10.2196/48134, author="van de Baan, Frank and Gifford, Rachel and Ruwaard, Dirk and Fleuren, Bram and Westra, Daan", title="Newspaper Coverage of Hospitals During a Prolonged Health Crisis: Longitudinal Mixed Methods Study", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="21", volume="10", pages="e48134", keywords="health communication", keywords="news coverage", keywords="media", keywords="misinformation", keywords="accuracy", keywords="news", keywords="reporting", keywords="newspaper", keywords="knowledge translation", keywords="COVID-19", keywords="dissemination", keywords="communication", abstract="Background: It is important for health organizations to communicate with the public through newspapers during health crises. Although hospitals were a main source of information for the public during the COVID-19 pandemic, little is known about how this information was presented to the public through (web-based) newspaper articles. Objective: This study aims to examine newspaper reporting on the situation in hospitals during the first year of the COVID-19 pandemic in the Netherlands and to assess the degree to which the reporting in newspapers aligned with what occurred in practice. Methods: We used a mixed methods longitudinal design to compare internal data from all hospitals (n=5) located in one of the most heavily affected regions of the Netherlands with the information reported by a newspaper covering the same region. The internal data comprised 763 pages of crisis meeting documents and 635 minutes of video communications. A total of 14,401 newspaper articles were retrieved from the LexisNexis Academic (RELX Group) database, of which 194 (1.3\%) articles were included for data analysis. For qualitative analysis, we used content and thematic analyses. For quantitative analysis, we used chi-square tests. Results: The content of the internal data was categorized into 12 themes: COVID-19 capacity; regular care capacity; regional, national, and international collaboration; human resources; well-being; public support; material resources; innovation; policies and protocols; finance; preparedness; and ethics. Compared with the internal documents, the newspaper articles focused significantly more on the themes COVID-19 capacity (P<.001), regular care capacity (P<.001), and public support (P<.001) during the first year of the pandemic, whereas they focused significantly less on the themes material resources (P=.004) and policies and protocols (P<.001). Differences in attention toward themes were mainly observed between the first and second waves of the pandemic and at the end of the third wave. For some themes, the attention in the newspaper articles preceded the attention given to these themes in the internal documents. Reporting was done through various forms, including diary articles written from the perspective of the hospital staff. No indication of the presence of misinformation was found in the newspaper articles. Conclusions: Throughout the first year of the pandemic, newspaper articles provided coverage on the situation of hospitals and experiences of staff. The focus on themes within newspaper articles compared with internal hospital data differed significantly for 5 (42\%) of the 12 identified themes. The discrepancies between newspapers and hospitals in their focus on themes could be attributed to their gatekeeping roles. Both parties should be aware of their gatekeeping role and how this may affect information distribution. During health crises, newspapers can be a credible source of information for the public. The information can also be valuable for hospitals themselves, as it allows them to anticipate internal and external developments. ", doi="10.2196/48134", url="https://publichealth.jmir.org/2024/1/e48134", url="http://www.ncbi.nlm.nih.gov/pubmed/38381496" } @Article{info:doi/10.2196/44395, author="Garrett, Camryn and Qiao, Shan and Li, Xiaoming", title="The Role of Social Media in Knowledge, Perceptions, and Self-Reported Adherence Toward COVID-19 Prevention Guidelines: Cross-Sectional Study", journal="JMIR Infodemiology", year="2024", month="Feb", day="16", volume="4", pages="e44395", keywords="COVID-19", keywords="digital media", keywords="social media", keywords="TikTok", keywords="Instagram", keywords="Twitter", keywords="Facebook", keywords="prevention guidelines", abstract="Background: Throughout the COVID-19 pandemic, social media has served as a channel of communication, a venue for entertainment, and a mechanism for information dissemination. Objective: This study aims to assess the associations between social media use patterns; demographics; and knowledge, perceptions, and self-reported adherence toward COVID-19 prevention guidelines, due to growing and evolving social media use. Methods: Quota-sampled data were collected through a web-based survey of US adults through the Qualtrics platform, from March 15, 2022, to March 23, 2022, to assess covariates (eg, demographics, vaccination, and political affiliation), frequency of social media use, social media sources of COVID-19 information, as well as knowledge, perceptions, and self-reported adherence toward COVID-19 prevention guidelines. Three linear regression models were used for data analysis. Results: A total of 1043 participants responded to the survey, with an average age of 45.3 years, among which 49.61\% (n=515) of participants were men, 66.79\% (n=696) were White, 11.61\% (n=121) were Black or African American, 13.15\% (n=137) were Hispanic or Latino, 37.71\% (n=382) were Democrat, 30.21\% (n=306) were Republican, and 25\% (n=260) were not vaccinated. After controlling for covariates, users of TikTok ($\beta$=--.29, 95\% CI --0.58 to --0.004; P=.047) were associated with lower knowledge of COVID-19 guidelines, users of Instagram ($\beta$=--.40, 95\% CI --0.68 to --0.12; P=.005) and Twitter ($\beta$=--.33, 95\% CI --0.58 to --0.08; P=.01) were associated with perceiving guidelines as strict, and users of Facebook ($\beta$=--.23, 95\% CI --0.42 to --0.043; P=.02) and TikTok ($\beta$=--.25, 95\% CI --0.5 to -0.009; P=.04) were associated with lower adherence to the guidelines (R2 0.06-0.23). Conclusions: These results allude to the complex interactions between online and physical environments. Future interventions should be tailored to subpopulations based on their demographics and social media site use. Efforts to mitigate misinformation and implement digital public health policy must account for the impact of the digital landscape on knowledge, perceptions, and level of adherence toward prevention guidelines for effective pandemic control. ", doi="10.2196/44395", url="https://infodemiology.jmir.org/2024/1/e44395", url="http://www.ncbi.nlm.nih.gov/pubmed/38194493" } @Article{info:doi/10.2196/46693, author="Pearce, Emily and Raj, Hannah and Emezienna, Ngozika and Gilkey, B. Melissa and Lazard, J. Allison and Ribisl, M. Kurt and Savage, A. Sharon and Han, KJ Paul", title="The Use of Social Media to Express and Manage Medical Uncertainty in Dyskeratosis Congenita: Content Analysis", journal="JMIR Infodemiology", year="2024", month="Jan", day="15", volume="4", pages="e46693", keywords="social media", keywords="medical uncertainty", keywords="telomere biology disorder", keywords="dyskeratosis congenita", keywords="social support", abstract="Background: Social media has the potential to provide social support for rare disease communities; however, little is known about the use of social media for the expression of medical uncertainty, a common feature of rare diseases. Objective: This study aims to evaluate the expression of medical uncertainty on social media in the context of dyskeratosis congenita, a rare cancer-prone inherited bone marrow failure and telomere biology disorder (TBD). Methods: We performed a content analysis of uncertainty-related posts on Facebook and Twitter managed by Team Telomere, a patient advocacy group for this rare disease. We assessed the frequency of uncertainty-related posts, uncertainty sources, issues, and management and associations between uncertainty and social support. Results: Across all TBD social media platforms, 45.98\% (1269/2760) of posts were uncertainty related. Uncertainty-related posts authored by Team Telomere on Twitter focused on scientific (306/434, 70.5\%) or personal (230/434, 53\%) issues and reflected uncertainty arising from probability, ambiguity, or complexity. Uncertainty-related posts in conversations among patients and caregivers in the Facebook community group focused on scientific (429/511, 84\%), personal (157/511, 30.7\%), and practical (114/511, 22.3\%) issues, many of which were related to prognostic unknowns. Both platforms suggested uncertainty management strategies that focused on information sharing and community building. Posts reflecting response-focused uncertainty management strategies (eg, emotional regulation) were more frequent on Twitter compared with the Facebook community group ($\chi$21=3.9; P=.05), whereas posts reflecting uncertainty-focused management strategies (eg, ordering information) were more frequent in the Facebook community group compared with Twitter ($\chi$21=55.1; P<.001). In the Facebook community group, only 36\% (184/511) of members created posts during the study period, and those who created posts did so with a low frequency (median 3, IQR 1-7 posts). Analysis of post creator characteristics suggested that most users of TBD social media are White, female, and parents of patients with dyskeratosis congenita. Conclusions: Although uncertainty is a pervasive and multifactorial issue in TBDs, our findings suggest that the discussion of medical uncertainty on TBD social media is largely limited to brief exchanges about scientific, personal, or practical issues rather than ongoing supportive conversation. The nature of uncertainty-related conversations also varied by user group: patients and caregivers used social media primarily to discuss scientific uncertainties (eg, regarding prognosis), form social connections, or exchange advice on accessing and organizing medical care, whereas Team Telomere used social media to express scientific and personal issues of uncertainty and to address the emotional impact of uncertainty. The higher involvement of female parents on TBD social media suggests a potentially greater burden of uncertainty management among mothers compared with other groups. Further research is needed to understand the dynamics of social media engagement to manage medical uncertainty in the TBD community. ", doi="10.2196/46693", url="https://infodemiology.jmir.org/2024/1/e46693", url="http://www.ncbi.nlm.nih.gov/pubmed/38224480" } @Article{info:doi/10.2196/43891, author="Cuff, P. Jordan and Dighe, Nivrutti Shrinivas and Watson, E. Sophie and Badell-Grau, A. Rafael and Weightman, J. Andrew and Jones, L. Davey and Kille, Peter", title="Monitoring SARS-CoV-2 Using Infoveillance, National Reporting Data, and Wastewater in Wales, United Kingdom: Mixed Methods Study", journal="JMIR Infodemiology", year="2023", month="Nov", day="23", volume="3", pages="e43891", keywords="COVID-19", keywords="Google Trends", keywords="infodemiology", keywords="quantitative reverse transcription polymerase chain reaction", keywords="RT-qPCR", keywords="wastewater", keywords="infoveillance", keywords="public health care", keywords="health care statistics", keywords="correlation analysis", keywords="analysis", keywords="public health", keywords="online health", keywords="eHealth", keywords="public interest", abstract="Background: The COVID-19 pandemic necessitated rapid real-time surveillance of epidemiological data to advise governments and the public, but the accuracy of these data depends on myriad auxiliary assumptions, not least accurate reporting of cases by the public. Wastewater monitoring has emerged internationally as an accurate and objective means for assessing disease prevalence with reduced latency and less dependence on public vigilance, reliability, and engagement. How public interest aligns with COVID-19 personal testing data and wastewater monitoring is, however, very poorly characterized. Objective: This study aims to assess the associations between internet search volume data relevant to COVID-19, public health care statistics, and national-scale wastewater monitoring of SARS-CoV-2 across South Wales, United Kingdom, over time to investigate how interest in the pandemic may reflect the prevalence of SARS-CoV-2, as detected by national testing and wastewater monitoring, and how these data could be used to predict case numbers. Methods: Relative search volume data from Google Trends for search terms linked to the COVID-19 pandemic were extracted and compared against government-reported COVID-19 statistics and quantitative reverse transcription polymerase chain reaction (RT-qPCR) SARS-CoV-2 data generated from wastewater in South Wales, United Kingdom, using multivariate linear models, correlation analysis, and predictions from linear models. Results: Wastewater monitoring, most infoveillance terms, and nationally reported cases significantly correlated, but these relationships changed over time. Wastewater surveillance data and some infoveillance search terms generated predictions of case numbers that correlated with reported case numbers, but the accuracy of these predictions was inconsistent and many of the relationships changed over time. Conclusions: Wastewater monitoring presents a valuable means for assessing population-level prevalence of SARS-CoV-2 and could be integrated with other data types such as infoveillance for increasingly accurate inference of virus prevalence. The importance of such monitoring is increasingly clear as a means of objectively assessing the prevalence of SARS-CoV-2 to circumvent the dynamic interest and participation of the public. Increased accessibility of wastewater monitoring data to the public, as is the case for other national data, may enhance public engagement with these forms of monitoring. ", doi="10.2196/43891", url="https://infodemiology.jmir.org/2023/1/e43891", url="http://www.ncbi.nlm.nih.gov/pubmed/37903300" } @Article{info:doi/10.2196/47677, author="Koskan, M. Alexis and Sivanandam, Shalini and Roschke, Kristy and Irby, Jonathan and Helitzer, L. Deborah and Doebbeling, Bradley", title="Sharing Reliable COVID-19 Information and Countering Misinformation: In-Depth Interviews With Information Advocates", journal="JMIR Infodemiology", year="2023", month="Oct", day="20", volume="3", pages="e47677", keywords="COVID-19", keywords="coronavirus", keywords="pandemic", keywords="infodemic", keywords="misinformation", keywords="social media", keywords="qualitative research", keywords="public health", keywords="health communication", abstract="Background: The rampant spread of misinformation about COVID-19 has been linked to a lower uptake of preventive behaviors such as vaccination. Some individuals, however, have been able to resist believing in COVID-19 misinformation. Further, some have acted as information advocates, spreading accurate information and combating misinformation about the pandemic. Objective: This work explores highly knowledgeable information advocates' perspectives, behaviors, and information-related practices. Methods: To identify participants for this study, we used outcomes of survey research of a national sample of 1498 adults to find individuals who scored a perfect or near-perfect score on COVID-19 knowledge questions and who also self-reported actively sharing or responding to news information within the past week. Among this subsample, we selected a diverse sample of 25 individuals to participate in a 1-time, phone-based, semistructured interview. Interviews were recorded and transcribed, and the team conducted an inductive thematic analysis. Results: Participants reported trusting in science, data-driven sources, public health, medical experts, and organizations. They had mixed levels of trust in various social media sites to find reliable health information, noting distrust in particular sites such as Facebook (Meta Platforms) and more trust in specific accounts on Twitter (X Corp) and Reddit (Advance Publications). They reported relying on multiple sources of information to find facts instead of depending on their intuition and emotions to inform their perspectives about COVID-19. Participants determined the credibility of information by cross-referencing it, identifying information sources and their potential biases, clarifying information they were unclear about with health care providers, and using fact-checking sites to verify information. Most participants reported ignoring misinformation. Others, however, responded to misinformation by flagging, reporting, and responding to it on social media sites. Some described feeling more comfortable responding to misinformation in person than online. Participants' responses to misinformation posted on the internet depended on various factors, including their relationship to the individual posting the misinformation, their level of outrage in response to it, and how dangerous they perceived it could be if others acted on such information. Conclusions: This research illustrates how well-informed US adults assess the credibility of COVID-19 information, how they share it, and how they respond to misinformation. It illustrates web-based and offline information practices and describes how the role of interpersonal relationships contributes to their preferences for acting on such information. Implications of our findings could help inform future training in health information literacy, interpersonal information advocacy, and organizational information advocacy. It is critical to continue working to share reliable health information and debunk misinformation, particularly since this information informs health behaviors. ", doi="10.2196/47677", url="https://infodemiology.jmir.org/2023/1/e47677", url="http://www.ncbi.nlm.nih.gov/pubmed/37862066" } @Article{info:doi/10.2196/43685, author="Alvarez-Mon, Angel Miguel and Pereira-Sanchez, Victor and Hooker, R. Elizabeth and Sanchez, Facundo and Alvarez-Mon, Melchor and Teo, R. Alan", title="Content and User Engagement of Health-Related Behavior Tweets Posted by Mass Media Outlets From Spain and the United States Early in the COVID-19 Pandemic: Observational Infodemiology Study", journal="JMIR Infodemiology", year="2023", month="Aug", day="22", volume="3", pages="e43685", keywords="COVID-19", keywords="health communication", keywords="social media", keywords="Twitter", keywords="health promotion", keywords="public health", keywords="mass media", abstract="Background: During the early pandemic, there was substantial variation in public and government responses to COVID-19 in Europe and the United States. Mass media are a vital source of health information and news, frequently disseminating this information through social media, and may influence public and policy responses to the pandemic. Objective: This study aims to describe the extent to which major media outlets in the United States and Spain tweeted about health-related behaviors (HRBs) relevant to COVID-19, compare the tweeting patterns between media outlets of both countries, and determine user engagement in response to these tweets. Methods: We investigated tweets posted by 30 major media outlets (n=17, 57\% from Spain and n=13, 43\% from the United States) between December 1, 2019 and May 31, 2020, which included keywords related to HRBs relevant to COVID-19. We classified tweets into 6 categories: mask-wearing, physical distancing, handwashing, quarantine or confinement, disinfecting objects, or multiple HRBs (any combination of the prior HRB categories). Additionally, we assessed the likes and retweets generated by each tweet. Poisson regression analyses compared the average predicted number of likes and retweets between the different HRB categories and between countries. Results: Of 50,415 tweets initially collected, 8552 contained content associated with an HRB relevant to COVID-19. Of these, 600 were randomly chosen for training, and 2351 tweets were randomly selected for manual content analysis. Of the 2351 COVID-19--related tweets included in the content analysis, 62.91\% (1479/2351) mentioned at least one HRB. The proportion of COVID-19 tweets mentioning at least one HRB differed significantly between countries (P=.006). Quarantine or confinement was mentioned in nearly half of all the HRB tweets in both countries. In contrast, the least frequently mentioned HRBs were disinfecting objects in Spain 6.9\% (56/809) and handwashing in the United States 9.1\% (61/670). For tweets from the United States mentioning at least one HRB, disinfecting objects had the highest median likes and retweets, whereas mask-wearing-- and handwashing-related tweets achieved the highest median number of likes in Spain. Tweets from Spain that mentioned social distancing or disinfecting objects had a significantly lower predicted count of likes compared with tweets mentioning a different HRB (P=.02 and P=.01, respectively). Tweets from the United States that mentioned quarantine or confinement or disinfecting objects had a significantly lower predicted number of likes compared with tweets mentioning a different HRB (P<.001), whereas mask- and handwashing-related tweets had a significantly greater predicted number of likes (P=.04 and P=.02, respectively). Conclusions: The type of HRB content and engagement with media outlet tweets varied between Spain and the United States early in the pandemic. However, content related to quarantine or confinement and engagement with handwashing was relatively high in both countries. ", doi="10.2196/43685", url="https://infodemiology.jmir.org/2023/1/e43685", url="http://www.ncbi.nlm.nih.gov/pubmed/37347948" } @Article{info:doi/10.2196/43011, author="Dasgupta, Pritam and Amin, Janaki and Paris, Cecile and MacIntyre, Raina C.", title="News Coverage of Face Masks in Australia During the Early COVID-19 Pandemic: Topic Modeling Study", journal="JMIR Infodemiology", year="2023", month="Aug", day="16", volume="3", pages="e43011", keywords="face masks", keywords="mask", keywords="COVID-19", keywords="web-based news", keywords="community sentiment", keywords="topic modeling", keywords="latent Dirichlet allocation", abstract="Background: During the COVID-19 pandemic, web-based media coverage of preventative strategies proliferated substantially. News media was constantly informing people about changes in public health policy and practices such as mask-wearing. Hence, exploring news media content on face mask use is useful to analyze dominant topics and their trends. Objective: The aim of the study was to examine news related to face masks as well as to identify related topics and temporal trends in Australian web-based news media during the early COVID-19 pandemic period. Methods: Following data collection from the Google News platform, a trend analysis on the mask-related news titles from Australian news publishers was conducted. Then, a latent Dirichlet allocation topic modeling algorithm was applied along with evaluation matrices (quantitative and qualitative measures). Afterward, topic trends were developed and analyzed in the context of mask use during the pandemic. Results: A total of 2345 face mask--related eligible news titles were collected from January 25, 2020, to January 25, 2021. Mask-related news showed an increasing trend corresponding to increasing COVID-19 cases in Australia. The best-fitted latent Dirichlet allocation model discovered 8 different topics with a coherence score of 0.66 and a perplexity measure of --11.29. The major topics were T1 (mask-related international affairs), T2 (introducing mask mandate in places such as Melbourne and Sydney), and T4 (antimask sentiment). Topic trends revealed that T2 was the most frequent topic in January 2021 (77 news titles), corresponding to the mandatory mask-wearing policy in Sydney. Conclusions: This study demonstrated that Australian news media reflected a wide range of community concerns about face masks, peaking as COVID-19 incidence increased. Harnessing the news media platforms for understanding the media agenda and community concerns may assist in effective health communication during a pandemic response. ", doi="10.2196/43011", url="https://infodemiology.jmir.org/2023/1/e43011", url="http://www.ncbi.nlm.nih.gov/pubmed/37379362" } @Article{info:doi/10.2196/45316, author="Starr, C. Michelle and Wallace, Samantha and Moore, Courtney and Cockrum, Brandon and Hawryluk, Bridget and Carroll, Aaron and Bennett, William", title="Development of a Family-Centered Communication Tool for Kidney Health in Premature Infants: Qualitative Focus Group Study Using Human-Centered Design Methodology", journal="J Particip Med", year="2023", month="Jul", day="10", volume="15", pages="e45316", keywords="qualitative research", keywords="patient-reported outcomes", keywords="neonates", keywords="chronic kidney disease", keywords="human-centered design", keywords="acute kidney injury", keywords="kidney health", abstract="Background: Premature infants are at increased risk of kidney-related complications, including acute kidney injury (AKI) and chronic kidney disease (CKD). The risk of CKD in prematurely born infants is underrecognized by health care teams and caregivers. Understanding how to communicate the risk of CKD to caregivers is essential for longitudinal clinical follow-up and adherence. Objective: This study aimed to determine family caregiver attitudes toward kidney health and risk communication during a neonatal intensive care admission. We also sought to understand caregiver preferences for the communication of information surrounding the risk of CKD in premature infants. Methods: We augmented standard qualitative group sessions with human-centered design methods to assess parent preferences and clinician perspectives. Caregivers recruited had a prematurely born child who spent time in the neonatal intensive care unit at Riley Hospital for Children in Indianapolis, Indiana, and experienced AKI or another kidney complication, which put them at risk for future CKD. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: A total of 7 clinicians and 8 caregivers participated in 3 group sessions. Caregivers and clinicians readily acknowledged barriers to and drivers of long-term kidney monitoring as well as opportunities for communication of the risk of long-term kidney disease. Caregivers' primary concerns were for both the type and depth of information conveyed as well as the time at which it was communicated. Participants emphasized the importance of collaboration between the hospital care team and the primary care provider. Participant input was synthesized into several prototype concepts and, ultimately, into a rough prototype of a website and an informational flyer. Conclusions: Caregivers of premature infants are open to communication about kidney health during their neonatal admission. The next phase of this work will translate caregivers' preferences into family-centered communication tools and test their efficacy in the neonatal intensive care unit. ", doi="10.2196/45316", url="https://jopm.jmir.org/2023/1/e45316", url="http://www.ncbi.nlm.nih.gov/pubmed/37428553" } @Article{info:doi/10.2196/38245, author="Eaton, C. Melissa and Probst, C. Yasmine and Smith, A. Marc", title="Characterizing the Discourse of Popular Diets to Describe Information Dispersal and Identify Leading Voices, Interaction, and Themes of Mental Health: Social Network Analysis", journal="JMIR Infodemiology", year="2023", month="May", day="5", volume="3", pages="e38245", keywords="social media", keywords="popular diets", keywords="nutrition", keywords="public health", keywords="social network analysis", abstract="Background: Social media has transformed the way health messages are communicated. This has created new challenges and ethical considerations while providing a platform to share nutrition information for communities to connect and for information to spread. However, research exploring the web-based diet communities of popular diets is limited. Objective: This study aims to characterize the web-based discourse of popular diets, describe information dissemination, identify influential voices, and explore interactions between community networks and themes of mental health. Methods: This exploratory study used Twitter social media posts for an online social network analysis. Popular diet keywords were systematically developed, and data were collected and analyzed using the NodeXL metrics tool (Social Media Research Foundation) to determine the key network metrics (vertices, edges, cluster algorithms, graph visualization, centrality measures, text analysis, and time-series analytics). Results: The vegan and ketogenic diets had the largest networks, whereas the zone diet had the smallest network. In total, 31.2\% (54/173) of the top users endorsed the corresponding diet, and 11\% (19/173) claimed a health or science education, which included 1.2\% (2/173) of dietitians. Complete fragmentation and hub and spoke messaging were the dominant network structures. In total, 69\% (11/16) of the networks interacted, where the ketogenic diet was mentioned most, with depression and anxiety and eating disorder words most prominent in the ``zone diet'' network and the least prominent in the ``soy-free,'' ``vegan,'' ``dairy-free,'' and ``gluten-free'' diet networks. Conclusions: Social media activity reflects diet trends and provides a platform for nutrition information to spread through resharing. A longitudinal exploration of popular diet networks is needed to further understand the impact social media can have on dietary choices. Social media training is vital, and nutrition professionals must work together as a community to actively reshare evidence-based posts on the web. ", doi="10.2196/38245", url="https://infodemiology.jmir.org/2023/1/e38245", url="http://www.ncbi.nlm.nih.gov/pubmed/37159259" } @Article{info:doi/10.2196/41969, author="Wu, Jiaxi and Origgi, Manuel Juan and Ranker, R. Lynsie and Bhatnagar, Aruni and Robertson, Marie Rose and Xuan, Ziming and Wijaya, Derry and Hong, Traci and Fetterman, L. Jessica", title="Compliance With the US Food and Drug Administration's Guidelines for Health Warning Labels and Engagement in Little Cigar and Cigarillo Content: Computer Vision Analysis of Instagram Posts", journal="JMIR Infodemiology", year="2023", month="Mar", day="14", volume="3", pages="e41969", keywords="tobacco", keywords="cigar", keywords="little cigar", keywords="cigarillo", keywords="Instagram", keywords="social media", keywords="influencer promotion", keywords="tobacco advertising", keywords="health warning", keywords="machine learning", keywords="computer vision", keywords="warning label", keywords="health label", keywords="health promotion", keywords="advertising", keywords="advertise", keywords="smoking", keywords="smoker", keywords="algorithm", keywords="visualization", abstract="Background: Health warnings in tobacco advertisements provide health information while also increasing the perceived risks of tobacco use. However, existing federal laws requiring warnings on advertisements for tobacco products do not specify whether the rules apply to social media promotions. Objective: This study aims to examine the current state of influencer promotions of little cigars and cigarillos (LCCs) on Instagram and the use of health warnings in influencer promotions. Methods: Instagram influencers were identified as those who were tagged by any of the 3 leading LCC brand Instagram pages between 2018 and 2021. Posts from identified influencers, which mentioned one of the three brands were considered LCC influencer promotions. A novel Warning Label Multi-Layer Image Identification computer vision algorithm was developed to measure the presence and properties of health warnings in a sample of 889 influencer posts. Negative binomial regressions were performed to examine the associations of health warning properties with post engagement (number of likes and comments). Results: The Warning Label Multi-Layer Image Identification algorithm was 99.3\% accurate in detecting the presence of health warnings. Only 8.2\% (n=73) of LCC influencer posts included a health warning. Influencer posts that contained health warnings received fewer likes (incidence rate ratio 0.59, P<.001, 95\% CI 0.48-0.71) and fewer comments (incidence rate ratio 0.46, P<.001, 95\% CI 0.31-0.67). Conclusions: Health warnings are rarely used by influencers tagged by LCC brands' Instagram accounts. Very few influencer posts met the US Food and Drug Administration's health warning requirement of size and placement for tobacco advertising. The presence of a health warning was associated with lower social media engagement. Our study provides support for the implementation of comparable health warning requirements to social media tobacco promotions. Using an innovative computer vision approach to detect health warning labels in influencer promotions on social media is a novel strategy for monitoring health warning compliance in social media tobacco promotions. ", doi="10.2196/41969", url="https://infodemiology.jmir.org/2023/1/e41969", url="http://www.ncbi.nlm.nih.gov/pubmed/37113379" } @Article{info:doi/10.2196/40198, author="DePaula, Nic and Hagen, Loni and Roytman, Stiven and Alnahass, Dana", title="Platform Effects on Public Health Communication: A Comparative and National Study of Message Design and Audience Engagement Across Twitter and Facebook", journal="JMIR Infodemiology", year="2022", month="Dec", day="20", volume="2", number="2", pages="e40198", keywords="platform effects", keywords="COVID-19", keywords="social media", keywords="health communication", keywords="message design", keywords="risk communication", keywords="Twitter", keywords="Facebook", keywords="user engagement", keywords="e-government", abstract="Background: Public health agencies widely adopt social media for health and risk communication. Moreover, different platforms have different affordances, which may impact the quality and nature of the messaging and how the public engages with the content. However, these platform effects are not often compared in studies of health and risk communication and not previously for the COVID-19 pandemic. Objective: This study measures the potential media effects of Twitter and Facebook on public health message design and engagement by comparing message elements and audience engagement in COVID-19--related posts by local, state, and federal public health agencies in the United States during the pandemic, to advance theories of public health messaging on social media and provide recommendations for tailored social media communication strategies. Methods: We retrieved all COVID-19--related posts from major US federal agencies related to health and infectious disease, all major state public health agencies, and selected local public health departments on Twitter and Facebook. A total of 100,785 posts related to COVID-19, from 179 different accounts of 96 agencies, were retrieved for the entire year of 2020. We adopted a framework of social media message elements to analyze the posts across Facebook and Twitter. For manual content analysis, we subsampled 1677 posts. We calculated the prevalence of various message elements across the platforms and assessed the statistical significance of differences. We also calculated and assessed the association between message elements with normalized measures of shares and likes for both Facebook and Twitter. Results: Distributions of message elements were largely similar across both sites. However, political figures (P<.001), experts (P=.01), and nonpolitical personalities (P=.01) were significantly more present on Facebook posts compared to Twitter. Infographics (P<.001), surveillance information (P<.001), and certain multimedia elements (eg, hyperlinks, P<.001) were more prevalent on Twitter. In general, Facebook posts received more (normalized) likes (0.19\%) and (normalized) shares (0.22\%) compared to Twitter likes (0.08\%) and shares (0.05\%). Elements with greater engagement on Facebook included expressives and collectives, whereas posts related to policy were more engaged with on Twitter. Science information (eg, scientific explanations) comprised 8.5\% (73/851) of Facebook and 9.4\% (78/826) of Twitter posts. Correctives of misinformation only appeared in 1.2\% (11/851) of Facebook and 1.4\% (12/826) of Twitter posts. Conclusions: In general, we find a data and policy orientation for Twitter messages and users and a local and personal orientation for Facebook, although also many similarities across platforms. Message elements that impact engagement are similar across platforms but with some notable distinctions. This study provides novel evidence for differences in COVID-19 public health messaging across social media sites, advancing knowledge of public health communication on social media and recommendations for health and risk communication strategies on these online platforms. ", doi="10.2196/40198", url="https://infodemiology.jmir.org/2022/2/e40198", url="http://www.ncbi.nlm.nih.gov/pubmed/36575712" } @Article{info:doi/10.2196/41198, author="Xu, Wayne Weiai and Tshimula, Marie Jean and Dub{\'e}, {\`E}ve and Graham, E. Janice and Greyson, Devon and MacDonald, E. Noni and Meyer, B. Samantha", title="Unmasking the Twitter Discourses on Masks During the COVID-19 Pandemic: User Cluster--Based BERT Topic Modeling Approach", journal="JMIR Infodemiology", year="2022", month="Dec", day="9", volume="2", number="2", pages="e41198", keywords="infoveillance", keywords="data analytics", keywords="Twitter", keywords="social media", keywords="user classification", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure's political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation. Objective: We aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework. Methods: We first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals. Results: This study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users. Conclusions: We conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts. ", doi="10.2196/41198", url="https://infodemiology.jmir.org/2022/2/e41198", url="http://www.ncbi.nlm.nih.gov/pubmed/36536763" } @Article{info:doi/10.2196/38441, author="Weeks, Rose and White, Sydney and Hartner, Anna-Maria and Littlepage, Shea and Wolf, Jennifer and Masten, Kristin and Tingey, Lauren", title="COVID-19 Messaging on Social Media for American Indian and Alaska Native Communities: Thematic Analysis of Audience Reach and Web Behavior", journal="JMIR Infodemiology", year="2022", month="Nov", day="25", volume="2", number="2", pages="e38441", keywords="COVID-19", keywords="American Indian or Alaska Native", keywords="social media", keywords="communication", keywords="tribal organization", keywords="community health", keywords="infodemiology", keywords="Twitter", keywords="online behavior", keywords="content analysis", keywords="thematic analysis", abstract="Background: During the COVID-19 pandemic, tribal and health organizations used social media to rapidly disseminate public health guidance highlighting protective behaviors such as masking and vaccination to mitigate the pandemic's disproportionate burden on American Indian and Alaska Native (AI/AN) communities. Objective: Seeking to provide guidance for future communication campaigns prioritizing AI/AN audiences, this study aimed to identify Twitter post characteristics associated with higher performance, measured by audience reach (impressions) and web behavior (engagement rate). Methods: We analyzed Twitter posts published by a campaign by the Johns Hopkins Center for Indigenous Health from July 2020 to June 2021. Qualitative analysis was informed by in-depth interviews with members of a Tribal Advisory Board and thematically organized according to the Health Belief Model. A general linearized model was used to analyze associations between Twitter post themes, impressions, and engagement rates. Results: The campaign published 162 Twitter messages, which organically generated 425,834 impressions and 6016 engagements. Iterative analysis of these Twitter posts identified 10 unique themes under theory- and culture-related categories of framing knowledge, cultural messaging, normalizing mitigation strategies, and interactive opportunities, which were corroborated by interviews with Tribal Advisory Board members. Statistical analysis of Twitter impressions and engagement rate by theme demonstrated that posts featuring culturally resonant community role models (P=.02), promoting web-based events (P=.002), and with messaging as part of Twitter Chats (P<.001) were likely to generate higher impressions. In the adjusted analysis controlling for the date of posting, only the promotion of web-based events (P=.003) and Twitter Chat messaging (P=.01) remained significant. Visual, explanatory posts promoting self-efficacy (P=.01; P=.01) and humorous posts (P=.02; P=.01) were the most likely to generate high--engagement rates in both the adjusted and unadjusted analysis. Conclusions: Results from the 1-year Twitter campaign provide lessons to inform organizations designing social media messages to reach and engage AI/AN social media audiences. The use of interactive events, instructional graphics, and Indigenous humor are promising practices to engage community members, potentially opening audiences to receiving important and time-sensitive guidance. ", doi="10.2196/38441", url="https://infodemiology.jmir.org/2022/2/e38441", url="http://www.ncbi.nlm.nih.gov/pubmed/36471705" } @Article{info:doi/10.2196/35663, author="Silva, Martha and Walker, Jonathan and Portillo, Erin and Dougherty, Leanne", title="Strengthening the Merci Mon H{\'e}ros Campaign Through Adaptive Management: Application of Social Listening Methodology", journal="JMIR Public Health Surveill", year="2022", month="Jun", day="28", volume="8", number="6", pages="e35663", keywords="social media", keywords="health communication", keywords="young people", keywords="reproductive health", abstract="Background: Between 2014 and 2018, the penetration of smartphones in sub-Saharan Africa increased from 10\% to 30\%, enabling increased access to the internet, Facebook, Twitter, Pinterest, and YouTube. These platforms engage users in multidirectional communication and provide public health programs with the tools to inform and engage diverse audiences on a range of public health issues, as well as monitor opinions and behaviors on health topics. Objective: This paper details the process used by the U.S. Agency for International Development--funded Breakthrough RESEARCH to apply social media monitoring and social listening techniques in Burkina Faso, C{\^o}te d'Ivoire, Niger, and Togo for the adaptive management of the Merci Mon H{\'e}ros campaign. We documented how these approaches were applied and how the lessons learned can be used to support future public health communication campaigns. Methods: The process involved 6 steps: (1) ensure there is a sufficient volume of topic-specific web-based conversation in the target countries; (2) develop measures to monitor the campaign's social media strategy; (3) identify search terms to assess campaign and related conversations; (4) quantitatively assess campaign audience demographics, campaign reach, and engagement through social media monitoring; (5) qualitatively assess audience attitudes, opinions, and behaviors and understand conversation context through social media listening; and (6) adapt campaign content and approach based on the analysis of social media data. Results: We analyzed posts across social media platforms from November 2019 to October 2020 based on identified key search terms related to family planning, reproductive health, menstruation, sexual activity, and gender. Based on the quantitative and qualitative assessments in steps 4 and 5, there were several adaptive shifts in the campaign's content and approach, of which the following 3 shifts are highlighted. (1) Social media monitoring identified that the Facebook campaign fans were primarily male, which prompted the campaign to target calls to action to the male audience already following the campaign and shift marketing approaches to increase the proportion of female followers. (2) Shorter videos had a higher chance of being viewed in their entirety. In response to this, the campaign shortened video lengths and created screenshot teasers to promote videos. (3) The most negative sentiment related to the campaign videos was associated with beliefs against premarital sex. In response to this finding, the campaign included videos and Facebook Live sessions with religious leaders who promoted talking openly with young people to support intergenerational discussion about reproductive health. Conclusions: Prior to launching health campaigns, programs should test the most relevant social media platforms and their limitations. Inherent biases to internet and social media access are important challenges, and ethical considerations around data privacy must continue to guide the advances in this technology's use for research. However, social listening and social media monitoring can be powerful monitoring and evaluation tools that can be used to aid the adaptive management of health campaigns that engage populations who have a digital presence. ", doi="10.2196/35663", url="https://publichealth.jmir.org/2022/6/e35663", url="http://www.ncbi.nlm.nih.gov/pubmed/35763319" } @Article{info:doi/10.2196/34940, author="Gomaa, Basma and Houghton, F. Rebecca and Crocker, Nicole and Walsh-Buhi, R. Eric", title="Skin Cancer Narratives on Instagram: Content Analysis", journal="JMIR Infodemiology", year="2022", month="Jun", day="2", volume="2", number="1", pages="e34940", keywords="digital health", keywords="social media", keywords="skin cancer", keywords="Instagram", keywords="melanoma", keywords="oncology", keywords="cancer", keywords="skin", keywords="content analysis", keywords="narrative", keywords="information sharing", keywords="online platform", abstract="Background: Skin cancer is among the deadliest forms of cancer in the United States. The American Cancer Society reported that 3 million skin cancer cases could be avoided every year if individuals are more aware of the risk factors related to sun exposure and prevention. Social media platforms may serve as potential intervention modalities that can be used to raise public awareness of several diseases and health conditions, including skin cancer. Social media platforms are efficient, cost-effective tools for health-related content that can reach a broad number of individuals who are already using these spaces in their day-to-day personal lives. Instagram was launched in 2010, and it is now used by 1 billion users, of which 90\% are under the age of 35 years. Despite previous research highlighting the potential of image-based platforms in skin cancer prevention and leveraging Instagram's popularity among the priority population to raise awareness, there is still a lack of studies describing skin cancer--related content on Instagram. Objective: This study aims to describe skin cancer--related content on Instagram, including the type of account; the characteristics of the content, such as the kind of media used; and the type of skin cancer discussed. This study also seeks to reveal content themes in terms of skin cancer risks, treatment, and prevention. Methods: Through CrowdTangle, a Facebook-owned tool, we retrieved content from publicly available accounts on Instagram for the 30 days preceding May 14, 2021. Out of 2932 posts, we randomly selected 1000 posts for review. Of the 1000 posts, 592 (59.2\%) met the following inclusion criteria: (1) content was focused on human skin cancer, (2) written in English language only, and (3) originated from the United States. Guided by previous research and through an iterative process, 2 undergraduate students independently coded the remaining posts. The 2 coders and a moderator met several times to refine the codebook. Results: Of the 592 posts, profiles representing organizations (n=321, 54.2\%) were slightly more common than individual accounts (n=256, 43.2\%). The type of media included in the posts varied, with posts containing photos occurring more frequently (n=315, 53.2\%) than posts containing infographics (n=233, 39.4\%) or videos (n=85, 14.4\%). Melanoma was the most mentioned type of skin cancer (n=252, 42.6\%). Prevention methods (n=404, 68.2\%) were discussed in Instagram posts more often than risk factors (n=271, 45.8\%). Only 81 out of 592 (13.7\%) posts provided a citation. Conclusions: This study's findings highlight the potential role of Instagram as a platform for improving awareness of skin cancer risks and the benefits of prevention practices. We believe that social media is the most promising venue for researchers and dermatologists to dedicate their efforts and presence that can widely reach the public to educate about skin cancer and empower prevention. ", doi="10.2196/34940", url="https://infodemiology.jmir.org/2022/1/e34940", url="http://www.ncbi.nlm.nih.gov/pubmed/37113805" } @Article{info:doi/10.2196/37632, author="McMann, J. Tiana and Calac, Alec and Nali, Matthew and Cuomo, Raphael and Maroulis, James and Mackey, K. Tim", title="Synthetic Cannabinoids in Prisons: Content Analysis of TikToks", journal="JMIR Infodemiology", year="2022", month="May", day="31", volume="2", number="1", pages="e37632", keywords="social media", keywords="substance use disorder", keywords="synthetic drugs", keywords="prison", keywords="cannabinoid", keywords="synthetic", keywords="psychoactive", keywords="illicit", keywords="video", keywords="substance use", keywords="harmful", keywords="K2/Spice", keywords="TikTok", abstract="Background: Synthetic cannabinoids are a significant public health concern, especially among incarcerated populations due to increased reports of abuse. Recent news reports have highlighted the severe consequences of K2/Spice, a synthetic cannabinoid, among the prison population in the United States. Despite regulations against cell phone use, inmates use TikTok to post K2/Spice-related content. Objective: This study aimed to examine TikTok posts for use and illicit distribution of psychoactive substances (eg, K2/Spice) among incarcerated populations. Methods: The study collected TikTok videos associated with the \#k2spice hashtag and used a data collection approach similar to snowball sampling. Inductive coding was used to conduct content analysis of video characteristics. Videos were manually annotated to generate binary classifications related to the use of K2/Spice as well as selling and buying activities associated with it. Statistical analysis was used to determine associations between a video's user engagement and an intent to buy or sell K2/Spice. Results: A total of 89 TikTok videos with the hashtag \#k2spice were manually coded, with 40\% (n=36) identified as displaying the use, solicitation, or adverse effects of K2/Spice among the prison population. Of them, 44.44\% (n=16) were in a prison-based setting documenting adverse effects including possible overdose. Videos with higher user engagement were positively correlated with comments indicating an intent to buy or sell K2/Spice. Conclusions: K2/Spice is a drug subject to abuse among prison inmates in the United States, including depictions of its harmful effects being recorded and shared on TikTok. Lack of policy enforcement on TikTok and the need for better access to treatment services within the prison system may be exacerbating substance use among this highly vulnerable population. Minimizing the potential individual harm of this content on the incarcerated population should be a priority for social media platforms and the criminal justice system alike. ", doi="10.2196/37632", url="https://infodemiology.jmir.org/2022/1/e37632", url="http://www.ncbi.nlm.nih.gov/pubmed/37113804" } @Article{info:doi/10.2196/30885, author="Grigsby-Toussaint, Diana and Champagne, Ashley and Uhr, Justin and Silva, Elizabeth and Noh, Madeline and Bradley, Adam and Rashleigh, Patrick", title="US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study", journal="JMIR Infodemiology", year="2022", month="Apr", day="20", volume="2", number="1", pages="e30885", keywords="Black maternal health", keywords="disparity", keywords="COVID-19", keywords="Twitter", keywords="topic modeling", keywords="digital humanities", keywords="infoveillance", keywords="maternal health", keywords="minority", keywords="women", keywords="advocacy", keywords="social media", keywords="model", keywords="trend", keywords="feasibility", abstract="Background: Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective: This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods: Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results: A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46\% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30\% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73\%, and discussions about creating space for Black women decreased by just under 30\%. Conclusions: The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts. ", doi="10.2196/30885", url="https://infodemiology.jmir.org/2022/1/e30885", url="http://www.ncbi.nlm.nih.gov/pubmed/35578642" } @Article{info:doi/10.2196/32449, author="Marshall, Christopher and Lanyi, Kate and Green, Rhiannon and Wilkins, C. Georgina and Pearson, Fiona and Craig, Dawn", title="Using Natural Language Processing to Explore Mental Health Insights From UK Tweets During the COVID-19 Pandemic: Infodemiology Study", journal="JMIR Infodemiology", year="2022", month="Mar", day="31", volume="2", number="1", pages="e32449", keywords="Twitter", keywords="mental health", keywords="COVID-19", keywords="sentiment", keywords="lockdown", keywords="soft intelligence", keywords="artificial intelligence", keywords="machine learning", keywords="natural language processing", abstract="Background: There is need to consider the value of soft intelligence, leveraged using accessible natural language processing (NLP) tools, as a source of analyzed evidence to support public health research outputs and decision-making. Objective: The aim of this study was to explore the value of soft intelligence analyzed using NLP. As a case study, we selected and used a commercially available NLP platform to identify, collect, and interrogate a large collection of UK tweets relating to mental health during the COVID-19 pandemic. Methods: A search strategy comprised of a list of terms related to mental health, COVID-19, and lockdown restrictions was developed to prospectively collate relevant tweets via Twitter's advanced search application programming interface over a 24-week period. We deployed a readily and commercially available NLP platform to explore tweet frequency and sentiment across the United Kingdom and identify key topics of discussion. A series of keyword filters were used to clean the initial data retrieved and also set up to track specific mental health problems. All collated tweets were anonymized. Results: We identified and analyzed 286,902 tweets posted from UK user accounts from July 23, 2020 to January 6, 2021. The average sentiment score was 50\%, suggesting overall neutral sentiment across all tweets over the study period. Major fluctuations in volume (between 12,622 and 51,340) and sentiment (between 25\% and 49\%) appeared to coincide with key changes to any local and/or national social distancing measures. Tweets around mental health were polarizing, discussed with both positive and negative sentiment. Key topics of consistent discussion over the study period included the impact of the pandemic on people's mental health (both positively and negatively), fear and anxiety over lockdowns, and anger and mistrust toward the government. Conclusions: Using an NLP platform, we were able to rapidly mine and analyze emerging health-related insights from UK tweets into how the pandemic may be impacting people's mental health and well-being. This type of real-time analyzed evidence could act as a useful intelligence source that agencies, local leaders, and health care decision makers can potentially draw from, particularly during a health crisis. ", doi="10.2196/32449", url="https://infodemiology.jmir.org/2022/1/e32449", url="http://www.ncbi.nlm.nih.gov/pubmed/36406146" } @Article{info:doi/10.2196/31732, author="Deiner, S. Michael and Seitzman, D. Gerami and Kaur, Gurbani and McLeod, D. Stephen and Chodosh, James and Lietman, M. Thomas and Porco, C. Travis", title="Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study", journal="JMIR Infodemiology", year="2022", month="Mar", day="16", volume="2", number="1", pages="e31732", keywords="COVID-19", keywords="pandemic", keywords="communicable disease", keywords="social distancing", keywords="infodemiology", keywords="Google Trends", keywords="influenza", keywords="conjunctivitis", keywords="ocular symptoms", keywords="seasonality", keywords="trend", keywords="online health information", keywords="information-seeking", abstract="Background: In a prior study at the start of the pandemic, we reported reduced numbers of Google searches for the term ``conjunctivitis'' in the United States in March and April 2020 compared with prior years. As one explanation, we conjectured that reduced information-seeking may have resulted from social distancing reducing contagious conjunctivitis cases. Here, after 1 year of continued implementation of social distancing, we asked if there have been persistent reductions in searches for ``conjunctivitis,'' and similarly for other communicable disease terms, compared to control terms. Objective: The aim of this study was to determine if reduction in searches in the United States for terms related to conjunctivitis and other common communicable diseases occurred in the spring-winter season of the COVID-19 pandemic, and to compare this outcome to searches for terms representing noncommunicable conditions, COVID-19, and to seasonality. Methods: Weekly relative search frequency volume data from Google Trends for 68 search terms in English for the United States were obtained for the weeks of March 2011 through February 2021. Terms were classified a priori as 16 terms related to COVID-19, 29 terms representing communicable conditions, and 23 terms representing control noncommunicable conditions. To reduce bias, all analyses were performed while masked to term names, classifications, and locations. To test for the significance of changes during the pandemic, we detrended and compared postpandemic values to those expected based on prepandemic trends, per season, computing one- and two-sided P values. We then compared these P values between term groups using Wilcoxon rank-sum and Fisher exact tests to assess if non-COVID-19 terms representing communicable diseases were more likely to show significant reductions in searches in 2020-2021 than terms not representing such diseases. We also assessed any relationship between a term's seasonality and a reduced search trend for the term in 2020-2021 seasons. P values were subjected to false discovery rate correction prior to reporting. Data were then unmasked. Results: Terms representing conjunctivitis and other communicable conditions showed a sustained reduced search trend in the first 4 seasons of the 2020-2021 COVID-19 pandemic compared to prior years. In comparison, the search for noncommunicable condition terms was significantly less reduced (Wilcoxon and Fisher exact tests, P<.001; summer, autumn, winter). A significant correlation was also found between reduced search for a term in 2020-2021 and seasonality of that term (Theil-Sen, P<.001; summer, autumn, winter). Searches for COVID-19--related conditions were significantly elevated compared to those in prior years, and searches for influenza-related terms were significantly lower than those for prior years in winter 2020-2021 (P<.001). Conclusions: We demonstrate the low-cost and unbiased use of online search data to study how a wide range of conditions may be affected by large-scale interventions or events such as social distancing during the COVID-19 pandemic. Our findings support emerging clinical evidence implicating social distancing and the COVID-19 pandemic in the reduction of communicable disease and on ocular conditions. ", doi="10.2196/31732", url="https://infodemiology.jmir.org/2022/1/e31732", url="http://www.ncbi.nlm.nih.gov/pubmed/35320981" } @Article{info:doi/10.2196/33029, author="Wong, Chun Frankie Ho and Leung, Yi Dara Kiu and Wong, Yan Edwin Lok and Liu, Tianyin and Lu, Shiyu and Chan, Fung On and Wong, Yan Gloria Hoi and Lum, Sang Terry Yat", title="The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey", journal="JMIR Infodemiology", year="2022", month="Feb", day="25", volume="2", number="1", pages="e33029", keywords="COVID-19", keywords="mental health", keywords="information technology", keywords="media trust", keywords="social media", keywords="Hong Kong", abstract="Background: Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an ``infodemic'' of overabundant and questionable information that has affected older adults' mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization's Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. Objective: This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. Methods: Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age?60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district--based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. Results: Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=--0.39, P=.002) and AFC-Communication Technology (b=--1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=--0.03, P=.002) and AFC-Communication Technology (b=--0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=--0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information {\texttimes} media trust b=--0.65, P<.001; AFC-Information {\texttimes} social media use b=--2.18, P<.001; 3-way interaction b=0.40, P=.003). Conclusions: Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults. ", doi="10.2196/33029", url="https://infodemiology.jmir.org/2022/1/e33029", url="http://www.ncbi.nlm.nih.gov/pubmed/35257090" } @Article{info:doi/10.2196/31259, author="Santarossa, Sara and Rapp, Ashley and Sardinas, Saily and Hussein, Janine and Ramirez, Alex and Cassidy-Bushrow, E. Andrea and Cheng, Philip and Yu, Eunice", title="Understanding the \#longCOVID and \#longhaulers Conversation on Twitter: Multimethod Study", journal="JMIR Infodemiology", year="2022", month="Feb", day="22", volume="2", number="1", pages="e31259", keywords="COVID-19", keywords="postacute sequela of COVID-19", keywords="PASC", keywords="patient-centered care", keywords="social media", keywords="social network analysis", keywords="long term", keywords="symptom", keywords="Twitter", keywords="communication", keywords="insight", keywords="perception", keywords="experience", keywords="patient-centered", abstract="Background: The scientific community is just beginning to uncover the potential long-term effects of COVID-19, and one way to start gathering information is by examining the present discourse on the topic. The conversation about long COVID-19 on Twitter provides insight into related public perception and personal experiences. Objective: The aim of this study was to investigate the \#longCOVID and \#longhaulers conversations on Twitter by examining the combined effects of topic discussion and social network analysis for discovery on long COVID-19. Methods: A multipronged approach was used to analyze data (N=2500 records from Twitter) about long COVID-19 and from people experiencing long COVID-19. A text analysis was performed by both human coders and Netlytic, a cloud-based text and social networks analyzer. The social network analysis generated Name and Chain networks that showed connections and interactions between Twitter users. Results: Among the 2010 tweets about long COVID-19 and 490 tweets by COVID-19 long haulers, 30,923 and 7817 unique words were found, respectively. For both conversation types, ``\#longcovid'' and ``covid'' were the most frequently mentioned words; however, through visually inspecting the data, words relevant to having long COVID-19 (ie, symptoms, fatigue, pain) were more prominent in tweets by COVID-19 long haulers. When discussing long COVID-19, the most prominent frames were ``support'' (1090/1931, 56.45\%) and ``research'' (435/1931, 22.53\%). In COVID-19 long haulers conversations, ``symptoms'' (297/483, 61.5\%) and ``building a community'' (152/483, 31.5\%) were the most prominent frames. The social network analysis revealed that for both tweets about long COVID-19 and tweets by COVID-19 long haulers, networks are highly decentralized, fragmented, and loosely connected. Conclusions: This study provides a glimpse into the ways long COVID-19 is framed by social network users. Understanding these perspectives may help generate future patient-centered research questions. ", doi="10.2196/31259", url="https://infodemiology.jmir.org/2022/1/e31259", url="http://www.ncbi.nlm.nih.gov/pubmed/35229074" } @Article{info:doi/10.2196/31473, author="Lwin, O. May and Sheldenkar, Anita and Lu, Jiahui and Schulz, Johannes Peter and Shin, Wonsun and Panchapakesan, Chitra and Gupta, Kumar Raj and Yang, Yinping", title="The Evolution of Public Sentiments During the COVID-19 Pandemic: Case Comparisons of India, Singapore, South Korea, the United Kingdom, and the United States", journal="JMIR Infodemiology", year="2022", month="Feb", day="10", volume="2", number="1", pages="e31473", keywords="COVID-19", keywords="public sentiment", keywords="Twitter", keywords="crisis communication", keywords="cross-country comparison", keywords="sentiment", keywords="social media", keywords="communication", keywords="public health", keywords="health information", keywords="emotion", keywords="perception", keywords="health literacy", keywords="information literacy", keywords="digital literacy", keywords="community health", abstract="Background: Public sentiments are an important indicator of crisis response, with the need to balance exigency without adding to panic or projecting overconfidence. Given the rapid spread of the COVID-19 pandemic, governments have enacted various nationwide measures against the disease with social media platforms providing the previously unparalleled communication space for the global populations. Objective: This research aims to examine and provide a macro-level narrative of the evolution of public sentiments on social media at national levels, by comparing Twitter data from India, Singapore, South Korea, the United Kingdom, and the United States during the current pandemic. Methods: A total of 67,363,091 Twitter posts on COVID-19 from January 28, 2020, to April 28, 2021, were analyzed from the 5 countries with ``wuhan,'' ``corona,'' ``nCov,'' and ``covid'' as search keywords. Change in sentiments (``very negative,'' ``negative,'' ``neutral or mixed,'' ``positive,'' ``very positive'') were compared between countries in connection with disease milestones and public health directives. Results: Country-specific assessments show that negative sentiments were predominant across all 5 countries during the initial period of the global pandemic. However, positive sentiments encompassing hope, resilience, and support arose at differing intensities across the 5 countries, particularly in Asian countries. In the next stage of the pandemic, India, Singapore, and South Korea faced escalating waves of COVID-19 cases, resulting in negative sentiments, but positive sentiments appeared simultaneously. In contrast, although negative sentiments in the United Kingdom and the United States increased substantially after the declaration of a national public emergency, strong parallel positive sentiments were slow to surface. Conclusions: Our findings on sentiments across countries facing similar outbreak concerns suggest potential associations between government response actions both in terms of policy and communications, and public sentiment trends. Overall, a more concerted approach to government crisis communication appears to be associated with more stable and less volatile public sentiments over the evolution of the COVID-19 pandemic. ", doi="10.2196/31473", url="https://infodemiology.jmir.org/2022/1/e31473", url="http://www.ncbi.nlm.nih.gov/pubmed/37113803" } @Article{info:doi/10.2196/30962, author="Lungu, Adrian Daniel and R{\o}islien, Jo and Wiig, Siri and Shortt, Therese Marie and Ferr{\`e}, Francesca and Berg, Hilde Siv and Thune, Henriette and Br{\o}nnick, Kallesten Kolbj{\o}rn", title="The Role of Recipient Characteristics in Health Video Communication Outcomes: Scoping Review", journal="J Med Internet Res", year="2021", month="Dec", day="30", volume="23", number="12", pages="e30962", keywords="health communication", keywords="video communication", keywords="communication outcomes", keywords="recipient characteristics", keywords="recipient factors", keywords="health video communication", abstract="Background: The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. Objective: The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? Methods: A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. Results: Of the 1040 documents initially identified, 128 (12.31\%) met the criteria for full-text assessment, and 39 (3.75\%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. Conclusions: Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication. ", doi="10.2196/30962", url="https://www.jmir.org/2021/12/e30962", url="http://www.ncbi.nlm.nih.gov/pubmed/34967758" } @Article{info:doi/10.2196/31671, author="Kahanek, Alexander and Yu, Xinchen and Hong, Lingzi and Cleveland, Ana and Philbrick, Jodi", title="Temporal Variations and Spatial Disparities in Public Sentiment Toward COVID-19 and Preventive Practices in the United States: Infodemiology Study of Tweets", journal="JMIR Infodemiology", year="2021", month="Dec", day="30", volume="1", number="1", pages="e31671", keywords="COVID-19", keywords="preventive practices", keywords="temporal variations", keywords="spatial disparities", keywords="Twitter", keywords="public sentiment", keywords="socioeconomic factors", abstract="Background: During the COVID-19 pandemic, US public health authorities and county, state, and federal governments recommended or ordered certain preventative practices, such as wearing masks, to reduce the spread of the disease. However, individuals had divergent reactions to these preventive practices. Objective: The purpose of this study was to understand the variations in public sentiment toward COVID-19 and the recommended or ordered preventive practices from the temporal and spatial perspectives, as well as how the variations in public sentiment are related to geographical and socioeconomic factors. Methods: The authors leveraged machine learning methods to investigate public sentiment polarity in COVID-19--related tweets from January 21, 2020 to June 12, 2020. The study measured the temporal variations and spatial disparities in public sentiment toward both general COVID-19 topics and preventive practices in the United States. Results: In the temporal analysis, we found a 4-stage pattern from high negative sentiment in the initial stage to decreasing and low negative sentiment in the second and third stages, to the rebound and increase in negative sentiment in the last stage. We also identified that public sentiment to preventive practices was significantly different in urban and rural areas, while poverty rate and unemployment rate were positively associated with negative sentiment to COVID-19 issues. Conclusions: The differences between public sentiment toward COVID-19 and the preventive practices imply that actions need to be taken to manage the initial and rebound stages in future pandemics. The urban and rural differences should be considered in terms of the communication strategies and decision making during a pandemic. This research also presents a framework to investigate time-sensitive public sentiment at the county and state levels, which could guide local and state governments and regional communities in making decisions and developing policies in crises. ", doi="10.2196/31671", url="https://infodemiology.jmir.org/2021/1/e31671", url="http://www.ncbi.nlm.nih.gov/pubmed/35013722" } @Article{info:doi/10.2196/33331, author="Yang, S. Joshua and Cuomo, E. Raphael and Purushothaman, Vidya and Nali, Matthew and Shah, Neal and Bardier, Cortni and Obradovich, Nick and Mackey, Tim", title="Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study", journal="JMIR Form Res", year="2021", month="Dec", day="24", volume="5", number="12", pages="e33331", keywords="tobacco-free policies", keywords="social media", keywords="colleges and universities", keywords="smoking", keywords="smoking policy", keywords="campus policy", keywords="tobacco use", keywords="Twitter analysis", keywords="smoke-free", keywords="tobacco-free", keywords="Twitter", keywords="college students", keywords="students", keywords="campus", keywords="health policy", abstract="Background: The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement. Objective: The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies. Methods: Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status. Results: The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7\% vs 66.4\%, P=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one's own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities. Conclusions: Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one's own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment. ", doi="10.2196/33331", url="https://formative.jmir.org/2021/12/e33331", url="http://www.ncbi.nlm.nih.gov/pubmed/34951597" } @Article{info:doi/10.2196/31056, author="Bonner, Carissa and Batcup, Carys and Cornell, Samuel and Fajardo, Anthony Michael and Hawkes, L. Anna and Trevena, Lyndal and Doust, Jenny", title="Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects", journal="JMIR Cardio", year="2021", month="Nov", day="5", volume="5", number="2", pages="e31056", keywords="heart age", keywords="cardiovascular disease", keywords="risk assessment", keywords="risk communication", keywords="prevention", abstract="Background: Cardiovascular disease (CVD) risk communication is a challenge for clinical practice, where physicians find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to heart age is increasingly used to promote lifestyle change, but a rapid review of biological age interventions found no clear evidence that they motivate behavior change. Objective: In this review, we aim to identify the content and effects of heart age interventions. Methods: We conducted a systematic review of studies presenting heart age interventions to adults for CVD risk communication in April 2020 (later updated in March 2021). The Johanna Briggs risk of bias assessment tool was applied to randomized studies. Behavior change techniques described in the intervention methods were coded. Results: From a total of 7926 results, 16 eligible studies were identified; these included 5 randomized web-based experiments, 5 randomized clinical trials, 2 mixed methods studies with quantitative outcomes, and 4 studies with qualitative analysis. Direct comparisons between heart age and absolute risk in the 5 web-based experiments, comprising 5514 consumers, found that heart age increased positive or negative emotional responses (4/5 studies), increased risk perception (4/5 studies; but not necessarily more accurate) and recall (4/4 studies), reduced credibility (2/3 studies), and generally had no effect on lifestyle intentions (4/5 studies). One study compared heart age and absolute risk to fitness age and found reduced lifestyle intentions for fitness age. Heart age combined with additional strategies (eg, in-person or phone counseling) in applied settings for 9582 patients improved risk control (eg, reduced cholesterol levels and absolute risk) compared with usual care in most trials (4/5 studies) up to 1 year. However, clinical outcomes were no different when directly compared with absolute risk (1/1 study). Mixed methods studies identified consultation time and content as important outcomes in actual consultations using heart age tools. There were differences between people receiving an older heart age result and those receiving a younger or equal to current heart age result. The heart age interventions included a wide range of behavior change techniques, and conclusions were sometimes biased in favor of heart age with insufficient supporting evidence. The risk of bias assessment indicated issues with all randomized clinical trials. Conclusions: The findings of this review provide little evidence that heart age motivates lifestyle behavior change more than absolute risk, but either format can improve clinical outcomes when combined with other behavior change strategies. The label for the heart age concept can affect outcomes and should be pretested with the intended audience. Future research should consider consultation time and differentiate between results of older and younger heart age. International Registered Report Identifier (IRRID): NPRR2-10.1101/2020.05.03.20089938 ", doi="10.2196/31056", url="https://cardio.jmir.org/2021/2/e31056", url="http://www.ncbi.nlm.nih.gov/pubmed/34738908" } @Article{info:doi/10.2196/28344, author="Rabbani, Golam Md and Akter, Orin and Hasan, Zahid Md and Samad, Nandeeta and Mahmood, Shaila Shehrin and Joarder, Taufique", title="COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey", journal="JMIR Form Res", year="2021", month="Nov", day="5", volume="5", number="11", pages="e28344", keywords="COVID-19", keywords="knowledge", keywords="attitude", keywords="practice", keywords="risk communication and community engagement", keywords="social and behavior change communication", keywords="Bangladesh", keywords="risk", keywords="pandemic", keywords="risk communication", abstract="Background: The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public's knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people's knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively. Objective: This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants. Methods: We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19. Results: A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4\% (492/576). Of the 492 participants, 321 (65.2\%) were male, and 304 (61.8\%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5\%) had poor knowledge, and 251 (49\%) expressed a negative attitude; 192 out of 359 respondents (53.5\%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7\%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73\%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95\% CI 2.03-4.83, and adjusted OR 2.33, 95\% CI 1.16-4.68) and a positive attitude (OR 2.43, 95\% CI 1.59-3.72, and adjusted OR 3.87, 95\% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures. Conclusions: Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups. ", doi="10.2196/28344", url="https://formative.jmir.org/2021/11/e28344", url="http://www.ncbi.nlm.nih.gov/pubmed/34519660" } @Article{info:doi/10.2196/33653, author="Spitale, Giovanni and Merten, Sonja and Jafflin, Kristen and Schwind, Bettina and Kaiser-Grolimund, Andrea and Biller-Andorno, Nikola", title="A Novel Risk and Crisis Communication Platform to Bridge the Gap Between Policy Makers and the Public in the Context of the COVID-19 Crisis (PubliCo): Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="1", volume="10", number="11", pages="e33653", keywords="disease outbreaks", keywords="coronavirus", keywords="COVID-19 surveys", keywords="COVID-19 questionnaires", keywords="qualitative methods", keywords="health literacy", keywords="policy making", keywords="risk and crisis communication", keywords="COVID-19", abstract="Background: Since the end of 2019, COVID-19 has had a significant impact on people around the globe. As governments institute more restrictive measures, public adherence could decrease and discontent may grow. Providing high-quality information and countering fake news are important. However, we also need feedback loops so that government officials can refine preventive measures and communication strategies. Policy makers need information---preferably based on real-time data---on people's cognitive, emotional, and behavioral reactions to public health messages and restrictive measures. PubliCo aims to foster effective and tailored risk and crisis communication as well as provide an assessment of the risks and benefits of prevention and control measures, since their effectiveness depends on public trust and cooperation. Objective: Our project aims to develop a tool that helps tackle the COVID-19 infodemic, with a focus on enabling a nuanced and in-depth understanding of public perception. The project adopts a transdisciplinary multistakeholder approach, including participatory citizen science. Methods: We aim to combine a literature and media review and analysis as well as empirical research using mixed methods, including an online survey and diary-based research, both of which are ongoing and continuously updated. Building on real-time data and continuous data collection, our research results will be highly adaptable to the evolving situation. Results: As of September 2021, two-thirds of the proposed tool is operational. The current development cycles are focusing on analytics, user experience, and interface refinement. We have collected a total of 473 responses through PubliCo Survey and 22 diaries through PubliCo Diaries. Conclusions: Pilot data show that PubliCo is a promising and efficient concept for bidirectional risk and crisis communication in the context of public health crises. Further data are needed to assess its function at a larger scale or in the context of an issue other than COVID-19. International Registered Report Identifier (IRRID): DERR1-10.2196/33653 ", doi="10.2196/33653", url="https://www.researchprotocols.org/2021/11/e33653", url="http://www.ncbi.nlm.nih.gov/pubmed/34612823" } @Article{info:doi/10.2196/30449, author="Baker, Venetia and Arnold, Georgia and Piot, Sara and Thwala, Lesedi and Glynn, Judith and Hargreaves, James and Birdthistle, Isolde", title="Young Adults' Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement", journal="JMIR Form Res", year="2021", month="Oct", day="29", volume="5", number="10", pages="e30449", keywords="COVID-19", keywords="adolescents", keywords="young people", keywords="social media", keywords="edutainment", abstract="Background: In April 2020, as cases of the novel COVID-19 spread across the globe, MTV Staying Alive Foundation created the educational entertainment miniseries MTV Shuga: Alone Together. In 70 short episodes released daily on YouTube, Alone Together aimed to disseminate timely and accurate information to increase young people's knowledge, motivation, and actions to prevent COVID-19. Objective: We sought to identify Alone Together viewer's perspectives on the global COVID-19 pandemic and national lockdowns by examining the words, conversations, experiences, and emotions expressed on social media in response to the Alone Together episodes. We also assessed how viewers used the series and its online community as a source of support during the global pandemic. Methods: A total of 3982 comments and 70 live chat conversations were extracted from YouTube between April and October 2020 and analyzed through a data-led inductive thematic approach. Aggregated demographic and geographical data were collected using YouTube Analytics. Results: The miniseries had a global reach across 5 continents, with a total of 7.7 million views across MTV Shuga platforms. The series had over 1 million views over 70 episodes on YouTube and an average of 5683 unique viewers per episode on YouTube. The dominant audience was adults under the age of 35 years and women. Across diverse countries such as Nigeria, Ghana, the United States, and the UK, viewers believed that COVID-19 was serious and expressed that it was socially responsible to follow public health measures. Storylines of the series about the impact of self-isolation on mental health, exposure to violence in lockdowns, and restricted employment opportunities due to the pandemic resonated with young viewers. Tuning in to the miniseries provided viewers with reliable information, entertainment, and an online community during an isolating, confusing, and worrying time. Conclusions: During the first wave of COVID-19, viewers from at least 53 countries connected on social media via the MTV miniseries. The analysis showed how digitally connected people under the age of 35 years, predominantly women, felt compelled to follow COVID-19 safety measures despite the pandemic's impact on their social, educational, and financial needs. Viewers used social media to reach out to fellow viewers for advice, solace, support, and resources. Organizations, governments, and individuals have been forced to innovate during the pandemic to ensure people can access services safely and remotely. This analysis showed that women under 35 years of age were especially receptive to receiving support from online communities and media services. Peer influence and support online can be a powerful public health tool as people have a great capacity to influence each other and shape norms around public health. However, online services are not accessible to everyone, and COVID-19 has increased disparities between digitally connected and unconnected younger adults. ", doi="10.2196/30449", url="https://formative.jmir.org/2021/10/e30449", url="http://www.ncbi.nlm.nih.gov/pubmed/34596568" } @Article{info:doi/10.2196/20970, author="Anderson, Elizabeth and Koss, Mary and Castro Luque, Luc{\'i}a Ana and Garcia, David and Lopez, Elise and Ernst, Kacey", title="WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality", journal="JMIR Form Res", year="2021", month="Oct", day="28", volume="5", number="10", pages="e20970", keywords="WhatsApp", keywords="synchronous text-based focus groups", keywords="Zika", keywords="Mexican-origin Latinas", keywords="social media", keywords="mHealth", keywords="focus groups", keywords="smartphones", keywords="mobile phone", abstract="Background: Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain. Objective: This study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups. Methods: A pilot focus group was conducted with Spanish-speaking women near the US--Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy. Results: Evidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days. Conclusions: The findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods. ", doi="10.2196/20970", url="https://formative.jmir.org/2021/10/e20970", url="http://www.ncbi.nlm.nih.gov/pubmed/34709185" } @Article{info:doi/10.2196/25659, author="Vromans, D. Ruben and van Eenbergen, C. Mies and Geleijnse, Gijs and Pauws, Steffen and van de Poll-Franse, V. Lonneke and Krahmer, J. Emiel", title="Exploring Cancer Survivor Needs and Preferences for Communicating Personalized Cancer Statistics From Registry Data: Qualitative Multimethod Study", journal="JMIR Cancer", year="2021", month="Oct", day="25", volume="7", number="4", pages="e25659", keywords="breast cancer", keywords="cancer statistics", keywords="personalization", keywords="prostate cancer", keywords="risk communication", keywords="cancer registry", keywords="cancer", keywords="patient needs and preferences", abstract="Background: Disclosure of cancer statistics (eg, survival or incidence rates) based on a representative group of patients can help increase cancer survivors' understanding of their own diagnostic and prognostic situation, and care planning. More recently, there has been an increasing interest in the use of cancer registry data for disclosing and communicating personalized cancer statistics (tailored toward personal and clinical characteristics) to cancer survivors and relatives. Objective: The aim of this study was to explore breast cancer (BCa) and prostate cancer (PCa) survivor needs and preferences for disclosing (what) and presenting (how) personalized statistics from a large Dutch population-based data set, the Netherlands Cancer Registry (NCR). Methods: To elicit survivor needs and preferences for communicating personalized NCR statistics, we created different (non)interactive tools visualizing hypothetical scenarios and adopted a qualitative multimethod study design. We first conducted 2 focus groups (study 1; n=13) for collecting group data on BCa and PCa survivor needs and preferences, using noninteractive sketches of what a tool for communicating personalized statistics might look like. Based on these insights, we designed a revised interactive tool, which was used to further explore the needs and preferences of another group of cancer survivors during individual think-aloud observations and semistructured interviews (study 2; n=11). All sessions were audio-recorded, transcribed verbatim, analyzed using thematic (focus groups) and content analysis (think-aloud observations), and reported in compliance with qualitative research reporting criteria. Results: In both studies, cancer survivors expressed the need to receive personalized statistics from a representative source, with especially a need for survival and conditional survival rates (ie, survival rate for those who have already survived for a certain period). Personalized statistics adjusted toward personal and clinical factors were deemed more relevant and useful to know than generic or average-based statistics. Participants also needed support for correctly interpreting the personalized statistics and putting them into perspective, for instance by adding contextual or comparative information. Furthermore, while thinking aloud, participants experienced a mix of positive (sense of hope) and negative emotions (feelings of distress) while viewing the personalized survival data. Overall, participants preferred simplicity and conciseness, and the ability to tailor the type of visualization and amount of (detailed) statistical information. Conclusions: The majority of our sample of cancer survivors wanted to receive personalized statistics from the NCR. Given the variation in patient needs and preferences for presenting personalized statistics, designers of similar information tools may consider potential tailoring strategies on multiple levels, as well as effective ways for providing supporting information to make sure that the personalized statistics are properly understood. This is encouraging for cancer registries to address this unmet need, but also for those who are developing or implementing personalized data-driven information tools for patients and relatives. ", doi="10.2196/25659", url="https://cancer.jmir.org/2021/4/e25659", url="http://www.ncbi.nlm.nih.gov/pubmed/34694237" } @Article{info:doi/10.2196/31733, author="Gold, Rachel and Sheppler, Christina and Hessler, Danielle and Bunce, Arwen and Cottrell, Erika and Yosuf, Nadia and Pisciotta, Maura and Gunn, Rose and Leo, Michael and Gottlieb, Laura", title="Using Electronic Health Record--Based Clinical Decision Support to Provide Social Risk--Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool", journal="JMIR Res Protoc", year="2021", month="Oct", day="8", volume="10", number="10", pages="e31733", keywords="social determinants of health", keywords="decision support systems, clinical", keywords="electronic health records", keywords="community health centers", keywords="health status disparities", abstract="Background: Consistent and compelling evidence demonstrates that social and economic adversity has an impact on health outcomes. In response, many health care professional organizations recommend screening patients for experiences of social and economic adversity or social risks---for example, food, housing, and transportation insecurity---in the context of care. Guidance on how health care providers can act on documented social risk data to improve health outcomes is nascent. A strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients' social risks. Objective: This study's aims are to develop electronic health record (EHR)--based clinical decision support (CDS) tools that suggest social risk--informed care plan adaptations for patients with diabetes or hypertension, assess tool adoption and its impact on selected clinical quality measures in community health centers, and examine perceptions of tool usability and impact on care quality. Methods: A systematic scoping review and several stakeholder activities will be conducted to inform development of the CDS tools. The tools will be pilot-tested to obtain user input, and their content and form will be revised based on this input. A randomized quasi-experimental design will then be used to assess the impact of the revised tools. Eligible clinics will be randomized to a control group or potential intervention group; clinics will be recruited from the potential intervention group in random order until 6 are enrolled in the study. Intervention clinics will have access to the CDS tools in their EHR, will receive minimal implementation support, and will be followed for 18 months to evaluate tool adoption and the impact of tool use on patient blood pressure and glucose control. Results: This study was funded in January 2020 by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Formative activities will take place from April 2020 to July 2021, the CDS tools will be developed between May 2021 and November 2022, the pilot study will be conducted from August 2021 to July 2022, and the main trial will occur from December 2022 to May 2024. Study data will be analyzed, and the results will be disseminated in 2024. Conclusions: Patients' social risk information must be presented to care teams in a way that facilitates social risk--informed care. To our knowledge, this study is the first to develop and test EHR-embedded CDS tools designed to support the provision of social risk--informed care. The study results will add a needed understanding of how to use social risk data to improve health outcomes and reduce disparities. International Registered Report Identifier (IRRID): PRR1-10.2196/31733 ", doi="10.2196/31733", url="https://www.researchprotocols.org/2021/10/e31733", url="http://www.ncbi.nlm.nih.gov/pubmed/34623308" } @Article{info:doi/10.2196/28957, author="Sharp, J. Kendall and Vitagliano, A. Julia and Weitzman, R. Elissa and Fitzgerald, Susan and Dahlberg, E. Suzanne and Austin, Bryn S.", title="Peer-to-Peer Social Media Communication About Dietary Supplements Used for Weight Loss and Sports Performance Among Military Personnel: Pilot Content Analysis of 11 Years of Posts on Reddit", journal="JMIR Form Res", year="2021", month="Oct", day="4", volume="5", number="10", pages="e28957", keywords="dietary supplements", keywords="social media", keywords="Reddit", keywords="OPSS", abstract="Background: Over 60\% of military personnel in the United States currently use dietary supplements. Two types of dietary supplements, weight loss and sports performance (WLSP) supplements, are commonly used by military personnel despite the associated serious adverse effects such as dehydration and stroke. Objective: To understand peer-to-peer communication about WLSP supplements among military personnel, we conducted a pilot study using the social media website, Reddit. Methods: A total of 64 relevant posts and 243 comments from 2009 to 2019 were collected from 6 military subreddits. The posts were coded for year of posting, subreddit, and content consistent with the following themes: resources about supplement safety and regulation, discernability of supplement use through drug testing, serious adverse effects, brand names or identifiers, and reasons for supplement use. Results: A primary concern posted by personnel who used supplements was uncertainty about the supplements that were not detectable on a drug test. Supplements to improve workout performance were the most frequently used. Conclusions: Our pilot study suggests that military personnel may seek out peer advice about WLSP supplements on Reddit and spread misinformation about the safety and effectiveness of these products through this platform. Future directions for the monitoring of WLSP supplement use in military personnel are discussed. ", doi="10.2196/28957", url="https://formative.jmir.org/2021/10/e28957", url="http://www.ncbi.nlm.nih.gov/pubmed/34605769" } @Article{info:doi/10.2196/27634, author="Ainiwaer, Abidan and Zhang, Shuai and Ainiwaer, Xiayiabasi and Ma, Feicheng", title="Effects of Message Framing on Cancer Prevention and Detection Behaviors, Intentions, and Attitudes: Systematic Review and Meta-analysis", journal="J Med Internet Res", year="2021", month="Sep", day="16", volume="23", number="9", pages="e27634", keywords="gain framing", keywords="loss framing", keywords="attitude", keywords="intention", keywords="behaviors", keywords="cancer prevention", keywords="cancer detection", abstract="Background: With the increasing health care burden of cancer, public health organizations are increasingly emphasizing the importance of calling people to engage in long-term prevention and periodical detection. How to best deliver behavioral recommendations and health outcomes in messaging is an important issue. Objective: This study aims to disaggregate the effects of gain-framed and loss-framed messages on cancer prevention and detection behaviors and intentions and attitudes, which has the potential to inform cancer control programs. Methods: A search of three electronic databases (Web of Science, Scopus, and PubMed) was conducted for studies published between January 2000 and December 2020. After a good agreement achieved on a sample by two authors, the article selection ($\kappa$=0.8356), quality assessment ($\kappa$=0.8137), and data extraction ($\kappa$=0.9804) were mainly performed by one author. The standardized mean difference (attitude and intention) and the odds ratio (behaviors) were calculated to evaluate the effectiveness of message framing (gain-framed message and loss-framed message). Calculations were conducted, and figures were produced by Review Manager 5.3. Results: The title and abstract of 168 unique citations were scanned, of which 53 were included for a full-text review. A total of 24 randomized controlled trials were included, predominantly examining message framing on cancer prevention and detection behavior change interventions. There were 9 studies that used attitude to predict message framing effect and 16 studies that used intention, whereas 6 studies used behavior to examine the message framing effect directly. The use of loss-framed messages improved cancer detection behavior (OR 0.76, 95\% CI 0.64-0.90; P=.001), and the results from subgroup analysis indicated that the effect would be weak with time. No effect of framing was found when effectiveness was assessed by attitudes (prevention: SMD=0.02, 95\% CI --0.13 to 0.17; P=.79; detection: SMD=--0.05, 95\% CI --0.15 to 0.05; P=.32) or intentions (prevention: SMD=--0.05, 95\% CI --0.19 to 0.09; P=.48; detection: SMD=0.02, 95\% CI --0.26 to 0.29; P=.92) among studies encouraging cancer prevention and cancer detection. Conclusions: Research has shown that it is almost impossible to change people's attitudes or intentions about cancer prevention and detection with a gain-framed or loss-framed message. However, loss-framed messages have achieved preliminary success in persuading people to adopt cancer detection behaviors. Future studies could improve the intervention design to achieve better intervention effectiveness. ", doi="10.2196/27634", url="https://www.jmir.org/2021/9/e27634", url="http://www.ncbi.nlm.nih.gov/pubmed/34528887" } @Article{info:doi/10.2196/30164, author="Ladapo, A. Joseph and Rothwell, T. Jonathan and Ramirez, M. Christina", title="Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study", journal="JMIR Form Res", year="2021", month="Aug", day="30", volume="5", number="8", pages="e30164", keywords="COVID-19", keywords="pandemic", keywords="mental health", keywords="public health", keywords="isolation", keywords="loneliness", keywords="guideline", keywords="risk", keywords="perception", keywords="United States", keywords="health risk", keywords="well-being", abstract="Background: Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the COVID-19 pandemic. Objective: The goal of this study was to examine the association of COVID-19 risk misperceptions with self-reported household isolation, a potential risk factor for social isolation and loneliness. Methods: We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July to December 2020) of 24,649 US adults. We also analyzed data from the Gallup Panel (March 2020 to February 2021), which included 123,516 observations about loneliness. The primary outcome was self-reported household isolation, which we defined as a respondent having no contact or very little contact with people outside their household, analogous to quarantining. Results: From July to December 2020, 53\% to 57\% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years old accounted for 7\% of total US deaths, respondents estimated that this population represented 43\% of deaths. Overestimating COVID-19 health risks was associated with increased self-reported household isolation, with percentage differences ranging from 5.6 to 11.8 (P<.001 at each time point). Characteristics associated with self-reported household isolation from the July and August 2020 surveys and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, self-reported household isolation was associated with a higher prevalence of loneliness. Conclusions: Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines. ", doi="10.2196/30164", url="https://formative.jmir.org/2021/8/e30164", url="http://www.ncbi.nlm.nih.gov/pubmed/34253507" } @Article{info:doi/10.2196/27824, author="van de Water, F. Lo{\"i}s and van den Boorn, G. H{\'e}ctor and Hoxha, Florian and Henselmans, Inge and Calff, M. Mart and Sprangers, G. Mirjam A. and Abu-Hanna, Ameen and Smets, A. Ellen M. and van Laarhoven, M. Hanneke W.", title="Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study", journal="J Med Internet Res", year="2021", month="Aug", day="27", volume="23", number="8", pages="e27824", keywords="prediction tool", keywords="communication skills training", keywords="shared decision-making", keywords="risk communication", keywords="treatment outcomes", keywords="esophageal cancer", keywords="gastric cancer", keywords="patient-physician communication", abstract="Background: Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. Objective: This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. Methods: We designed a web-based, physician-assisted prediction tool---Source---to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds---a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. Results: The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. Conclusions: The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making. ", doi="10.2196/27824", url="https://www.jmir.org/2021/8/e27824", url="http://www.ncbi.nlm.nih.gov/pubmed/34448703" } @Article{info:doi/10.2196/25242, author="Patel, Janhavi and Desai, Harsheev and Okhowat, Ali", title="The Role of the Canadian Media During the Initial Response to the COVID-19 Pandemic: A Topic Modelling Approach Using Canadian Broadcasting Corporation News Articles", journal="JMIR Infodemiology", year="2021", month="Jul", day="18", volume="1", number="1", pages="e25242", keywords="COVID-19", keywords="topic modelling", keywords="LDA", keywords="health communication", keywords="mass media", keywords="coronavirus", keywords="media", keywords="dissemination", keywords="online health information", keywords="public health", abstract="Background: Beginning as a local epidemic, COVID-19 has since rapidly evolved into a pandemic. As countries around the world battle this outbreak, mass media has played an active role in disseminating public health information. Objective: The aim of this study was to get a better understanding of the role that the Canadian media played during the pandemic and to investigate the patterns of topics covered by media news reporting. Methods: We used a data set consisting of news articles published on the Canadian Broadcasting Corporation (CBC) website between December 2019 and May 2020. We then used Python software to analyze the data using Latent Dirichlet Allocation topic modelling. Subsequently, we used the pyLDAvis tool to plot these topics on a 2D plane through multidimensional scaling and divided these topics into different themes. Results: After removing articles that were published before the year 2019, we identified 6771 relevant news articles. According to the CV coherence value, we divided these articles into 15 topics, which were categorized into 6 themes. The three most popular themes were case reporting and testing (n=1738), Canadian response to the pandemic (n=1259), and changes to social life (n=1171), which accounted for 25.67\%, 18.59\%, and 17.29\% of the total articles, respectively. Conclusions: Understanding the Canadian media's reporting on the COVID-19 pandemic shows that the Canadian pandemic response is a product of consistent government communication, as well as the public's understanding of and adherence to protocols. ", doi="10.2196/25242", url="https://infodemiology.jmir.org/2021/1/e25242", url="http://www.ncbi.nlm.nih.gov/pubmed/34447922" } @Article{info:doi/10.2196/26876, author="Stevens, R. Hannah and Oh, Jung Yoo and Taylor, D. Laramie", title="Desensitization to Fear-Inducing COVID-19 Health News on Twitter: Observational Study", journal="JMIR Infodemiology", year="2021", month="Jul", day="16", volume="1", number="1", pages="e26876", keywords="desensitization", keywords="death toll", keywords="pandemic", keywords="fear-inducing", keywords="fear", keywords="health news", keywords="anxiety", keywords="COVID-19", keywords="mass media", keywords="public health", keywords="behavior change", keywords="coronavirus", abstract="Background: As of May 9, 2021, the United States had 32.7 million confirmed cases of COVID-19 (20.7\% of confirmed cases worldwide) and 580,000 deaths (17.7\% of deaths worldwide). Early on in the pandemic, widespread social, financial, and mental insecurities led to extreme and irrational coping behaviors, such as panic buying. However, despite the consistent spread of COVID-19 transmission, the public began to violate public safety measures as the pandemic got worse. Objective: In this work, we examine the effect of fear-inducing news articles on people's expression of anxiety on Twitter. Additionally, we investigate desensitization to fear-inducing health news over time, despite the steadily rising COVID-19 death toll. Methods: This study examined the anxiety levels in news articles (n=1465) and corresponding user tweets containing ``COVID,'' ``COVID-19,'' ``pandemic,'' and ``coronavirus'' over 11 months, then correlated that information with the death toll of COVID-19 in the United States. Results: Overall, tweets that shared links to anxious articles were more likely to be anxious (odds ratio [OR] 2.65, 95\% CI 1.58-4.43, P<.001). These odds decreased (OR 0.41, 95\% CI 0.2-0.83, P=.01) when the death toll reached the third quartile and fourth quartile (OR 0.42, 95\% CI 0.21-0.85, P=.01). However, user tweet anxiety rose rapidly with articles when the death toll was low and then decreased in the third quartile of deaths (OR 0.61, 95\% CI 0.37-1.01, P=.06). As predicted, in addition to the increasing death toll being matched by a lower level of article anxiety, the extent to which article anxiety elicited user tweet anxiety decreased when the death count reached the second quartile. Conclusions: The level of anxiety in users' tweets increased sharply in response to article anxiety early on in the COVID-19 pandemic, but as the casualty count climbed, news articles seemingly lost their ability to elicit anxiety among readers. Desensitization offers an explanation for why the increased threat is not eliciting widespread behavioral compliance with guidance from public health officials. This work investigated how individuals' emotional reactions to news of the COVID-19 pandemic manifest as the death toll increases. Findings suggest individuals became desensitized to the increased COVID-19 threat and their emotional responses were blunted over time. ", doi="10.2196/26876", url="https://infodemiology.jmir.org/2021/1/e26876", url="http://www.ncbi.nlm.nih.gov/pubmed/34447923" } @Article{info:doi/10.2196/26481, author="Cui, Limeng and Chu, Lijuan", title="YouTube Videos Related to the Fukushima Nuclear Disaster: Content Analysis", journal="JMIR Public Health Surveill", year="2021", month="Jun", day="7", volume="7", number="6", pages="e26481", keywords="YouTube", keywords="Fukushima nuclear disaster", keywords="social media", keywords="risk communication", keywords="disaster", keywords="video platform", keywords="radiation", keywords="public safety", keywords="nuclear disaster", abstract="Background: YouTube (Alphabet Incorporated) has become the most popular video-sharing platform in the world. The Fukushima Daiichi Nuclear Power Plant (FDNPP) disaster resulted in public anxiety toward nuclear power and radiation worldwide. YouTube is an important source of information about the FDNPP disaster for the world. Objective: This study's objectives were to examine the characteristics of YouTube videos related to the FDNPP disaster, analyze the content and comments of videos with a quantitative method, and determine which features contribute to making a video popular with audiences. This study is the first to examine FDNPP disaster--related videos on YouTube. Methods: We searched for the term ``Fukushima nuclear disaster'' on YouTube on November 2, 2019. The first 60 eligible videos in the relevance, upload date, view count, and rating categories were recorded. ?Videos that were irrelevant, were non-English, had inappropriate words, were machine synthesized, and were <3 minutes long were excluded. In total, 111 videos met the inclusion criteria. Parameters of the videos, including the number of subscribers, length, the number of days since the video was uploaded, region, video popularity (views, views/day, likes, likes/day, dislikes, dislikes/day, comments, comments/day), the tone of the videos, the top ten comments, affiliation, whether Japanese people participated in the video, whether the video recorder visited Fukushima, whether the video contained theoretical knowledge, and whether the video contained information about the recent situation in Fukushima, were recorded. By using criteria for content and ?technical design, two evaluators scored videos and grouped them into the useful (score: 11-14), slightly useful (score: 6-10), and useless (score: 0-5) video categories. Results: Of the 111 videos, 43 (38.7\%) videos were useful, 43 (38.7\%) were slightly useful, and 25 (22.5\%) were useless. Useful videos had good visual and aural effects, provided vivid information on the Fukushima disaster, and had a mean score of 12 (SD 0.9). Useful videos had more views per day (P<.001), likes per day (P<.001), and comments per day (P=.02) than useless and slightly useful videos. The popularity of videos had a significant correlation with clear sounds (likes/day: P=.001; comments/day: P=.02), vivid information (likes/day: P<.001; comments/day: P=.007), understanding content (likes/day: P=.001; comments/day: P=.04). There was no significant difference in likes per day (P=.72) and comments per day (P=.11) between negative and neutral- and mixed-tone videos. Videos about the recent situation in Fukushima had more likes and comments per day. Video recorders who personally visited Fukushima Prefecture had more subscribers and received more views and likes. Conclusions: The possible features that made videos popular to the public included ?video quality, videos made in Fukushima, and information on the recent situation in Fukushima. During risk communication on new forms of media, health institutes should increase publicity and be more approachable to resonate with international audiences. ", doi="10.2196/26481", url="https://publichealth.jmir.org/2021/6/e26481", url="http://www.ncbi.nlm.nih.gov/pubmed/34096880" } @Article{info:doi/10.2196/27668, author="Kuhlberg, Henna and Kujala, Sari and H{\"o}rhammer, Iiris and Koskela, Tuomas", title="STAR Duodecim eHealth Tool to Recognize Chronic Disease Risk Factors and Change Unhealthy Lifestyle Choices Among the Long-Term Unemployed: Protocol for a Mixed Methods Validation Study", journal="JMIR Res Protoc", year="2021", month="Jun", day="1", volume="10", number="6", pages="e27668", keywords="eHealth", keywords="risk assessment", keywords="long-term unemployed", keywords="expected age of death", keywords="online intervention", keywords="risk factors", keywords="chronic illnesses", keywords="primary prevention", keywords="online health check", keywords="long-term", keywords="multimorbidity", keywords="health care services", keywords="examination", keywords="evaluation", keywords="lifestyle", abstract="Background: Lifestyle choices and socioeconomic status have a significant impact on the expected onset of diseases, age of death, and risk factors concerning long-term illnesses and morbidity. STAR is an online health examination tool, which gives users a report that includes an evaluation of their life expectancy and an estimated risk for developing common long-term illnesses based on questions about health, characteristics, lifestyle, and quality of life. Objective: The goals of this study are to (1) review the capacity of STAR to recognize morbidity risks in comparison to a traditional nurse-led health examination and patient-reported health challenges; (2) evaluate the user experience and usability of STAR; and (3) assess the potential impact of STAR on the health confidence and motivation of patients to make healthier lifestyle choices. Methods: This mixed methods validation study will consist of a quantitative part (questionnaires) and a qualitative part (phone interviews and open-ended questions from the questionnaires). The participants will include 100 long-term unemployed individuals attending a health check for the unemployed. The participants will be recruited from three Finnish public health centers in Espoo, H{\"a}meenlinna, and Tampere. At the health centers, the participants will use STAR and attend a nurse's health check. Surveys with multiple-choice and open-ended questions will be collected from the participants, the nurse, and a study assistant. The questionnaires include questions about the participant's background and health challenges from the patient and nurse points of view, as well as questions about how well the health challenges matched the STAR report. The questionnaires also gather data about user experience, health confidence, and usability of STAR. A study assistant will fill out an observer's form containing questions about use time and possible problems encountered while using STAR. A sample of the unemployed participants will be interviewed by telephone subsequently. For the quantitative data, descriptive statistics and a reliability analysis will be performed, and mean sum scores will be computed for the study variables. Thematic analysis of the qualitative data will be performed. Results: This study was approved by the Ethics Committee of the Expert Responsibility Area of Tampere University Hospital in June 2020 (ETL Code R20067). Data collection will begin in June 2021 and will take approximately 3-6 months. Conclusions: Online health examinations can improve the effectiveness of primary prevention in health care by supporting efficient evidence-based morbidity risk estimation and motivating patients to change unhealthy behaviors. A multimethod approach is used to allow for assessment of the tool's usefulness from the points of view of both professionals and patients. This study will further provide a rich understanding of how the tool can be used as part of routine health checks, and how and why the tool may or may not motivate users for making healthier lifestyle choices. International Registered Report Identifier (IRRID): PRR1-10.2196/27668 ", doi="10.2196/27668", url="https://www.researchprotocols.org/2021/6/e27668", url="http://www.ncbi.nlm.nih.gov/pubmed/34061041" }