@Article{info:doi/10.2196/69170, author="Stauch, Lisa and Renninger, Denise and Rangnow, Pia and Hartmann, Anja and Fischer, Lisa and Dadaczynski, Kevin and Okan, Orkan", title="Digital Health Literacy of Children and Adolescents and Its Association With Sociodemographic Factors: Representative Study Findings From Germany", journal="J Med Internet Res", year="2025", month="May", day="5", volume="27", pages="e69170", keywords="digital health literacy", keywords="sociodemographic", keywords="health promotion", keywords="child and adolescent health", keywords="cross-sectional", abstract="Background: Children and adolescents extensively use the internet in their daily lives, often seeking information related to health and well-being. In modern society, the volume of health information available in digital environments is constantly increasing. This includes both reliable and misleading content, making it challenging to assess trustworthiness. Digital health literacy is essential for navigating the digital information ecosystem, protecting oneself from misinformation, and making informed health decisions. Objective: This representative study aims to examine the digital health literacy of children and adolescents in Germany and its association with sociodemographic factors. Methods: A cross-sectional study design with face-to-face interviews was utilized to collect data from 1448 children and adolescents aged 9-18 years in Germany between October and November 2022. Digital health literacy was assessed using an adapted and translated version of the Digital Health Literacy Instrument (DHLI), which comprises 7 subscales: operational skills, navigation skills, information searching, self-generated content, evaluating reliability, protecting privacy, and determining relevance. Bivariate and binary logistic regression analyses were conducted to examine associations between digital health literacy subscales and sociodemographic characteristics (sex, age, migration background, school type, and perceived family affluence). Results: The study found that 419 out of 1362 (30.76\%) children and adolescents had a problematic level of digital health literacy, while 63 out of 1362 (4.63\%) had an inadequate level. Overall, the least difficulties were observed in operational skills and determining relevance, whereas the greatest challenges were related to protecting privacy and navigation skills. Age was significantly associated with 6 of the 7 subscales (excluding protecting privacy), with younger children (9-11 years) facing a higher risk of limited skills (operational skills: odds ratio [OR] 5.42, P=.002; navigation skills: OR 4.76, P<.001; information searching: OR 4.68, P<.001; adding self-generated content: OR 7.03, P<.001; evaluating reliability: OR 3.82, P<.001; and determining relevance: OR 4.76.42, P<.001). Migration background was associated with fewer limited digital health literacy skills, while low perceived family affluence was associated with more limited skills. In the subscales of information searching, self-generated content, and evaluating information reliability, a lower risk of limited skills was observed among those with a 2-sided migration background (information searching: OR 0.62, P=.02; adding self-generated content: OR 0.30, P=.003; and evaluating reliability: OR 0.66, P=.03). By contrast, a higher risk was found among those with low perceived family affluence, including in the subscale of determining relevance (information searching: OR 2.18, P<.001; adding self-generated content: OR 1.77, P=.01; evaluating reliability: OR 1.67, P<.001; and determining relevance: OR 1.58, P<.001). Although school type was not associated with any dimension, sex was linked to operational skills, with females having an increased risk of limited skills (OR 1.58, P=.03). Conclusions: The results highlight a strong need for interventions to improve digital health literacy among children and adolescents, particularly in protecting privacy, navigation skills, and evaluating the reliability of health information. Effective interventions should be tailored to address the varying needs associated with age, migration background, and family affluence. ", doi="10.2196/69170", url="https://www.jmir.org/2025/1/e69170" } @Article{info:doi/10.2196/62884, author="Shin, Sangyoon and Kim, Seungyeon and Song, Youngshin and Jeong, Hyesun and Yu, Mi Yun and Lee, Euni", title="Development and Validation of the Media Health Literacy Scale: Assessment Tool Development Study", journal="J Med Internet Res", year="2025", month="May", day="5", volume="27", pages="e62884", keywords="media", keywords="internet", keywords="media health literacy", keywords="ehealth literacy", keywords="survey development", keywords="validation", keywords="health-related information", keywords="communication", abstract="Background: Advancements in IT have transformed methods for accessing and conveying health-related information. While technical advancements offer more options for people to choose their preferred information sources, injudicious dissemination of incorrect or unverified health-related information by internet-based media poses a threat to society. The concepts of media health literacy (MeHlit) and eHealth literacy have emerged for assessing one's ability to understand and use health-related information from media sources. However, tools to evaluate the level of MeHlit within the domain of communication or follow a solid validation process are scarce. Objective: This study aimed to develop a validated tool to evaluate the level of MeHlit in adults in South Korea. Methods: A 2-step tool development process, including item development and validation processes, was carried out. At first, tool development studies were identified by a systematic review of the literature. A conceptual framework was established from the review by constructing an affinity diagram, and an item pool was generated. Face validation was conducted to assess whether the items measured MeHlit properly. Content validation was conducted to assess the overall relationship between domains by calculating the content validity index. Construct validation processes, including exploratory and confirmatory factor analyses, were completed with 1000 adults. Internal consistency of the Media Health Literacy Scale (MHLS) was assessed with Cronbach $\alpha$. Concurrent validation was conducted to validate the MHLS's performance by comparing it with an established tool, the Korean version of the eHealth Literacy scale (K-eHEALS). Results: A total of 13 published studies from the systematic review was used to develop the conceptual framework and an item pool of 65 items was created, including 3 domains (access, critical evaluation, and communication) and 9 subdomains. Through face and content validation processes, the MHLS was refined to comprise 3 domains, 6 subdomains, and 29 items. A total of 1000 participants were recruited for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Five subdomains were identified through EFA, and CFA demonstrated a good model fit (chi-square [Cmin $\chi$2/df] under 2.659, root mean square error of approximation=0.058 [90\% CI 0.053-0.062], comparative fit index=0.927, and standard root mean residual under 0.067). Following the EFA and CFA, Cronbach $\alpha$ scores of 0.915 and 0.932, respectively, were obtained, indicating that the tool had good reliability. A positive correlation was found between the MHLS and K-eHEALS from the concurrent validity evaluation, indicating that the MHLS can assess the target concept similarly as the K-eHEALS (Pearson correlation coefficient=0.736, P<.001). Conclusions: The MHLS was developed and validated in a step-by-step process to assess individuals' ability to access, critically evaluate, and communicate health-related information through media platforms. This validated tool can serve in identifying deficiencies in specific MHLS areas and subsequently providing targeted education. ", doi="10.2196/62884", url="https://www.jmir.org/2025/1/e62884", url="http://www.ncbi.nlm.nih.gov/pubmed/40323645" } @Article{info:doi/10.2196/59037, author="Wang, Charlotte and Fang, Hsiu-Ju and Lu, Hsin-Yang and Chen, Chen-Fen", title="Media Discourse, Influence, and Reflection: Content Analysis and Text-Mining Study of Suicides and Homicides in Long-Term Care", journal="J Med Internet Res", year="2025", month="Apr", day="28", volume="27", pages="e59037", keywords="family caregiver", keywords="news framing", keywords="homicide", keywords="suicide", keywords="text mining", abstract="Background: As populations age, the demand for long-term care services steadily increases. The effectiveness of government-promoted long-term care policies and the public's access to relevant service information are demonstrably influenced by media representation. In addition, prior research has suggested that news framing can mitigate the negative influence (the Werther effect) with a more hopeful framing (the Papageno effect), thereby reducing the public's susceptibility to negative news. Objective: This study investigates the phenomenon of suicides and homicides in long-term care reported in the news, in which family caregivers or care receivers died by suicide or homicide. We examined changes in the media's reporting framework before and after the implementation of Taiwan's Long-Term Care Plan 2.0 in 2017. We further examined the consistency between the content of news reports and the information provided by the media on long-term care services and suicide prevention (eg, hotlines). Methods: Content analysis and text-mining techniques were used to analyze 433 news reports covering 95 cases of suicides and homicides in long-term care in Taiwan from 2009 to 2021. A random-effects model was applied to examine term frequency transition post implementation. Results: The majority (>60\%) of the cases involved family caregivers' homicide-suicide. The term ``family moral tragedy'' has been replaced by ``long-term care tragedy'' in recent discourse. This shift is evident in a decline in the frequency of ``family moral tragedy'' since 2017, with usage decreasing by 32.4\% in headlines and by 24\% in news content. The term frequency of ``care burden'' has significantly increased from 0.0006 (SD 0.0008) to 0.017 (SD 0.0461; t337=3.006; P=.003). While linguistic characteristics of the content have remained consistent, there were statistically significant differences in medical and ethics-related terms. The media tends to provide more suicide prevention information (eg, hotlines; >50\%), offering relatively limited coverage on long-term care services (<25\%). Conclusions: The news media have the potential to change the public's response to specific issues. Our findings suggest that government efforts to encourage media coverage of positive experiences with long-term care services can be a preventative measure against caregiving suicides and homicides. Moreover, government initiatives should focus on strengthening media publicity and enhancing media literacy within the long-term care sector. By empowering the media to provide readers with clear channels for seeking help, such as hotlines, the media will contribute positively to the mental health of family caregivers. Finally, an annual database on family caregiver homicide-suicide should be established. In that case, the government could identify potential risk factors and inform the formulation and revision of relevant policies and services via this database, ultimately contributing to preventing suicides and homicides in long-term care and achieving public health goals. ", doi="10.2196/59037", url="https://www.jmir.org/2025/1/e59037" } @Article{info:doi/10.2196/67129, author="Mayor, Eric and Bietti, M. Lucas", title="A Social Media Study of Portrayals of Bipolar Disorders on YouTube: Content and Thematic Analyses", journal="J Med Internet Res", year="2025", month="Apr", day="25", volume="27", pages="e67129", keywords="bipolar disorder", keywords="YouTube", keywords="social media", keywords="content analysis", keywords="thematic analysis", abstract="Background: Individuals with mental disorders frequently use YouTube to express themselves, reach an audience, or as a means of understanding their condition. Testimonies posted on YouTube provide longer and richer perspectives than the short posts found on other social media platforms. Research focusing on the depiction of mental disorders on YouTube is blossoming. Bipolar disorders (BDs) are disabling mood disorders. The diagnosis of any mental disorder, and more so BD, is often a life-changing event. However, no published study has investigated the portrayal of diagnoses of BD on YouTube. Objective: This study aims to investigate the portrayals of BDs on YouTube, focusing on the diagnosis narratives and their accompanying narrative context, in particular, reports of personal experiences and reactions. Methods: We performed a manual content analysis of 39 testimonies (women: n=24, 62\%) depicting BDs and their diagnosis by individuals with BD. We also performed a thematic analysis of the corpus relying upon a deductive and inductive approach. Results: Our manual content analysis revealed that portrayals included the disclosure of diagnoses of BD-I (as per both coders' agreement: 10 testimonies) and BD-II (11 testimonies) to a similar extent. The reactions to the diagnosis were mostly negative (8 testimonies), followed by positive (5 testimonies), while fewer portrayals indicated a denial of the condition (4 testimonies). Several portrayals made mention of issues in the areas of money and accommodation (15 testimonies), profession and education (13 testimonies), and relationships (20 testimonies). Medication (31 testimonies) and psychotherapy (23 testimonies) were often mentioned as part of treatment for BD, most generally in positive terms. The 8 themes emerging from the thematic analysis were: ``reactions on diagnosis, treatment, and health care professionals' expertise,'' ``trial and error in medication,'' ``positive effects of BD,'' ``disability, stigma, and shame,'' ``loss,'' ``family planning and genetics,'' ``identity change (psychological and physical),'' and ``human social relationships.'' Conclusions: Overall, our results underline the complexity and richness of the depiction of the diagnosis of BD and its narrative context, and highlight the importance of the moment of the diagnosis, medication, and psychotherapy. Our study emphasizes the need for further exploration of the impact of social media on mental health awareness. ", doi="10.2196/67129", url="https://www.jmir.org/2025/1/e67129" } @Article{info:doi/10.2196/68724, author="Shereefdeen, Hisba and Grant, Elizabeth Lauren and Patel, Vayshali and MacKay, Melissa and Papadopoulos, Andrew and Cheng, Leslie and Phypers, Melissa and McWhirter, Elizabeth Jennifer", title="Assessing the Dissemination of Federal Risk Communication by News Media Outlets During Enteric Illness Outbreaks: Canadian Content Analysis", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="10", volume="11", pages="e68724", keywords="risk communication", keywords="health communication", keywords="enteric illness", keywords="foodborne illness", keywords="zoonotic disease", keywords="media", keywords="content analysis", keywords="health belief model", keywords="public health", keywords="Canada", abstract="Background: Effective dissemination of federal risk communication by news media during multijurisdictional enteric illness outbreaks can increase message reach to rapidly contain outbreaks, limit adverse outcomes, and promote informed decision-making by the public. However, dissemination of risk communication from the federal government by mass media has not been evaluated. Objective: This study aimed to describe and assess the dissemination of federal risk communication by news media outlets during multijurisdictional enteric illness outbreaks in Canada. Methods: A comprehensive systematic search of 2 databases, Canadian Newsstream and Canadian Business \& Current Affairs, was run using search terms related to the source of enteric illnesses, general outbreak characteristics, and relevant enteric pathogen names to retrieve news media articles issued between 2014 and 2023, corresponding to 46 public health notices (PHNs) communicating information about multijurisdictional enteric illness outbreaks during the same period. A codebook comprised of 3 sections---general characteristics of the article, consistency and accuracy of information presented between PHNs and news media articles, and presence of health belief model constructs---was developed and applied to the dataset. Data were tabulated and visualized using RStudio (Posit). Results: News media communicated about almost all PHNs (44/46, 96\%). News media commonly developed their own articles (320/528, 60.6\%) to notify the public about an outbreak and its associated product recall (121/320, 37.8\%), but rarely communicated about the conclusion of an outbreak (12/320, 3.8\%). News media communicated most outbreak characteristics, such as the number of cases (237/319, 74.3\%), but the number of deaths was communicated less than half the time (114/260, 43.8\%). Benefit and barrier constructs of the health belief model were infrequently present (50/243, 20.6\% and 15/243, 6.2\%, respectively). Conclusions: Canadian news media disseminated information about most multijurisdictional enteric illness outbreaks. However, differences in coverage of multijurisdictional enteric illness outbreaks by news media were evident. Federal organizations can improve future risk communication of multijurisdictional enteric illness outbreaks by news media by maintaining and strengthening interorganizational connections and ensuring the information quality of PHNs as a key information source for news media. ", doi="10.2196/68724", url="https://publichealth.jmir.org/2025/1/e68724" } @Article{info:doi/10.2196/55065, author="Zhu, Zhiyu and Ye, Zhiyun and Wang, Qian and Li, Ruomei and Li, Hairui and Guo, Weiming and Li, Zhenxia and Xia, Lunguo and Fang, Bing", title="Evolutionary Trend of Dental Health Care Information on Chinese Social Media Platforms During 2018-2022: Retrospective Observational Study", journal="JMIR Infodemiology", year="2025", month="Apr", day="10", volume="5", pages="e55065", keywords="social media", keywords="dental health education", keywords="natural language processing", keywords="information quality assessment", keywords="dental care", keywords="dental hygiene", keywords="dentistry", keywords="orthodontic", keywords="health care information", keywords="retrospective study", keywords="observational study", keywords="user engagement", keywords="Chinese", keywords="dental practitioner", keywords="WeChat", keywords="health information", keywords="preventive care", abstract="Background: Social media holds an increasingly significant position in contemporary society, wherein evolving public perspectives are mirrored by changing information. However, there remains a lack of comprehensive analysis regarding the nature and evolution of dental health care information on Chinese social media platforms (SMPs) despite extensive user engagement and voluminous content. Objective: This study aimed to probe into the nature and evolution of dental health care information on Chinese SMPs from 2018 to 2022, providing valuable insights into the evolving digital public perception of dental health for dental practitioners, investigators, and educators. Methods: This study was conducted on 3 major Chinese SMPs: Weibo, WeChat, and Zhihu. Data from March 1 to 31 in 2018, 2020, and 2022 were sampled to construct a social media original database (ODB), from which the most popular long-text posts (N=180) were selected to create an analysis database (ADB). Natural language processing (NLP) tools were used to assist tracking topic trends, and word frequencies were analyzed. The DISCERN health information quality assessment questionnaire was used for information quality evaluation. Results: The number of Weibo posts in the ODB increased approximately fourfold during the observation period, with discussion of orthodontic topics showing the fastest growth, surpassing that of general dentistry after 2020. In the ADB, the engagement of content on Weibo and Zhihu also displayed an upward trend. The overall information quality of long-text posts on the 3 platforms was moderate or low. Of the long-text posts, 143 (79.4\%) were written by nonprofessionals, and 105 (58.3\%) shared personal medical experiences. On Weibo and WeChat, long-text posts authored by health care professionals had higher DISCERN scores (Weibo P=.04; WeChat P=.02), but there was a negative correlation between engagement and DISCERN scores (Weibo tau-b [$\tau$b]=--0.45, P=.01; WeChat $\tau$b=--0.30, P=.02). Conclusions: There was a significant increase in the dissemination and evolution of public interest in dental health care information on Chinese social media during 2018-2022. However, the quality of the most popular long-text posts was rated as moderate or low, which may mislead patients and the public. ", doi="10.2196/55065", url="https://infodemiology.jmir.org/2025/1/e55065" } @Article{info:doi/10.2196/59767, author="Yeung, Kan Andy Wai and Hammerle, Peter Fabian and Behrens, Sybille and Matin, Maima and Mickael, Michel-Edwar and Litvinova, Olena and Parvanov, D. Emil and Kletecka-Pulker, Maria and Atanasov, G. Atanas", title="Online Information About Side Effects and Safety Concerns of Semaglutide: Mixed Methods Study of YouTube Videos", journal="JMIR Infodemiology", year="2025", month="Apr", day="8", volume="5", pages="e59767", keywords="YouTube", keywords="semaglutide", keywords="social media", keywords="Ozempic", keywords="Wegovy", keywords="Rybelsus", keywords="safety", keywords="knowledge exchange", keywords="side effects", keywords="online information", keywords="online", keywords="videos", keywords="health issues", keywords="drugs", keywords="weight loss", keywords="assessment", keywords="long-term data", keywords="consultation", abstract="Background: Social media has been extensively used by the public to seek information and share views on health issues. Recently, the proper and off-label use of semaglutide drugs for weight loss has attracted huge media attention and led to temporary supply shortages. Objective: The aim of this study was to perform a content analysis on English YouTube (Google) videos related to semaglutide. Methods: YouTube was searched with the words semaglutide, Ozempic, Wegovy, and Rybelsus. The first 30 full-length videos (videos without a time limit) and 30 shorts (videos that are no longer than 1 minute) resulting from each search word were recorded. After discounting duplicates resulting from multiple searches, a total of 96 full-length videos and 93 shorts were analyzed. Video content was evaluated by 3 tools, that is, a custom checklist, a Global Quality Score (GQS), and Modified DISCERN. Readability and sentiment of the transcripts were also assessed. Results: There was no significant difference in the mean number of views between full-length videos and shorts (mean 288,563.1, SD 513,598.3 vs mean 188,465.2, SD 780,376.2, P=.30). The former had better content quality in terms of GQS, Modified DISCERN, and the number of mentioned points from the custom checklist (all P<.001). The transcript readability of both types of videos was at a fairly easy level and mainly had a neutral tone. Full-length videos from health sources had a higher content quality in terms of GQS and Modified DISCERN (both P<.001) than their counterparts. Conclusions: The analyzed videos lacked coverage of several important aspects, including the lack of long-term data, the persistence of side effects due to the long half-life of semaglutide, and the risk of counterfeit drugs. It is crucial for the public to be aware that videos cannot replace consultations with physicians. ", doi="10.2196/59767", url="https://infodemiology.jmir.org/2025/1/e59767" } @Article{info:doi/10.2196/56080, author="Liu, Xiao and Susarla, Anjana and Padman, Rema", title="Promoting Health Literacy With Human-in-the-Loop Video Understandability Classification of YouTube Videos: Development and Evaluation Study", journal="J Med Internet Res", year="2025", month="Apr", day="8", volume="27", pages="e56080", keywords="patient education", keywords="video analysis", keywords="video understandability", keywords="machine learning", keywords="cotraining", keywords="human-in-the-loop", keywords="augmented intelligence", keywords="artificial intelligence", keywords="AI", abstract="Background: An estimated 93\% of adults in the United States access the internet, with up to 80\% looking for health information. However, only 12\% of US adults are proficient enough in health literacy to interpret health information and make informed health care decisions meaningfully. With the vast amount of health information available in multimedia formats on social media platforms such as YouTube and Facebook, there is an urgent need and a unique opportunity to design an automated approach to curate online health information using multiple criteria to meet the health literacy needs of a diverse population. Objective: This study aimed to develop an automated approach to assessing the understandability of patient educational videos according to the Patient Education Materials Assessment Tool (PEMAT) guidelines and evaluating the impact of video understandability on viewer engagement. We also offer insights for content creators and health care organizations on how to improve engagement with these educational videos on user-generated content platforms. Methods: We developed a human-in-the-loop, augmented intelligence approach that explicitly focused on the human-algorithm interaction, combining PEMAT-based patient education constructs mapped to features extracted from the videos, annotations of the videos by domain experts, and cotraining methods from machine learning to assess the understandability of videos on diabetes and classify them. We further examined the impact of understandability on several dimensions of viewer engagement with the videos. Results: We collected 9873 YouTube videos on diabetes using search keywords extracted from a patient-oriented forum and reviewed by a medical expert. Our machine learning methods achieved a weighted precision of 0.84, a weighted recall of 0.79, and an F1-score of 0.81 in classifying video understandability and could effectively identify patient educational videos that medical experts would like to recommend for patients. Videos rated as highly understandable had an average higher view count (average treatment effect [ATE]=2.55; P<.001), like count (ATE=2.95; P<.001), and comment count (ATE=3.10; P<.001) than less understandable videos. In addition, in a user study, 4 medical experts recommended 72\% (144/200) of the top 10 videos ranked by understandability compared to 40\% (80/200) of the top 10 videos ranked by YouTube's default algorithm for 20 ramdomly selected search keywords. Conclusions: We developed a human-in-the-loop, scalable algorithm to assess the understandability of health information on YouTube. Our method optimally combines expert input with algorithmic support, enhancing engagement and aiding medical experts in recommending educational content. This solution also guides health care organizations in creating effective patient education materials for underserved health topics. ", doi="10.2196/56080", url="https://www.jmir.org/2025/1/e56080" } @Article{info:doi/10.2196/66812, author="Morena, Nina and Htite, Dimya Elly and Ahisar, Yitzchok and Hayman, Victoria and Rentschler, A. Carrie and Meguerditchian, N. Ari", title="Breast Cancer Vlogs on YouTube: Descriptive and Content Analyses", journal="JMIR Infodemiology", year="2025", month="Mar", day="31", volume="5", pages="e66812", keywords="breast cancer vlog", keywords="YouTube", keywords="social media", keywords="experience", keywords="video", keywords="content analysis", keywords="breast", keywords="cancer", keywords="women", keywords="oncology", keywords="descriptive analysis", abstract="Background: Many women with breast cancer document their experiences in YouTube vlogs, which may serve as peer-to-peer and community support. Objective: This study aimed to determine (1) the forms of content about breast cancer that tend to be discussed in vlogs, (2) the reasons why women choose to vlog their breast cancer experiences, and (3) the potential for breast cancer vlogs to serve as an alternative or complement to peer-to-peer support as well as a site of digital community overall. Methods: YouTube was searched in incognito mode in November 2023 using the search terms ``breast cancer vlog.'' A maximum of 10 videos/creator were included based on viewership and date created. Video characteristics collected included title; length; number of views, likes, comments; and playlist inclusion. Videos were assessed for sponsorship; presence of explanation and discussion on breast cancer; type of content; and themes. Creator characteristics included age, location, and engagement approaches. Descriptive and content analyses were performed to analyze video content and potential areas where peer-to-peer support may be provided. Results: Ninety vlogs by 13 creators were included, all from personal accounts. The mean (SD) video length, number of views, and number of comments were 21.4 (9.1) minutes, 266,780 (534,465), and 1485 (3422), respectively. Of the 90 videos, 35 (39\%) included hashtags, and 11 (12\%) included paid sponsorships. The most common filming location was the home (87/90; 97\%), followed by the hospital (28/90; 31\%) and car (19/90; 21\%). Home vlogs were most often set in the living room (43/90; 44\%), bedroom (32/90; 33\%), or kitchen (20/90; 21\%). Thirty-four of 60 videos (57\%) included treatment visuals and physical findings. Creators addressed motivation for vlogging in 44/90 videos (49\%); the two most common reasons were wanting to build a community and helping others. In 42/90 videos (47\%), creators explicitly expressed emotion. Most common themes were treatment (77/90; 86\%), mental health (73/90; 81\%), adverse effects (65/90; 72\%), appearance (57/90; 63\%), and family relationships (33/90; 37\%). Patient-directed advice was offered in 52/90 videos (58\%), mostly on treatment-related issues. In 51/90 videos (57\%), creators provided explicit treatment definitions. Chemotherapy was discussed in 63/90 videos (70\%); surgery in 52/90 (58\%), primarily mastectomy; radiation in 27/90 (30\%); and general adverse effects in 64/90 (71\%). Twenty-two of 90 videos (24\%) were about a new diagnosis. When mentioned (40/90; 44\%), the most common creator location was the United States. When mentioned (27/90; 30\%), the most common age was 20?29 years. Conclusions: The dedication to building community support by vlog creators, and the personal nature of their storytelling, may make vlogs a potential resource for peer-to-peer support. ", doi="10.2196/66812", url="https://infodemiology.jmir.org/2025/1/e66812" } @Article{info:doi/10.2196/56147, author="Wang, Xiao and Xiao, Yuxue and Nam, Sujin and Zhong, Ting and Tang, Dongyan and Li, Cheung William Ho and Song, Peige and Xia, Wei", title="Use of Mukbang in Health Promotion: Scoping Review", journal="J Med Internet Res", year="2025", month="Mar", day="27", volume="27", pages="e56147", keywords="mukbang", keywords="health promotion", keywords="eating behaviors", keywords="appetite", keywords="scoping review", abstract="Background: Mukbang is a recent internet phenomenon in which anchors publicly record and show their eating through short video platforms. Researchers reported a tangible impact of mukbang on the psychological and physical health, appetite, and eating behavior of the public, it is critical to obtain clear and comprehensive insights concerning the use of mukbang to promote the viewers' appetite, eating behaviors, and health to identify directions for future work. Objective: This scoping review aims to comprehensively outline the current evidence regarding the impact of mukbang consumption on dietary behaviors, appetite regulation, flavor perception, and physical and psychological well-being. Specifically, we conducted an analysis of public perceptions and attitudes toward mukbang while summarizing the reciprocal influence it has on health promotion. Methods: This study was conducted as a scoping review following the Joanna Briggs Institute guideline and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We comprehensively searched 8 electronic databases in Chinese, English, and Korean languages. We also searched gray literature sources like Google Scholar and ProQuest. We used a data extraction chart to extract information relevant to the impact of mukbang on health. The extracted data were qualitatively analyzed to form different themes related to health, categorizing and integrating the results based on the type of study (qualitative, observational, and experimental). Results: This scoping review finally included 53 studies; the annual distribution exhibited a consistent upward trend across all categories since their initial publication in 2017. Based on the results of the analysis, we have summarized 4 themes, which showed that mukbang may have positive effects on viewers' appetite, food choices, and weight control; it can also meet the psychological needs of viewers and provide digital companionship and happiness. However, excessive viewing may also be harmful to viewer's health, which has also caused health concerns for some viewers. Conclusions: This study conducted a comprehensive search, screening, and synthesis of existing studies focusing on mukbang and health across various languages and varying levels of quality, which has presented the analytical evidence of the relationship between mukbang and dietary behaviors, appetite, flavor perception, and health. According to the results, future research could consider analyzing the beneficial and harmful factors of mukbang, thereby further optimizing the existing mukbang videos accordingly to explore the potential of using mukbang for health intervention or promotion, so as to improve or customize the content of mukbang based on this scoping review, maximize the appetite and health promotion effects of mukbang videos. Trial Registration: INPLASY INPLASY2022120109; https://inplasy.com/inplasy-2022-12-0109/ ", doi="10.2196/56147", url="https://www.jmir.org/2025/1/e56147" } @Article{info:doi/10.2196/66683, author="Li, Hongmin and Li, Dongxu and Zhai, Min and Lin, Li and Cao, ZhiHeng", title="Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Mar", day="14", volume="27", pages="e66683", keywords="online health information seeking (OHIS)", keywords="online health information perception (OHIP)", keywords="mediating effect", keywords="health service utilization", keywords="health information", keywords="health perception", keywords="data", keywords="China", keywords="Chinese General Social Survey (CGSS)", keywords="database", keywords="medical information", keywords="survey", abstract="Background: Seeking online health information can empower individuals to better understand their health concerns, facilitating their ability to manage their health conditions more effectively. It has the potential to change the likelihood and frequency of health service usage. Although existing literature has demonstrated the prevalence of seeking online health information among different populations, the factors affecting online health information perception and discussions on the associations between seeking online health information and health service utilization are limited. Objective: We analyzed the associations between online health information seeking behavior and health service utilization, as well as the online health information perception delivery mechanism. Methods: We analyzed data from the Chinese General Social Survey, the first national representative survey conducted in mainland China. The independent variable was the online health information seeking behavior. The outcome variable was health service utilization by the respondents, and online health information perception was selected as the mediating variable in this analysis. Factor analysis was conducted to obtain online health information perception. Multiple regressions were performed to investigate the effect of online health information seeking behavior on physician visits. Bootstrap methods were conducted to test the mediation effects of online health information perception. Results: This analysis included 1475 cases. Among the participants, 939 (63.66\%) sought online health information in the last 12 months. The mean age of the respondents was 46.72 (SD 15.86) years, and 794 (53.83\%) were females. After controlling for other variables, individuals with online health information seeking behaviors showed 0.289 times more outpatient visits (P=.003), 0.131 times more traditional Chinese medicine outpatient visits (P=.01), and 0.158 times more Western medicine outpatient visits (P=.007) over the past year compared to those who did not seek health information online. Additionally, multiple regression analyses revealed statistically significant effects of gender, age, and health status on physician visits. The total effect revealed that seeking online health information significantly influenced the total physician visits ($\beta$=0.290; P=.003), indicating a certain correlation between online health information seeking behavior and physician visits. Seeking online health information had a significant positive impact on the perception ($\beta$=0.265; P<.001). The mediation effects analysis identified that online health information perception led to a significant increase in physician visits with the increase in the online health information seeking behaviors ($\beta$=0.232; P=.02). Conclusions: The online health information perception of an individual influences the effect online health information seeking has on the frequency of physician visits. The online health information seeking behavior impacts outpatient service utilization both directly and indirectly through online health information perception and significantly increases the frequency of clinic visits after controlling for other variables. Interventions can be explored to improve the health utilization of residents by increasing their online health information perception. ", doi="10.2196/66683", url="https://www.jmir.org/2025/1/e66683" } @Article{info:doi/10.2196/58855, author="Liu, Jinpei and Qiu, Yifan and Liu, Yilong and Xu, Wenping and Ning, Weichen and Shi, Peimei and Yuan, Zongli and Wang, Fang and Shi, Yihai", title="The Reliability and Quality of Videos as Guidance for Gastrointestinal Endoscopy: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Mar", day="11", volume="27", pages="e58855", keywords="gastrointestinal endoscopy", keywords="YouTube", keywords="patient education", keywords="social media gastrointestinal", keywords="large language model", keywords="LLM", keywords="reliability", keywords="quality", keywords="video", keywords="cross-sectional study", keywords="endoscopy-related videos", keywords="health information", keywords="endoscopy", keywords="gastroscopy", keywords="colonoscopy", abstract="Background: Gastrointestinal endoscopy represents a useful tool for the diagnosis and treatment of gastrointestinal diseases. Video platforms for spreading endoscopy-related knowledge may help patients understand the pros and cons of endoscopy on the premise of ensuring accuracy. However, videos with misinformation may lead to adverse consequences. Objective: This study aims to evaluate the quality of gastrointestinal endoscopy-related videos on YouTube and to assess whether large language models (LLMs) can help patients obtain information from videos more efficiently. Methods: We collected information from YouTube videos about 3 commonly used gastrointestinal endoscopes (gastroscopy, colonoscopy, and capsule endoscopy) and assessed their quality (rated by the modified DISCERN Tool, mDISCERN), reliability (rated by the Journal of the American Medical Association), and recommendation (rated by the Global Quality Score). We tasked LLM with summarizing the video content and assessed it from 3 perspectives: accuracy, completeness, and readability. Results: A total of 167 videos were included. According to the indicated scoring, the quality, reliability, and recommendation of the 3 gastrointestinal endoscopy-related videos on YouTube were overall unsatisfactory, and the quality of the videos released by patients was particularly poor. Capsule endoscopy yielded a significantly lower Global Quality Score than did gastroscopy and colonoscopy. LLM-based summaries yielded accuracy scores of 4 (IQR 4-5), completeness scores of 4 (IQR 4-5), and readability scores of 2 (IQR 1-2). Conclusions: The quality of gastrointestinal endoscope-related videos currently on YouTube is poor. Moreover, additional regulatory and improvement strategies are needed in the future. LLM may be helpful in generalizing video-related information, but there is still room for improvement in its ability. ", doi="10.2196/58855", url="https://www.jmir.org/2025/1/e58855" } @Article{info:doi/10.2196/64307, author="Shao, Anqi and Chen, Kaiping and Johnson, Branden and Miranda, Shaila and Xing, Qidi", title="Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study", journal="J Med Internet Res", year="2025", month="Mar", day="10", volume="27", pages="e64307", keywords="risk communication", keywords="panel study", keywords="computational method", keywords="intermedia agenda setting", keywords="protective behaviors", keywords="infectious disease", abstract="Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals' intentions to adopt these behaviors in the United States. Methods: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F1,426=16.39; P<.001 for newspapers; F1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals' perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals' media exposure increased perceived benefits of mask-wearing ($\beta$=.057; P<.001 for household benefits; $\beta$=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks ($\beta$=--.026; P=.04). Conclusions: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align. ", doi="10.2196/64307", url="https://www.jmir.org/2025/1/e64307" } @Article{info:doi/10.2196/66634, author="Haughey, Marketa and Neyens, M. David and Hopkins, S. Casey and Gonzaga, Christofer and Harman, Melinda", title="Identifying Strategies for Home Management of Ostomy Care: Content Analysis of YouTube", journal="JMIR Hum Factors", year="2025", month="Mar", day="6", volume="12", pages="e66634", keywords="medical device usability", keywords="digital health", keywords="online support groups", keywords="living with chronic medical conditions", keywords="ostomy self-care", keywords="YouTube", keywords="patient education", keywords="user needs assessment", keywords="users experience", keywords="social media", keywords="ostomates", keywords="colostomy", keywords="ileostomy", keywords="usability", keywords="usefulness", keywords="utility", keywords="wearable device", keywords="medical device", keywords="support group", keywords="socials", keywords="social network", keywords="ostomy", keywords="digital", keywords="digital technology", keywords="digital intervention", abstract="Background: The social media platform YouTube is a recognized educational resource for health information, but few studies have explored its value for conveying the lived experience of individuals managing chronic health conditions and end users' interactions with medical device technology. Our study explores self-care strategies and end user needs of people living with a stoma because patient education and engagement in ostomy self-care are essential for avoiding ostomy-related complications. Ostomy surgery creates a stoma (an opening) in the abdomen to alter the route of excreta from digestive and urinary organs into a detachable external pouching system. After hospital discharge, people who have undergone ostomies perform critical self-care tasks including frequent ostomy appliance changes and stomal and peristomal skin maintenance. Objective: The purpose of this study was to systematically assess YouTube videos narrated by people who have undergone ostomies about their ostomy self-care in home (nonhospital) settings with a focus on identifying end user needs and different strategies used by people who have undergone ostomies during critical self-care tasks. Methods: Using predefined search terms and clear inclusion and exclusion criteria, we identified YouTube videos depicting narrators who have undergone ostomies and their ostomy self-care in home settings. Using a consensus coding approach among 3 independent reviewers, all videos were analyzed to collect metadata, data of narrators who have undergone ostomies, and specific content data. Results: There were 65 user-generated YouTube videos that met the inclusion and exclusion criteria. These videos were posted by 28 unique content creators representing a broad range of ages who used a variety of supplies. The common challenges discussed were peristomal skin complications, inadequate appliance adhesion and subsequent leakage, and supplies-related challenges. Narrators who have undergone ostomies discussed various expert tricks and tips to successfully combat these challenges. Conclusions: This study used a novel approach to gain insights about end user interactions with medical devices while performing ostomy self-care, which are difficult to gain using traditional behavioral techniques. The analysis revealed that people who have undergone ostomies are willing to share their personal experience with ostomy self-care on the web and that these videos are viewed by the public. User-generated videos demonstrated a variety of supplies used, end user needs, and different strategies for performing ostomy self-care. Future research should examine how these findings connect to YouTube ostomy self-care content generated by health care professionals and organizations and to guidelines for ostomy self-care. ", doi="10.2196/66634", url="https://humanfactors.jmir.org/2025/1/e66634", url="http://www.ncbi.nlm.nih.gov/pubmed/40053741" } @Article{info:doi/10.2196/59387, author="Rivera, M. Yonaira and Corpuz, Kathryna and Karver, Sanchez Tahilin", title="Engagement With and Use of Health Information on Social Media Among US Latino Individuals: National Cross-Sectional Survey Study", journal="J Med Internet Res", year="2025", month="Feb", day="24", volume="27", pages="e59387", keywords="Latinos", keywords="health misinformation", keywords="engagement", keywords="utilization", keywords="social media", keywords="health information", keywords="United States", keywords="national", keywords="trends", keywords="survey", keywords="pandemic", keywords="non-Latino whites", abstract="Background: During the COVID-19 pandemic, US Latino individuals were more likely to report accessing coronavirus information on social media than other groups, despite copious amounts of health misinformation documented on these platforms. Among the existing literature on factors associated with engagement and use of health information, racial minority status has been associated with greater susceptibility to health misinformation. However, literature to date has not reported national trends on how Latino individuals engage with or use health information on social media compared to non-Latino White (NLW) individuals, nor whether perceptions of the amount of health misinformation on social media influence health information engagement and usage. Objective: This study aimed to examine differences in engagement with and use of health information on social media among Latino and NLW individuals in the United States. Methods: We examined a nationally representative cross-sectional sample of Latino (n=827) and NLW (n=2563) respondents of the 2022 Health Information National Trends Survey who used social media in 2022 to assess differences in engagement with and use of health information. Items related to the perceived quantity of health misinformation on social media, social media use frequency, health information engagement (sharing content; watching videos), and health information usage (health decision-making; discussions with health care providers) were selected to conduct weighted bivariate analyses and logistic regressions. Results: Latino individuals perceive lower amounts of health misinformation on social media (28.9\% perceived little to no misinformation vs 13.6\% NLW individuals, P<.001). Latino audiences also reported higher health information engagement compared to NLW individuals (20\% vs 10.2\% shared information several times a month or more, P<.001; 42.4\% vs 27.2\% watched videos several times a month or more, P<.001), as well as higher information usage for health decision-making (22.8\% vs 13.7\%, P=.003). When controlling for ethnicity and other sociodemographic variables, perceiving lower amounts of health misinformation on social media was associated with higher odds of watching videos more frequently, making health decisions, and discussing health-related content with a health care provider (P<.001). Furthermore, Latino audiences were 1.85 times more likely to watch videos (P<.001), when controlling for the perceived amount of health misinformation and other sociodemographic variables. Finally, when compared to NLW individuals perceiving little to no health misinformation, Latino audiences perceiving little to no health misinformation were 2.91 times more likely to watch videos (P<.001). Conclusions: The findings suggest that Latino individuals engage with visual health (mis)information at higher rates. Digital health literacy interventions should consider video formats and preferred social media platforms among Latino individuals. Further research is warranted to understand sociocultural factors important to Latino social media users when consuming health information, as these may impact the success of digital media literacy interventions that teach users how to navigate misinformation online. ", doi="10.2196/59387", url="https://www.jmir.org/2025/1/e59387" } @Article{info:doi/10.2196/53087, author="Krewulak, Karla and Strayer, Kathryn and Jaworska, Natalia and Spence, Krista and Foster, Nadine and Kupsch, Scotty and Sauro, Khara and Fiest, M. Kirsten", title="Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e53087", keywords="education", keywords="health information", keywords="internet", keywords="delirium", keywords="patient", keywords="caregiver", keywords="brain lesions", keywords="confusion", keywords="inattentiveness", keywords="disorientation", keywords="family education", keywords="information seeking", keywords="readability", keywords="high-quality websites", keywords="accessibility", abstract="Background: Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown. Objective: This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education. Methods: We searched Microsoft Bing, Google, and Yahoo using the keywords ``delirium'' and the misspelled ``delerium'' to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians. Results: We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20\%) from commercial websites (20/106, 19\%), government-affiliated organizations (19/106, 18\%), or from a foundation or advocacy group (16/106, 15\%). The median time since the last content update was 3 (IQR 2-5) years. Most websites' content (101/106, 95\%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites' content had poor transparency. Conclusions: We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education. ", doi="10.2196/53087", url="https://www.jmir.org/2025/1/e53087", url="http://www.ncbi.nlm.nih.gov/pubmed/39977019" } @Article{info:doi/10.2196/66446, author="Zhang, Zhongmin and Xu, Hengyi and Pan, Jing and Song, Fujian and Chen, Ting", title="Spatiotemporal Characteristics and Influential Factors of Electronic Cigarette Web-Based Attention in Mainland China: Time Series Observational Study", journal="J Med Internet Res", year="2025", month="Feb", day="10", volume="27", pages="e66446", keywords="electronic cigarettes", keywords="Baidu index", keywords="web-based attention", keywords="spatiotemporal characteristics", keywords="China", abstract="Background: The popularity of electronic cigarettes (e-cigarettes) has steadily increased, prompting a considerable number of individuals to search for relevant information on them. Previous e-cigarette infodemiology studies have focused on assessing the quality and reliability of website content and quantifying the impact of policies. In reality, most low-income countries and low- and middle-income countries have not yet conducted e-cigarette use surveillance. Data sourced from web-based search engines related to e-cigarettes have the potential to serve as cost-effective supplementary means to traditional monitoring approaches. Objective: This study aimed to analyze the spatiotemporal distribution characteristics and associated sociodemographic factors of e-cigarette searches using trends from the Baidu search engine. Methods: The query data related to e-cigarettes for 31 provinces in mainland China were retrieved from the Baidu index database from January 1, 2015, to December 31, 2022. Concentration ratio methods and spatial autocorrelation analysis were applied to analyze the temporal aggregation and spatial aggregation of the e-cigarette Baidu index, respectively. A variance inflation factor test was performed to avoid multicollinearity. A spatial panel econometric model was developed to assess the determinants of e-cigarette web-based attention. Results: The daily average Baidu index for e-cigarettes increased from 53,234.873 in 2015 to 85,416.995 in 2021 and then declined to 52,174.906 in 2022. This index was concentrated in the southeastern coastal region, whereas the hot spot shifted to the northwestern region after adjusting for population size. Positive spatial autocorrelation existed in the per capita Baidu index of e-cigarettes from 2015 to 2022. The results of the local Moran's I showed that there were mainly low-low cluster areas of the per capita Baidu index, especially in the central region. Furthermore, the male-female ratio, the proportion of high school and above education, and the per capita gross regional domestic product were positively correlated with the per capita Baidu index for e-cigarettes. A higher urbanization rate was associated with a reduced per capita Baidu index. Conclusions: With the increasing popularity of web-based searches for e-cigarettes, a targeted e-cigarette health education program for individuals in the northwest, males, rural populations, high school and above educated individuals, and high-income groups is warranted. ", doi="10.2196/66446", url="https://www.jmir.org/2025/1/e66446", url="http://www.ncbi.nlm.nih.gov/pubmed/39928402" } @Article{info:doi/10.2196/58615, author="Polat, Halil Yunus and Cankurtaran, Eren Rasim", title="Assessment of Reliability and Validity of Celiac Disease--Related YouTube Videos: Content Analysis", journal="JMIR Infodemiology", year="2025", month="Feb", day="4", volume="5", pages="e58615", keywords="gastroenterology", keywords="celiac", keywords="YouTube", keywords="internet-based information", keywords="medical information", keywords="health-related", keywords="reliability", keywords="validity", keywords="quality", keywords="videos", keywords="celiac sprue", keywords="sprue", keywords="gluten enteropathy", keywords="cross-sectional", abstract="Background: YouTube is an increasingly used platform for medical information. However, the reliability and validity of health-related information on celiac disease (CD) on YouTube have not been determined. Objective: This study aimed to analyze the reliability and validity of CD-related YouTube videos. Methods: On November 15, 2023, a search was performed on YouTube using the keyword ``celiac disease.'' This search resulted in a selection of videos, which were then reviewed by 2 separate evaluators for content, origin, and specific features. The evaluators assessed the reliability and quality of these videos using a modified DISCERN (mDISCERN) score, the Journal of the American Medical Association (JAMA) benchmark criteria score, the usefulness score, video power index (VPI), and the Global Quality Scale (GQS) score. Results: In the analysis of 120 initially screened CD videos, 85 met the criteria for inclusion in the study after certain videos were excluded based on predefined criteria. While the duration of the videos uploaded by health care professionals was significantly longer than the other group (P=.009), it was concluded that the median scores for mDISCERN (4, IQR 4-5 vs 2, IQR 2-3; P<.001), GQS (4, IQR 4-5 vs 3, IQR 2-3; P<.001), JAMA (4, IQR 3-4 vs 2, IQR 2-3; P<.001), and usefulness (8, IQR 7-9 vs 6, IQR 3-6; P<.001) of the videos from this group were significantly higher than those from non--health care professionals. Video interaction parameters, including the median number of views, views per day, likes, dislikes, comments, and VPI, demonstrated no significant difference between the 2 groups. Conclusions: This study showed that YouTube videos about CD vary significantly in reliability and quality depending on their source. Increasing the production of reliable videos by health care professionals may help to improve patient education and make YouTube a more reliable resource. ", doi="10.2196/58615", url="https://infodemiology.jmir.org/2025/1/e58615", url="http://www.ncbi.nlm.nih.gov/pubmed/39756057" } @Article{info:doi/10.2196/55275, author="Baker, Venetia and Mulwa, Sarah and Khanyile, David and Arnold, Georgia and Cousens, Simon and Cawood, Cherie and Birdthistle, Isolde", title="Evaluating Reaction Videos of Young People Watching Edutainment Media (MTV Shuga): Qualitative Observational Study", journal="JMIR Form Res", year="2025", month="Jan", day="31", volume="9", pages="e55275", keywords="mass media", keywords="edutainment", keywords="adolescents", keywords="sexual health", keywords="HIV prevention", keywords="participatory research", abstract="Background: Mass media campaigns, particularly edutainment, are critical in disseminating sexual health information to young people. However, there is limited understanding of the authentic viewing experience or how viewing contexts influence engagement with media campaigns. Reaction videos, a popular format in web-based culture in which users film themselves reacting to television shows, can be adapted as a research method for immediate and unfiltered insights into young people's engagement with edutainment media. Objective: We explored how physical and social context influences young people's engagement with MTV Shuga, a dramatic television series based on sexual health and relationships among individuals aged 15 to 25 years. We trialed reaction videos as a novel research method to investigate how young people in South Africa experience the show, including sexual health themes and messages, in their viewing environments. Methods: In Eastern Cape, in 2020, purposively selected participants aged 18 to 24 years of an evaluation study were invited to take part in further research to video record themselves watching MTV Shuga episodes with their COVID-19 social bubble. To guide the analysis of the visual and audio data, we created a framework to examine the physical setting, group composition, social dynamics, coinciding activities, and viewers' spoken and unspoken reactions to the show. We identified patterns within and across groups to generate themes about the nature and role of viewing contexts. We also reflected on the utility of the method and analytical framework. Results: In total, 8 participants recorded themselves watching MTV Shuga episodes in family or friendship groups. Viewings occurred around a laptop in the home (living room or bedroom) and outside (garden or vehicle). In same-age groups, viewers appeared relaxed, engaging with the content through discussion, comments, empathy, and laughter. Intergenerational groups experienced discomfort, with older relatives' presence causing embarrassment and younger siblings' distractions interrupting the engagement. Scenes featuring physical intimacy prompted some viewers to hide their eyes or leave the room. While some would prefer watching MTV Shuga alone to avoid the self-consciousness experienced in group settings, others valued the social experience and the lively discussions it spurred. This illustrates varied preferences for consuming edutainment and the factors influencing these preferences. Conclusions: The use of reaction videos for research captured real-time verbal and nonverbal reactions, physical environments, and social dynamics that other methods cannot easily measure. They revealed how group composition, dynamics, settings, and storylines can maximize engagement with MTV Shuga to enhance HIV prevention education. The presence of parents and the camera may alter young people's behavior, limiting the authenticity of their viewing experience. Still, reaction videos offer a unique opportunity to understand audience engagement with media interventions and promote participatory digital research with young people. ", doi="10.2196/55275", url="https://formative.jmir.org/2025/1/e55275" } @Article{info:doi/10.2196/66896, author="Abroms, C. Lorien and Yousefi, Artin and Wysota, N. Christina and Wu, Tien-Chin and Broniatowski, A. David", title="Assessing the Adherence of ChatGPT Chatbots to Public Health Guidelines for Smoking Cessation: Content Analysis", journal="J Med Internet Res", year="2025", month="Jan", day="30", volume="27", pages="e66896", keywords="ChatGPT", keywords="large language models", keywords="chatbots", keywords="tobacco", keywords="smoking cessation", keywords="cigarettes", keywords="artificial intelligence", abstract="Background: Large language model (LLM) artificial intelligence chatbots using generative language can offer smoking cessation information and advice. However, little is known about the reliability of the information provided to users. Objective: This study aims to examine whether 3 ChatGPT chatbots---the World Health Organization's Sarah, BeFreeGPT, and BasicGPT---provide reliable information on how to quit smoking. Methods: A list of quit smoking queries was generated from frequent quit smoking searches on Google related to ``how to quit smoking'' (n=12). Each query was given to each chatbot, and responses were analyzed for their adherence to an index developed from the US Preventive Services Task Force public health guidelines for quitting smoking and counseling principles. Responses were independently coded by 2 reviewers, and differences were resolved by a third coder. Results: Across chatbots and queries, on average, chatbot responses were rated as being adherent to 57.1\% of the items on the adherence index. Sarah's adherence (72.2\%) was significantly higher than BeFreeGPT (50\%) and BasicGPT (47.8\%; P<.001). The majority of chatbot responses had clear language (97.3\%) and included a recommendation to seek out professional counseling (80.3\%). About half of the responses included the recommendation to consider using nicotine replacement therapy (52.7\%), the recommendation to seek out social support from friends and family (55.6\%), and information on how to deal with cravings when quitting smoking (44.4\%). The least common was information about considering the use of non--nicotine replacement therapy prescription drugs (14.1\%). Finally, some types of misinformation were present in 22\% of responses. Specific queries that were most challenging for the chatbots included queries on ``how to quit smoking cold turkey,'' ``...with vapes,'' ``...with gummies,'' ``...with a necklace,'' and ``...with hypnosis.'' All chatbots showed resilience to adversarial attacks that were intended to derail the conversation. Conclusions: LLM chatbots varied in their adherence to quit-smoking guidelines and counseling principles. While chatbots reliably provided some types of information, they omitted other types, as well as occasionally provided misinformation, especially for queries about less evidence-based methods of quitting. LLM chatbot instructions can be revised to compensate for these weaknesses. ", doi="10.2196/66896", url="https://www.jmir.org/2025/1/e66896" } @Article{info:doi/10.2196/64993, author="Biro, Joshua and Handley, L. Jessica and Cobb, K. Nathan and Kottamasu, Varsha and Collins, Jeffrey and Krevat, Seth and Ratwani, M. Raj", title="Accuracy and Safety of AI-Enabled Scribe Technology: Instrument Validation Study", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e64993", keywords="artificial intelligence", keywords="AI", keywords="patient safety", keywords="ambient digital scribe", keywords="AI-enabled scribe technology", keywords="AI scribe technology", keywords="scribe technology", keywords="accuracy", keywords="safety", keywords="ambient scribe", keywords="digital scribe", keywords="patient-clinician", keywords="patient-clinician communication", keywords="doctor-patient relationship", keywords="doctor-patient communication", keywords="patient engagement", keywords="dialogue script", keywords="scribe", doi="10.2196/64993", url="https://www.jmir.org/2025/1/e64993" } @Article{info:doi/10.2196/58310, author="Lamprell, Klay and Pulido, Fajardo Diana and Arnolda, Gaston and Easpaig, Giolla Br{\'o}na Nic and Tran, Yvonne and Braithwaite, Jeffrey", title="From Stories to Solutions: A Research Cycle Framework for Enhancing Trustworthiness in Studies of Online Patient Narratives", journal="J Med Internet Res", year="2025", month="Jan", day="23", volume="27", pages="e58310", keywords="online research", keywords="exploratory study", keywords="patient experience", keywords="patient narratives", keywords="narrative analysis", keywords="mixed methods", keywords="young-onset colorectal cancer", keywords="cancer", keywords="oncology", keywords="internal medicine", abstract="International Registered Report Identifier (IRRID): RR2-10.2196/25056 ", doi="10.2196/58310", url="https://www.jmir.org/2025/1/e58310", url="http://www.ncbi.nlm.nih.gov/pubmed/39847425" } @Article{info:doi/10.2196/41175, author="Joshi, Ashish and Mohan, Krishna Surapaneni and Pandya, Kumar Apurva and Grover, Ashoo and Saggu, Rani Sofia and Revathi, Kalpana Saravanavel and Sharma, Shruti", title="Digital Health Intervention (SANGYAN Podcast) to Enhance Knowledge Related to COVID-19 and Other Health Conditions: Protocol for an Implementation and Evaluation Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="20", volume="14", pages="e41175", keywords="podcast", keywords="human-centered behavior", keywords="pandemic", keywords="coronavirus", keywords="intervention", keywords="digital health", keywords="usefulness", keywords="effectiveness", keywords="usability", abstract="Background: Podcasts are an unconventional method of disseminating information through audio to the masses. They are an emerging portable technology and a valuable resource that provides unlimited access for promoting health among participants. Podcasts related to health care have been used as a source of medical education, but there is a dearth of studies on the use of podcasts as a source of health information. This study will provide new perspectives by implementing the SANGYAN podcast, which contains information about COVID-19 and other health conditions.? Objective: The study aims to determine the usefulness and effectiveness of the SANGYAN podcast as a digital health intervention to address misinformation related to COVID-19 and other health conditions among individuals in Chennai, Tamil Nadu, India. Methods: An implementation and evaluation study will be conducted with 500 participants from the Panimalar Medical College Hospital \& Research Institute (PMCHRI) and Rural Health Training Centre in Chennai. Among individuals aged 18 years and older, those residing in the selected urban and rural settings who visit the outpatient department of the PMCHRI and Rural Health Training Centre will be recruited. For participants who consent to the study, their sociodemographic details will be noted and their health literacy will be assessed using the Rapid Estimate of Adult Literacy in Medicine scale. Once the participants have listened to the podcast, the usability, acceptance, and user satisfaction of the podcast will be assessed. Descriptive analysis will be used for continuous variables, and frequency analysis will be used for categorical variables. Bivariate analysis will be conducted to understand the correlation of sociodemographic features in response to perception, usefulness, acceptance, and user satisfaction of the podcast. All analysis will be performed using SPSS (version 24), and the results will be reported with 95\% CIs and P<.05. Results: As of December 2024, the SANGYAN podcast has been launched for voluntary usage in the PMCHRI. Conclusions: The finding from this research project will aid in the development and implementation of data-driven, evidence-based, and human-centered behavior change interventions using podcasts to address public health challenges among populations living in diverse settings. This would also help in enhancing the acceptability of podcasts as a source of health-related information. International Registered Report Identifier (IRRID): DERR1-10.2196/41175 ", doi="10.2196/41175", url="https://www.researchprotocols.org/2025/1/e41175" } @Article{info:doi/10.2196/63489, author="Furukawa, Emi and Okuhara, Tsuyoshi and Liu, Mingxin and Okada, Hiroko and Kiuchi, Takahiro", title="Evaluating Online and Offline Health Information With the Patient Education Materials Assessment Tool: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2025", month="Jan", day="15", volume="14", pages="e63489", keywords="patient education", keywords="health communication", keywords="health information", keywords="behavior change", keywords="understandability", keywords="actionability Patient Education Materials Assessment Tool", keywords="PEMAT", keywords="medical information", keywords="health literacy", keywords="patient education materials", abstract="Background: The Patient Education Materials Assessment Tool (PEMAT) is a reliable and validated instrument for assessing the understandability and actionability of patient education materials. It has been applied across diverse cultural and linguistic contexts, enabling cross-field and cross-national material quality comparisons. Accumulated evidence from studies using the PEMAT over the past decade underscores its potential impact on patient and public action. Objective: This systematic review aims to investigate how the quality of patient education materials has been assessed using the PEMAT. Methods: This review protocol follows PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycInfo, and Web of Science Core Collection will be searched systematically for articles published since September 2014. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Rayyan QCRI software will be used for screening and data extraction. Results: The results will be included in the full systematic review, which is expected to start in September 2024 and be completed to be submitted for publication by early 2025. Conclusions: The findings are expected to identify the quality of materials evaluated by the PEMAT and the areas under evaluation. This review can also highlight gaps that exist in research and practice for improving the understandability and actionability of the materials, offering deeper insights into how existing materials can facilitate patient and public action. International Registered Report Identifier (IRRID): PRR1-10.2196/63489 ", doi="10.2196/63489", url="https://www.researchprotocols.org/2025/1/e63489" } @Article{info:doi/10.2196/53057, author="Isaac, Mohsen Sarah and Dawes, Mark and Howell, Ruth Emily and Oladipo, Francis Antonia", title="Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="6", volume="12", pages="e53057", keywords="OBGYN", keywords="transgender", keywords="nonbinary", keywords="pregnancy", keywords="maternity", keywords="transmasculine", keywords="observational study", keywords="gestational", keywords="perinatal care", keywords="communication", keywords="labor", keywords="USA", keywords="United States", keywords="New York City", keywords="sexual orientation", keywords="inclusion", keywords="parents", keywords="obstetrician gynecologist", keywords="delivery", abstract="Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy. Objective: The aim of this study was to evaluate the current prevalence of gender-inclusive terminology among labor and delivery services in the New York tristate area. Methods: The labor and delivery web pages of 189 hospitals from New York, New Jersey, and Connecticut were examined for gender-inclusive language. ``Fully inclusive'' websites explicitly acknowledged lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus other gender- and sexual-oriented (LGBTQIA+) parents, ``inclusive'' websites did not use gendered terminology for parents, and ``noninclusive'' websites used gendered terms at least once in the text reviewed. The hospitals' web pages were further stratified by Healthcare Equality Index scores and population classifications defined by the 2013 National Center for Health Statistics Urban-Rural classification given to the county that each hospital was located in. Results: Of the 300 hospital websites reviewed, only 189 websites met the criteria for inclusion. Overall, only 6.3\% (n=12) of labor and delivery web pages were ``inclusive'' or ``fully inclusive.'' No geographic areas (P=.61) or Healthcare Equality Index scores (P=.81) were associated with inclusive or fully inclusive language. Conclusions: Hospitals need to use inclusive language to help TGNB people identify hospitals where their existence and needs are acknowledged and thus feel more comfortable in their transition to parenthood. ", doi="10.2196/53057", url="https://humanfactors.jmir.org/2025/1/e53057" } @Article{info:doi/10.2196/64343, author="Pearce, Eidenier Emily and Majid, Alina and Brown, Toniya and Shepherd, Forbes Rowan and Rising, Camella and Wilsnack, Catherine and Thompson, S. Ashley and Gilkey, B. Melissa and Ribisl, M. Kurt and Lazard, J. Allison and Han, KJ Paul and Werner-Lin, Allison and Hutson, P. Sadie and Savage, A. Sharon", title="``Crying in the Wilderness''---The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis", journal="JMIR Form Res", year="2024", month="Dec", day="16", volume="8", pages="e64343", keywords="social media", keywords="dyskeratosis congenita", keywords="telomere biology disorder", keywords="health communication", keywords="qualitative", keywords="thematic analysis", keywords="web-based information", keywords="web-based support", keywords="telomere", keywords="biology disorder", keywords="social support", keywords="emotional support", keywords="genetic", keywords="internet-based", keywords="information-seeking", keywords="descriptive study", keywords="semistructured interview", keywords="adult", keywords="illness experience", keywords="psychosocial", keywords="digital health", keywords="health intervention", keywords="health informatics", abstract="Background: Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk. Objective: This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers. Methods: Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team. Results: A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88\%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91\%) and TBD-specific social media (n=26, 81\%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience. Conclusions: Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated ``safe spaces'' designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information. ", doi="10.2196/64343", url="https://formative.jmir.org/2024/1/e64343", url="http://www.ncbi.nlm.nih.gov/pubmed/39680438" } @Article{info:doi/10.2196/60033, author="Niu, Zheyu and Hao, Yijie and Yang, Faji and Jiang, Qirong and Jiang, Yupeng and Zhang, Shizhe and Song, Xie and Chang, Hong and Zhou, Xu and Zhu, Huaqiang and Gao, Hengjun and Lu, Jun", title="Quality of Pancreatic Neuroendocrine Tumor Videos Available on TikTok and Bilibili: Content Analysis", journal="JMIR Form Res", year="2024", month="Dec", day="11", volume="8", pages="e60033", keywords="pancreatic neuroendocrine tumors", keywords="short videos", keywords="quality analysis", keywords="TikTok", keywords="Bilibili", keywords="social media", abstract="Background: Disseminating disease knowledge through concise videos on various platforms is an innovative and efficient approach. However, it remains uncertain whether pancreatic neuroendocrine tumor (pNET)-related videos available on current short video platforms can effectively convey accurate and impactful information to the general public. Objective: Our study aims to extensively analyze the quality of pNET-related videos on TikTok and Bilibili, intending to enhance the development of pNET-related social media content to provide the general public with more comprehensive and suitable avenues for accessing pNET-related information. Methods: A total of 168 qualifying videos pertaining to pNETs were evaluated from the video-sharing platforms Bilibili and TikTok. Initially, the fundamental information conveyed in the videos was documented. Subsequently, we discerned the source and content type of each video. Following that, the Global Quality Scale (GQS) and modified DISCERN (mDISCERN) scale were employed to appraise the educational value and quality of each video. A comparative evaluation was conducted on the videos obtained from these two platforms. Results: The number of pNET-related videos saw a significant increase since 2020, with 9 videos in 2020, 19 videos in 2021, 29 videos in 2022, and 106 videos in 2023. There were no significant improvements in the mean GQS or mDISCERN scores from 2020 to 2023, which were 3.22 and 3.00 in 2020, 3.33 and 2.94 in 2021, 2.83 and 2.79 in 2022, and 2.78 and 2.94 in 2023, respectively. The average quality scores of the videos on Bilibili and Tiktok were comparable, with GQS and mDISCERN scores of 2.98 on Bilibili versus 2.77 on TikTok and 2.82 on Bilibili versus 3.05 on TikTok, respectively. The source and format of the videos remained independent factors affecting the two quality scores. Videos that were uploaded by professionals (hazard ratio=7.02, P=.002) and recorded in specialized popular science formats (hazard ratio=12.45, P<.001) tended to exhibit superior quality. Conclusions: This study demonstrates that the number of short videos on pNETs has increased in recent years, but video quality has not improved significantly. This comprehensive analysis shows that the source and format of videos are independent factors affecting video quality, which provides potential measures for improving the quality of short videos. ", doi="10.2196/60033", url="https://formative.jmir.org/2024/1/e60033" } @Article{info:doi/10.2196/51701, author="Almenara, A. Carlos and Gulec, Hayriye", title="Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach", journal="JMIR Infodemiology", year="2024", month="Dec", day="11", volume="4", pages="e51701", keywords="consumer health informatics", keywords="cyberattack risk", keywords="data mining", keywords="Google", keywords="information seeking", keywords="weight loss", keywords="online health information", keywords="website analysis", keywords="digital health", keywords="internet search", abstract="Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, ``People Also Ask'' featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved ``Health'' (104/623, 16.69\%), ``Personal Pages and Blogs'' (91/623, 14.61\%), ``Nutrition and Diet'' (48/623, 7.7\%), and ``Exercise'' (34/623, 5.46\%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. ", doi="10.2196/51701", url="https://infodemiology.jmir.org/2024/1/e51701" } @Article{info:doi/10.2196/60283, author="Muenster, Mika Roxana and Gangi, Kai and Margolin, Drew", title="Alternative Health and Conventional Medicine Discourse About Cancer on TikTok: Computer Vision Analysis of TikTok Videos", journal="J Med Internet Res", year="2024", month="Dec", day="9", volume="26", pages="e60283", keywords="misinformation", keywords="social media", keywords="TikTok", keywords="alternative health", keywords="cancer", keywords="computer vision", abstract="Background: Health misinformation is abundant online and becoming an increasingly pressing concern for both oncology practitioners and patients with cancer. On social media platforms, including the popular audiovisual app TikTok, the flourishing alternative health industry is further contributing to the spread of misleading and often harmful information, endangering patients' health and outcomes and sowing distrust of the medical community. The prevalence of false and potentially dangerous treatments on a platform that is used as a quasi--search engine by young people poses a serious risk to the health of patients with cancer. Objective: This study seeks to examine how cancer discourse on TikTok differs between alternative health and conventional medicine videos. It aims to look beyond mere facts and falsehoods that TikTok users may utter to understand the visual language and format used in the support of both misleading and truthful narratives, as well as other messages. Methods: Using computer vision analysis and subsequent qualitative close reading of 831 TikTok videos, this study examined how alternative health and conventional medicine videos on cancer differ with regard to the visual language used. Videos were examined for the length of time and prominence in which faces are displayed, as well as for the background setting, location, and dominant color scheme. Results: The results show that the alt-health and conventional health samples made different use of the audiovisual affordances of TikTok. First, videos from the alternative health sample were more likely to contain a single face that was prominently featured (making up at least 7.5\% of the image) for a substantial period of time (35\% of the shots), with these testimonial-style videos making up 28.5\% (93/326) of the sample compared to 18.6\% (94/505) of the conventional medicine sample. Alternative health videos predominantly featured cool tones (P<.001) and were significantly more likely to be filmed outdoors (P<.001), whereas conventional medicine videos were more likely to be shot indoors and feature warm tones such as red, orange, or yellow. Conclusions: The findings of this study contribute to an increased understanding of misinformation as not merely a matter of individual falsehoods but also a phenomenon whose effects might be transported through emotive as well as rational means. They also point to influencer practices and style being an important contributing factor in the declining health of the information environment around cancer and its treatment. The results suggest that public health efforts must extend beyond correcting false statements by injecting factual information into the online cancer discourse and look toward incorporating both visual and rational strategies. ", doi="10.2196/60283", url="https://www.jmir.org/2024/1/e60283" } @Article{info:doi/10.2196/63281, author="Gaba, Ann and Bennett, Richard", title="Health-Related Messages About Herbs, Spices, and Other Botanicals Appearing in Print Issues and Websites of Legacy Media: Content Analysis and Evaluation", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e63281", keywords="legacy media", keywords="health applications", keywords="health communication", keywords="botanical products", keywords="content analysis", abstract="Background: Legacy media are publications that existed before the internet. Many of these have migrated to a web format, either replacing or in parallel to their print issues. Readers place an economic value on access to the information presented as they pay for subscriptions and place a higher degree of trust in their content. Much has been written about inaccurate and misleading health information in social media; however, the content and accuracy of information contained in legacy media has not been examined in detail. Discussion of herbs, spices, and other botanicals has been absent from this context. Objective: The objectives of this study were to (1) identify the health associations of botanical products mentioned in legacy media targeted to a range of demographic groups and (2) evaluate these health associations for accuracy against published scientific studies. Methods: In total, 10 popular magazines targeting a range of gender, race/ethnicity, and sexual orientation demographic groups were selected for analysis. Relevant content was extracted and coded over 1 year. Associations between specific botanical products and health factors were identified. For the most frequent botanical--health application associations, a PubMed search was conducted to identify reviews corresponding to each item's indicated applications. Where no systematic reviews were available, single research studies were sought. Results: A total of 237 unique botanical products were identified. There were 128 mentions of these in the print issues and 1215 on the websites. In total, 18 health applications were identified and used to categorize the indicated uses for the various products individually and as general categories. The most frequently mentioned applications were skin care, with 913 mentions, immunity enhancement, with 705 mentions, gastrointestinal health and probiotics, with 184 mentions, and cognitive function (stress and mental health), with 106 mentions. Comparison to published literature evaluating the efficacy of these functions identified positive support for aloe vera, argan oil, chamomile, jojoba oil, lavender, rosemary, and tea tree oil in skin care. Berries, ginger, turmeric, and green tea had the strongest evidence for a role in immunity enhancement. Ginger and oats were supported as having a role in gastrointestinal health. Finally, berries, lavender, ashwagandha, and cannabidiol were supported as having a role in managing stress. Other frequently mentioned items such as aloe vera, ashwagandha, or mushrooms for immunity were less strongly supported. Conclusions: Comparison of the most prevalent associations between botanical products and health applications to published literature indicates that, overall, these associations were consistent with current scientific reports about the health applications of botanical products. While some products had a greater degree of research support than others, truly egregious falsehoods were absent. Therefore, legacy media may be considered a credible source of information to readers about these topics. ", doi="10.2196/63281", url="https://formative.jmir.org/2024/1/e63281" } @Article{info:doi/10.2196/63410, author="Karupaiah, Tilakavati and Rahman, Mahfuzur Shah Md and Zhang, Juan and Kumar, Naveen and Jamiyan, Batjargal and Pokharel, Kumar Raj and Borazon, Quintana Elaine and Thoradeniya, Tharanga and Tho, Thi Nguyen Thi and Mackay, Sally and Kelly, Bridget and Swinburn, Boyd and Chinna, Karuthan and Dashzeveg, Enkhmyagmar and Ong, Rick Gild and Narayanan, Sankara Sreelakshmi and Sameeha, Jamil Mohd and Uddin, Ahsan Mohammad and Tang, Yuxiang and Sharma, Kumar Naresh and Pokharel, Rishav and Rome, Christine Anna and Wickramasinghe, Pujitha V. and Huy, Thanh Phan", title="Extent and Nature of Television Food and Nonalcoholic Beverage Marketing in 9 Asian Countries: Cross-Sectional Study Using a Harmonized Approach", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="4", volume="7", pages="e63410", keywords="children", keywords="Asian food marketing", keywords="television", keywords="unhealthy food", keywords="WHO nutrient profile model", keywords="World Health Organization", keywords="pediatrics", keywords="commercial", keywords="Asia", keywords="unhealthy", keywords="nutrition", keywords="diet", keywords="market", keywords="advertisement", keywords="food", keywords="beverage", keywords="consumption", abstract="Background: Rising childhood obesity rates in Asia are adding risk for the future adult burden of obesity and noncommunicable diseases. Weak policies across most Asian countries enable unrestricted marketing of obesogenic foods and beverages to children. Television is the common medium for food marketing to reach this audience. Objective: This study aimed to assess the extent and nature of television food and nonalcoholic beverage marketing in 9 Asian countries (Bangladesh, China, India, Malaysia, Mongolia, Nepal, the Philippines, Sri Lanka, and Vietnam) with capacity building support from the International Network for Food and Obesity/Non-Communicable Disease Research, Monitoring and Action Support, who enabled harmonization of data collection method and content analyses. Methods: Advertised foods were categorized as permitted or not permitted based on the nutrient profile models established by the World Health Organization regional offices for South-East Asia (SEARO) and the World Health Organization regional offices for Western Pacific (WPRO). Overall rates of food advertisements (advertisements per hour per channel) and persuasive strategy use were analyzed along with comparisons between children's peak viewing time (PVT) and non-PVT. Results: Cross-country comparisons, irrespective of country income level, indicated that not permitted food advertising dominated children's popular television channels, especially during PVT with rates as per WPRO or SEARO criteria ranging from 2.40/2.29 (Malaysia) to 9.70/9.41 advertisements per hour per channel (the Philippines). Persuasive strategy rates were also comparatively higher during PVT. Sugar-sweetened beverages, sugar-containing solid foods, and high salt- and fat-containing snacks and fast foods were frequently advertised. Evaluation of the application of WPRO and SEARO nutrient profile models identified inconsistencies due to regional taste and cuisine variations across Asia. Conclusions: This study clearly showed that unhealthy food marketing through popular children's television channels is widely occurring in Asia and is a clear breach of child rights. Evidence outcomes will benefit advocacy toward stronger policy regulations to control unhealthy food marketing and strengthen strategies to promote a healthier food environment for Asia's children. ", doi="10.2196/63410", url="https://pediatrics.jmir.org/2024/1/e63410", url="http://www.ncbi.nlm.nih.gov/pubmed/39630493" } @Article{info:doi/10.2196/53440, author="Blank, Ann Carol and Biedka, Sarah and Montalmant, Abigail and Saft, Katelyn and Lape, Miranda and Mao, Kate and Bradt, Joke and Liou, T. Kevin", title="Scope, Findability, and Quality of Information About Music-Based Interventions in Oncology: Quantitative Content Analysis of Public-Facing Websites at National Cancer Institute--Designated Cancer Centers", journal="JMIR Cancer", year="2024", month="Nov", day="22", volume="10", pages="e53440", keywords="music-based interventions", keywords="cancer", keywords="oncology", keywords="symptom management", keywords="music therapy", keywords="music services", keywords="National Cancer Institute", abstract="Background: Music-based interventions (MBIs) are evidence-based, nonpharmacological treatments that include music therapy (MT) delivered by board-certified music therapists, as well as music services (MS) delivered by other health professionals and volunteers. Despite MBI's growing evidence base in cancer symptom management, it remains unclear how MBI-related information is presented to the public. Over 80\% of people with cancer use the internet to find health-related information. In the United States, the National Cancer Institute (NCI) identifies certain Cancer Centers (CCs) as NCI-designated CCs or Comprehensive Cancer Centers (CCCs) based on their excellence in research. As NCI-designated CCs and CCCs are considered the gold standard in cancer care, their websites are viewed by the public as important sources of information. Objective: We aimed to determine scope, findability, and quality of MBI-related information on public-facing websites of NCI-designated CCs/CCCs. Methods: We reviewed 64 NCI-designated CC/CCC websites (excluding basic laboratories) between November 2022 and January 2023. We extracted data on the scope of information: (1) type of MBI offered (MT or MS), (2) format (individual, group), (3) method of delivery (in person or remotely delivered), (4) setting (inpatient or outpatient), (5) target population (pediatric or adult), (6) MBI practitioner qualifications, (7) clinical indications or benefits, (8) presence of testimonials, (9) cost, and (10) scheduling or referral information. We also extracted data on findability (ie, presence of direct link or drop-down menu and the number of clicks to locate MBI-related information). Based on the scope and findability data, we rated the information quality as high, moderate, or low using an adapted scale informed by prior research. Results: Thirty-one (48\%) of the 64 CC/CCCs described MBIs on their websites. Of these, 6 (19\%) mentioned both MT and MS, 16 (52\%) mentioned MT only, and 9 (29\%) mentioned MS only. The most common format was hybrid, involving individuals and groups (n=20, 65\%). The most common delivery method was in person (n=16, 52\%). The most common target population was adults (n=12, 39\%). The most common MBI practitioners were board-certified music therapists (n=21, 68\%). The most described indications or benefits were psychological. Twenty-eight (90\%) websites lacked testimonials, and 26 (84\%) lacked cost information. Twenty-six (84\%) websites provided scheduling or referral information. MBI-related information was found with an average of 4 (SD 1) clicks. Nine (29\%) websites were of high quality, 18 (58\%) were moderate, and 4 (13\%) were low. Conclusions: Based on public websites, MBIs were most commonly delivered in person by board-certified music therapists to outpatient and inpatient adults, using individual and group formats to provide psychological benefits. The findability and quality of this information should be improved to promote the dissemination of MBIs for cancer symptom management. ", doi="10.2196/53440", url="https://cancer.jmir.org/2024/1/e53440" } @Article{info:doi/10.2196/58088, author="Patel, Mohammed Ahmed and Baxter, Weston and Porat, Talya", title="Toward Guidelines for Designing Holistic Integrated Information Visualizations for Time-Critical Contexts: Systematic Review", journal="J Med Internet Res", year="2024", month="Nov", day="20", volume="26", pages="e58088", keywords="visualization", keywords="design", keywords="holistic", keywords="integrated", keywords="time-critical", keywords="guidelines", keywords="pre-attentive processing", keywords="gestalt theory", keywords="situation awareness", keywords="decision-making", keywords="mobile phone", abstract="Background: With the extensive volume of information from various and diverse data sources, it is essential to present information in a way that allows for quick understanding and interpretation. This is particularly crucial in health care, where timely insights into a patient's condition can be lifesaving. Holistic visualizations that integrate multiple data variables into a single visual representation can enhance rapid situational awareness and support informed decision-making. However, despite the existence of numerous guidelines for different types of visualizations, this study reveals that there are currently no specific guidelines or principles for designing holistic integrated information visualizations that enable quick processing and comprehensive understanding of multidimensional data in time-critical contexts. Addressing this gap is essential for enhancing decision-making in time-critical scenarios across various domains, particularly in health care. Objective: This study aims to establish a theoretical foundation supporting the argument that holistic integrated visualizations are a distinct type of visualization for time-critical contexts and identify applicable design principles and guidelines that can be used to design for such cases. Methods: We systematically searched the literature for peer-reviewed research on visualization strategies, guidelines, and taxonomies. The literature selection followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted across 6 databases: ACM Digital Library, Google Scholar, IEEE Xplore, PubMed, Scopus, and Web of Science. The search was conducted up to August 2024 using the terms (``visualisations'' OR ``visualizations'') AND (``guidelines'' OR ``taxonomy'' OR ``taxonomies''), with studies restricted to the English language. Results: Of 936 papers, 46 (4.9\%) were included in the final review. In total, 48\% (22/46) related to providing a holistic understanding and overview of multidimensional data; 28\% (13/46) focused on integrated presentation, that is, integrating or combining multidimensional data into a single visual representation; and 35\% (16/46) pertained to time and designing for rapid information processing. In total, 65\% (30/46) of the papers presented general information visualization or visual communication guidelines and principles. No specific guidelines or principles were found that addressed all the characteristics of holistic, integrated visualizations in time-critical contexts. A summary of the key guidelines and principles from the 46 papers was extracted, collated, and categorized into 60 guidelines that could aid in designing holistic integrated visualizations. These were grouped according to different characteristics identified in the systematic review (eg, gestalt principles, reduction, organization, abstraction, and task complexity) and further condensed into 5 main proposed guidelines. Conclusions: Holistic integrated information visualizations in time-critical domains are a unique use case requiring a unique set of design guidelines. Our proposed 5 main guidelines, derived from existing design theories and guidelines, can serve as a starting point to enable both holistic and rapid processing of information, facilitating better-informed decisions in time-critical contexts. ", doi="10.2196/58088", url="https://www.jmir.org/2024/1/e58088" } @Article{info:doi/10.2196/49761, author="Woolard, Alix and Paciente, Rigel and Munro, Emily and Wickens, Nicole and Wells, Gabriella and Ta, Daniel and Mandzufas, Joelie and Lombardi, Karen", title="\#TraumaTok---TikTok Videos Relating to Trauma: Content Analysis", journal="JMIR Form Res", year="2024", month="Nov", day="7", volume="8", pages="e49761", keywords="trauma", keywords="traumatic events", keywords="traumatic stress", keywords="TikTok", keywords="public health", keywords="social media", keywords="content analysis", abstract="Background: Experiencing a traumatic event can significantly impact mental and emotional well-being. Social media platforms offer spaces for sharing stories, seeking support, and accessing psychoeducation. TikTok (ByteDance), a rapidly growing social media platform, is increasingly used for advice, validation, and information, although the content of this requires further study. Research is particularly needed to better understand TikTok content relating to trauma and the potential implications for young viewers, considering the distressing nature of the subject and the possibility of users experiencing vicarious trauma through exposure to these videos. Objective: This study aims to explore the content of trauma-related videos on TikTok, focusing on hashtags related to trauma. Specifically, this study analyzes how TikTok videos present information, advice, stories, and support relating to trauma. Methods: A quantitative cross-sectional descriptive content analysis was performed on TikTok in December 2022. A total of 5 hashtags related to trauma were selected: \#trauma, \#traumatized, \#traumatok, \#traumatic, and \#traumabond, with the top 50 videos from each hashtag analyzed (total N=250 videos). A standardized codebook was developed inductively to analyze the content of the videos, while an existing generic codebook was used to collect the video features (eg, age of people in the video) and metadata (likes, comments, and shares) for each video. Results: A total of 2 major content themes were identified, which were instructional videos (54/250, 21.6\%) and videos disclosing personal stories (168/250, 67.3\%). The videos garnered significant engagement, with a total of 296.6 million likes, 2.3 million comments, and 4.6 million shares, indicating that users find this content engaging and useful. Alarmingly, only 3.7\% (9/250) of videos included a trigger warning, despite many featuring highly distressing stories that young people and those with trauma may be exposed to. Conclusions: The study highlights the potential risks of vicarious trauma due to trauma dumping without trigger warnings on TikTok, and the need for further research to assess the accuracy of advice and information in these videos. However, it also underscores the platform's potential to foster social connections, provide validation, and reduce stigma around mental health issues. Public health professionals should leverage social media to disseminate accurate mental health information, while promoting user education and content moderation to mitigate potential harms. People often use social media, such as TikTok to share advice, stories, and support around mental health, including their experiences with trauma. Out of 250 videos, most were either giving advice (54/250, 21.6\%) or sharing personal experiences (168/250, 67.3\%). The study found many videos lacked warnings about upsetting content, which could potentially harm young viewers or people suffering from trauma. While TikTok can help people feel connected and reduce the stigma around mental health, it is important to seek support from professionals when needed. ", doi="10.2196/49761", url="https://formative.jmir.org/2024/1/e49761" } @Article{info:doi/10.2196/64221, author="Nachman, Sophie and Ortiz-Prado, Esteban and Tucker, D. Joseph", title="Video Abstracts in Research", journal="J Med Internet Res", year="2024", month="Nov", day="4", volume="26", pages="e64221", keywords="video abstract", keywords="abstract", keywords="dissemination", keywords="public engagement", keywords="online", keywords="videos", keywords="public audience", keywords="communication", keywords="infographics", keywords="health literacy", keywords="patient education", keywords="public health", doi="10.2196/64221", url="https://www.jmir.org/2024/1/e64221" } @Article{info:doi/10.2196/60291, author="Yau, Yi-Shin Jonathan and Saadat, Soheil and Hsu, Edmund and Murphy, Suk-Ling Linda and Roh, S. Jennifer and Suchard, Jeffrey and Tapia, Antonio and Wiechmann, Warren and Langdorf, I. Mark", title="Accuracy of Prospective Assessments of 4 Large Language Model Chatbot Responses to Patient Questions About Emergency Care: Experimental Comparative Study", journal="J Med Internet Res", year="2024", month="Nov", day="4", volume="26", pages="e60291", keywords="artificial intelligence", keywords="AI", keywords="chatbots", keywords="generative AI", keywords="natural language processing", keywords="consumer health information", keywords="patient education", keywords="literacy", keywords="emergency care information", keywords="chatbot", keywords="misinformation", keywords="health care", keywords="medical consultation", abstract="Background: Recent surveys indicate that 48\% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice. Objective: We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions. Methods: We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability, source reliability, and source relevancy. We determined the correct, complete response to the 10 questions from reputable and scholarly emergency medical references. These were compiled by an EM resident physician. For the readability of the chatbot responses, we used the Flesch-Kincaid Grade Level of each response from readability statistics embedded in Microsoft Word. Differences between chatbots were determined by the chi-square test. Results: Each of the 4 chatbots' responses to the 10 clinical questions were scored across 8 domains by 5 EM faculty, for 400 assessments for each chatbot. Together, the 4 chatbots had the best performance in clarity and understandability (both 85\%), intermediate performance in accuracy and completeness (both 50\%), and poor performance (10\%) for source relevance and reliability (mostly unreported). Chatbots contained dangerous information in 5\% to 35\% of responses, with no statistical difference between chatbots on this metric (P=.24). ChatGPT, Google Bard, and Claud AI had similar performances across 6 out of 8 domains. Only Bing AI performed better with more identified or relevant sources (40\%; the others had 0\%-10\%). Flesch-Kincaid Reading level was 7.7-8.9 grade for all chatbots, except ChatGPT at 10.8, which were all too advanced for average emergency patients. Responses included both dangerous (eg, starting cardiopulmonary resuscitation with no pulse check) and generally inappropriate advice (eg, loosening the collar to improve breathing without evidence of airway compromise). Conclusions: AI chatbots, though ubiquitous, have significant deficiencies in EM patient advice, despite relatively consistent performance. Information for when to seek urgent or emergent care is frequently incomplete and inaccurate, and patients may be unaware of misinformation. Sources are not generally provided. Patients who use AI to guide health care decisions assume potential risks. AI chatbots for health should be subject to further research, refinement, and regulation. We strongly recommend proper medical consultation to prevent potential adverse outcomes. ", doi="10.2196/60291", url="https://www.jmir.org/2024/1/e60291" } @Article{info:doi/10.2196/60939, author="Joshi, Saubhagya and Ha, Eunbin and Amaya, Andee and Mendoza, Melissa and Rivera, Yonaira and Singh, K. Vivek", title="Ensuring Accuracy and Equity in Vaccination Information From ChatGPT and CDC: Mixed-Methods Cross-Language Evaluation", journal="JMIR Form Res", year="2024", month="Oct", day="30", volume="8", pages="e60939", keywords="vaccination", keywords="health equity", keywords="multilingualism", keywords="language equity", keywords="health literacy", keywords="online health information", keywords="conversational agents", keywords="artificial intelligence", keywords="large language models", keywords="health information", keywords="public health", abstract="Background: In the digital age, large language models (LLMs) like ChatGPT have emerged as important sources of health care information. Their interactive capabilities offer promise for enhancing health access, particularly for groups facing traditional barriers such as insurance and language constraints. Despite their growing public health use, with millions of medical queries processed weekly, the quality of LLM-provided information remains inconsistent. Previous studies have predominantly assessed ChatGPT's English responses, overlooking the needs of non--English speakers in the United States. This study addresses this gap by evaluating the quality and linguistic parity of vaccination information from ChatGPT and the Centers for Disease Control and Prevention (CDC), emphasizing health equity. Objective: This study aims to assess the quality and language equity of vaccination information provided by ChatGPT and the CDC in English and Spanish. It highlights the critical need for cross-language evaluation to ensure equitable health information access for all linguistic groups. Methods: We conducted a comparative analysis of ChatGPT's and CDC's responses to frequently asked vaccination-related questions in both languages. The evaluation encompassed quantitative and qualitative assessments of accuracy, readability, and understandability. Accuracy was gauged by the perceived level of misinformation; readability, by the Flesch-Kincaid grade level and readability score; and understandability, by items from the National Institutes of Health's Patient?Education?Materials Assessment Tool (PEMAT) instrument. Results: The study found that both ChatGPT and CDC provided mostly accurate and understandable (eg, scores over 95 out of 100) responses. However, Flesch-Kincaid grade levels often exceeded the American Medical Association's recommended levels, particularly in English (eg, average grade level in English for ChatGPT=12.84, Spanish=7.93, recommended=6). CDC responses outperformed ChatGPT in readability across both languages. Notably, some Spanish responses appeared to be direct translations from English, leading to unnatural phrasing. The findings underscore the potential and challenges of using ChatGPT for health care access. Conclusions: ChatGPT holds potential as a health information resource but requires improvements in readability and linguistic equity to be truly effective for diverse populations. Crucially, the default user experience with ChatGPT, typically encountered by those without advanced language and prompting skills, can significantly shape health perceptions. This is vital from a public health standpoint, as the majority of users will interact with LLMs in their most accessible form. Ensuring that default responses are accurate, understandable, and equitable is imperative for fostering informed health decisions across diverse communities. ", doi="10.2196/60939", url="https://formative.jmir.org/2024/1/e60939" } @Article{info:doi/10.2196/51655, author="Guan, Jia-Lun and Xia, Su-Hong and Zhao, Kai and Feng, Li-Na and Han, Ying-Ying and Li, Ji-Yan and Liao, Jia-Zhi and Li, Pei-Yuan", title="Videos in Short-Video Sharing Platforms as Sources of Information on Colorectal Polyps: Cross-Sectional Content Analysis Study", journal="J Med Internet Res", year="2024", month="Oct", day="29", volume="26", pages="e51655", keywords="colorectal polyps", keywords="short videos", keywords="health information", keywords="quality assessment", keywords="reliability", abstract="Background: Short videos have demonstrated huge potential in disseminating health information in recent years. However, to our knowledge, no study has examined information about colorectal polyps on short-video sharing platforms. Objective: This study aimed to analyze the content and quality of colorectal polyps-related videos on short-video sharing platforms. Methods: The terms ``???'' (intestinal polyps) or ``????'' (colonic polyps) or ``????'' (rectal polyps) or ``?????'' (colorectal polyps) or ``????'' (polyps of large intestine) were used to search in TikTok (ByteDance), WeChat (Tencent Holdings Limited), and Xiaohongshu (Xingyin Information Technology Limited) between May 26 and June 8, 2024, and then the top 100 videos for each search term on different platforms were included and recorded. The Journal of American Medical Association (JAMA) score, the Global Quality Scale (GQS), the modified DISCERN, and the Patient Education Materials Assessment Tool (PEMAT) were used to evaluate the content and quality of selected videos by 2 independent researchers. SPSS (version 22.0; IBM Corp) and GraphPad Prism (version 9.0; Dotmatics) were used for analyzing the data. Descriptive statistics were generated, and the differences between groups were compared. Spearman correlation analysis was used to evaluate the relationship between quantitative variables. Results: A total of 816 eligible videos were included for further analysis, which mainly conveyed disease-related knowledge (n=635, 77.8\%). Most videos were uploaded by physicians (n=709, 86.9\%). These videos had an average JAMA score of 2.0 (SD 0.6), GQS score of 2.5 (SD 0.8), modified DISCERN score of 2.5 (SD 0.8), understandability of 80.4\% (SD 15.6\%), and actionability of 42.2\% (SD 36.1\%). Videos uploaded by news agencies were of higher quality and received more likes and comments (all P<.05). The number of collections and shares of videos about posttreatment caveats were more than those for other content (P=.03 and P=.006). There was a positive correlation between the number of likes, comments, collections, and shares (all P<.001). The duration and the number of fans were positively correlated with the quality of videos (all P<.05). Conclusions: There are numerous videos about colorectal polyps on short-video sharing platforms, but the reliability and quality of these videos are not good enough and need to be improved. ", doi="10.2196/51655", url="https://www.jmir.org/2024/1/e51655", url="http://www.ncbi.nlm.nih.gov/pubmed/39470708" } @Article{info:doi/10.2196/57720, author="Zhang, Baolu and Kalampakorn, Surintorn and Powwattana, Arpaporn and Sillabutra, Jutatip and Liu, Gang", title="Oral Diabetes Medication Videos on Douyin: Analysis of Information Quality and User Comment Attitudes", journal="JMIR Form Res", year="2024", month="Oct", day="18", volume="8", pages="e57720", keywords="diabetes", keywords="oral diabetes medication", keywords="information quality", keywords="user comment attitude", keywords="video analysis", keywords="Douyin", abstract="Background: Oral diabetes medications are important for glucose management in people with diabetes. Although there are many health-related videos on Douyin (the Chinese version of TikTok), the quality of information and the effects on user comment attitudes are unclear. Objective: The purpose of this study was to analyze the quality of information and user comment attitudes related to oral diabetes medication videos on Douyin. Methods: The key phrase ``oral diabetes medications'' was used to search Douyin on July 24, 2023, and the final samples included 138 videos. The basic information in the videos and the content of user comments were captured using Python. Each video was assigned a sentiment category based on the predominant positive, neutral, or negative attitude, as analyzed using the Weiciyun website. Two independent raters assessed the video content and information quality using the DISCERN (a tool for assessing health information quality) and PEMAT-A/V (Patient Education Materials Assessment Tool for Audiovisual Materials) instruments. Results: Doctors were the main source of the videos (136/138, 98.6\%). The overall information quality of the videos was acceptable (median 3, IQR 1). Videos on Douyin showed relatively high understandability (median 75\%, IQR 16.6\%) but poor actionability (median 66.7\%, IQR 48\%). Most content on oral diabetes medications on Douyin related to the mechanism of action (75/138, 54.3\%), precautions (70/138, 50.7\%), and advantages (68/138, 49.3\%), with limited content on indications (19/138, 13.8\%) and contraindications (14/138, 10.1\%). It was found that 10.1\% (14/138) of the videos contained misinformation, of which 50\% (7/14) were about the method of administration. Regarding user comment attitudes, the majority of videos garnered positive comments (81/138, 58.7\%), followed by neutral comments (46/138, 33.3\%) and negative comments (11/138, 8\%). Multinomial logistic regression revealed 2 factors influencing a positive attitude: user comment count (adjusted odds ratio [OR] 1.00, 95\% CI 1.00-1.00; P=.02) and information quality of treatment choices (adjusted OR 1.49, 95\% CI 1.09-2.04; P=.01). Conclusions: Despite most videos on Douyin being posted by doctors, with generally acceptable information quality and positive user comment attitudes, some content inaccuracies and poor actionability remain. Users show more positive attitudes toward videos with high-quality information about treatment choices. This study suggests that health care providers should ensure the accuracy and actionability of video content, enhance the information quality of treatment choices of oral diabetes medications to foster positive user attitudes, help users access accurate health information, and promote medication adherence. ", doi="10.2196/57720", url="https://formative.jmir.org/2024/1/e57720" } @Article{info:doi/10.2196/54135, author="Liu, Diyi and Yang, Shuhang and Cheng, Yixiang Calvin and Cai, Lin and Su, Jing", title="Online Health Information Seeking, eHealth Literacy, and Health Behaviors Among Chinese Internet Users: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="Oct", day="18", volume="26", pages="e54135", keywords="eHealth literacy", keywords="online health information seeking", keywords="health behavior", keywords="perceived information quality", keywords="health promotion", keywords="China", keywords="mobile phone", abstract="Background: The internet has become an increasingly vital platform for health-related information, especially in upper-middle-income countries such as China. While previous research has suggested that online health information seeking (OHIS) can significantly impact individuals' engagement in health behaviors, most research focused on patient-centered health communication. Objective: This study aims to examine how OHIS influences health behavior engagement among Chinese internet users, focusing on the role of eHealth literacy and perceived information quality in influencing relationships. Methods: An online cross-sectional survey was conducted in November 2021 among 10,000 Chinese internet users, using quota sampling based on sex, age, and urban and rural residence, in line with the 48th Statistical Report on Internet Development of China. Nonparametric tests were used to examine the differences in eHealth literacy across sociodemographic groups. Partial correlation analysis and stepwise linear regression were conducted to test the associations between key variables. Confirmatory factor analysis and structural equation modeling were conducted to test the hypotheses. Results: Our study identified significant disparities in functional and critical eHealth literacy between urban and rural residents across age groups, income levels, education backgrounds, and health conditions (all P<.001). In terms of sex and regional differences, we found higher functional literacy among female users than male users, and critical literacy varied significantly across different regions. The proposed structural model showed excellent fit ($\chi$2404=4183.6, $\chi$2404=10.4,P<.001; root mean square error of approximation value of 0.031, 95\% CI 0.030-.031; standardized root mean square residual value of 0.029; and comparative fit index value of 0.955), highlighting reciprocal associations between 2 types of eHealth literacy and OHIS. Participants' functional eHealth literacy, critical eHealth literacy, and OHIS have positive impacts on their health behavioral engagement. Perceived information quality was found to mediate the influence of OHIS on health behavior (b=0.003, 95\% CI 0.002-0.003; P<.001). Conclusions: The study revealed the pathways linking sociodemographic factors, eHealth literacy, OHIS, and perceived information quality and how they together influenced health outcomes. The findings underscore the significance of enhancing eHealth literacy and improving information quality to promote better health outcomes among Chinese internet users. ", doi="10.2196/54135", url="https://www.jmir.org/2024/1/e54135" } @Article{info:doi/10.2196/57698, author="Dhakal, Smita and Merani, Shermeen and Ahluwalia, Vandana and Battistella, Marisa and Borkhoff, M. Cornelia and Hazlewood, Stewart Glen and Lofters, Aisha and Marshall, A. Deborah and MacKay, Crystal and Gagliardi, R. Anna", title="The Quality and Cultural Safety of Online Osteoarthritis Information for Affected Persons and Health Care Professionals: Content Analysis", journal="J Med Internet Res", year="2024", month="Oct", day="18", volume="26", pages="e57698", keywords="osteoarthritis", keywords="women's health", keywords="equity", keywords="educational materials", keywords="internet", keywords="content analysis", keywords="Canada", keywords="persons living with osteoarthritis", keywords="healthcare professionals", keywords="OA care", keywords="ethno-culturally women", keywords="immigrant women", keywords="diverse women", keywords="online materials", keywords="health information", keywords="prevention", keywords="management", keywords="misinformation", keywords="cultural safety", abstract="Background: Osteoarthritis is more prevalent and severe among women than among men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Previous research advocated for greater access to culturally safe osteoarthritis information for both diverse women and health care professionals. The internet can reduce disparities by facilitating access to health information, but online materials can vary in quality. Objective: This study aimed to assess the quality and cultural safety of online osteoarthritis materials for persons affected by osteoarthritis and health care professionals. Methods: Content analysis was used to describe publicly available materials on osteoarthritis first-line management developed by Canadian organizations for affected persons or health care professionals. Searching, screening, and data extraction were performed in triplicate. We identified materials by searching Google, MEDLINE, and references of osteoarthritis-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN (University of Oxford) and a compiled framework for affected persons and health care professionals. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (<50\%), moderate (50\%-69\%), or high (?70\%+) for criteria met. Results: After screening 176 items and eliminating 129, we included 47 osteoarthritis materials published between 2013 and 2023. Of those, 43 were for persons with osteoarthritis, most were developed by charities (n=31, 72.1\%), based on expert advice (n=16, 55.2\%), and in the format of booklets (n=15, 34.9\%) or text on web pages (n=10, 23.3\%). Of those, 23.3\% (10/43) low, 46.5\% (20/43) moderate, and 30.2\% (13/43) high scored quality; and 25.6\% (11/43), 48.8\% (21/43), and 25.6\% (11/43) were rated low, moderate, and high cultural safety, respectively. Of the 47 included osteoarthritis materials, 4 were for health care professionals. They were developed by a consortium (2/4, 50\%), a charity (1/4, 25\%), and a professional society (1/4, 25\%), and largely based on expert advice (3/4, 75\%). The format included infographics (3/4, 75\%) and text on web pages (1/4, 25\%). Of those, 25\% (1/4), 25\% (1/4), and 50\% (2/4) were rated low, moderate, and high quality, respectively; and all were rated low for cultural safety. Quality and cultural safety did not appear to be associated with the characteristics of osteoarthritis materials (eg, type of developer, development method, and format). Conclusions: Overall, included osteoarthritis materials for persons with osteoarthritis and health care professionals were of low to moderate quality and cultural safety. These findings reveal the need for further efforts to improve existing or develop new osteoarthritis materials for both affected persons, including ethnoculturally diverse immigrant women, and health care professionals. Further research is needed to assess the quality and cultural safety of osteoarthritis materials developed by organizations outside of Canada and to establish a framework or instrument to assess cultural safety in the osteoarthritis context. ", doi="10.2196/57698", url="https://www.jmir.org/2024/1/e57698", url="http://www.ncbi.nlm.nih.gov/pubmed/39422989" } @Article{info:doi/10.2196/62807, author="Cassidy, Omni and Bragg, Marie and Elbel, Brian", title="Virtual Reality--Based Food and Beverage Marketing: Potential Implications for Young People of Color, Knowledge Gaps, and Future Research Directions", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="17", volume="10", pages="e62807", keywords="virtual reality", keywords="VR", keywords="digital food and beverage marketing", keywords="obesity", keywords="marketing", keywords="food", keywords="consumption", keywords="beverage", keywords="immersive", keywords="market", keywords="consumer", doi="10.2196/62807", url="https://publichealth.jmir.org/2024/1/e62807" } @Article{info:doi/10.2196/50057, author="Wu, Manli and Yan, Jun and Qiao, Chongming and Yan, Chu", title="Impact of Concurrent Media Exposure on Professional Identity: Cross-Sectional Study of 1087 Medical Students During Long COVID", journal="J Med Internet Res", year="2024", month="Oct", day="17", volume="26", pages="e50057", keywords="COVID-19", keywords="media exposure", keywords="social support", keywords="professional identity", keywords="medical students", keywords="Stimulus-Organism-Response framework", abstract="Background: Long COVID has widened the health gap across society and highlighted the vulnerabilities and risks faced by health care systems. For instance, the global trend of medical workers resigning has become a prominent topic on social media. In response to this severe social problem in global public health within the digital society, it is urgent to investigate how the professional identity of medical students, who are digital natives and the future workforce of medical practitioners, is affected by the media environment. Objective: This study aims to examine how media exposure relates to medical students' perceptions of informational and emotional support, and how these perceptions further influence the development of their professional identity. Methods: Building on the Stimulus-Organism-Response (SOR) framework, this study develops a theoretical model to illustrate how media exposure affects medical students' professional identity through the mediation of social support. Specifically, media exposure was assessed through online news media and social media exposure; social support was evaluated in terms of informational and emotional support; and professional identity was measured through medical students' sense of belonging and professional commitment. A survey was conducted at a medical school in China, yielding 1087 valid responses that were analyzed using SmartPLS 4.0. Results: Consistent with our expectations, online news media exposure was positively associated with both informational support ($\beta$=.163; P<.001) and emotional support ($\beta$=.084; P=.007). Similarly, social media exposure showed positive associations with informational support ($\beta$=.122; P<.001) and emotional support ($\beta$=.235; P<.001). Thereafter, informational support ($\beta$=.228; P<.001) and emotional support ($\beta$=.344; P<.001) were positively associated with students' sense of belonging. Meanwhile, both informational support ($\beta$=.245; P<.001) and emotional support ($\beta$=.412; P<.001) positively impacted medical students' professional commitment. In addition, a mediation test was conducted. The results confirmed that informational support and emotional support partially mediated the effect of online news media, while fully mediating the effect of social media on medical students' sense of belonging and professional commitment. Conclusions: This study finds that exposure to online news media and social media can enhance medical students' sense of belonging and professional commitment through the formation of informational and emotional support. It expands the discussion on the role of media in providing social support and facilitating the development of medical students' professional identity. This is a valuable contribution to addressing complex public health crises through effective media governance in the network era. ", doi="10.2196/50057", url="https://www.jmir.org/2024/1/e50057", url="http://www.ncbi.nlm.nih.gov/pubmed/39418080" } @Article{info:doi/10.2196/56354, author="Zenone, Marco and van Schalkwyk, May and Hartwell, Greg and Caulfield, Timothy and Maani, Nason", title="Selling Misleading ``Cancer Cure'' Books on Amazon: Systematic Search on Amazon.com and Thematic Analysis", journal="J Med Internet Res", year="2024", month="Oct", day="8", volume="26", pages="e56354", keywords="cancer", keywords="Amazon", keywords="misinformation", keywords="e-commerce", keywords="cancer cure", keywords="cancer misinformation", keywords="misleading", keywords="cancer information", keywords="treatment", keywords="cancer treatment", keywords="thematic analysis", keywords="online information", abstract="Background: While the evidence base on web-based cancer misinformation continues to develop, relatively little is known about the extent of such information on the world's largest e-commerce website, Amazon. Multiple media reports indicate that Amazon may host on its platform questionable cancer-related products for sale, such as books on purported cancer cures. This context suggests an urgent need to evaluate Amazon.com for cancer misinformation. Objective: This study sought to (1) examine to what extent are misleading cancer cure books for sale on Amazon.com and (2) determine how cancer cure books on Amazon.com provide misleading cancer information. Methods: We searched ``cancer cure'' on Amazon.com and retrieved the top 1000 English-language book search results. We reviewed the books' descriptions and titles to determine whether the books provided misleading cancer cure or treatment information. We considered a book to be misleading if it suggested scientifically unsupported cancer treatment approaches to cure or meaningfully treat cancer. Among books coded as misleading, we conducted an inductive latent thematic analysis to determine the informational value the books sought to offer. Results: Nearly half (494/1000, 49.4\%) of the sampled ``cancer cure'' books for sale on Amazon.com appeared to contain misleading cancer treatment and cure information. Overall, 17 (51.5\%) out of 33 Amazon.com results pages had 50\% or more of the books coded as misleading. The first search result page had the highest percentage of misleading books (23/33, 69.7\%). Misleading books (n=494) contained eight themes: (1) claims of efficacious cancer cure strategies (n=451, 91.3\%), (2) oversimplifying cancer and cancer treatment (n=194, 39.3\%), (3) falsely justifying ineffective treatments as science based (n=189, 38.3\%), (4) discrediting conventional cancer treatments (n=169, 34.2\%), (5) finding the true cause of cancer (n=133, 26.9\%), (6) homogenizing cancer (n=132, 26.7\%), (7) discovery of new cancer treatments (n=119, 24.1\%), and (8) cancer cure suppression (n=82, 16.6\%). Conclusions: The results demonstrate that misleading cancer cure books are for sale, visible, and prevalent on Amazon.com, with prominence in initial search hits. These misleading books for sale on Amazon can be conceived of as forming part of a wider, cross-platform, web-based information environment in which misleading cancer cures are often given prominence. Our results suggest that greater enforcement is needed from Amazon and that cancer-focused organizations should engage in preemptive misinformation debunking. ", doi="10.2196/56354", url="https://www.jmir.org/2024/1/e56354" } @Article{info:doi/10.2196/58378, author="Chimukuche, Samanthia Rujeko and Ndlazi, Julia and Mtolo, Thembani Lucky and Bird, Kristien and Seeley, Janet", title="Evaluation of Drug and Herbal Medicinal Promotions on Social Media During the COVID-19 Pandemic in Relation to World Health Organization Ethical Criteria and South African Health Products Regulatory Authority Guidelines in South Africa: Cross-Sectional Content Analysis", journal="Online J Public Health Inform", year="2024", month="Sep", day="18", volume="16", pages="e58378", keywords="drug advertising", keywords="internet", keywords="social media", keywords="ethical guidelines", keywords="traditional medicine", keywords="COVID-19", abstract="Background: Consideration of ethics in the promotion of medications is essential to safeguard the health of consumers, particularly during health crises. The World Health Organization (WHO) and the South African Health Products Regulatory Authority (SAHPRA) have established stringent standards to ensure the integrity of pharmaceutical promotions and safeguard public health, including advertisements on the internet and social media platforms. However, the dynamic nature of online advertising poses challenges for monitoring and enforcing ethical standards. Objective: The study aimed (1) to examine the COVID-19 drug and medicinal promotions across online platforms and social media from 2020 to 2022 in South Africa and (2) to ensure that drug promotions adhere to ethical guidelines outlined by the WHO and SAPHRA. Methods: A cross-sectional content analysis was conducted to assess drug and medicinal advertisements across various internet and social media platforms. A systematic approach was used to identify and analyze promotional content, focusing on adherence to ethical guidelines outlined by WHO and SAPHRA. Data were collected and analyzed to determine the extent of compliance and identify any potential violations or areas for improvement. Results: A total of 14 online drug advertisements were included in this analysis. Our findings show that most of the drugs advertised did not meet the regulations and guidelines provided by WHO and SAHPRA. There were omissions about active ingredients, proprietary names, adverse drug responses, precautions, and overdosage and adverse drug reactions. Traditional medicines were not fully consistent with the approved WHO ethical criteria data sheet. Conclusions: Our analysis highlights the critical importance of ensuring compliance with ethical guidelines in drug promotions on the internet and social media platforms. There is a need for continued vigilance and enforcement efforts to uphold ethical standards and protect the health of the public. Ongoing monitoring and collaboration between national drug regulatory agencies, pharmaceutical companies, and online platforms will be essential for promoting responsible advertising. In addition, safety monitoring and pharmacovigilance systems for herbal medicinal products are yet to be established. ", doi="10.2196/58378", url="https://ojphi.jmir.org/2024/1/e58378", url="http://www.ncbi.nlm.nih.gov/pubmed/39293046" } @Article{info:doi/10.2196/56854, author="Ho, S. Shirley and Chuah, F. Agnes S. and Ho, S. Vanessa and Rosenthal, Sonny and Kim, Kyung Hye and Soh, H. Shannon S.", title="Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis", journal="J Med Internet Res", year="2024", month="Sep", day="17", volume="26", pages="e56854", keywords="COVID-19", keywords="crisis and emergency risk communication", keywords="CERC", keywords="emotional appeal", keywords="content analysis", keywords="public health", keywords="Facebook", keywords="social media", keywords="Singapore", abstract="Background: Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government's response to the pandemic to keep the public updated and equip them in protecting themselves. Objective: Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. Methods: Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. Results: The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. Conclusions: Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies. ", doi="10.2196/56854", url="https://www.jmir.org/2024/1/e56854" } @Article{info:doi/10.2196/48257, author="Alasmari, Ashwag and Zhou, Lina", title="Quality Measurement of Consumer Health Questions: Content and Language Perspectives", journal="J Med Internet Res", year="2024", month="Sep", day="12", volume="26", pages="e48257", keywords="question quality", keywords="quality measurement", keywords="health questions", keywords="", keywords="information needs", keywords="information behavior", keywords="information sharing", keywords="consumer", keywords="health information", keywords="health information consumers", keywords="quality", abstract="Background: Health information consumers increasingly rely on question-and-answer (Q\&A) communities to address their health concerns. However, the quality of questions posted significantly impacts the likelihood and relevance of received answers. Objective: This study aims to improve our understanding of the quality of health questions within web-based Q\&A communities. Methods: We develop a novel framework for defining and measuring question quality within web-based health communities, incorporating content- and language-based variables. This framework leverages k-means clustering and establishes automated metrics to assess overall question quality. To validate our framework, we analyze questions related to kidney disease from expert-curated and community-based Q\&A platforms. Expert evaluations confirm the validity of our quality construct, while regression analysis helps identify key variables. Results: High-quality questions were more likely to include demographic and medical information than lower-quality questions (P<.001). In contrast, asking questions at the various stages of disease development was less likely to reflect high-quality questions (P<.001). Low-quality questions were generally shorter with lengthier sentences than high-quality questions (P<.01). Conclusions: Our findings empower consumers to formulate more effective health information questions, ultimately leading to better engagement and more valuable insights within web-based Q\&A communities. Furthermore, our findings provide valuable insights for platform developers and moderators seeking to enhance the quality of user interactions and foster a more trustworthy and informative environment for health information exchange. ", doi="10.2196/48257", url="https://www.jmir.org/2024/1/e48257" } @Article{info:doi/10.2196/47562, author="Fari{\v c}, Nu{\vs}a and Potts, WW Henry and Heilman, M. James", title="Quality of Male and Female Medical Content on English-Language Wikipedia: Quantitative Content Analysis", journal="J Med Internet Res", year="2024", month="Sep", day="12", volume="26", pages="e47562", keywords="Wikipedia", keywords="wikis", keywords="writing", keywords="internet", keywords="health information", keywords="sex", keywords="sex bias", keywords="consumer health information", keywords="health communication", keywords="public education", keywords="social media", abstract="Background: Wikipedia is the largest free online encyclopedia and the seventh most visited website worldwide, containing >45,000 freely accessible English-language medical articles accessed nearly 1.6 billion times annually. Concerns have been expressed about the balance of content related to biological sex on Wikipedia. Objective: This study aims to categorize the top 1000 most-read (most popular) English-language Wikipedia health articles for June 2019 according to the relevance of the article topic to each sex and quality. Methods: In the first step, Wikipedia articles were identified using WikiProject Medicine Popular Pages. These were analyzed on 13 factors, including total views, article quality, and total number of references. In the second step, 2 general medical textbooks were used as comparators to assess whether Wikipedia's spread of articles was typical compared to the general medical coverage. According to the article's content, we proposed criteria with 5 categories: 1=``exclusively female,'' 2=``predominantly female but can also affect male individuals,'' 3=``not sex specific or neutral,'' 4=predominantly male but can affect female individuals,'' and 5=``exclusively male.'' Results: Of the 1000 Wikipedia health articles, 933 (93.3\%) were not sex specific and 67 (6.7\%) were sex specific. There was no statistically significant difference in the number of reads per month between the sex-specific and non--sex-specific articles (P=.29). Coverage of female topics was higher (50/1000, 5\%) than male topics (17/1000, 1.7\%; this difference was also observed for the 2 medical textbooks, in which 90.2\% (2330/2584) of content was not sex specific, female topics accounted for 8.1\% (209/2584), and male topics for accounted for 1.7\% (45/2584; statistically significant difference; Fisher exact test P=.03). Female-category articles were ranked higher on the Wikipedia medical topic importance list (top, high, or mid importance) than male-category articles (borderline statistical significance; Fisher exact test P=.05). Female articles had a higher number of total and unique references; a slightly higher number of page watchers, pictures, and available languages; and lower number of edits than male articles (all were statistically nonsignificant). Conclusions: Across several metrics, a sample of popular Wikipedia health-related articles for both sexes had comparable quality. Wikipedia had a lower number of female articles and a higher number of neutral articles relative to the 2 medical textbooks. These differences were small, but statistically significant. Higher exclusively female coverage, compared to exclusively male coverage, in Wikipedia articles was similar to the 2 medical textbooks and can be explained by inclusion of sections on obstetrics and gynecology. This is unlike the imbalance seen among biographies of living people, in which approximately 77.6\% pertain to male individuals. Although this study included a small sample of articles, the spread of Wikipedia articles may reflect the readership and the population's content consumption at a given time. Further study of a larger sample of Wikipedia articles would be valuable. ", doi="10.2196/47562", url="https://www.jmir.org/2024/1/e47562" } @Article{info:doi/10.2196/51513, author="Gong, Xun and Chen, Meijuan and Ning, Lihong and Zeng, Lingzhong and Dong, Bo", title="The Quality of Short Videos as a Source of Coronary Heart Disease Information on TikTok: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Sep", day="3", volume="8", pages="e51513", keywords="coronary heart disease", keywords="content quality", keywords="social media", keywords="short-video platform", keywords="TikTok", abstract="Background: Coronary heart disease (CHD) is a leading cause of death worldwide and imposes a significant economic burden. TikTok has risen as a favored platform within the social media sphere for disseminating CHD-related information and stands as a pivotal resource for patients seeking knowledge about CHD. However, the quality of such content on TikTok remains largely unexplored. Objective: This study aims to assess the quality of information conveyed in TikTok CHD-related videos. Methods: A comprehensive cross-sectional study was undertaken on TikTok videos related to CHD. The sources of the videos were identified and analyzed. The comprehensiveness of content was assessed through 6 questions addressing the definition, signs and symptoms, risk factors, evaluation, management, and outcomes. The quality of the videos was assessed using 3 standardized evaluative instruments: DISCERN, the Journal of the American Medical Association (JAMA) benchmarks, and the Global Quality Scale (GQS). Furthermore, correlative analyses between video quality and characteristics of the uploaders and the videos themselves were conducted. Results: The search yielded 145 CHD-related videos from TikTok, predominantly uploaded by health professionals (n=128, 88.3\%), followed by news agencies (n=6, 4.1\%), nonprofit organizations (n=10, 6.9\%), and for-profit organizations (n=1, 0.7\%). Content comprehensiveness achieved a median score of 3 (IQR 2-4). Median values for the DISCERN, JAMA, and GQS evaluations across all videos stood at 27 (IQR 24-32), 2 (IQR 2-2), and 2 (IQR 2-3), respectively. Videos from health professionals and nonprofit organizations attained significantly superior JAMA scores in comparison to those of news agencies (P<.001 and P=.02, respectively), whereas GQS scores for videos from health professionals were also notably higher than those from news agencies (P=.048). Within health professionals, cardiologists demonstrated discernibly enhanced performance over noncardiologists in both DISCERN and GQS assessments (P=.02). Correlative analyses unveiled positive correlations between video quality and uploader metrics, encompassing the positive correlations between the number of followers; total likes; average likes per video; and established quality indices such as DISCERN, JAMA, or GQS scores. Similar investigations relating to video attributes showed correlations between user engagement factors---likes, comments, collections, shares---and the aforementioned quality indicators. In contrast, a negative correlation emerged between the number of days since upload and quality indices, while a longer video duration corresponded positively with higher DISCERN and GQS scores. Conclusions: The quality of the videos was generally poor, with significant disparities based on source category. The content comprehensiveness coverage proved insufficient, casting doubts on the reliability and quality of the information relayed through these videos. Among health professionals, video contributions from cardiologists exhibited superior quality compared to noncardiologists. As TikTok's role in health information dissemination expands, ensuring accurate and reliable content is crucial to better meet patients' needs for CHD information that conventional health education fails to fulfill. ", doi="10.2196/51513", url="https://formative.jmir.org/2024/1/e51513" } @Article{info:doi/10.2196/54072, author="Aboalshamat, Khalid", title="Assessment of the Quality and Readability of Web-Based Arabic Health Information on Halitosis: Infodemiological Study", journal="J Med Internet Res", year="2024", month="Aug", day="28", volume="26", pages="e54072", keywords="halitosis", keywords="bad breath", keywords="malodor, Arabic web-based", keywords="infodemiological study", keywords="oral malodor", keywords="readability", keywords="infodemiology", keywords="health information", keywords="Arabic mouth medical information", keywords="reliable information", keywords="odor treatment", abstract="Background: Halitosis, characterized by an undesirable mouth odor, represents a common concern. Objective: This study aims to assess the quality and readability of web-based Arabic health information on halitosis as the internet is becoming a prominent global source of medical information. Methods: A total of 300 Arabic websites were retrieved from Google using 3 commonly used phrases for halitosis in Arabic. The quality of the websites was assessed using benchmark criteria established by the Journal of the American Medical Association, the DISCERN tool, and the presence of the Health on the Net Foundation Code of Conduct (HONcode). The assessment of readability (Flesch Reading Ease [FRE], Simple Measure of Gobbledygook, and Flesch-Kincaid Grade Level [FKGL]) was conducted using web-based readability indexes. Results: A total of 127 websites were examined. Regarding quality assessment, 87.4\% (n=111) of websites failed to fulfill any Journal of the American Medical Association requirements, highlighting a lack of authorship (authors' contributions), attribution (references), disclosure (sponsorship), and currency (publication date). The DISCERN tool had a mean score of 34.55 (SD 7.46), with the majority (n=72, 56.6\%) rated as moderate quality, 43.3\% (n=55) as having a low score, and none receiving a high DISCERN score, indicating a general inadequacy in providing quality health information to make decisions and treatment choices. No website had HONcode certification, emphasizing the concern over the credibility and trustworthiness of these resources. Regarding readability assessment, Arabic halitosis websites had high readability scores, with 90.5\% (n=115) receiving an FRE score ?80, 98.4\% (n=125) receiving a Simple Measure of Gobbledygook score <7, and 67.7\% (n=86) receiving an FKGL score <7. There were significant correlations between the DISCERN scores and the quantity of words (P<.001) and sentences (P<.001) on the websites. Additionally, there was a significant relationship (P<.001) between the number of sentences and FKGL and FRE scores. Conclusions: While readability was found to be very good, indicating that the information is accessible to the public, the quality of Arabic halitosis websites was poor, reflecting a significant gap in providing reliable and comprehensive health information. This highlights the need for improving the availability of high-quality materials to ensure Arabic-speaking populations have access to reliable information about halitosis and its treatment options, tying quality and availability together as critical for effective health communication. ", doi="10.2196/54072", url="https://www.jmir.org/2024/1/e54072", url="http://www.ncbi.nlm.nih.gov/pubmed/39196637" } @Article{info:doi/10.2196/55535, author="Ko, Ki Tsz and Tan, Yun Denise Jia and Fan, Siu Ka", title="Evaluation of the Quality and Readability of Web-Based Information Regarding Foreign Bodies of the Ear, Nose, and Throat: Qualitative Content Analysis", journal="JMIR Form Res", year="2024", month="Aug", day="15", volume="8", pages="e55535", keywords="foreign body", keywords="quality of internet information", keywords="readability of internet information", keywords="EQIP", keywords="Ensuring Quality Information for Patients", keywords="medical informatics", keywords="readability", keywords="readable", keywords="health information", keywords="online information", keywords="information resource", keywords="information resources", keywords="website", keywords="websites", keywords="quality", keywords="evaluation", keywords="evaluations", keywords="reading level", keywords="grade level", abstract="Background: Foreign body (FB) inhalation, ingestion, and insertion account for 11\% of emergency admissions for ear, nose, and throat conditions. Children are disproportionately affected, and urgent intervention may be needed to maintain airway patency and prevent blood vessel occlusion. High-quality, readable online information could help reduce poor outcomes from FBs. Objective: We aim to evaluate the quality and readability of available online health information relating to FBs. Methods: In total, 6 search phrases were queried using the Google search engine. For each search term, the first 30 results were captured. Websites in the English language and displaying health information were included. The provider and country of origin were recorded. The modified 36-item Ensuring Quality Information for Patients tool was used to assess information quality. Readability was assessed using a combination of tools: Flesch Reading Ease score, Flesch-Kincaid Grade Level, Gunning-Fog Index, and Simple Measure of Gobbledygook. Results: After the removal of duplicates, 73 websites were assessed, with the majority originating from the United States (n=46, 63\%). Overall, the quality of the content was of moderate quality, with a median Ensuring Quality Information for Patients score of 21 (IQR 18-25, maximum 29) out of a maximum possible score of 36. Precautionary measures were not mentioned on 41\% (n=30) of websites and 30\% (n=22) did not identify disk batteries as a risky FB. Red flags necessitating urgent care were identified on 95\% (n=69) of websites, with 89\% (n=65) advising patients to seek medical attention and 38\% (n=28) advising on safe FB removal. Readability scores (Flesch Reading Ease score=12.4, Flesch-Kincaid Grade Level=6.2, Gunning-Fog Index=6.5, and Simple Measure of Gobbledygook=5.9 years) showed most websites (56\%) were below the recommended sixth-grade level. Conclusions: The current quality and readability of information regarding FBs is inadequate. More than half of the websites were above the recommended sixth-grade reading level, and important information regarding high-risk FBs such as disk batteries and magnets was frequently excluded. Strategies should be developed to improve access to high-quality information that informs patients and parents about risks and when to seek medical help. Strategies to promote high-quality websites in search results also have the potential to improve outcomes. ", doi="10.2196/55535", url="https://formative.jmir.org/2024/1/e55535", url="http://www.ncbi.nlm.nih.gov/pubmed/39145998" } @Article{info:doi/10.2196/55937, author="Zhao, Keyang and Li, Xiaojing and Li, Jingyang", title="Cancer Prevention and Treatment on Chinese Social Media: Machine Learning--Based Content Analysis Study", journal="J Med Internet Res", year="2024", month="Aug", day="14", volume="26", pages="e55937", keywords="social media", keywords="cancer information", keywords="text mining", keywords="supervised machine learning", keywords="content analysis", abstract="Background: Nowadays, social media plays a crucial role in disseminating information about cancer prevention and treatment. A growing body of research has focused on assessing access and communication effects of cancer information on social media. However, there remains a limited understanding of the comprehensive presentation of cancer prevention and treatment methods across social media platforms. Furthermore, research comparing the differences between medical social media (MSM) and common social media (CSM) is also lacking. Objective: Using big data analytics, this study aims to comprehensively map the characteristics of cancer treatment and prevention information on MSM and CSM. This approach promises to enhance cancer coverage and assist patients in making informed treatment decisions. Methods: We collected all posts (N=60,843) from 4 medical WeChat official accounts (accounts with professional medical backgrounds, classified as MSM in this paper) and 5 health and lifestyle WeChat official accounts (accounts with nonprofessional medical backgrounds, classified as CSM in this paper). We applied latent Dirichlet allocation topic modeling to extract cancer-related posts (N=8427) and identified 6 cancer themes separately in CSM and MSM. After manually labeling posts according to our codebook, we used a neural-based method for automated labeling. Specifically, we framed our task as a multilabel task and utilized different pretrained models, such as Bidirectional Encoder Representations from Transformers (BERT) and Global Vectors for Word Representation (GloVe), to learn document-level semantic representations for labeling. Results: We analyzed a total of 4479 articles from MSM and 3948 articles from CSM related to cancer. Among these, 35.52\% (2993/8427) contained prevention information and 44.43\% (3744/8427) contained treatment information. Themes in CSM were predominantly related to lifestyle, whereas MSM focused more on medical aspects. The most frequently mentioned prevention measures were early screening and testing, healthy diet, and physical exercise. MSM mentioned vaccinations for cancer prevention more frequently compared with CSM. Both types of media provided limited coverage of radiation prevention (including sun protection) and breastfeeding. The most mentioned treatment measures were surgery, chemotherapy, and radiotherapy. Compared with MSM (1137/8427, 13.49\%), CSM (2993/8427, 35.52\%) focused more on prevention. Conclusions: The information about cancer prevention and treatment on social media revealed a lack of balance. The focus was primarily limited to a few aspects, indicating a need for broader coverage of prevention measures and treatments in social media. Additionally, the study's findings underscored the potential of applying machine learning to content analysis as a promising research approach for mapping key dimensions of cancer information on social media. These findings hold methodological and practical significance for future studies and health promotion. ", doi="10.2196/55937", url="https://www.jmir.org/2024/1/e55937" } @Article{info:doi/10.2196/57823, author="Erbas, Ege Mert and Ziehfreund, Stefanie and Wecker, Hannah and Biedermann, Tilo and Zink, Alexander", title="Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany", journal="J Med Internet Res", year="2024", month="Aug", day="7", volume="26", pages="e57823", keywords="psoriasis", keywords="dermatology", keywords="digital health", keywords="digital media", keywords="internet use", keywords="questionnaire", keywords="physician-patient relationship", abstract="Background: Psoriasis is a chronic skin disorder with a high burden of disease. People affected with psoriasis increasingly use the internet for health-related reasons, especially those with younger age, higher education, and higher disease severity. Despite advantages such as enhancing the individuals' knowledge with the use of digital media for health-related issues, disadvantages were also present such as quality control, and variability in the individuals' health information literacy. While patients with psoriasis within medical settings generally trust physicians over digital media, they commonly withhold their web-based research findings from health care providers. Objective: The study aims to (1) identify further factors associated with regular psoriasis-related internet use, (2) rank specific digital media platforms used, and (3) examine digital media within the physician-patient relationship among individuals with and without dermatological treatment. Methods: A cross-sectional, questionnaire-based study was conducted among individuals with self-reported psoriasis in Germany between September 2021 and February 2022. Participants were recruited via digital media platforms and in person at a University Hospital Department of Dermatology in southern Germany. The questionnaire asked about demographic and medical information, individual psoriasis-related digital media use, and the impact of digital media on the physician-patient relationship. Data were analyzed descriptively, and logistic regression models were performed to assess the factors associated with regular psoriasis-related internet use. Results: Among 321 individuals with a median age of 53 (IQR 41-61) years (nonnormally distributed; females: 195/321), female sex, shorter disease duration, moderate mental burden of disease, and good self-assessed psoriasis-related knowledge were associated with regular psoriasis-related internet use. Of the 188 participants with a mean age of 51.2 (SD 13.9) years (normally distributed) who used digital media 106 (56.4\%) usually searched for information on psoriasis-based websites and 98 (52.1\%) on search engines, primarily for obtaining information about the disease and therapy options, while social media were less frequently used (49/188, 26.1\%). Nearly two-thirds of internet users (125/188) claimed that their physicians did not recommend digital media platforms. About 44\% (82/188) of the individuals reported to seek for additional information due to the insufficient information provided by their physician. Conclusions: This study revealed the importance of digital media in the context of psoriasis, especially among women, individuals with shorter disease duration, and moderate mental disease severity. The lack of physicians' digital media recommendations despite their patients' desire to receive such and being more involved in health-related decisions seems to be a shortcoming within the physician-patient relationships. Physicians should guide their patients on digital media by recommending platforms with evidence-based information, thereby potentially creating an adequate framework for shared decision-making. Future research should focus on strategies to prevent the spread of false information on digital media and address the needs of patients and physicians to enhance health-related digital media offerings. ", doi="10.2196/57823", url="https://www.jmir.org/2024/1/e57823" } @Article{info:doi/10.2196/51740, author="Srinivasa, Komal and Charlton, Amanda and Moir, Fiona and Goodyear-Smith, Felicity", title="How to Develop an Online Video for Teaching Health Procedural Skills: Tutorial for Health Educators New to Video Production", journal="JMIR Med Educ", year="2024", month="Aug", day="7", volume="10", pages="e51740", keywords="online video", keywords="developing video", keywords="procedural video", keywords="medical education", keywords="clinician educator", keywords="health education", abstract="Background: Clinician educators are experts in procedural skills that students need to learn. Some clinician educators are interested in creating their own procedural videos but are typically not experts in video production, and there is limited information on this topic in the clinical education literature. Therefore, we present a tutorial for clinician educators to develop a procedural video. Objective: We describe the steps needed to develop a medical procedural video from the perspective of a clinician educator new to creating videos, informed by best practices as evidenced by the literature. We also produce a checklist of elements that ensure a quality video. Finally, we identify the barriers and facilitators to making such a video. Methods: We used the example of processing a piece of skeletal muscle in a pathology laboratory to make a video. We developed the video by dividing it into 3 phases: preproduction, production, and postproduction. After writing the learning outcomes, we created a storyboard and script, which were validated by subject matter and audiovisual experts. Photos and videos were captured on a digital camera mounted on a monopod. Video editing software was used to sequence the video clips and photos, insert text and audio narration, and generate closed captions. The finished video was uploaded to YouTube (Google) and then inserted into open-source authoring software to enable an interactive quiz. Results: The final video was 4 minutes and 4 seconds long and took 70 hours to create. The final video included audio narration, closed captioning, bookmarks, and an interactive quiz. We identified that an effective video has six key factors: (1) clear learning outcomes, (2) being engaging, (3) being learner-centric, (4) incorporating principles of multimedia learning, (5) incorporating adult learning theories, and (6) being of high audiovisual quality. To ensure educational quality, we developed a checklist of elements that educators can use to develop a video. One of the barriers to creating procedural videos for a clinician educator who is new to making videos is the significant time commitment to build videography and editing skills. The facilitators for developing an online video include creating a community of practice and repeated skill-building rehearsals using simulations. Conclusions: We outlined the steps in procedural video production and developed a checklist of quality elements. These steps and the checklist can guide a clinician educator in creating a quality video while recognizing the time, technical, and cognitive requirements. ", doi="10.2196/51740", url="https://mededu.jmir.org/2024/1/e51740", url="http://www.ncbi.nlm.nih.gov/pubmed/39110488" } @Article{info:doi/10.2196/52058, author="Cho, HyunYi and Li, Wenbo and Lopez, Rachel", title="A Multidimensional Approach for Evaluating Reality in Social Media: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Aug", day="6", volume="26", pages="e52058", keywords="fake", keywords="fact", keywords="misinformation", keywords="reality", keywords="social media", keywords="scale", keywords="measure", keywords="instrument", keywords="user-centric", keywords="tailoring", keywords="digital media literacy", abstract="Background: Misinformation is a threat to public health. The effective countering of misinformation may require moving beyond the binary classification of fake versus fact to capture the range of schemas that users employ to evaluate social media content. A more comprehensive understanding of user evaluation schemas is necessary. Objective: The goal of this research was to advance the current understanding of user evaluations of social media information and to develop and validate a measurement instrument for assessing social media realism. Methods: This research involved a sequence of 2 studies. First, we used qualitative focus groups (n=48). Second, building on the first study, we surveyed a national sample of social media users (n=442). The focus group data were analyzed using the constant comparison approach. The survey data were analyzed using confirmatory factor analyses and ordinary least squares regression. Results: The findings showed that social media reality evaluation involves 5 dimensions: falsity, naturality, authenticity, resonance, and social assurance. These dimensions were differentially mapped onto patterns of social media use. Authenticity was strongly associated with the existing global measure of social media realism (P<.001). Naturality, or the willingness to accept artificiality and engineered aspects of social media representations, was linked to hedonic enjoyment (P<.001). Resonance predicted reflective thinking (P<.001), while social assurance was strongly related to addictive use (P<.001). Falsity, the general belief that much of what is on social media is not real, showed a positive association with both frequency (P<.001) and engagement with (P=.003) social media. These results provide preliminary validity data for a social media reality measure that encompasses multiple evaluation schemas for social media content. Conclusions: The identification of divergent schemas expands the current focus beyond fake versus fact, while the goals, contexts, and outcomes of social media use associated with these schemas can guide future digital media literacy efforts. Specifically, the social media reality measure can be used to develop tailored digital media literacy interventions for addressing diverse public health issues. ", doi="10.2196/52058", url="https://www.jmir.org/2024/1/e52058", url="http://www.ncbi.nlm.nih.gov/pubmed/39106092" } @Article{info:doi/10.2196/55680, author="Campbell, Laura and Quicke, Jonathan and Stevenson, Kay and Paskins, Zoe and Dziedzic, Krysia and Swaithes, Laura", title="Using Twitter (X) to Mobilize Knowledge for First Contact Physiotherapists: Qualitative Study", journal="J Med Internet Res", year="2024", month="Jul", day="8", volume="26", pages="e55680", keywords="Twitter", keywords="X", keywords="social media", keywords="first contact physiotherapy", keywords="musculoskeletal", keywords="knowledge mobilisation", keywords="primary care", keywords="mindlines", keywords="qualitative", keywords="physiotherapy", keywords="implementation", abstract="Background: Twitter (now X) is a digital social network commonly used by health care professionals. Little is known about whether it helps health care professionals to share, mobilize, and cocreate knowledge or reduce the time between research knowledge being created and used in clinical practice (the evidence-to-practice gap). Musculoskeletal first contact physiotherapists (FCPs) are primary care specialists who diagnose and treat people with musculoskeletal conditions without needing to see their general practitioner (family physician) first. They often work as a sole FCP in practice; hence, they are an ideal health care professional group with whom to explore knowledge mobilization using Twitter. Objective: We aimed to explore how Twitter is and can be used to mobilize knowledge, including research findings, to inform FCPs' clinical practice. Methods: Semistructured interviews of FCPs with experience of working in English primary care were conducted. FCPs were purposively sampled based on employment arrangements and Twitter use. Recruitment was accomplished via known FCP networks and Twitter, supplemented by snowball sampling. Interviews were conducted digitally and used a topic guide exploring FCP's perceptions and experiences of accessing knowledge, via Twitter, for clinical practice. Data were analyzed thematically and informed by the knowledge mobilization mindlines model. Public contributors were involved throughout. Results: In total, 19 FCPs consented to the interview (Twitter users, n=14 and female, n=9). Three themes were identified: (1) How Twitter meets the needs of FCPs, (2) Twitter and a journey of knowledge to support clinical practice, and (3) factors impeding knowledge sharing on Twitter. FCPs described needs relating to isolated working practices, time demands, and role uncertainty. Twitter provided rapid access to succinct knowledge, the opportunity to network, and peer reassurance regarding clinical cases, evidence, and policy. FCPs took a journey of knowledge exchange on Twitter, including scrolling for knowledge, filtering for credibility and adapting knowledge for in-service training and clinical practice. Participants engaged best with images and infographics. FCPs described misinformation, bias, echo chambers, unprofessionalism, hostility, privacy concerns and blurred personal boundaries as factors impeding knowledge sharing on Twitter. Consequently, many did not feel confident enough to actively participate on Twitter. Conclusions: This study explores how Twitter is and can be used to mobilize knowledge to inform FCP clinical practice. Twitter can meet the knowledge needs of FCPs through rapid access to succinct knowledge, networking opportunities, and professional reassurance. The journey of knowledge exchange from Twitter to clinical practice can be explained by considering the mindlines model, which describes how FCPs exchange knowledge in digital and offline contexts. Findings demonstrate that Twitter can be a useful adjunct to FCP practice, although several factors impede knowledge sharing on the platform. We recommend social media training and enhanced governance guidance from professional bodies to support the use of Twitter for knowledge mobilization. ", doi="10.2196/55680", url="https://www.jmir.org/2024/1/e55680", url="http://www.ncbi.nlm.nih.gov/pubmed/38742615" } @Article{info:doi/10.2196/52992, author="Huo, Weixue and He, Mengwei and Zeng, Zhaoxiang and Bao, Xianhao and Lu, Ye and Tian, Wen and Feng, Jiaxuan and Feng, Rui", title="Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study", journal="J Med Internet Res", year="2024", month="Jul", day="2", volume="26", pages="e52992", keywords="patient satisfaction", keywords="physician-patient relationship", keywords="ChatGPT", keywords="patient concern", keywords="COVID-19", abstract="Background: In the era of the internet, individuals have increasingly accustomed themselves to gathering necessary information and expressing their opinions on public web-based platforms. The health care sector is no exception, as these comments, to a certain extent, influence people's health care decisions. During the onset of the COVID-19 pandemic, how the medical experience of Chinese patients and their evaluations of hospitals have changed remains to be studied. Therefore, we plan to collect patient medical visit data from the internet to reflect the current status of medical relationships under specific circumstances. Objective: This study aims to explore the differences in patient comments across various stages (during, before, and after) of the COVID-19 pandemic, as well as among different types of hospitals (children's hospitals, maternity hospitals, and tumor hospitals). Additionally, by leveraging ChatGPT (OpenAI), the study categorizes the elements of negative hospital evaluations. An analysis is conducted on the acquired data, and potential solutions that could improve patient satisfaction are proposed. This study is intended to assist hospital managers in providing a better experience for patients who are seeking care amid an emergent public health crisis. Methods: Selecting the top 50 comprehensive hospitals nationwide and the top specialized hospitals (children's hospitals, tumor hospitals, and maternity hospitals), we collected patient reviews from these hospitals on the Dianping website. Using ChatGPT, we classified the content of negative reviews. Additionally, we conducted statistical analysis using SPSS (IBM Corp) to examine the scoring and composition of negative evaluations. Results: A total of 30,317 pieces of effective comment information were collected from January 1, 2018, to August 15, 2023, including 7696 pieces of negative comment information. Manual inspection results indicated that ChatGPT had an accuracy rate of 92.05\%. The F1-score was 0.914. The analysis of this data revealed a significant correlation between the comments and ratings received by hospitals during the pandemic. Overall, there was a significant increase in average comment scores during the outbreak (P<.001). Furthermore, there were notable differences in the composition of negative comments among different types of hospitals (P<.001). Children's hospitals received sensitive feedback regarding waiting times and treatment effectiveness, while patients at maternity hospitals showed a greater concern for the attitude of health care providers. Patients at tumor hospitals expressed a desire for timely examinations and treatments, especially during the pandemic period. Conclusions: The COVID-19 pandemic had some association with patient comment scores. There were variations in the scores and content of comments among different types of specialized hospitals. Using ChatGPT to analyze patient comment content represents an innovative approach for statistically assessing factors contributing to patient dissatisfaction. The findings of this study could provide valuable insights for hospital administrators to foster more harmonious physician-patient relationships and enhance hospital performance during public health emergencies. ", doi="10.2196/52992", url="https://www.jmir.org/2024/1/e52992" } @Article{info:doi/10.2196/49077, author="Terada, Marina and Okuhara, Tsuyoshi and Yokota, Rie and Kiuchi, Takahiro and Murakami, Kentaro", title="Nutrients and Foods Recommended for Blood Pressure Control on Twitter in Japan: Content Analysis", journal="J Med Internet Res", year="2024", month="Jun", day="20", volume="26", pages="e49077", keywords="Twitter", keywords="food", keywords="nutrition", keywords="misinformation", keywords="salt", keywords="content analysis", keywords="hypertension", keywords="blood pressure", keywords="sodium", keywords="salt reduction", abstract="Background: Management and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter. Objective: This study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control. Methods: A total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated. Results: Of the 2347 tweets, 80\% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2\%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1\% (n=1301), followed by potassium at 8.4\% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8\% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75\% (n=21) of tweets from ``doctors'' mentioned salt reduction is effective for hypertension control, while 31.1\% (n=74) of tweets from ``health, losing weight, and beauty-related users,'' 25.9\% (n=429) of tweets from ``general public,'' and 23.5\% (n=4) tweets from ``dietitian or registered dietitian'' denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5\% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control. Conclusions: The large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic. ", doi="10.2196/49077", url="https://www.jmir.org/2024/1/e49077" } @Article{info:doi/10.2196/50698, author="Stupnicki, Aleksander and Suresh, Basil and Jain, Saurabh", title="Online Visibility and Scientific Relevance of Strabismus Research: Bibliometric Analysis", journal="Interact J Med Res", year="2024", month="Jun", day="12", volume="13", pages="e50698", keywords="strabismus research", keywords="squint", keywords="social media", keywords="scientific relevance", keywords="altmetrics", keywords="accuracy", keywords="medical knowledge", keywords="metric", keywords="bibliometric analysis", keywords="research", keywords="strabismus", keywords="online visibility", keywords="platform", keywords="evidence-based information", keywords="accessibility", abstract="Background: Quality and accuracy of online scientific data are crucial, given that the internet and social media serve nowadays as primary sources of medical knowledge. Objective: This study aims to analyze the relationship between scientific relevance and online visibility of strabismus research to answer the following questions: (1) Are the most popular strabismus papers scientifically relevant? (2) Are the most high-impact strabismus studies shared enough online? Methods: The Altmetric Attention Score (AAS) was used as a proxy for online visibility, whereas citations and the journal's impact factor (IF) served as a metric for scientific relevance. Using ``strabismus'' as a keyword, 100 papers with the highest AAS and 100 papers with the highest number of citations were identified. Statistical analyses, including the Spearman rank test, linear regression, and factor analysis, were performed to assess the relationship between AAS, citations, a journal's IF, and mentions across 18 individual Web 2.0 platforms. Results: A weak, positive, statistically significant correlation was observed between normalized AAS and normalized citations (P<.001; r=0.27) for papers with high visibility. Only Twitter mentions and Mendeley readers correlated significantly with normalized citations (P=.02 and P<.001, respectively) and IF (P=.04 and P=.009, respectively), with Twitter being the strongest significant predictor of citation numbers (r=0.53). For high-impact papers, no correlation was found between normalized citations and normalized AAS (P=.12) or the IF of the journal (P=.55). Conclusions: While clinical relevance influences online attention, most high-impact research related to strabismus is not sufficiently shared on the web. Therefore, researchers should make a greater effort to share high-impact papers related to strabismus on online media platforms to improve accessibility and quality of evidence-based knowledge for patients. ", doi="10.2196/50698", url="https://www.i-jmr.org/2024/1/e50698", url="http://www.ncbi.nlm.nih.gov/pubmed/38865170" } @Article{info:doi/10.2196/47620, author="Lu, Qianfeng and Schulz, Johannes Peter", title="Physician Perspectives on Internet-Informed Patients: Systematic Review", journal="J Med Internet Res", year="2024", month="Jun", day="6", volume="26", pages="e47620", keywords="internet-informed patients", keywords="physician-patient communication", keywords="health information--seeking", keywords="misinformation", keywords="digital health", abstract="Background: The internet has become a prevalent source of health information for patients. However, its accuracy and relevance are often questionable. While patients seek physicians' expertise in interpreting internet health information, physicians' perspectives on patients' information-seeking behavior are less explored. Objective: This review aims to understand physicians' perceptions of patients' internet health information-seeking behavior as well as their communication strategies and the challenges and needs they face with internet-informed patients. Methods: An initial search in PubMed, Scopus, CINAHL, Communication and Mass Media Complete, and PsycINFO was conducted to collect studies published from January 1990 to August 1, 2022. A subsequent search on December 24, 2023, targeted recent studies published after the initial search cutoff date. Two reviewers independently performed title, abstract, and full-text screening, adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. Thematic analysis was then used to identify key themes and systematically categorize evidence from both qualitative and quantitative studies under these themes. Results: A total of 22 qualifying articles were identified after the search and screening process. Physicians were found to hold diverse views on patients' internet searches, which can be viewed as a continuous spectrum of opinions ranging from positive to negative. While some physicians leaned distinctly toward either positive or negative perspectives, a significant number expressed more balanced views. These physicians recognized both the benefits, such as increased patient health knowledge and informed decision-making, and the potential harms, including misinformation and the triggering of negative emotions, such as patient anxiety or confusion, associated with patients' internet health information seeking. Two communicative strategies were identified: the participative and defensive approaches. While the former seeks to guide internet-informed patients to use internet information with physicians' expertise, the latter aims to discourage patients from using the internet to seek health information. Physicians' perceptions were linked to their strategies: those holding positive views tended to adopt a participative approach, while those with negative views favored a defensive strategy. Some physicians claimed to shift between the 2 approaches depending on their interaction with a certain patient. We also identified several challenges and needs of physicians in dealing with internet-informed patients, including the time pressure to address internet-informed patient demands, a lack of structured training, and being uninformed about trustworthy internet sites that can be recommended to internet-informed patients. Conclusions: This review highlights the diverse perceptions that physicians hold toward internet-informed patients, as well as the interplay between their perceptions, communication strategies, and their interactions with individual patients. Incorporating elements into the medical teaching curriculum that introduce physicians to reliable internet health resources for patient guidance, coupled with providing updates on technological advancements, could be instrumental in equipping physicians to more effectively manage internet-informed patients. Trial Registration: PROSPERO CRD42022356317; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=356317 ", doi="10.2196/47620", url="https://www.jmir.org/2024/1/e47620", url="http://www.ncbi.nlm.nih.gov/pubmed/38842920" } @Article{info:doi/10.2196/51496, author="Zhang, Yujie and Fu, Jiaqi and Lai, Jie and Deng, Shisi and Guo, Zihan and Zhong, Chuhan and Tang, Jianyao and Cao, Wenqiong and Wu, Yanni", title="Reporting of Ethical Considerations in Qualitative Research Utilizing Social Media Data on Public Health Care: Scoping Review", journal="J Med Internet Res", year="2024", month="May", day="17", volume="26", pages="e51496", keywords="qualitative research", keywords="informed consent", keywords="ethics approval", keywords="privacy", keywords="internet community", abstract="Background: The internet community has become a significant source for researchers to conduct qualitative studies analyzing users' views, attitudes, and experiences about public health. However, few studies have assessed the ethical issues in qualitative research using social media data. Objective: This study aims to review the reportage of ethical considerations in qualitative research utilizing social media data on public health care. Methods: We performed a scoping review of studies mining text from internet communities and published in peer-reviewed journals from 2010 to May 31, 2023. These studies, limited to the English language, were retrieved to evaluate the rates of reporting ethical approval, informed consent, and privacy issues. We searched 5 databases, that is, PubMed, Web of Science, CINAHL, Cochrane, and Embase. Gray literature was supplemented from Google Scholar and OpenGrey websites. Studies using qualitative methods mining text from the internet community focusing on health care topics were deemed eligible. Data extraction was performed using a standardized data extraction spreadsheet. Findings were reported using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: After 4674 titles, abstracts, and full texts were screened, 108 studies on mining text from the internet community were included. Nearly half of the studies were published in the United States, with more studies from 2019 to 2022. Only 59.3\% (64/108) of the studies sought ethical approval, 45.3\% (49/108) mentioned informed consent, and only 12.9\% (14/108) of the studies explicitly obtained informed consent. Approximately 86\% (12/14) of the studies that reported informed consent obtained digital informed consent from participants/administrators, while 14\% (2/14) did not describe the method used to obtain informed consent. Notably, 70.3\% (76/108) of the studies contained users' written content or posts: 68\% (52/76) contained verbatim quotes, while 32\% (24/76) paraphrased the quotes to prevent traceability. However, 16\% (4/24) of the studies that paraphrased the quotes did not report the paraphrasing methods. Moreover, 18.5\% (20/108) of the studies used aggregated data analysis to protect users' privacy. Furthermore, the rates of reporting ethical approval were different between different countries (P=.02) and between papers that contained users' written content (both direct and paraphrased quotes) and papers that did not contain users' written content (P<.001). Conclusions: Our scoping review demonstrates that the reporting of ethical considerations is widely neglected in qualitative research studies using social media data; such studies should be more cautious in citing user quotes to maintain user privacy. Further, our review reveals the need for detailed information on the precautions of obtaining informed consent and paraphrasing to reduce the potential bias. A national consensus of ethical considerations such as ethical approval, informed consent, and privacy issues is needed for qualitative research of health care using social media data of internet communities. ", doi="10.2196/51496", url="https://www.jmir.org/2024/1/e51496", url="http://www.ncbi.nlm.nih.gov/pubmed/38758590" } @Article{info:doi/10.2196/55847, author="Lv, Xiaolei and Zhang, Xiaomeng and Li, Yuan and Ding, Xinxin and Lai, Hongchang and Shi, Junyu", title="Leveraging Large Language Models for Improved Patient Access and Self-Management: Assessor-Blinded Comparison Between Expert- and AI-Generated Content", journal="J Med Internet Res", year="2024", month="Apr", day="25", volume="26", pages="e55847", keywords="large language model", keywords="artificial intelligence", keywords="public oral health", keywords="health care access", keywords="patient education", abstract="Background: While large language models (LLMs) such as ChatGPT and Google Bard have shown significant promise in various fields, their broader impact on enhancing patient health care access and quality, particularly in specialized domains such as oral health, requires comprehensive evaluation. Objective: This study aims to assess the effectiveness of Google Bard, ChatGPT-3.5, and ChatGPT-4 in offering recommendations for common oral health issues, benchmarked against responses from human dental experts. Methods: This comparative analysis used 40 questions derived from patient surveys on prevalent oral diseases, which were executed in a simulated clinical environment. Responses, obtained from both human experts and LLMs, were subject to a blinded evaluation process by experienced dentists and lay users, focusing on readability, appropriateness, harmlessness, comprehensiveness, intent capture, and helpfulness. Additionally, the stability of artificial intelligence responses was also assessed by submitting each question 3 times under consistent conditions. Results: Google Bard excelled in readability but lagged in appropriateness when compared to human experts (mean 8.51, SD 0.37 vs mean 9.60, SD 0.33; P=.03). ChatGPT-3.5 and ChatGPT-4, however, performed comparably with human experts in terms of appropriateness (mean 8.96, SD 0.35 and mean 9.34, SD 0.47, respectively), with ChatGPT-4 demonstrating the highest stability and reliability. Furthermore, all 3 LLMs received superior harmlessness scores comparable to human experts, with lay users finding minimal differences in helpfulness and intent capture between the artificial intelligence models and human responses. Conclusions: LLMs, particularly ChatGPT-4, show potential in oral health care, providing patient-centric information for enhancing patient education and clinical care. The observed performance variations underscore the need for ongoing refinement and ethical considerations in health care settings. Future research focuses on developing strategies for the safe integration of LLMs in health care settings. ", doi="10.2196/55847", url="https://www.jmir.org/2024/1/e55847", url="http://www.ncbi.nlm.nih.gov/pubmed/38663010" } @Article{info:doi/10.2196/51211, author="Wanberg, J. Lindsey and Pearson, R. David", title="Evaluating the Disease-Related Experiences of TikTok Users With Lupus Erythematosus: Qualitative and Content Analysis", journal="JMIR Infodemiology", year="2024", month="Apr", day="17", volume="4", pages="e51211", keywords="lupus", keywords="TikTok", keywords="autoimmune disease", keywords="qualitative research", keywords="quality of life", abstract="Background: Lupus erythematosus (LE) is an autoimmune condition that is associated with significant detriments to quality of life and daily functioning. TikTok, a popular social networking platform for sharing short videos, provides a unique opportunity to understand experiences with LE within a nonclinical sample, a population that is understudied in LE research. This is the first qualitative study that explores LE experiences using the TikTok platform. Objective: This study aims to evaluate the disease-related experiences of TikTok users with LE using qualitative and content analysis. Methods: TikTok videos were included if the hashtags included \#lupus, were downloadable, were in English, and involved the personal experience of an individual with LE. A codebook was developed using a standardized inductive approach of iterative coding until saturation was reached. NVivo (Lumivero), a qualitative analysis software platform, was used to code videos and perform content analysis. Inductive thematic analysis was used to derive themes from the data. Results: A total of 153 TikTok videos met the inclusion criteria. The most common codes were experiences with symptoms (106/153, 69.3\%), mucocutaneous symptoms (61/153, 39.9\%), and experiences with treatment (59/153, 38.6\%). Experiences with symptoms and mucocutaneous symptoms had the greatest cumulative views (25,381,074 and 14,879,109 views, respectively). Five thematic conclusions were derived from the data: (1) mucocutaneous symptoms had profound effects on the mental health and body image of TikTok users with LE; (2) TikTok users' negative experiences with health care workers were often derived from diagnostic delays and perceptions of ``medical gaslighting''; (3) TikTok users tended to portray pharmacologic and nonpharmacologic interventions, such as diet and naturopathic remedies, positively, whereas pharmacologic treatments were portrayed negatively or referred to as ``chemotherapy''; (4) LE symptoms, particularly musculoskeletal symptoms and fatigue, interfered with users' daily functioning; and (5) although TikTok users frequently had strong support systems, feelings of isolation were often attributed to battling an ``invisible illness.'' Conclusions: This study demonstrates that social media can provide important, clinically relevant information for health practitioners caring for patients with chronic conditions such as LE. As mucocutaneous symptoms were the predominant drivers of distress in our sample, the treatment of hair loss and rash is vital in this population. However, pharmacologic therapies were often depicted negatively, reinforcing the significance of discussions on the safety and effectiveness of these treatments. In addition, while TikTok users demonstrated robust support systems, feelings of having an ``invisible illness'' and ``medical gaslighting'' dominated negative interactions with others. This underscores the importance of providing validation in clinical interactions. ", doi="10.2196/51211", url="https://infodemiology.jmir.org/2024/1/e51211", url="http://www.ncbi.nlm.nih.gov/pubmed/38631030" } @Article{info:doi/10.2196/49163, author="Bene, Ayaka Benard and Ibeneme, Sunny and Fadahunsi, Philip Kayode and Harri, Isa Bala and Ukor, Nkiruka and Mastellos, Nikolaos and Majeed, Azeem and Car, Josip", title="Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review", journal="J Med Internet Res", year="2024", month="Apr", day="11", volume="26", pages="e49163", keywords="regulation", keywords="standard", keywords="framework", keywords="guidance", keywords="guideline", keywords="health app", keywords="self-management", keywords="World Health Organization", keywords="WHO African Region", keywords="sub-Saharan Africa", abstract="Background: Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety. Objective: This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management. Methods: A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management. Results: The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps. Conclusions: Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025714 ", doi="10.2196/49163", url="https://www.jmir.org/2024/1/e49163", url="http://www.ncbi.nlm.nih.gov/pubmed/38602718" } @Article{info:doi/10.2196/53373, author="Haff, L. Priscilla and Jacobson, Alli and Taylor, M. Madison and Schandua, P. Hayden and Farris, P. David and Doan, Q. Hung and Nelson, C. Kelly", title="The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review", journal="JMIR Dermatol", year="2024", month="Apr", day="8", volume="7", pages="e53373", keywords="social media", keywords="communication", keywords="skin cancer", keywords="melanoma", keywords="misinformation", keywords="scoping review", abstract="Background: The wide availability of web-based sources, including social media (SM), has supported rapid, widespread dissemination of health information. This dissemination can be an asset during public health emergencies; however, it can also present challenges when the information is inaccurate or ill-informed. Of interest, many SM sources discuss cancer, specifically cutaneous melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma). Objective: Through a comprehensive and scoping review of the literature, this study aims to gain an actionable perspective of the state of SM information regarding skin cancer diagnostics, prognostics, and prevention. Methods: We performed a scoping literature review to establish the relationship between SM and skin cancer. A literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from January 2000 to June 2023. The included studies discussed SM and its relationship to and effect on skin cancer. Results: Through the search, 1009 abstracts were initially identified, 188 received full-text review, and 112 met inclusion criteria. The included studies were divided into 7 groupings based on a publication's primary objective: misinformation (n=40, 36\%), prevention campaign (n=19, 17\%), engagement (n=16, 14\%), research (n=12, 11\%), education (n=11, 10\%), demographics (n=10, 9\%), and patient support (n=4, 3\%), which were the most common identified themes. Conclusions: Through this review, we gained a better understanding of the SM environment addressing skin cancer information, and we gained insight into the best practices by which SM could be used to positively influence the health care information ecosystem. ", doi="10.2196/53373", url="https://derma.jmir.org/2024/1/e53373", url="http://www.ncbi.nlm.nih.gov/pubmed/38587890" } @Article{info:doi/10.2196/48130, author="Chlabicz, Ma?gorzata and Nabo?ny, Aleksandra and Koszelew, Jolanta and ?aguna, Wojciech and Szpakowicz, Anna and Sowa, Pawe? and Budny, Wojciech and Guziejko, Katarzyna and R{\'o}g-Makal, Magdalena and Pancewicz, S?awomir and Kondrusik, Maciej and Czupryna, Piotr and Cudowska, Beata and Lebensztejn, Dariusz and Moniuszko-Malinowska, Anna and Wierzbicki, Adam and Kami?ski, A. Karol", title="Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study", journal="J Med Internet Res", year="2024", month="Mar", day="29", volume="26", pages="e48130", keywords="infodemic", keywords="fake news", keywords="information credibility", keywords="online health information", keywords="evidence based medicine", keywords="EBM", keywords="false", keywords="credibility", keywords="credible", keywords="health information", keywords="online information", keywords="information quality", keywords="infoveillance", keywords="infodemiology", keywords="misinformation", keywords="disinformation", abstract="Background: Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. Objective: This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. Methods: We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. Results: In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57\% (43/76) to 24\% (6/25) and 42\% (10/25) to 30\% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11\% (3/28) to 26\% (9/35) and from 18\% (5/28) to 26\% (6/23), respectively. Conclusions: Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially ``filling the vacuum'' and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects. ", doi="10.2196/48130", url="https://www.jmir.org/2024/1/e48130", url="http://www.ncbi.nlm.nih.gov/pubmed/38551638" } @Article{info:doi/10.2196/45855, author="Ng, Reuben and Indran, Nicole", title="Youth is Prized in Medicine, Old Age is Valued in Law: Analysis of Media Narratives Over 200 Years", journal="J Med Internet Res", year="2024", month="Mar", day="26", volume="26", pages="e45855", keywords="older professionals", keywords="ageism", keywords="media", keywords="historical analysis", keywords="reframe aging", keywords="learned professions", keywords="psychomics", abstract="Background: This is the first study to explore how age has influenced depictions of doctors and lawyers in the media over the course of 210 years, from 1810 to 2019. The media represents a significant platform for examining age stereotypes and possesses tremendous power to shape public opinion. Insights could be used to improve depictions of older professionals in the media. Objective: This study aims to understand how age shapes the portrayals of doctors and lawyers. Specifically, it compares the difference in sentiments toward younger and older doctors as well as younger and older lawyers in the media over 210 years. Methods: Leveraging a 600-million-word corpus of American media publications spanning 210 years, we compiled top descriptors (N=478,452) of nouns related to youth {\texttimes} occupation (eg, younger doctor or physician) and old age {\texttimes} occupation (eg, older lawyer or attorney). These descriptors were selected using well-established criteria including co-occurrence frequency and context relevance, and were rated on a Likert scale from 1 (very negative) to 5 (very positive). Sentiment scores were generated for ``doctor/physician,'' ``young(er) doctor/physician,'' ``old(er) doctor/physician,'' ``lawyer/attorney,'' ``young(er) lawyer/attorney,'' and ``old(er) lawyer/attorney.'' The scores were calculated per decade for 21 decades from 1810 to 2019. Topic modeling was conducted on the descriptors of each occupation in both the 1800s and 1900s using latent Dirichlet allocation. Results: As hypothesized, the media placed a premium on youth in the medical profession, with portrayals of younger doctors becoming 10\% more positive over 210 years, and those of older doctors becoming 1.4\% more negative. Meanwhile, a premium was placed on old age in law. Positive portrayals of older lawyers increased by 22.6\% over time, while those of younger lawyers experienced a 4.3\% decrease. In the 1800s, narratives on younger doctors revolved around their participation in rural health care. In the 1900s, the focus shifted to their mastery of new medical technologies. There was no marked change in narratives surrounding older doctors from the 1800s to the 1900s, though less attention was paid to their skills in the 1900s. Narratives on younger lawyers in the 1800s referenced their limited experience. In the 1900s, there was more focus on courtroom affairs. In both the 1800s and 1900s, narratives on older lawyers emphasized their prestige, especially in the 1900s. Conclusions: Depending on the occupation, one's age may either be seen as an asset or a liability. Efforts must be expended to ensure that older professionals are recognized for their wealth of knowledge and skills. Failing to capitalize on the merits of an older workforce could ultimately be a grave disservice not only to older adults but to society in general. ", doi="10.2196/45855", url="https://www.jmir.org/2024/1/e45855", url="http://www.ncbi.nlm.nih.gov/pubmed/38530338" } @Article{info:doi/10.2196/49198, author="AlMeshrafi, Azzam and AlHamad, F. Arwa and AlKuraidees, Hamoud and AlNasser, A. Lubna", title="Arabic Web-Based Information on Oral Lichen Planus: Content Analysis", journal="JMIR Form Res", year="2024", month="Mar", day="19", volume="8", pages="e49198", keywords="oral lichen planus", keywords="health information", keywords="Arabic", keywords="medical information", keywords="information seeking", keywords="quality", keywords="online information", keywords="Arab", keywords="oral", keywords="inflammatory", keywords="inflammation", keywords="chronic", keywords="mouth", keywords="mucous membrane", keywords="mucous membranes", keywords="reliable", keywords="reliability", keywords="credible", keywords="credibility", keywords="periodontology", keywords="dental", keywords="dentist", keywords="dentistry", abstract="Background: The use of web-based health information (WBHI) is on the rise, serving as a valuable tool for educating the public about health concerns and enhancing treatment adherence. Consequently, evaluating the availability and quality of context-specific WBHI is crucial to tackle disparities in health literacy and advance population health outcomes. Objective: This study aims to explore and assess the quality of the WBHI available and accessible to the public on oral lichen planus (OLP) in Arabic. Methods: The Arabic translation of the term OLP and its derivatives were searched in three general search platforms, and each platform's first few hundred results were reviewed for inclusion. We excluded content related to cutaneous LP, content not readily accessible to the public (eg, requiring subscription fees or directed to health care providers), and content not created by health care providers or organizations (ie, community forums, blogs, and social media). We assessed the quality of the Arabic WBHI with three standardized and validated tools: DISCERN, Journal of the American Medical Association (JAMA) benchmarks, and Health On the Net (HON). Results: Of the 911 resources of WBHI reviewed for eligibility, 49 were included in this study. Most WBHI resources were provided by commercial affiliations (n=28, 57.1\%), with the remainder from academic or not-for-profit affiliations. WBHI were often presented with visual aids (ie, images; n=33, 67.4\%). DISCERN scores were highest for WBHI resources that explicitly stated their aim, while the lowest scores were for providing the effect of OLP (or OLP treatment) on the quality of life. One-quarter of the resources (n=11, 22.4\%) met all 4 JAMA benchmarks, indicating the high quality of the WBHI, while the remainder of the WBHI failed to meet one or more of the JAMA benchmarks. HON scores showed that one-third of WBHI sources had scores above 75\%, indicating higher reliability and credibility of the WBHI source, while one-fifth of the sources scored below 50\%. Only 1 in 7 WBHI resources scored simultaneously high on all three quality instruments. Generally, WBHI from academic affiliations had higher quality scores than content provided by commercial affiliations. Conclusions: There are considerable variations in the quality of WBHI on OLP in Arabic. Most WBHI resources were deemed to be of moderate quality at best. Providers of WBHI could benefit from increasing collaboration between commercial and academic institutions in creating WBHI and integrating guidance from international quality assessment tools to improve the quality and, hopefully, the utility of these valuable WBHI resources. ", doi="10.2196/49198", url="https://formative.jmir.org/2024/1/e49198", url="http://www.ncbi.nlm.nih.gov/pubmed/38502161" } @Article{info:doi/10.2196/42849, author="Ling, Eunice and de Pieri, Domenico and Loh, Evenne and Scott, M. Karen and Li, H. Stephen C. and Medbury, J. Heather", title="Evaluation of the Accuracy, Credibility, and Readability of Statin-Related Websites: Cross-Sectional Study", journal="Interact J Med Res", year="2024", month="Mar", day="14", volume="13", pages="e42849", keywords="statins", keywords="consumer health information", keywords="readability", keywords="credibility", keywords="accuracy", keywords="digital health, health information seeking", keywords="cardiovascular", keywords="mortality", keywords="management", keywords="pharmacotherapy", keywords="risk", keywords="medication", abstract="Background: Cardiovascular disease (CVD) represents the greatest burden of mortality worldwide, and statins are the most commonly prescribed drug in its management. A wealth of information pertaining to statins and their side effects is on the internet; however, to date, no assessment of the accuracy, credibility, and readability of this information has been undertaken. Objective: This study aimed to evaluate the quality (accuracy, credibility, and readability) of websites likely to be visited by the general public undertaking a Google search of the side effects and use of statin medications. Methods: Following a Google web search, we reviewed the top 20 consumer-focused websites with statin information. Website accuracy, credibility, and readability were assessed based on website category (commercial, not-for-profit, and media), website rank, and the presence or absence of the Health on the Net Code of Conduct (HONcode) seal. Accuracy and credibility were assessed following the development of checklists (with 20 and 13 items, respectively). Readability was assessed using the Simple Measure of Gobbledegook scores. Results: Overall, the accuracy score was low (mean 14.35 out of 20). While side effects were comprehensively covered by 18 websites, there was little information about statin use in primary and secondary prevention. None of the websites met all criteria on the credibility checklist (mean 7.8 out of 13). The median Simple Measure of Gobbledegook score was 9.65 (IQR 8.825-10.85), with none of the websites meeting the recommended reading grade of 6, even the media websites. A website bearing the HONcode seal did not mean that the website was more comprehensive or readable. Conclusions: The quality of statin-related websites tended to be poor. Although the information contained was accurate, it was not comprehensive and was presented at a reading level that was too difficult for an average reader to fully comprehend. As such, consumers risk being uninformed about this pharmacotherapy. ", doi="10.2196/42849", url="https://www.i-jmr.org/2024/1/e42849", url="http://www.ncbi.nlm.nih.gov/pubmed/38483461" } @Article{info:doi/10.2196/54107, author="Jia, Chenjin and Li, Pengcheng", title="Generation Z's Health Information Avoidance Behavior: Insights From Focus Group Discussions", journal="J Med Internet Res", year="2024", month="Mar", day="8", volume="26", pages="e54107", keywords="information avoidance", keywords="health information", keywords="Generation Z", keywords="information overload", keywords="planned risk information avoidance model", abstract="Background: Younger generations actively use social media to access health information. However, research shows that they also avoid obtaining health information online at times when confronted with uncertainty. Objective: This study aims to examine the phenomenon of health information avoidance among Generation Z, a representative cohort of active web users in this era. Methods: Drawing on the planned risk information avoidance model, we adopted a qualitative approach to explore the factors related to information avoidance within the context of health and risk communication. The researchers recruited 38 participants aged 16 to 25 years for the focus group discussion sessions. Results: In this study, we sought to perform a deductive qualitative analysis of the focus group interview content with open, focused, and theoretical coding. Our findings support several key components of the planned risk information avoidance model while highlighting the underlying influence of cognition on emotions. Specifically, socioculturally, group identity and social norms among peers lead some to avoid health information. Cognitively, mixed levels of risk perception, conflicting values, information overload, and low credibility of information sources elicited their information avoidance behaviors. Affectively, negative emotions such as anxiety, frustration, and the desire to stay positive contributed to avoidance. Conclusions: This study has implications for understanding young users' information avoidance behaviors in both academia and practice. ", doi="10.2196/54107", url="https://www.jmir.org/2024/1/e54107", url="http://www.ncbi.nlm.nih.gov/pubmed/38457223" } @Article{info:doi/10.2196/50031, author="Miller, Tiev and Hosseinzadeh, Ali and Thordarson, Thomas and Kalimullina, Tamila and Samejima, Soshi and Shackleton, Claire and Malik, Raza and Calder{\'o}n-Ju{\'a}rez, Mart{\'i}n and Sachdeva, Rahul and Krassioukov, Andrei", title="Web-Based Information on Spinal Cord Stimulation: Qualitative Assessment of Publicly Accessible Online Resources", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="23", volume="10", pages="e50031", keywords="access to information", keywords="consumer health information", keywords="internet", keywords="spinal cord stimulation", keywords="web-based information", keywords="communication", keywords="quality", keywords="readability", keywords="Google Trends", keywords="misinformation", keywords="synthesis", abstract="Background: Despite the growing accessibility of web-based information related to spinal cord stimulation (SCS), the content and quality of commonly encountered websites remain unknown. Objective: This study aimed to assess the content and quality of web-based information on SCS. Methods: This qualitative study was prospectively registered in Open Science Framework. Google Trends was used to identify the top trending, SCS-related search queries from 2012 to 2022. Top queried terms were then entered into separate search engines. Information found on websites within the first 2 pages of results was extracted and assessed for quality using the DISCERN instrument, the Journal of the American Medical Association benchmark criteria, and the Health on the Net Foundation code of conduct certification. Website readability and SCS-related information were also assessed. Results: After exclusions, 42 unique sites were identified (scientific resources: n=6, nonprofit: n=12, for-profit: n=20, news or media: n=2, and personal or blog: n=2). Overall, information quality was moderate (DISCERN). Few sites met all the Journal of the American Medical Association benchmark criteria (n=3, 7\%) or had Health on the Net Foundation certification (n=7, 16\%). On average, information was difficult to read, requiring a 9th- to 10th-grade level of reading comprehension. Sites described SCS subcategories (n=14, 33\%), indications (n=38, 90\%), contraindications (n=14, 33\%), side effects or risks (n=28, 66\%), device considerations (n=25, 59\%), follow-up (n=22, 52\%), expected outcomes (n=31, 73\%), provided authorship details (n=20, 47\%), and publication dates (n=19, 45\%). The proportion of for-profit sites reporting authorship information was comparatively less than other site types (n=3, 15\%). Almost all sites focused on surgically implanted SCS (n=37, 88\%). On average, nonprofit sites contained the greatest number of peer-reviewed reference citations (n=6, 50\%). For-profit sites showed the highest proportion of physician or clinical referrals among site types (n=17, 85\%) indicating implicit bias (ie, auto-referral). Conclusions: Overall, our findings suggest the public may be exposed to incomplete or dated information from unidentifiable sources that could put consumers and patient groups at risk. ", doi="10.2196/50031", url="https://publichealth.jmir.org/2024/1/e50031", url="http://www.ncbi.nlm.nih.gov/pubmed/38393781" } @Article{info:doi/10.2196/54805, author="Murakami, Kentaro and Shinozaki, Nana and Okuhara, Tsuyoshi and McCaffrey, A. Tracy and Livingstone, E. M. Barbara", title="Prevalence and Correlates of Dietary and Nutrition Information Seeking Through Various Web-Based and Offline Media Sources Among Japanese Adults: Web-Based Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="14", volume="10", pages="e54805", keywords="nutrition", keywords="diet", keywords="information seeking", keywords="health literacy", keywords="food literacy", keywords="diet quality", keywords="Japan", abstract="Background: The advent of the internet has changed the landscape of available nutrition information. However, little is known about people's information-seeking behavior toward healthy eating and its potential consequences. Objective: We aimed to examine the prevalence and correlates of nutrition information seeking from various web-based and offline media sources. Methods: This cross-sectional study included 5998 Japanese adults aged 20 to 79 years participating in a web-based questionnaire survey (February and March 2023). The dependent variable was the regular use of web-based and offline media as a reliable source of nutrition information. The main independent variables included health literacy, food literacy, and diet quality, which were assessed using validated tools, as well as sociodemographic factors (sex, age, education level, and nutrition- and health-related occupations). Results: The top source of nutrition information was television (1973/5998, 32.89\%), followed by web searches (1333/5998, 22.22\%), websites of government and medical manufacturers (997/5998, 16.62\%), newspapers (901/5998, 15.02\%), books and magazines (697/5998, 11.62\%), and video sites (eg, YouTube; 634/5998, 10.57\%). Multivariable logistic regression showed that higher health literacy was associated with higher odds of using all the individual sources examined; odds ratios (ORs) for 1-point score increase ranged from 1.27 (95\% CI 1.09-1.49) to 1.81 (95\% CI 1.57-2.09). By contrast, food literacy was inversely associated with the use of television (OR 0.65, 95\% CI 0.55-0.77), whereas it was positively associated with the use of websites of government and medical manufacturers (OR 1.98, 95\% CI 1.62-2.44), books and magazines (OR 2.09, 95\% CI 1.64-2.66), and video sites (OR 1.53, 95\% CI 1.19-1.96). Furthermore, diet quality was positively associated with the use of newspapers (OR 1.02, 95\% CI 1.01-1.03) and books and magazines (OR 1.03, 95\% CI 1.02-1.04). Being female was associated with using television and books and magazines, whereas being male was associated with using websites of government and medical manufacturers, newspapers, and video sites. Age was positively associated with using newspapers and inversely associated with using websites of government and medical manufacturers and video sites. People with higher education were more likely to refer to websites of government and medical manufacturers and newspapers but less likely to use television and video sites. Dietitians were more likely to use websites of government and medical manufacturers and books and magazines than the general public but less likely to use television and video sites. Conclusions: We identified various web-based and offline media sources regularly used by Japanese adults when seeking nutrition information, and their correlates varied widely. A lack of positive associations between the use of the top 2 major sources (television and web searches) and food literacy or diet quality is highlighted. These findings provide useful insights into the potential for developing and disseminating evidence-based health promotion materials. ", doi="10.2196/54805", url="https://publichealth.jmir.org/2024/1/e54805", url="http://www.ncbi.nlm.nih.gov/pubmed/38354021" } @Article{info:doi/10.2196/50561, author="Ni, Chen-xu and Fei, Yi-bo and Wu, Ran and Cao, Wen-xiang and Liu, Wenhao and Huang, Fang and Shen, Fu-ming and Li, Dong-jie", title="Tumor Immunotherapy--Related Information on Internet-Based Videos Commonly Used by the Chinese Population: Content Quality Analysis", journal="JMIR Form Res", year="2024", month="Feb", day="7", volume="8", pages="e50561", keywords="immunotherapy", keywords="internet videos", keywords="quality", keywords="misinformation", keywords="health informatics", keywords="Chinese", abstract="Background: Tumor immunotherapy is an innovative treatment today, but there are limited data on the quality of immunotherapy information on social networks. Dissemination of misinformation through the internet is a major social issue. Objective: Our objective was to characterize the quality of information and presence of misinformation about tumor immunotherapy on internet-based videos commonly used by the Chinese population. Methods: Using the keyword ``tumor immunotherapy'' in Chinese, we searched TikTok, Tencent, iQIYI, and BiliBili on March 5, 2022. We reviewed the 118 screened videos using the Patient Education Materials Assessment Tool---a validated instrument to collect consumer health information. DISCERN quality criteria and the JAMA (Journal of the American Medical Association) Benchmark Criteria were used for assessing the quality and reliability of the health information. The videos' content was also evaluated. Results: The 118 videos about tumor immunotherapy were mostly uploaded by channels dedicated to lectures, health-related animations, and interviews; their median length was 5 minutes, and 79\% of them were published in and after 2018. The median understandability and actionability of the videos were 71\% and 71\%, respectively. However, the quality of information was moderate to poor on the validated DISCERN and JAMA assessments. Only 12 videos contained misinformation (score of >1 out of 5). Videos with a doctor (lectures and interviews) not only were significantly less likely to contain misinformation but also had better quality and a greater forwarding number. Moreover, the results showed that more than half of the videos contain little or no content on the risk factors and management of tumor immunotherapy. Overall, over half of the videos had some or more information on the definition, symptoms, evaluation, and outcomes of tumor immunotherapy. Conclusions: Although the quality of immunotherapy information on internet-based videos commonly used by Chinese people is moderate, these videos have less misinformation and better content. Caution must be exercised when using these videos as a source of tumor immunotherapy--related information. ", doi="10.2196/50561", url="https://formative.jmir.org/2024/1/e50561", url="http://www.ncbi.nlm.nih.gov/pubmed/38324352" } @Article{info:doi/10.2196/49514, author="Holland, Lena and Kanzow, Friederike Amelie and Wiegand, Annette and Kanzow, Philipp", title="Quality of Patient-Centered eHealth Information on Erosive Tooth Wear: Systematic Search and Evaluation of Websites and YouTube Videos", journal="J Med Internet Res", year="2024", month="Jan", day="31", volume="26", pages="e49514", keywords="consumer health information", keywords="dental erosion", keywords="dental sciences", keywords="digital media", keywords="erosive tooth wear", keywords="evidence-based dentistry", keywords="health education", keywords="information quality", keywords="internet", keywords="shared decision making", abstract="Background: Due to the declining prevalence of dental caries, noncarious tooth defects such as erosive tooth wear have gained increased attention over the past decades. While patients more frequently search the internet for health-related information, the quality of patient-centered, web-based health information on erosive tooth wear is currently unknown. Objective: This study aimed to assess the quality of patient-centered, web-based health information (websites and YouTube videos) on erosive tooth wear. Methods: German-language websites were systematically identified through 3 electronic search engines (google.de, bing.de or yahoo.de, and duckduckgo.com) in September 2021. Eligible websites were independently assessed for (1) technical and functional aspects via the LIDA instrument, (2) readability via the Flesch reading-ease score, (3) comprehensiveness of information via a structured checklist, and (4) generic quality and risk of bias via the DISCERN instrument by 2 different reviewers. An overall quality score (ie, higher scores being favored) generated from all 4 domains was used as the primary outcome. Quality scores from each domain were separately analyzed as secondary outcomes and compared by the Friedman test. The effect of practice-specific variables on quality scores of websites from private dental offices was assessed using generalized linear modeling. Eligible YouTube videos were judged based on (1) the comprehensiveness of information, (2) viewers' interaction, and (3) viewing rate. The comprehensiveness of information was compared between websites and YouTube videos using the Wilcoxon rank-sum test. Results: Overall, 231 eligible websites and 7 YouTube videos were identified and assessed. The median overall quality of the websites was 33.6\% (IQR 29.8\%-39.2\%). Secondary outcome scores amounted to 64.3\% (IQR 59.8\%-69.0\%) for technical and functional aspects, 40.0\% (IQR 34.0\%-49.0\%) for readability, 11.5\% (IQR 3.9\%-26.9\%) for comprehensiveness of information, and 16.7\% (IQR 8.3\%-23.3\%) for generic quality. While the comprehensiveness of information and generic quality received low scores, technical and functional aspects as well as readability resulted in higher scores (both Padjusted<.001). Regarding practice-specific variables, websites from private dental offices outside Germany (P=.04; B=--6.64, 95\% CI --12.85 to --0.42) or from dentists who are a dental society member (P=.049; B=--3.55, 95\% CI --7.09 to --0.01) resulted in lower readability scores (ie, were more difficult to read), while a shorter time since dentists' examination resulted in higher readability scores (P=.01; B=0.24 per year, 95\% CI 0.05-0.43). The comprehensiveness of information from YouTube videos was 34.6\% (IQR 13.5\%-38.5\%). However, the comprehensiveness of information did not vary between websites and YouTube videos (P=.09). Additionally, viewers' interaction (1.7\%, IQR 0.7\%-3.4\%) and viewing rates (101\%, IQR 54.6\%-112.6\%) were low. Conclusions: The quality of German-language, patient-centered, web-based information on erosive tooth wear was limited. Especially, the comprehensiveness and trustworthiness of the available information were insufficient. Web-based information on erosive tooth wear requires improvement to inform patients comprehensively and reliably. ", doi="10.2196/49514", url="https://www.jmir.org/2024/1/e49514", url="http://www.ncbi.nlm.nih.gov/pubmed/38167299" } @Article{info:doi/10.2196/48599, author="Moens, Maarten and Van Doorslaer, Leen and Billot, Maxime and Eeckman, Edgard and Roulaud, Manuel and Rigoard, Philippe and Fobelets, Maaike and Goudman, Lisa", title="Examining the Type, Quality, and Content of Web-Based Information for People With Chronic Pain Interested in Spinal Cord Stimulation: Social Listening Study", journal="J Med Internet Res", year="2024", month="Jan", day="30", volume="26", pages="e48599", keywords="online information", keywords="social listening", keywords="neuromodulation", keywords="patient care", keywords="chronic pain", keywords="web-based data", abstract="Background: The increased availability of web-based medical information has encouraged patients with chronic pain to seek health care information from multiple sources, such as consultation with health care providers combined with web-based information. The type and quality of information that is available on the web is very heterogeneous, in terms of content, reliability, and trustworthiness. To date, no studies have evaluated what information is available about neuromodulation on the web for patients with chronic pain. Objective: This study aims to explore the type, quality, and content of web-based information regarding spinal cord stimulation (SCS) for chronic pain that is freely available and targeted at health care consumers. Methods: The social listening tool Awario was used to search Facebook (Meta Platforms, Inc), Twitter (Twitter, Inc), YouTube (Google LLC), Instagram (Meta Platforms, Inc), blogs, and the web for suitable hits with ``pain'' and ``neuromodulation'' as keywords. Quality appraisal of the extracted information was performed using the DISCERN instrument. A thematic analysis through inductive coding was conducted. Results: The initial search identified 2174 entries, of which 630 (28.98\%) entries were eventually withheld, which could be categorized as web pages, including news and blogs (114/630, 18.1\%); Reddit (Reddit, Inc) posts (32/630, 5.1\%); Vimeo (Vimeo, Inc) hits (38/630, 6\%); or YouTube (Google LLC) hits (446/630, 70.8\%). Most posts originated in the United States (519/630, 82.4\%). Regarding the content of information, 66.2\% (383/579) of the entries discussed (fully discussed or partially discussed) how SCS works. In total, 55.6\% (322/579) of the entries did not elaborate on the fact that there may be >1 potential treatment choice and 47.7\% (276/579) did not discuss the influence of SCS on the overall quality of life. The inductive coding revealed 4 main themes. The first theme of pain and the burden of pain (1274/8886, 14.34\% coding references) explained about pain, pain management, individual impact of pain, and patient experiences. The second theme included neuromodulation as a treatment approach (3258/8886, 36.66\% coding references), incorporating the background on neuromodulation, patient-centered care, SCS therapy, and risks. Third, several device-related aspects (1722/8886, 19.38\% coding references) were presented. As a final theme, patient benefits and testimonials of treatment with SCS (2632/8886, 29.62\% coding references) were revealed with subthemes regarding patient benefits, eligibility, and testimonials and expectations. Conclusions: Health care consumers have access to web-based information about SCS, where details about the surgical procedures, the type of material, working mechanisms, risks, patient expectations, testimonials, and the potential benefits of this therapy are discussed. The reliability, trustworthiness, and correctness of web-based sources should be carefully considered before automatically relying on the content. ", doi="10.2196/48599", url="https://www.jmir.org/2024/1/e48599", url="http://www.ncbi.nlm.nih.gov/pubmed/38289645" } @Article{info:doi/10.2196/49749, author="Garg, Ashvita and Nyitray, G. Alan and Roberts, R. James and Shungu, Nicholas and Ruggiero, J. Kenneth and Chandler, Jessica and Damgacioglu, Haluk and Zhu, Yenan and Brownstein, C. Naomi and Sterba, R. Katherine and Deshmukh, A. Ashish and Sonawane, Kalyani", title="Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context", journal="J Med Internet Res", year="2024", month="Jan", day="15", volume="26", pages="e49749", keywords="awareness", keywords="health awareness", keywords="health information", keywords="health videos", keywords="HINTS", keywords="HPV vaccine", keywords="HPV", keywords="information behavior", keywords="information behaviors", keywords="information seeking", keywords="online information", keywords="reproductive health", keywords="rural", keywords="sexual health", keywords="sexually transmitted", keywords="social media", keywords="STD", keywords="STI", keywords="urban", keywords="video", keywords="videos", keywords="YouTube", abstract="Background: Nearly 70\% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. Objective: We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. Methods: We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms ``HPV'' and ``HPV vaccine'' on YouTube. Results: In 2022, 59.6\% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100\% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4\% in 2017 to 59.8\% in 2022; P<.001) and rural (from 22.4\% in 2017 to 58\% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term ``HPV'' was more frequently searched on YouTube compared with ``HPV vaccine.'' Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. Conclusions: The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics. ", doi="10.2196/49749", url="https://www.jmir.org/2024/1/e49749", url="http://www.ncbi.nlm.nih.gov/pubmed/38224476" } @Article{info:doi/10.2196/48243, author="Sirohi, Diksha and Ng, Man Cecilia Hoi and Bidargaddi, Niranjan and Slater, Helen and Parker, A. Melissa and Hull, Louise Mary and O'Hara, Rebecca", title="High-Quality eHealth Websites for Information on Endometriosis: Systematic Search", journal="J Med Internet Res", year="2024", month="Jan", day="10", volume="26", pages="e48243", keywords="digital health", keywords="endometriosis", keywords="eHealth websites", keywords="eHealth", keywords="pelvic pain", keywords="adenomyosis", abstract="Background: eHealth websites are increasingly being used by community members to obtain information about endometriosis. Additionally, clinicians can use these websites to enhance their understanding of the condition and refer patients to these websites. However, poor-quality information can adversely impact users. Therefore, a critical evaluation is needed to assess and recommend high-quality endometriosis websites. Objective: This study aimed to evaluate the quality and provide recommendations for high-quality endometriosis eHealth websites for the community and clinicians. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed 2 Google searches of international and Australian eHealth websites. The first search string used the terms ``endometriosis,'' ``adenomyosis,'' or ``pelvic pain,'' whereas ``Australia'' was added to the second search string. Only free eHealth websites in English were included. ENLIGHT, a validated tool, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. Websites with a total score of 3.5 or more were classified as ``good'' according to the ENLIGHT scoring system and are recommended as high-quality eHealth websites for information on endometriosis. Results: In total, 117 eHealth websites were screened, and 80 were included in the quality assessment. Four high-quality eHealth websites (ie, those that scored 3.5 or more) were identified (Endometriosis Australia Facebook Page, Endometriosis UK, National Action Plan for Endometriosis on EndoActive, and Adenomyosis by the Medical Republic). These websites provided easily understood, engaging, and accurate information. Adenomyosis by the Medical Republic can be used as a resource in clinical practice. Most eHealth websites scored well, 3.5 or more in the domains of usability (n=76, 95\%), visual design (n=64, 80\%), and content (n=63, 79\%). However, of the 63 websites, only 25 provided references and 26 provided authorship details. Few eHealth websites scored well on user engagement (n=18, 23\%), therapeutic persuasiveness (n=2, 3\%), and therapeutic alliance (n=22, 28\%). In total, 30 (38\%) eHealth websites scored well on general subjective evaluation. Conclusions: Although geographical location can influence the search results, we identified 4 high-quality endometriosis eHealth websites that can be recommended to the endometriosis community and clinicians. To improve quality, eHealth websites must provide evidence-based information with appropriate referencing and authorship. Factors that enhance usability, visual design, user engagement, therapeutic persuasiveness, and therapeutic alliance can lead to the successful and long-term uptake of eHealth websites. User engagement, therapeutic persuasiveness, and therapeutic alliance can be strengthened by sharing lived experiences and personal stories and by cocreating meaningful content for both the community and clinicians. Reach and discoverability can be improved by leveraging search engine optimization tools. Trial Registration: PROSPERO CRD42020185475; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=185475\&VersionID=2124365 ", doi="10.2196/48243", url="https://www.jmir.org/2024/1/e48243", url="http://www.ncbi.nlm.nih.gov/pubmed/38198205" } @Article{info:doi/10.2196/48402, author="Manne, Sharon and Wu, Yelena and Buller, David and Heckman, Carolyn and Devine, Katie and Frederick, Sara and Solleder, Justin and Schaefer, Alexis and Lu, Shou-En", title="The Effects of a Parent-Focused Social Media Intervention on Child Sun Safety: Pilot and Feasibility Study", journal="JMIR Form Res", year="2023", month="Dec", day="8", volume="7", pages="e48402", keywords="health behavior", keywords="health promotion and prevention", keywords="parenting", keywords="prevention science", keywords="parents", keywords="parent", keywords="Facebook", keywords="social media", keywords="sun", keywords="prevention", keywords="skin", keywords="dermatology", abstract="Background: Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child's increasing independence while providing practical assistance to ensure sun protection is implemented. Objective: The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. Methods: The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. Results: Enrollment (64.3\%, 92/143) and retention (94.6\%, 87/92) were good. On average, participants viewed 67.6\% (56.8/84) of posts, ``liked'' 16.4\% (13.77/84) of posts, commented on 14.8\% (12.43/84) of posts, and voted on 46\% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). Conclusions: This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted. ", doi="10.2196/48402", url="https://formative.jmir.org/2023/1/e48402", url="http://www.ncbi.nlm.nih.gov/pubmed/38064250" } @Article{info:doi/10.2196/47849, author="Thornton, Christopher and Lanyi, Kate and Wilkins, Georgina and Potter, Rhiannon and Hunter, Emily and Kolehmainen, Niina and Pearson, Fiona", title="Scoping the Priorities and Concerns of Parents: Infodemiology Study of Posts on Mumsnet and Reddit", journal="J Med Internet Res", year="2023", month="Nov", day="28", volume="25", pages="e47849", keywords="childhood", keywords="child", keywords="toddler", keywords="infant", keywords="behavior", keywords="parent", keywords="parenting", keywords="topic modeling", keywords="data mining", keywords="social media", keywords="infodemiology", keywords="Reddit", keywords="web-based forum", keywords="well-being", keywords="children", keywords="data", keywords="family health", abstract="Background: Health technology innovation is increasingly supported by a bottom-up approach to priority setting, aiming to better reflect the concerns of its intended beneficiaries. Web-based forums provide parents with an outlet to share concerns, advice, and information related to parenting and the health and well-being of their children. They provide a rich source of data on parenting concerns and priorities that could inform future child health research and innovation. Objective: The aim of the study is to identify common concerns expressed on 2 major web-based forums and cluster these to identify potential family health concern topics as indicative priority areas for future research and innovation. Methods: We text-mined the r/Parenting subreddit (69,846 posts) and the parenting section of Mumsnet (99,848 posts) to create a large corpus of posts. A generative statistical model (latent Dirichlet allocation) was used to identify the most discussed topics in the corpus, and content analysis was applied to identify the parenting concerns found in a subset of posts. Results: A model with 25 topics produced the highest coherence and a wide range of meaningful parenting concern topics. The most frequently expressed parenting concerns are related to their child's sleep, self-care, eating (and food), behavior, childcare context, and the parental context including parental conflict. Topics directly associated with infants, such as potty training and bottle feeding, were more common on Mumsnet, while parental context and screen time were more common on r/Parenting. Conclusions: Latent Dirichlet allocation topic modeling can be applied to gain a rapid, yet meaningful overview of parent concerns expressed on a large and diverse set of social media posts and used to complement traditional insight gathering methods. Parents framed their concerns in terms of children's everyday health concerns, generating topics that overlap significantly with established family health concern topics. We provide evidence of the range of family health concerns found at these sources and hope this can be used to generate material for use alongside traditional insight gathering methods. ", doi="10.2196/47849", url="https://www.jmir.org/2023/1/e47849", url="http://www.ncbi.nlm.nih.gov/pubmed/38015600" } @Article{info:doi/10.2196/45101, author="Morena, Nina and Ahisar, Yitzchok and Wang, Xena and Nguyen, Diana and Rentschler, A. Carrie and Meguerditchian, N. Ari", title="Content Quality of YouTube Videos About Metastatic Breast Cancer in Young Women: Systematic Assessment", journal="JMIR Cancer", year="2023", month="Nov", day="14", volume="9", pages="e45101", keywords="social media", keywords="YouTube", keywords="metastatic breast cancer", keywords="breast cancer", keywords="patient education", keywords="health education", keywords="patient literacy", keywords="media literacy", keywords="health literacy", keywords="consumer health information", keywords="assessment tool", keywords="treatment", keywords="false information", keywords="women", keywords="videos", keywords="web-based", abstract="Background: Young women with metastatic breast cancer (MBC) are part of a digitally connected generation yet are underserved in terms of information needs. YouTube is widely used to find and identify health information. The accessibility of health-related content on social media together with the rare and marginalized experiences of young women with MBC and the digital media practices of younger generations imply a considerable likelihood that young women with MBC will seek information and community on the internet. Objective: This study aims to assess the content quality of MBC YouTube videos and to identify themes in the experiences of young women with MBC based on YouTube videos. Methods: A systematic assessment of MBC YouTube videos using the search term ``metastatic breast cancer young'' was conducted in August 2021. The search was performed in an incognito browser and with no associated YouTube or Google account. Search results were placed in order from most to least views. Title, date uploaded, length, poster identity, number of likes, and number of comments were collected. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT); information reliability and quality were assessed with DISCERN. Themes, sponsorships, and health care professionals' and patients' narratives were reported. Results: A total of 101 videos were identified. Of these, 78.2\% (n=79) included sponsorships. The mean PEMAT scores were 78.8\% (SD 15.3\%) and 43.1\% (SD 45.2\%) for understandability and actionability, respectively. The mean DISCERN score was 2.44 (SD 0.7) out of 5. Identified themes included treatment (n=67, 66.3\%), family relationship (n=46, 45.5\%), and motherhood (n=38, 37.6\%). Conclusions: YouTube videos about young women with MBC are highly understandable but demonstrate moderate rates of actionability, with low reliability and quality scores. Many have a commercial bias. While web-based materials have limitations, their potential to provide patient support is not fully developed. By acknowledging their patients' media habits, health care professionals can further develop a trusting bond with their patients, provide a space for open and honest discussions of web-based materials, and avoid any potential instances of confusion caused by misleading, inaccurate, or false web-based materials. ", doi="10.2196/45101", url="https://cancer.jmir.org/2023/1/e45101", url="http://www.ncbi.nlm.nih.gov/pubmed/37737837" } @Article{info:doi/10.2196/47714, author="Hu, Xinwen and Pennington, Tellor Bethany R. and Avidan, S. Michael and Kheterpal, Sachin and deBourbon, G. Nastassjia and Politi, C. Mary", title="Description of the Content and Quality of Publicly Available Information on the Internet About Inhaled Volatile Anesthesia and Total Intravenous Anesthesia: Descriptive Study", journal="JMIR Perioper Med", year="2023", month="Nov", day="2", volume="6", pages="e47714", keywords="internet", keywords="general anesthesia", keywords="inhaled volatile anesthesia", keywords="total intravenous anesthesia", keywords="patient education", keywords="shared decision-making", keywords="surgery", keywords="information", keywords="decision-making", keywords="web-based", keywords="anesthesia", keywords="anesthesiology", keywords="anesthesiologist", abstract="Background: More than 300 million patients undergo surgical procedures requiring anesthesia worldwide annually. There are 2 standard-of-care general anesthesia administration options: inhaled volatile anesthesia (INVA) and total intravenous anesthesia (TIVA). There is limited evidence comparing these methods and their impact on patient experiences and outcomes. Patients often seek this information from sources such as the internet. However, the majority of websites on anesthesia-related topics are not comprehensive, updated, and fully accurate. The quality and availability of web-based patient information about INVA and TIVA have not been sufficiently examined. Objective: This study aimed to (1) assess information on the internet about INVA and TIVA for availability, readability, accuracy, and quality and (2) identify high-quality websites that can be recommended to patients to assist in their anesthesia information-seeking and decision-making. Methods: Web-based searches were conducted using Google from April 2022 to November 2022. Websites were coded using a coding instrument developed based on the International Patient Decision Aids Standards criteria and adapted to be appropriate for assessing websites describing INVA and TIVA. Readability was calculated with the Flesch-Kincaid (F-K) grade level and the simple measure of Gobbledygook (SMOG) readability formula. Results: A total of 67 websites containing 201 individual web pages were included for coding and analysis. Most of the websites provided a basic definition of general anesthesia (unconsciousness, n=57, 85\%; analgesia, n=47, 70\%). Around half of the websites described common side effects of general anesthesia, while fewer described the rare but serious adverse events, such as intraoperative awareness (n=31, 46\%), allergic reactions or anaphylaxis (n=29, 43\%), and malignant hyperthermia (n=18, 27\%). Of the 67 websites, the median F-K grade level was 11.3 (IQR 9.5-12.8) and the median SMOG score was 13.5 (IQR 12.2-14.4), both far above the American Medical Association (AMA) recommended reading level of sixth grade. A total of 51 (76\%) websites distinguished INVA versus TIVA as general anesthesia options. A total of 12 of the 51 (24\%) websites explicitly stated that there is a decision to be considered about receiving INVA versus TIVA for general anesthesia. Only 10 (20\%) websites made any direct comparisons between INVA and TIVA, discussing their positive and negative features. A total of 12 (24\%) websites addressed the concept of shared decision-making in planning anesthesia care, but none specifically asked patients to think about which features of INVA and TIVA matter the most to them. Conclusions: While the majority of websites described INVA and TIVA, few provided comparisons. There is a need for high-quality patient education and decision support about the choice of INVA versus TIVA to provide accurate and more comprehensive information in a format conducive to patient understanding. ", doi="10.2196/47714", url="https://periop.jmir.org/2023/1/e47714", url="http://www.ncbi.nlm.nih.gov/pubmed/37917148" } @Article{info:doi/10.2196/49962, author="Montero-Pons, Laura and Rodr{\'i}guez-Mart{\'i}n, Dolors and Esquinas, Cristina and Garc{\'i}a-Sierra, Rosa and Manresa-Dom{\'i}nguez, Maria Josep and Reyes-Lacalle, Azahara and Cabedo-Ferreiro, Rosa and Vicente-Hern{\'a}ndez, M{\textordfeminine}Mercedes and G{\'o}mez Masvidal, M{\'i}riam and Toran-Monserrat, Pere and Falguera-Puig, Gemma", title="Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: Multicenter Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Oct", day="26", volume="25", pages="e49962", keywords="sex education", keywords="adolescent", keywords="young adult", keywords="internet", keywords="cross-sectional studies", keywords="program evaluation", keywords="gender mainstreaming", abstract="Background: Today's young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today's young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality by the Department of Health of the Government of Catalonia (Spain). It is designed for people aged 14 to 25 years. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. Objective: The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education, and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status, and location within Catalonia (urban, semiurban, and rural areas). Methods: This was an observational, descriptive, and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. Results: Almost 30\% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2\% (n=260) said they were familiar with the website and of these, 6.5\% said they used it (n=114). The website content rated most indispensable was on sexual abuse, harassment, and violence, followed by sexually transmitted infections; 70.5\% (n=1200) reported that they visit pornographic websites. Conclusions: The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective sexual education for young people. International Registered Report Identifier (IRRID): RR2-10.3390/ijerph192416586 ", doi="10.2196/49962", url="https://www.jmir.org/2023/1/e49962", url="http://www.ncbi.nlm.nih.gov/pubmed/37883153" } @Article{info:doi/10.2196/48905, author="Chi, Yu and Chen, Huai-yu", title="Investigating Substance Use via Reddit: Systematic Scoping Review", journal="J Med Internet Res", year="2023", month="Oct", day="25", volume="25", pages="e48905", keywords="substance use", keywords="systematic scoping review", keywords="Reddit", keywords="social media", keywords="drug use", keywords="tobacco use", keywords="alcohol use", abstract="Background: Reddit's (Reddit Inc) large user base, diverse communities, and anonymity make it a useful platform for substance use research. Despite a growing body of literature on substance use on Reddit, challenges and limitations must be carefully considered. However, no systematic scoping review has been conducted on the use of Reddit as a data source for substance use research. Objective: This review aims to investigate the use of Reddit for studying substance use by examining previous studies' objectives, reasons, limitations, and methods for using Reddit. In addition, we discuss the implications and contributions of previous studies and identify gaps in the literature that require further attention. Methods: A total of 7 databases were searched using keyword combinations including Reddit and substance-related keywords in April 2022. The initial search resulted in 456 articles, and 227 articles remained after removing duplicates. All included studies were peer reviewed, empirical, available in full text, and pertinent to Reddit and substance use, and they were all written in English. After screening, 60 articles met the eligibility criteria for the review, with 57 articles identified from the initial database search and 3 from the ancestry search. A codebook was developed, and qualitative content analysis was performed to extract relevant evidence related to the research questions. Results: The use of Reddit for studying substance use has grown steadily since 2015, with a sharp increase in 2021. The primary objective was to identify tendencies and patterns in various types of substance use discussions (52/60, 87\%). Reddit was also used to explore unique user experiences, propose methodologies, investigate user interactions, and develop interventions. A total of 9 reasons for using Reddit to study substance use were identified, such as the platform's anonymity, its widespread popularity, and the explicit topics of subreddits. However, 7 limitations were noted, including the platform's low representativeness of the general population with substance use and the lack of demographic information. Most studies use application programming interfaces for data collection and quantitative approaches for analysis, with few using qualitative approaches. Machine learning algorithms are commonly used for natural language processing tasks. The theoretical, methodological, and practical implications and contributions of the included articles are summarized and discussed. The most prevalent practical implications are investigating prevailing topics in Reddit discussions, providing recommendations for clinical practices and policies, and comparing Reddit discussions on substance use across various sources. Conclusions: This systematic scoping review provides an overview of Reddit's use as a data source for substance use research. Although the limitations of Reddit data must be considered, analyzing them can be useful for understanding patterns and user experiences related to substance use. Our review also highlights gaps in the literature and suggests avenues for future research. ", doi="10.2196/48905", url="https://www.jmir.org/2023/1/e48905", url="http://www.ncbi.nlm.nih.gov/pubmed/37878361" } @Article{info:doi/10.2196/48508, author="Zhu, Zicheng and Liu, Shiyu and Zhang, Renwen", title="Examining the Persuasive Effects of Health Communication in Short Videos: Systematic Review", journal="J Med Internet Res", year="2023", month="Oct", day="13", volume="25", pages="e48508", keywords="short video", keywords="persuasion", keywords="health", keywords="systematic review", keywords="mobile phone", abstract="Background: The ubiquity of short videos has demonstrated vast potential for health communication. An expansion of research has examined the persuasive effect of health communication in short videos, yet a synthesis of the research is lacking. Objective: This paper aims to provide an overview of the literature by examining the persuasive effect of health communication in short videos, offering guidance for researchers and practitioners. In particular, it seeks to address 4 key research questions: What are the characteristics of short videos, samples, and research designs in short video--based health communication literature? What theories underpin the short video--based health communication literature? What are the persuasive effects of health communication in short videos? and What directions should future research in this area take? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 10 databases up to March 10, 2023, generated 4118 results. After the full-text screening, 18 articles met the eligibility criteria. Results: The current research lacks a uniform definition of short videos, demonstrates sample biases in location and education, and adopts limited methodologies. Most studies in this synthesis are theoretically grounded or use theoretical concepts, which are predominantly well examined in persuasion research. Moreover, relevant topics and suitable themes are effective in persuasive health communication outcomes, whereas the impact of diverse narrative techniques remains ambiguous. Conclusions: We recommend that future research extends the definition of short videos beyond time constraints and explores non-Western and less-educated populations. In addition, researchers should consider diverse methods to provide a more comprehensive examination and investigate the impact of audience targeting and narrative techniques in short video health communication. Finally, investigating how the unique aspects of short videos interact with or challenge traditional persuasion theories is essential. ", doi="10.2196/48508", url="https://www.jmir.org/2023/1/e48508", url="http://www.ncbi.nlm.nih.gov/pubmed/37831488" } @Article{info:doi/10.2196/43060, author="Tanner, P. Joshua and Takats, Courtney and Lathan, Stuart Hannah and Kwan, Amy and Wormer, Rachel and Romero, Diana and Jones, E. Heidi", title="Approaches to Research Ethics in Health Research on YouTube: Systematic Review", journal="J Med Internet Res", year="2023", month="Oct", day="4", volume="25", pages="e43060", keywords="data anonymization", keywords="research ethics", keywords="ethics", keywords="informed consent", keywords="public health", keywords="research", keywords="social media", keywords="YouTube", abstract="Background: YouTube has become a popular source of health care information, reaching an estimated 81\% of adults in 2021; approximately 35\% of adults in the United States have used the internet to self-diagnose a condition. Public health researchers are therefore incorporating YouTube data into their research, but guidelines for best practices around research ethics using social media data, such as YouTube, are unclear. Objective: This study aims to describe approaches to research ethics for public health research implemented using YouTube data. Methods: We implemented a systematic review of articles found in PubMed, SocINDEX, Web of Science, and PsycINFO following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To be eligible to be included, studies needed to be published in peer-reviewed journals in English between January 1, 2006, and October 31, 2019, and include analyses on publicly available YouTube data on health or public health topics; studies using primary data collection, such as using YouTube for study recruitment, interventions, or dissemination evaluations, were not included. We extracted data on the presence of user identifying information, institutional review board (IRB) review, and informed consent processes, as well as research topic and methodology. Results: This review includes 119 articles from 88 journals. The most common health and public health topics studied were in the categories of chronic diseases (44/119, 37\%), mental health and substance use (26/119, 21.8\%), and infectious diseases (20/119, 16.8\%). The majority (82/119, 68.9\%) of articles made no mention of ethical considerations or stated that the study did not meet the definition of human participant research (16/119, 13.4\%). Of those that sought IRB review (15/119, 12.6\%), 12 out of 15 (80\%) were determined to not meet the definition of human participant research and were therefore exempt from IRB review, and 3 out of 15 (20\%) received IRB approval. None of the 3 IRB-approved studies contained identifying information; one was explicitly told not to include identifying information by their ethics committee. Only 1 study sought informed consent from YouTube users. Of 119 articles, 33 (27.7\%) contained identifying information about content creators or video commenters, one of which attempted to anonymize direct quotes by not including user information. Conclusions: Given the variation in practice, concrete guidelines on research ethics for social media research are needed, especially around anonymizing and seeking consent when using identifying information. Trial Registration: PROSPERO CRD42020148170; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=148170 ", doi="10.2196/43060", url="https://www.jmir.org/2023/1/e43060", url="http://www.ncbi.nlm.nih.gov/pubmed/37792443" } @Article{info:doi/10.2196/46488, author="Uhawenimana, Claudien Thierry and Musabwasoni, Sandra Marie Grace and Nsengiyumva, Richard and Mukamana, Donatilla", title="Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels", journal="J Med Internet Res", year="2023", month="Sep", day="27", volume="25", pages="e46488", keywords="sexuality", keywords="sexual and reproductive health", keywords="Kinyarwanda YouTube channels", keywords="content analysis", keywords="social media", keywords="media platform", keywords="COVID-19", abstract="Background: Social media platforms such as YouTube can be used to educate people of reproductive age about healthy and nonrisky sexual and reproductive health (SRH) practices and behaviors. However, there is a paucity of evidence to ascertain the authenticity of sexuality and SRH content on Kinyarwanda YouTube, making it difficult to determine the extent to which these topics are covered, the characteristics of available videos, and the themes covered by these videos. Objective: The aims of this study were (1) to determine the extent to which YouTube channels in Kinyarwanda-language videos address sexuality and SRH issues, identify the general characteristics of the available videos (type of video, when published, intention for the audience, and content focus), and the aspects of sexuality and SRH covered; and (2) to identify the themes covered by retrieved Kinyarwanda videos, and the extent to which the channels have been used to communicate issues of sexuality and SRH during the COVID-19 pandemic. Methods: Using a content analysis approach, we searched Kinyarwanda YouTube channels to analyze videos about sexuality and SRH. The adopted framework for data collection from social media platforms builds on three key steps: (1) development, (2) application, and (3) assessment of search filters. To be included, an audio and/or visual video had to be in Kinyarwanda and the video had to be directed to the general public. Descriptive statistics (frequency and percentages) were computed to characterize the basic characteristics of retrieved channels, portrayal of the videos, and presentation of sexuality and SRH themes that emerged from retrieved videos. Further analysis involved cross-tabulations to explore associations between the focus of the channel and the date when the channel was opened and the focus of the channel and who was involved in the video. Results: The YouTube search retrieved 21,506 videos that tackled sexuality and SRH topics. During the COVID-19 pandemic, there was a 4-fold increase (from 7.2\% to 30.6\%) in channels that solely focused on sexually explicit content. The majority of the 1369 retrieved channels (n=1150, 84.0\%) tackled the topic of sexuality, with sexually explicit content predominantly found in the majority of these videos (n=1082, 79\%), and only 16\% (n=287) of the videos covered SRH topics. Conclusions: This is the first study to analyze the use of YouTube in communicating about sexuality and SRH in the Kinyarwanda language. This study relied on videos that appeared online. Further research should gather information about who accesses the videos, and how channel owners and individuals involved in the videos perceive the impact of their videos on the Rwandan community's sexuality and SRH. ", doi="10.2196/46488", url="https://www.jmir.org/2023/1/e46488", url="http://www.ncbi.nlm.nih.gov/pubmed/37756040" } @Article{info:doi/10.2196/45433, author="Napetschnig, Alina and Brixius, Klara and Deiters, Wolfgang", title="Development of a Core Set of Quality Criteria for Virtual Reality Applications Designed for Older Adults: Multistep Qualitative Study", journal="Interact J Med Res", year="2023", month="Sep", day="27", volume="12", pages="e45433", keywords="virtual reality", keywords="older adults", keywords="quality criteria", keywords="user-centered", abstract="Background: Virtual reality (VR) applications are gaining growing significance, particularly among older adults. These applications can provide valuable support to older adults by offering immersive VR content that positively influences various aspects of their daily lives, including activities of daily living. Furthermore, VR applications can contribute to the enhancement of cognitive and motor skills, ultimately leading to an improved quality of life for older individuals. Nevertheless, to ensure a positive impact, it is crucial to develop VR experiences that are tailored to the needs and preferences of the users. Objective: This study aims to develop a core set of quality criteria and guidelines for the development of user-centered VR applications specifically designed for older adults (target group). Methods: The multistep qualitative study design comprised several key stages, beginning with a systematic literature search. This was followed by a framework analysis aimed at identifying a core set of criteria. Subsequently, these criteria underwent validation through expert workshops. The outcomes achieved through this iterative process were organized and categorized into criteria, accompanied by explanations detailing the underlying categories or codes. Results: The quality criteria core set for older adults--friendly VR applications has been developed through an iterative process. It is divided into 2 distinct parts, each containing criteria categorized into specific areas. The first part includes the following categories: (1) quality assurance of medical/health content, (2) data protection provisions, (3) quality requirements, (4) consumer protection, and (5) interoperability. The second part includes the following categories: (1) graphic/quality, (2) 3D character/avatar, (3) providing in-game instructions and prompts, (4) interaction, (5) navigation, and (6) promotion of user motivation and loyalty to use. The results imply a differentiated scope as well as a differentiated granularity of the criteria. Conclusions: Considering the ongoing advancement of VR technology and the diverse needs within the older adult demographic, it is essential to assess the quality criteria core set results on an individual basis. ", doi="10.2196/45433", url="https://www.i-jmr.org/2023/1/e45433", url="http://www.ncbi.nlm.nih.gov/pubmed/37756112" } @Article{info:doi/10.2196/44656, author="Bizzotto, Nicole and Schulz, Johannes Peter and de Bruijn, Gert-Jan", title="The ``Loci'' of Misinformation and Its Correction in Peer- and Expert-Led Online Communities for Mental Health: Content Analysis", journal="J Med Internet Res", year="2023", month="Sep", day="18", volume="25", pages="e44656", keywords="online communities", keywords="social media", keywords="mental health", keywords="misinformation", keywords="empowerment", keywords="content analysis", keywords="online community", keywords="infodemiology", keywords="information seeking", keywords="help seeking", keywords="information behavior", keywords="online search", keywords="search query", keywords="information quality", keywords="information accuracy", abstract="Background: Mental health problems are recognized as a pressing public health issue, and an increasing number of individuals are turning to online communities for mental health to search for information and support. Although these virtual platforms have the potential to provide emotional support and access to anecdotal experiences, they can also present users with large amounts of potentially inaccurate information. Despite the importance of this issue, limited research has been conducted, especially on the differences that might emerge due to the type of content moderation of online communities: peer-led or expert-led. Objective: We aim to fill this gap by examining the prevalence, the communicative context, and the persistence of mental health misinformation on Facebook online communities for mental health, with a focus on understanding the mechanisms that enable effective correction of inaccurate information and differences between expert-led and peer-led groups. Methods: We conducted a content analysis of 1534 statements (from 144 threads) in 2 Italian-speaking Facebook groups. Results: The study found that an alarming number of comments (26.1\%) contained medically inaccurate information. Furthermore, nearly 60\% of the threads presented at least one misinformation statement without any correction attempt. Moderators were more likely to correct misinformation than members; however, they were not immune to posting content containing misinformation, which was an unexpected finding. Discussions about aspects of treatment (including side effects or treatment interruption) significantly increased the probability of encountering misinformation. Additionally, the study found that misinformation produced in the comments of a thread, rather than as the first post, had a lower probability of being corrected, particularly in peer-led communities. Conclusions: The high prevalence of misinformation in online communities, particularly when left uncorrected, underscores the importance of conducting additional research to identify effective mechanisms to prevent its spread. This is especially important given the study's finding that misinformation tends to be more prevalent around specific ``loci'' of discussion that, once identified, can serve as a starting point to develop strategies for preventing and correcting misinformation within them. ", doi="10.2196/44656", url="https://www.jmir.org/2023/1/e44656", url="http://www.ncbi.nlm.nih.gov/pubmed/37721800" } @Article{info:doi/10.2196/49061, author="Ng, Margaret Yee Man and Hoffmann Pham, Katherine and Luengo-Oroz, Miguel", title="Exploring YouTube's Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories", journal="J Med Internet Res", year="2023", month="Sep", day="15", volume="25", pages="e49061", keywords="algorithmic auditing", keywords="antivaccine sentiment", keywords="crowdsourcing", keywords="recommendation systems", keywords="watch history", keywords="YouTube", abstract="Background: Throughout the COVID-19 pandemic, there has been a concern that social media may contribute to vaccine hesitancy due to the wide availability of antivaccine content on social media platforms. YouTube has stated its commitment to removing content that contains misinformation on vaccination. Nevertheless, such claims are difficult to audit. There is a need for more empirical research to evaluate the actual prevalence of antivaccine sentiment on the internet. Objective: This study examines recommendations made by YouTube's algorithms in order to investigate whether the platform may facilitate the spread of antivaccine sentiment on the internet. We assess the prevalence of antivaccine sentiment in recommended videos and evaluate how real-world users' experiences are different from the personalized recommendations obtained by using synthetic data collection methods, which are often used to study YouTube's recommendation systems. Methods: We trace trajectories from a credible seed video posted by the World Health Organization to antivaccine videos, following only video links suggested by YouTube's recommendation system. First, we gamify the process by asking real-world participants to intentionally find an antivaccine video with as few clicks as possible. Having collected crowdsourced trajectory data from respondents from (1) the World Health Organization and United Nations system (nWHO/UN=33) and (2) Amazon Mechanical Turk (nAMT=80), we next compare the recommendations seen by these users to recommended videos that are obtained from (3) the YouTube application programming interface's RelatedToVideoID parameter (nRTV=40) and (4) from clean browsers without any identifying cookies (nCB=40), which serve as reference points. We develop machine learning methods to classify antivaccine content at scale, enabling us to automatically evaluate 27,074 video recommendations made by YouTube. Results: We found no evidence that YouTube promotes antivaccine content; the average share of antivaccine videos remained well below 6\% at all steps in users' recommendation trajectories. However, the watch histories of users significantly affect video recommendations, suggesting that data from the application programming interface or from a clean browser do not offer an accurate picture of the recommendations that real users are seeing. Real users saw slightly more provaccine content as they advanced through their recommendation trajectories, whereas synthetic users were drawn toward irrelevant recommendations as they advanced. Rather than antivaccine content, videos recommended by YouTube are likely to contain health-related content that is not specifically related to vaccination. These videos are usually longer and contain more popular content. Conclusions: Our findings suggest that the common perception that YouTube's recommendation system acts as a ``rabbit hole'' may be inaccurate and that YouTube may instead be following a ``blockbuster'' strategy that attempts to engage users by promoting other content that has been reliably successful across the platform. ", doi="10.2196/49061", url="https://www.jmir.org/2023/1/e49061", url="http://www.ncbi.nlm.nih.gov/pubmed/37713243" } @Article{info:doi/10.2196/46346, author="Nattam, Anunita and Vithala, Tripura and Wu, Tzu-Chun and Bindhu, Shwetha and Bond, Gregory and Liu, Hexuan and Thompson, Amy and Wu, Y. Danny T.", title="Assessing the Readability of Online Patient Education Materials in Obstetrics and Gynecology Using Traditional Measures: Comparative Analysis and Limitations", journal="J Med Internet Res", year="2023", month="Aug", day="30", volume="25", pages="e46346", keywords="obstetrics and gynecology", keywords="online patient education materials", keywords="readability", keywords="online education", keywords="education", keywords="health literacy", keywords="literature", keywords="medical documents", keywords="tool", keywords="utilization", keywords="online content", keywords="health education", keywords="education material", keywords="assessment", keywords="obstetrics", keywords="gynecology", abstract="Background: Patient education materials (PEMs) can be vital sources of information for the general population. However, despite American Medical Association (AMA) and National Institutes of Health (NIH) recommendations to make PEMs easier to read for patients with low health literacy, they often do not adhere to these recommendations. The readability of online PEMs in the obstetrics and gynecology (OB/GYN) field, in particular, has not been thoroughly investigated. Objective: The study sampled online OB/GYN PEMs and aimed to examine (1) agreeability across traditional readability measures (TRMs), (2) adherence of online PEMs to AMA and NIH recommendations, and (3) whether the readability level of online PEMs varied by web-based source and medical topic. This study is not a scoping review, rather, it focused on scoring the readability of OB/GYN PEMs using the traditional measures to add empirical evidence to the literature. Methods: A total of 1576 online OB/GYN PEMs were collected via 3 major search engines. In total 93 were excluded due to shorter content (less than 100 words), yielding 1483 PEMs for analysis. Each PEM was scored by 4 TRMs, including Flesch-Kincaid grade level, Gunning fog index, Simple Measure of Gobbledygook, and the Dale-Chall. The PEMs were categorized based on publication source and medical topic by 2 research team members. The readability scores of the categories were compared statistically. Results: Results indicated that the 4 TRMs did not agree with each other, leading to the use of an averaged readability (composite) score for comparison. The composite scores across all online PEMs were not normally distributed and had a median at the 11th grade. Governmental PEMs were the easiest to read amongst source categorizations and PEMs about menstruation were the most difficult to read. However, the differences in the readability scores among the sources and the topics were small. Conclusions: This study found that online OB/GYN PEMs did not meet the AMA and NIH readability recommendations and would be difficult to read and comprehend for patients with low health literacy. Both findings connected well to the literature. This study highlights the need to improve the readability of OB/GYN PEMs to help patients make informed decisions. Research has been done to create more sophisticated readability measures for medical and health documents. Once validated, these tools need to be used by web-based content creators of health education materials. ", doi="10.2196/46346", url="https://www.jmir.org/2023/1/e46346", url="http://www.ncbi.nlm.nih.gov/pubmed/37647115" } @Article{info:doi/10.2196/40003, author="Long, Memphis and Forbes, E. Laura and Papagerakis, Petros and Lieffers, L. Jessica R.", title="YouTube Videos on Nutrition and Dental Caries: Content Analysis", journal="JMIR Infodemiology", year="2023", month="Aug", day="10", volume="3", pages="e40003", keywords="dental caries", keywords="diet", keywords="nutrition", keywords="YouTube", keywords="internet", keywords="consumer health information", abstract="Background: Dental caries is the most common health condition worldwide, and nutrition and dental caries have a strong interconnected relationship. Foods and eating behaviors can be both harmful (eg, sugar) and healthful (eg, meal spacing) for dental caries. YouTube is a popular source for the public to access information. To date, there is no information available on the nutrition and dental caries content of easily accessible YouTube videos. Objective: This study aimed to analyze the content of YouTube videos on nutrition and dental caries. Methods: In total, 6 YouTube searches were conducted using keywords related to nutrition and dental caries. The first 20 videos were selected from each search. Video content was scored (17 possible points; higher scores were associated with more topics covered) by 2 individuals based on the inclusion of information regarding various foods and eating behaviors that impact dental caries risk. For each video, information on video characteristics (ie, view count, length, number of likes, number of dislikes, and video age) was captured. Videos were divided into 2 groups by view rate (views/day); differences in scores and types of nutrition messages between groups were determined using nonparametric statistics. Results: In total, 42 videos were included. Most videos were posted by or featured oral health professionals (24/42, 57\%). The mean score was 4.9 (SD 3.4) out of 17 points. Videos with >30 views/day (high view rate; 20/42, 48\% videos) had a trend toward a lower score (mean 4.0, SD 3.7) than videos with ?30 views/day (low view rate; 22/42, 52\%; mean 5.8, SD 3.0; P=.06), but this result was not statistically significant. Sugar was the most consistently mentioned topic in the videos (31/42, 74\%). No other topics were mentioned in more than 50\% of videos. Low--view rate videos were more likely to mention messaging on acidic foods and beverages (P=.04), water (P=.09), and frequency of sugar intake (P=.047) than high--view rate videos. Conclusions: Overall, the analyzed videos had low scores for nutritional and dental caries content. This study provides insights into the messaging available on nutrition and dental caries for the public and guidance on how to make improvements in this area. ", doi="10.2196/40003", url="https://infodemiology.jmir.org/2023/1/e40003", url="http://www.ncbi.nlm.nih.gov/pubmed/37561564" } @Article{info:doi/10.2196/45731, author="El Mikati, K. Ibrahim and Hoteit, Reem and Harb, Tarek and El Zein, Ola and Piggott, Thomas and Melki, Jad and Mustafa, A. Reem and Akl, A. Elie", title="Defining Misinformation and Related Terms in Health-Related Literature: Scoping Review", journal="J Med Internet Res", year="2023", month="Aug", day="9", volume="25", pages="e45731", keywords="misinformation", keywords="disinformation", keywords="infodemic", keywords="fake news", keywords="malinformation", keywords="health", keywords="COVID-19", keywords="scoping review", keywords="health-related literature", keywords="electronic database", keywords="misleading", keywords="related term", keywords="systematic review", abstract="Background: Misinformation poses a serious challenge to clinical and policy decision-making in the health field. The COVID-19 pandemic amplified interest in misinformation and related terms and witnessed a proliferation of definitions. Objective: We aim to assess the definitions of misinformation and related terms used in health-related literature. Methods: We conducted a scoping review of systematic reviews by searching Ovid MEDLINE, Embase, Cochrane, and Epistemonikos databases for articles published within the last 5 years up till March 2023. Eligible studies were systematic reviews that stated misinformation or related terms as part of their objectives, conducted a systematic search of at least one database, and reported at least 1 definition for misinformation or related terms. We extracted definitions for the terms misinformation, disinformation, fake news, infodemic, and malinformation. Within each definition, we identified concepts and mapped them across misinformation-related terms. Results: We included 41 eligible systematic reviews, out of which 32 (78\%) reviews addressed the topic of public health emergencies (including the COVID-19 pandemic) and contained 75 definitions for misinformation and related terms. The definitions consisted of 20 for misinformation, 19 for disinformation, 10 for fake news, 24 for infodemic, and 2 for malinformation. ``False/inaccurate/incorrect'' was mentioned in 15 of 20 definitions of misinformation, 13 of 19 definitions of disinformation, 5 of 10 definitions of fake news, 6 of 24 definitions of infodemic, and 0 of 2 definitions of malinformation. Infodemic had 19 of 24 definitions addressing ``information overload'' and malinformation had 2 of 2 definitions with ``accurate'' and 1 definition ``used in the wrong context.'' Out of all the definitions, 56 (75\%) were referenced from other sources. Conclusions: While the definitions of misinformation and related terms in the health field had inconstancies and variability, they were largely consistent. Inconstancies related to the intentionality in misinformation definitions (7 definitions mention ``unintentional,'' while 5 definitions have ``intentional''). They also related to the content of infodemic (9 definitions mention ``valid and invalid info,'' while 6 definitions have ``false/inaccurate/incorrect''). The inclusion of concepts such as ``intentional'' may be difficult to operationalize as it is difficult to ascertain one's intentions. This scoping review has the strength of using a systematic method for retrieving articles but does not cover all definitions in the extant literature outside the field of health. This scoping review of the health literature identified several definitions for misinformation and related terms, which showed variability and included concepts that are difficult to operationalize. Health practitioners need to exert caution before labeling a piece of information as misinformation or any other related term and only do so after ascertaining accurateness and sometimes intentionality. Additional efforts are needed to allow future consensus around clear and operational definitions. ", doi="10.2196/45731", url="https://www.jmir.org/2023/1/e45731", url="http://www.ncbi.nlm.nih.gov/pubmed/37556184" } @Article{info:doi/10.2196/47582, author="Kami?ski, Miko?aj and Czarny, Jakub and Skrzypczak, Piotr and Sienicki, Krzysztof and Roszak, Magdalena", title="The Characteristics, Uses, and Biases of Studies Related to Malignancies Using Google Trends: Systematic Review", journal="J Med Internet Res", year="2023", month="Aug", day="4", volume="25", pages="e47582", keywords="Google Trends", keywords="oncology", keywords="malignancies", keywords="prophylaxis", keywords="celebrity", keywords="infodemiology", keywords="infoveillance", keywords="cancer", keywords="carcinoma", keywords="lymphoma", keywords="leukemia", keywords="multiple myeloma", keywords="sarcoma", keywords="internet", keywords="tumor", keywords="bias", keywords="quality", abstract="Background: The internet is a primary source of health information for patients, supplementing physician care. Google Trends (GT), a popular tool, allows the exploration of public interest in health-related phenomena. Despite the growing volume of GT studies, none have focused explicitly on oncology, creating a need for a systematic review to bridge this gap. Objective: We aimed to systematically characterize studies related to oncology using GT to describe its utilities and biases. Methods: We included all studies that used GT to analyze Google searches related to malignancies. We excluded studies written in languages other than English. The search was performed using the PubMed engine on August 1, 2022. We used the following search input: ``Google trends'' AND (``oncology'' OR ``cancer'' or ``malignancy'' OR ``tumor'' OR ``lymphoma'' OR ``multiple myeloma'' OR ``leukemia''). We analyzed sources of bias that included using search terms instead of topics, lack of confrontation of GT statistics with real-world data, and absence of sensitivity analysis. We performed descriptive statistics. Results: A total of 85 articles were included. The first study using GT for oncology research was published in 2013, and since then, the number of publications has increased annually. The studies were categorized as follows: 22\% (19/85) were related to prophylaxis, 20\% (17/85) pertained to awareness events, 11\% (9/85) were celebrity-related, 13\% (11/85) were related to COVID-19, and 47\% (40/85) fell into other categories. The most frequently analyzed cancers were breast (n=28), prostate (n=26), lung (n=18), and colorectal cancers (n=18). We discovered that of the 85 studies, 17 (20\%) acknowledged using GT topics instead of search terms, 79 (93\%) disclosed all search input details necessary for replicating their results, and 34 (40\%) compared GT statistics with real-world data. The most prevalent methods for analyzing the GT data were correlation analysis (55/85, 65\%) and peak analysis (43/85, 51\%). The authors of only 11\% (9/85) of the studies performed a sensitivity analysis. Conclusions: The number of studies related to oncology using GT data has increased annually. The studies included in this systematic review demonstrate a variety of concerning topics, search strategies, and statistical methodologies. The most frequently analyzed cancers were breast, prostate, lung, colorectal, skin, and cervical cancers, potentially reflecting their prevalence in the population or public interest. Although most researchers provided reproducible search inputs, only one-fifth used GT topics instead of search terms, and many studies lacked a sensitivity analysis. Scientists using GT for medical research should ensure the quality of studies by providing a transparent search strategy to reproduce results, preferring to use topics over search terms, and performing robust statistical calculations coupled with sensitivity analysis. ", doi="10.2196/47582", url="https://www.jmir.org/2023/1/e47582", url="http://www.ncbi.nlm.nih.gov/pubmed/37540544" } @Article{info:doi/10.2196/46421, author="Hays, D. Ron and Qureshi, Nabeel and Herman, M. Patricia and Rodriguez, Anthony and Kapteyn, Arie and Edelen, Orlando Maria", title="Effects of Excluding Those Who Report Having ``Syndomitis'' or ``Chekalism'' on Data Quality: Longitudinal Health Survey of a Sample From Amazon's Mechanical Turk", journal="J Med Internet Res", year="2023", month="Aug", day="4", volume="25", pages="e46421", keywords="misrepresentation", keywords="survey", keywords="data quality", keywords="MTurk", keywords="Amazon Mechanical Turk", abstract="Background: Researchers have implemented multiple approaches to increase data quality from existing web-based panels such as Amazon's Mechanical Turk (MTurk). Objective: This study extends prior work by examining improvements in data quality and effects on mean estimates of health status by excluding respondents who endorse 1 or both of 2 fake health conditions (``Syndomitis'' and ``Chekalism''). Methods: Survey data were collected in 2021 at baseline and 3 months later from MTurk study participants, aged 18 years or older, with an internet protocol address in the United States, and who had completed a minimum of 500 previous MTurk ``human intelligence tasks.'' We included questions about demographic characteristics, health conditions (including the 2 fake conditions), and the Patient Reported Outcomes Measurement Information System (PROMIS)-29+2 (version 2.1) preference--based score survey. The 3-month follow-up survey was only administered to those who reported having back pain and did not endorse a fake condition at baseline. Results: In total, 15\% (996/6832) of the sample endorsed at least 1 of the 2 fake conditions at baseline. Those who endorsed a fake condition at baseline were more likely to identify as male, non-White, younger, report more health conditions, and take longer to complete the survey than those who did not endorse a fake condition. They also had substantially lower internal consistency reliability on the PROMIS-29+2 scales than those who did not endorse a fake condition: physical function (0.69 vs 0.89), pain interference (0.80 vs 0.94), fatigue (0.80 vs 0.92), depression (0.78 vs 0.92), anxiety (0.78 vs 0.90), sleep disturbance (?0.27 vs 0.84), ability to participate in social roles and activities (0.77 vs 0.92), and cognitive function (0.65 vs 0.77). The lack of reliability of the sleep disturbance scale for those endorsing a fake condition was because it includes both positively and negatively worded items. Those who reported a fake condition reported significantly worse self-reported health scores (except for sleep disturbance) than those who did not endorse a fake condition. Excluding those who endorsed a fake condition improved the overall mean PROMIS-29+2 (version 2.1) T-scores by 1-2 points and the PROMIS preference--based score by 0.04. Although they did not endorse a fake condition at baseline, 6\% (n=59) of them endorsed at least 1 of them on the 3-month survey and they had lower PROMIS-29+2 score internal consistency reliability and worse mean scores on the 3-month survey than those who did not report having a fake condition. Based on these results, we estimate that 25\% (1708/6832) of the MTurk respondents provided careless or dishonest responses. Conclusions: This study provides evidence that asking about fake health conditions can help to screen out respondents who may be dishonest or careless. We recommend this approach be used routinely in samples of members of MTurk. ", doi="10.2196/46421", url="https://www.jmir.org/2023/1/e46421", url="http://www.ncbi.nlm.nih.gov/pubmed/37540543" } @Article{info:doi/10.2196/43901, author="Wang, Yanyan and Zhang, Jin", title="A Study on User-Oriented Subjects of Child Abuse on Wikipedia: Temporal Analysis of Wikipedia History Versions and Traffic Data", journal="J Med Internet Res", year="2023", month="Jul", day="17", volume="25", pages="e43901", keywords="child abuse", keywords="user-oriented subject", keywords="subject schema", keywords="subject change", keywords="popularity trend", keywords="temporal analysis", keywords="Wikipedia", abstract="Background: Many people turn to online open encyclopedias such as Wikipedia to seek knowledge about child abuse. However, the information available on this website is often disorganized and incomplete. Objective: The aim of this study is to analyze Wikipedia's coverage of child abuse and provide a more accessible way for users to browse child abuse--related content. The study explored the main themes and subjects related to child abuse on Wikipedia and proposed a multilayer user-oriented subject schema from the general users' perspective. Methods: The knowledge of child abuse on Wikipedia is presented in the child abuse--related articles on it. The study analyzed child abuse--related articles on Wikipedia, examining their history versions and yearly page views data to reveal the evolution of content and popularity. The themes and subjects were identified from the articles' text using the open coding, self-organizing map, and n-gram approaches. The subjects in different periods were compared to reveal changes in content. Results: This study collected and investigated 241 associated Wikipedia articles and their history versions and traffic data. Four facets were identified: (1) maltreatment behavior (n=118, 48.9\%); (2) people and environment (n=28, 11.6\%); (3) problems and risks (n=33, 13.7\%); and (4) protection and support (n=62, 25.7\%). A total of 8 themes and 51 subjects were generated from the text, and a user-oriented subject schema linking the facets, themes, subjects, and articles was created. Maltreatment behavior (number of total views = 1.15 {\texttimes} 108) was the most popular facet viewed by users, while people and environment (number of total views = 2.42 {\texttimes} 107) was the least popular. The popularity of child abuse increased from 2010 to 2014 but decreased after that. Conclusions: The user-oriented subject schema provides an easier way for users to seek information and learn about child abuse. The knowledge of child abuse on Wikipedia covers the harms done to children, the problems caused by child abuse, the protection of children, and the people involved in child abuse. However, there was an inconsistency between the interests of general users and Wikipedia editors, and the child abuse knowledge on Wikipedia was found to be deficient, lacking content about typical child abuse types. To meet users' needs, health information creators need to generate more information to fill the knowledge gap. ", doi="10.2196/43901", url="https://www.jmir.org/2023/1/e43901", url="http://www.ncbi.nlm.nih.gov/pubmed/37459149" } @Article{info:doi/10.2196/47210, author="Zheng, Shusen and Tong, Xinyu and Wan, Dalong and Hu, Chen and Hu, Qing and Ke, Qinghong", title="Quality and Reliability of Liver Cancer--Related Short Chinese Videos on TikTok and Bilibili: Cross-Sectional Content Analysis Study", journal="J Med Internet Res", year="2023", month="Jul", day="5", volume="25", pages="e47210", keywords="liver cancer", keywords="short videos", keywords="information quality", keywords="social media", keywords="TikTok", keywords="Bilibili", keywords="GQS", keywords="global quality score", keywords="DISCERN", keywords="reliability", abstract="Background: Liver cancer incidence has been increasing in China in the recent years, leading to increased public concern regarding the burden of this disease. Short videos on liver cancer are disseminated through TikTok and Bilibili apps, which have gained popularity in recent years as an easily accessible source of health information. However, the credibility, quality, and usefulness of the information in these short videos and the professional knowledge of the individuals uploading health information--based videos in these platforms have not yet been evaluated. Objective: Our study aims to assess the quality of the information in Chinese short videos on liver cancer shared on the TikTok and Bilibili short video--sharing platforms. Methods: In March 2023, we assessed the top 100 Chinese short videos on liver cancer in TikTok and Bilibili (200 videos in total) for their information quality and reliability by using 2 rating tools, namely, global quality score (GQS) and the DISCERN instrument. Correlation and Poisson regression analyses were applied to discuss the factors that could impact video quality. Results: Compared to Bilibili, TikTok is more popular, although the length of the videos on TikTok is shorter than that of the videos on Bilibili (P<.001). The quality of the short videos on liver cancer in TikTok and Bilibili was not satisfactory, with median GQS of 3 (IQR 2-4) and 2 (IQR 1-5) and median DISCERN scores of 5 (IQR 4-6) and 4 (IQR 2-7), respectively. In general, the quality of videos sourced from professional institutions and individuals was better than that of those sourced from nonprofessionals, and videos involving disease-related knowledge were of better quality than those covering news and reports. No significant differences were found in the quality of videos uploaded by individuals from different professions, with the exception of those uploaded by traditional Chinese medicine professionals, which demonstrated poorer quality. Only video shares were positively correlated with the GQS (r=0.17, P=.01), and no video variables could predict the video quality. Conclusions: Our study shows that the quality of short videos on health information related to liver cancer is poor on Bilibili and TikTok, but videos uploaded by health care professionals can be considered reliable in terms of comprehensiveness and content quality. Thus, short videos providing medical information on TikTok and Bilibili must be carefully considered for scientific soundness by active information seekers before they make decisions on their health care management. ", doi="10.2196/47210", url="https://www.jmir.org/2023/1/e47210", url="http://www.ncbi.nlm.nih.gov/pubmed/37405825" } @Article{info:doi/10.2196/47343, author="Qin, Lang and Zheng, Ming and Schwebel, C. David and Li, Li and Cheng, Peixia and Rao, Zhenzhen and Peng, Ruisha and Ning, Peishan and Hu, Guoqing", title="Content Quality of Web-Based Short-Form Videos for Fire and Burn Prevention in China: Content Analysis", journal="J Med Internet Res", year="2023", month="Jun", day="30", volume="25", pages="e47343", keywords="fire", keywords="burn", keywords="prevention", keywords="first aid", keywords="short video", keywords="content quality", keywords="public impact", keywords="China", abstract="Background: Web-based short-form videos are increasingly popular for disseminating fire and burn prevention information, but their content quality is unknown. Objective: We aimed to systematically assess the characteristics, content quality, and public impact of web-based short-form videos offering primary and secondary (first aid) prevention recommendations for fires and burns in China between 2018 and 2021. Methods: We retrieved short-form videos offering both primary and secondary (first aid) information to prevent fire and burn injuries published on the 3 most popular web-based short-form video platforms in China: TikTok, Kwai, and Bilibili. To assess video content quality, we calculated the proportion of short-form videos that included information on each of the 15 recommendations for burn prevention education from the World Health Organization (WHO; P1) and that correctly disseminated each recommendation (P2). High P1 and P2 indicated better content quality. To assess their public impact, we calculated the median (IQR) of 3 indicators: the number of comments, likes, and saves as a favorite by viewers. Chi-square test, trend chi-square test, and Kruskal-Wallis H test examined differences in indicators across the 3 platforms, years, content, and time duration of videos and between videos disseminating correct versus incorrect information. Results: Overall, 1459 eligible short-form videos were included. The number of short-form videos increased by 16 times between 2018 and 2021. Of them, 93.97\% (n=1371) were about secondary prevention (first aid) and 86.02\% (n=1255) lasted <2 minutes. The proportion of short-form videos including each of the 15 WHO recommendations ranged from 0\% to 77.86\% (n=1136). Recommendations 8, 13, and 11 had the highest proportions (n=1136, 77.86\%; n=827, 56.68\%; and n=801, 54.9\%, respectively), whereas recommendations 3 and 5 were never mentioned. Among the short-form videos that included the WHO recommendations, recommendations 1, 2, 4, 6, 9, and 12 were always disseminated correctly, but the other 9 recommendations were correctly disseminated in 59.11\% (120/203) to 98.68\% (1121/1136) of videos. The proportion of short-form videos including and correctly disseminating the WHO recommendations varied across platforms and years. The public impact of short videos varied greatly across videos, with a median (IQR) of 5 (0-34) comments, 62 (7-841) likes, and 4 (0-27) saves as a favorite. Short-form videos disseminating correct recommendations had larger public impact than those disseminating either partially correct or incorrect knowledge (median 5 vs 4 comments, 68 vs 51 likes, and 5 vs 3 saves as a favorite, respectively; all P<.05). Conclusions: Despite the rapid increase in the number of web-based short-form videos about fire and burn prevention available in China, their content quality and public impact were generally low. Systematic efforts are recommended to improve the content quality and public impact of short-form videos on injury prevention topics such as fire and burn prevention. ", doi="10.2196/47343", url="https://www.jmir.org/2023/1/e47343", url="http://www.ncbi.nlm.nih.gov/pubmed/37389906" } @Article{info:doi/10.2196/45550, author="O'Neill, Braden and Ferguson, Jacob and Dalueg, Lauren and Yusuf, Abban and Kirubarajan, Abirami and Lloyd, Taryn and Mollanji, Eisi and Persaud, Navindra", title="Evaluating the Supporting Evidence of Medical Cannabis Claims Made on Clinic Websites: Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Jun", day="29", volume="25", pages="e45550", keywords="cannabis", keywords="evidence-based medicine", keywords="adverse effects", keywords="consumer health information", abstract="Background: Since the legalization of medical cannabis in Canada in 2013, prescription of cannabis for medical purposes has become commonplace and a multibillion dollar industry has formed. Much of the media coverage surrounding medical cannabis has been positive in nature, leading to Canadians potentially underestimating the adverse effects of medical cannabis use. In recent years, there has been a large increase in clinic websites advertising the use of medical cannabis for health indications. However, little is known about the quality of the evidence used by these clinic websites to describe the effectiveness of cannabis used for medical purposes. Objective: We aimed to identify the indications for medical cannabis reported by cannabis clinics in Ontario, Canada, and the evidence these clinics cited to support cannabis prescription. Methods: We conducted a cross-sectional web search to identify all cannabis clinic websites within Ontario, Canada, that had physician involvement and identified their primary purpose as cannabis prescription. Two reviewers independently searched these websites to identify all medical indications for which cannabis was promoted and reviewed and critically appraised all studies cited using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. Results: A total of 29 clinics were identified, promoting cannabis for 20 different medical indications including migraines, insomnia, and fibromyalgia. There were 235 unique studies cited on these websites to support the effectiveness of cannabis for these indications. A high proportion (36/235, 15.3\%) of the studies were identified to be at the lowest level of evidence (level 5). Only 4 clinic websites included any mention of harms associated with cannabis. Conclusions: Cannabis clinic websites generally promote cannabis use as medically effective but cite low-quality evidence to support these claims and rarely discuss harms. The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients. This disparity should be carefully evaluated in context of the specific medical indication and an individualized patient risk assessment. Our work illustrates the need to increase the quality of research performed on the medical effects of cannabis. ", doi="10.2196/45550", url="https://www.jmir.org/2023/1/e45550", url="http://www.ncbi.nlm.nih.gov/pubmed/37384372" } @Article{info:doi/10.2196/45024, author="Yang, Kunhao and Tanaka, Mikihito", title="Crowdsourcing Knowledge Production of COVID-19 Information on Japanese Wikipedia in the Face of Uncertainty: Empirical Analysis", journal="J Med Internet Res", year="2023", month="Jun", day="29", volume="25", pages="e45024", keywords="scientific uncertainty", keywords="COVID-19", keywords="Wikipedia", keywords="crowdsourcing information production", abstract="Background: A worldwide overabundance of information comprising misinformation, rumors, and propaganda concerning COVID-19 has been observed in addition to the pandemic. By addressing this data confusion, Wikipedia has become an important source of information. Objective: This study aimed to investigate how the editors of Wikipedia have handled COVID-19--related information. Specifically, it focused on 2 questions: What were the knowledge preferences of the editors who participated in producing COVID-19--related information? and How did editors with different knowledge preferences collaborate? Methods: This study used a large-scale data set, including >2 million edits in the histories of 1857 editors who edited 133 articles related to COVID-19 on Japanese Wikipedia. Machine learning methods, including graph neural network methods, Bayesian inference, and Granger causality analysis, were used to establish the editors' topic proclivity and collaboration patterns. Results: Overall, 3 trends were observed. Two groups of editors were involved in the production of information on COVID-19. One group had a strong preference for sociopolitical topics (social-political group), and the other group strongly preferred scientific and medical topics (scientific-medical group). The social-political group played a central role (contributing 16,544,495/23,485,683, 70.04\% of bits of content and 57,969/76,673, 75.61\% of the references) in the information production part of the COVID-19 articles on Wikipedia, whereas the scientific-medical group played only a secondary role. The severity of the pandemic in Japan activated the editing behaviors of the social-political group, leading them to contribute more to COVID-19 information production on Wikipedia while simultaneously deactivating the editing behaviors of the scientific-medical group, resulting in their less contribution to COVID-19 information production on Wikipedia (Pearson correlation coefficient=0.231; P<.001). Conclusions: The results of this study showed that lay experts (ie, Wikipedia editors) in the fields of science and medicine tended to remain silent when facing high scientific uncertainty related to the pandemic. Considering the high quality of the COVID-19--related articles on Japanese Wikipedia, this research also suggested that the sidelining of the science and medicine editors in discussions is not necessarily a problem. Instead, the social and political context of the issues with high scientific uncertainty is more important than the scientific discussions that support accuracy. ", doi="10.2196/45024", url="https://www.jmir.org/2023/1/e45024", url="http://www.ncbi.nlm.nih.gov/pubmed/37384371" } @Article{info:doi/10.2196/40802, author="Squires, A. Natalie and Soyemi, Elizabeth and Yee, M. Lynn and Birch, M. Eleanor and Badreldin, Nevert", title="Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis", journal="JMIR Infodemiology", year="2023", month="Jun", day="23", volume="3", pages="e40802", keywords="health information", keywords="internet", keywords="YouTube", keywords="cesarean section", keywords="cesarean", keywords="C-section", keywords="postpartum", keywords="social media", keywords="web-based video", keywords="maternal", keywords="postnatal", keywords="pain", keywords="systematic search", keywords="patient education", keywords="information quality", keywords="accuracy", keywords="credibility", keywords="health education", keywords="educational video", keywords="education resource", keywords="health video", abstract="Background: YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain. Objective: The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management. Methods: A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management--related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video's relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ?5 and a DISCERN score of ?39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted. Results: Of 73 unique videos, video sources included medical videos (n=36, 49\%), followed by personal video blogs (vlogs; n=32, 44\%), advertisements (n=3, 4\%), and media (n=2, 3\%). The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos (n=22, 30\%) most frequently addressed overall content regarding pain duration (22/22, 100\%), pain types (20/22, 91\%), return-to-activity instructions (19/22, 86\%), and nonpharmacologic methods for pain control (19/22, 86\%). There were differences in the overall content score (P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score. Conclusions: Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource. ", doi="10.2196/40802", url="https://infodemiology.jmir.org/2023/1/e40802", url="http://www.ncbi.nlm.nih.gov/pubmed/37351938" } @Article{info:doi/10.2196/45787, author="Kato, Mio and Yoshimatsu, Fumi and Saito, Tomoya", title="Trends in Media Coverage During the Monkeypox Outbreak: Content Analysis", journal="J Med Internet Res", year="2023", month="Jun", day="19", volume="25", pages="e45787", keywords="risk perception", keywords="protection motivation theory", keywords="agenda setting", keywords="news media", keywords="media", keywords="infectious disease", keywords="monkeypox", doi="10.2196/45787", url="https://www.jmir.org/2023/1/e45787", url="http://www.ncbi.nlm.nih.gov/pubmed/37335596" } @Article{info:doi/10.2196/44307, author="Maleki, Negar and Padmanabhan, Balaji and Dutta, Kaushik", title="The Effect of Monetary Incentives on Health Care Social Media Content: Study Based on Topic Modeling and Sentiment Analysis", journal="J Med Internet Res", year="2023", month="May", day="11", volume="25", pages="e44307", keywords="health care analytics", keywords="social media", keywords="incentive mechanisms", keywords="content analysis", keywords="contrastive topic modeling", abstract="Background: While there is high-quality online health information, a lot of recent work has unfortunately highlighted significant issues with the health content on social media platforms (eg, fake news and misinformation), the consequences of which are severe in health care. One solution is to investigate methods that encourage users to post high-quality content. Objective: Incentives have been shown to work in many domains, but until recently, there was no method to provide financial incentives easily on social media for users to generate high-quality content. This study investigates the following question: What effect does the provision of incentives have on the creation of social media health care content? Methods: We analyzed 8328 health-related posts from an incentive-based platform (Steemit) and 1682 health-related posts from a traditional platform (Reddit). Using topic modeling and sentiment analysis--based methods in machine learning, we analyzed these posts across the following 3 dimensions: (1) emotion and language style using the IBM Watson Tone Analyzer service, (2) topic similarity and difference from contrastive topic modeling, and (3) the extent to which posts resemble clickbait. We also conducted a survey using 276 Amazon Mechanical Turk (MTurk) users and asked them to score the quality of Steemit and Reddit posts. Results: Using the Watson Tone Analyzer in a sample of 2000 posts from Steemit and Reddit, we found that more than double the number of Steemit posts had a confident language style compared with Reddit posts (77 vs 30). Moreover, 50\% more Steemit posts had analytical content and 33\% less Steemit posts had a tentative language style compared with Reddit posts (619 vs 430 and 416 vs 627, respectively). Furthermore, more than double the number of Steemit posts were considered joyful compared with Reddit posts (435 vs 200), whereas negative posts (eg, sadness, fear, and anger) were 33\% less on Steemit than on Reddit (384 vs 569). Contrastive topic discovery showed that only 20\% (2/10) of topics were common, and Steemit had more unique topics than Reddit (5 vs 3). Qualitatively, Steemit topics were more informational, while Reddit topics involved discussions, which may explain some of the quantitative differences. Manual labeling marked more Steemit headlines as clickbait than Reddit headlines (66 vs 26), and machine learning model labeling consistently identified a higher percentage of Steemit headlines as clickbait than Reddit headlines. In the survey, MTurk users said that at least 57\% of Steemit posts had better quality than Reddit posts, and they were at least 52\% more likely to like and comment on Steemit posts than Reddit posts. Conclusions: It is becoming increasingly important to ensure high-quality health content on social media; therefore, incentive-based social media could be important in the design of next-generation social platforms for health information. ", doi="10.2196/44307", url="https://www.jmir.org/2023/1/e44307", url="http://www.ncbi.nlm.nih.gov/pubmed/37166952" } @Article{info:doi/10.2196/43001, author="Josey, Maria and Gaid, Dina and Bishop, D. Lisa and Blackwood, Michael and Najafizada, Maisam and Donnan, R. Jennifer", title="The Quality, Readability, and Accuracy of the Information on Google About Cannabis and Driving: Quantitative Content Analysis", journal="JMIR Infodemiology", year="2023", month="May", day="2", volume="3", pages="e43001", keywords="cannabis", keywords="driving", keywords="quality", keywords="readability", keywords="accuracy", keywords="public education", keywords="internet", keywords="Google search", keywords="analysis", keywords="accessibility", keywords="information", keywords="evaluation", keywords="tool", keywords="data", keywords="misinterpretation", abstract="Background: The public perception of driving under the influence of cannabis (DUIC) is not consistent with current evidence. The internet is an influential source of information available for people to find information about cannabis. Objective: The purpose of this study was to assess the quality, readability, and accuracy of the information about DUIC found on the internet using the Google Canada search engine. Methods: A quantitative content analysis of the top Google search web pages was conducted to analyze the information available to the public about DUIC. Google searches were performed using keywords, and the first 20 pages were selected. Web pages or web-based resources were eligible if they had text on cannabis and driving in English. We assessed (1) the quality of information using the Quality Evaluation Scoring Tool (QUEST) and the presence of the Health on the Net (HON) code; (2) the readability of information using the Gunning Fox Index (GFI), Flesch Reading Ease Scale (FRES), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG) scores; and (3) the accuracy of information pertaining to the effects of cannabis consumption, prevalence of DUIC, DUIC effects on driving ability, risk of collision, and detection by law enforcement using an adapted version of the 5Cs website evaluation tool. Results: A total of 82 web pages were included in the data analysis. The average QUEST score was 17.4 (SD 5.6) out of 28. The average readability scores were 9.7 (SD 2.3) for FKGL, 11.4 (SD 2.9) for GFI, 12.2 (SD 1.9) for SMOG index, and 49.9 (SD 12.3) for FRES. The readability scores demonstrated that 8 (9.8\%) to 16 (19.5\%) web pages were considered readable by the public. The accuracy results showed that of the web pages that presented information on each key topic, 96\% (22/23) of them were accurate about the effects of cannabis consumption; 97\% (30/31) were accurate about the prevalence of DUIC; 92\% (49/53) were accurate about the DUIC effects on driving ability; 80\% (41/51) were accurate about the risk of collision; and 71\% (35/49) were accurate about detection by law enforcement. Conclusions: Health organizations should consider health literacy of the public when creating content to help prevent misinterpretation and perpetuate prevailing misperceptions surrounding DUIC. Delivering high quality, readable, and accurate information in a way that is comprehensible to the public is needed to support informed decision-making. ", doi="10.2196/43001", url="https://infodemiology.jmir.org/2023/1/e43001" } @Article{info:doi/10.2196/40043, author="El Sherif, Reem and Pluye, Pierre and Paquet, Virginie and Ibekwe, Fidelia and Grad, Roland", title="How People Use Web-Based Parenting Information to Support Others in Their Social Circle: Qualitative Descriptive Study", journal="JMIR Pediatr Parent", year="2023", month="Apr", day="28", volume="6", pages="e40043", keywords="consumer health information", keywords="information seeking behavior", keywords="child development", keywords="child health", keywords="information outcomes", keywords="health information", keywords="digital health", keywords="parenting", keywords="web-based information", abstract="Background: Almost two-thirds of the North American population have searched for health information on the web, and the majority report searching on behalf of someone else in their social circle, a phenomenon referred to as proxy seeking. Little is known about how proxy seekers use web-based health information and the outcomes they experience. Objective: The main aim of this study was to explore why proxy seekers used a parenting website on behalf of parents in their social circle and the outcomes they reported. Methods: A qualitative descriptive study was conducted in the context of a partnership with a web-based parenting resource to explore the contexts and motivations for proxy web-based health information seeking, use of information, and subsequent outcomes. A total of 14 participants who self-identified as family members, friends of parents of young children, or professionals who worked with young children were interviewed, and a thematic analysis was conducted. Results: The following 4 reasons for proxy seeking were uncovered: for reassurance, out of personal curiosity, as part of a professional role, or following an explicit request from the parents. Information was used to provide informational support for parents or material support for a child. Positive outcomes of using the information and some of the resulting interpersonal tensions were described. Conclusions: This study provides an in-depth look at proxy seeking behavior and outcomes among users of a web-based parenting resource. ", doi="10.2196/40043", url="https://pediatrics.jmir.org/2023/1/e40043", url="http://www.ncbi.nlm.nih.gov/pubmed/37115603" } @Article{info:doi/10.2196/44010, author="Jiang, Zheng and Yang, Xin and Chen, Fei and Liu, Jun", title="Critical Analysis and Cross-Comparison Between English and Chinese Websites Providing Online Medical Information for Patients With Adenoid Hypertrophy: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Apr", day="24", volume="7", pages="e44010", keywords="adenoid hypertrophy", keywords="website quality", keywords="critical analysis", keywords="English and Chinese", keywords="English", keywords="Chinese", keywords="patient", keywords="internet", keywords="online", keywords="decisions", keywords="medical issues", keywords="airway obstruction", keywords="airway", keywords="accessibility", keywords="quality", abstract="Background: In the information era, patients can easily be misled by inaccurate internet content, thus making not well-informed decisions about medical issues. Adenoid hypertrophy, one of the most common causes of chronic upper airway obstruction in children and adolescents, may lead to serious complications, including sleep apnea and craniofacial change. There have been no critical studies about the quality of websites on adenoid hypertrophy, posing a challenge for users without a medical background to determine which website offers more reliable information. Moreover, the blockage of access to internet search tools such as Google, Yahoo, and others has created an isolated internet environment for the enormous user population in mainland China. Differences in internet legislation, the commercial environment, and culture are also likely to result in varied quality of online health information inside and outside mainland China. To date, no study has compared the quality difference between mainland Chinese and English websites. Objective: The aims of this study were to (1) analyze the quality of websites about adenoid hypertrophy accessible by patients, (2) investigate the quality differences between Chinese and English websites, (3) determine which type of website (eg, government-sponsored, health care provider) is more reliable in terms of medical information, and (4) determine whether the blockage of foreign websites is hindering users' accessibility to better-quality websites in mainland China. Methods: The first 100 websites (excluding advertisements) displayed on the top three search engines worldwide and in mainland China for the key search term ``enlarged adenoids'' were collected as the data source. The websites were evaluated based on accessibility, accountability, interactivity, structure, and content quality (accuracy, content coverage, and objectivity). Cohen $\kappa$ was calculated, and one-way ANOVA and the Kruskal-Wallis test were performed to compare the results between groups and subgroups. Results: The mean score for the content quality of English websites was significantly higher than that of Chinese websites (6.16 vs 4.94, P=.03 for Google, Bing, and Yahoo; 6.16 vs 4.16, P<.001 for Baidu, Sougou, and Bing China). Chinese users who are not influenced by the Internet Censorship System are more likely to access higher-quality online medical information (4.94 vs 4.16, P=.02). In within-group Student-Newman-Keuls q posthoc analysis, professional organization and government-sponsored websites were generally of better quality than other websites for both Chinese and English websites (P<.05). Conclusions: Generally, the English websites on adenoid hypertrophy are of better quality than Chinese websites; thus, Chinese users residing outside of the Chinese mainland are less influenced by inaccurate online medical information. ", doi="10.2196/44010", url="https://formative.jmir.org/2023/1/e44010", url="http://www.ncbi.nlm.nih.gov/pubmed/37093621" } @Article{info:doi/10.2196/42218, author="Murthy, Dhiraj and Lee, Juhan and Dashtian, Hassan and Kong, Grace", title="Influence of User Profile Attributes on e-Cigarette--Related Searches on YouTube: Machine Learning Clustering and Classification", journal="JMIR Infodemiology", year="2023", month="Apr", day="12", volume="3", pages="e42218", keywords="electronic cigarettes", keywords="electronic nicotine delivery systems", keywords="ENDS", keywords="tobacco products", keywords="YouTube", keywords="social media", keywords="minority groups", keywords="exposure", keywords="youth", keywords="behavior", keywords="user", keywords="machine learning", keywords="policy", abstract="Background: The proliferation of e-cigarette content on YouTube is concerning because of its possible effect on youth use behaviors. YouTube has a personalized search and recommendation algorithm that derives attributes from a user's profile, such as age and sex. However, little is known about whether e-cigarette content is shown differently based on user characteristics. Objective: The aim of this study was to understand the influence of age and sex attributes of user profiles on e-cigarette--related YouTube search results. Methods: We created 16 fictitious YouTube profiles with ages of 16 and 24 years, sex (female and male), and ethnicity/race to search for 18 e-cigarette--related search terms. We used unsupervised (k-means clustering and classification) and supervised (graph convolutional network) machine learning and network analysis to characterize the variation in the search results of each profile. We further examined whether user attributes may play a role in e-cigarette--related content exposure by using networks and degree centrality. Results: We analyzed 4201 nonduplicate videos. Our k-means clustering suggested that the videos could be clustered into 3 categories. The graph convolutional network achieved high accuracy (0.72). Videos were classified based on content into 4 categories: product review (49.3\%), health information (15.1\%), instruction (26.9\%), and other (8.5\%). Underage users were exposed mostly to instructional videos (37.5\%), with some indication that more female 16-year-old profiles were exposed to this content, while young adult age groups (24 years) were exposed mostly to product review videos (39.2\%). Conclusions: Our results indicate that demographic attributes factor into YouTube's algorithmic systems in the context of e-cigarette--related queries on YouTube. Specifically, differences in the age and sex attributes of user profiles do result in variance in both the videos presented in YouTube search results as well as in the types of these videos. We find that underage profiles were exposed to e-cigarette content despite YouTube's age-restriction policy that ostensibly prohibits certain e-cigarette content. Greater enforcement of policies to restrict youth access to e-cigarette content is needed. ", doi="10.2196/42218", url="https://infodemiology.jmir.org/2023/1/e42218", url="http://www.ncbi.nlm.nih.gov/pubmed/37124246" } @Article{info:doi/10.2196/45147, author="Almomani, Hamzeh and Patel, Nilesh and Donyai, Parastou", title="News Media Coverage of the Problem of Purchasing Fake Prescription Medicines on the Internet: Thematic Analysis", journal="JMIR Form Res", year="2023", month="Mar", day="21", volume="7", pages="e45147", keywords="prescription medicine", keywords="internet", keywords="online pharmacy", keywords="fake medicine", keywords="media", keywords="newspaper article", keywords="Theory of Planned Behavior", keywords="thematic analysis", abstract="Background: More people are turning to internet pharmacies to purchase their prescription medicines. This kind of purchase is associated with serious risks, including the risk of buying fake medicines, which are widely available on the internet. This underresearched issue has been highlighted by many newspaper articles in the past few years. Newspapers can play an important role in shaping public perceptions of the risks associated with purchasing prescription medicines on the internet. Thus, it is important to understand how the news media present this issue. Objective: This study aimed to explore newspaper coverage of the problem of purchasing fake prescription medicines on the internet. Methods: Newspaper articles were retrieved from the ProQuest electronic database using search terms related to the topic of buying fake prescription medicines on the internet. The search was limited to articles published between April 2019 and March 2022 to retrieve relevant articles in this fast-developing field. Articles were included if they were published in English and focused on prescription medicines. Thematic analysis was employed to analyze the articles, and the Theory of Planned Behavior framework was used as a conceptual lens to develop the coding of themes. Results: A total of 106 articles were included and analyzed using thematic analysis. We identified 4 superordinate themes that represent newspaper coverage of the topic of buying prescription medicines on the internet. These themes are (1) the risks of purchasing medicines on the internet (eg, health risks and product quality concerns, financial risks, lack of accountability, risk of purchasing stolen medicines), (2) benefits that entice consumers to make the purchase (eg, convenience and quick purchase, lower cost, privacy of the purchase), (3) social influencing factors of the purchase (influencers, health care providers), and (4) facilitators of the purchase (eg, medicines shortages, pandemic disease such as COVID-19, social media, search engines, accessibility, low risk perception). Conclusions: This theory-based study explored the news media coverage of the problem of fake prescription medicines being purchased on the internet by highlighting the complexity of personal beliefs and the range of external circumstances that could influence people to make these purchases. Further research is needed in this area to identify the factors that lead people to buy prescription medicines on the internet. Identifying these factors could enable the development of interventions to dissuade people from purchasing medicines from unsafe sources on the internet, thus protecting consumers from unsafe or illegal medicines. ", doi="10.2196/45147", url="https://formative.jmir.org/2023/1/e45147", url="http://www.ncbi.nlm.nih.gov/pubmed/36943354" } @Article{info:doi/10.2196/45571, author="Lorenzo-Luaces, Lorenzo and Dierckman, Clare and Adams, Sydney", title="Attitudes and (Mis)information About Cognitive Behavioral Therapy on TikTok: An Analysis of Video Content", journal="J Med Internet Res", year="2023", month="Mar", day="13", volume="25", pages="e45571", keywords="social media", keywords="cognitive behavioral therapy", keywords="misinformation", keywords="public health", keywords="mental health", keywords="TikTok", keywords="psychotherapy", keywords="content analysis", keywords="therapist", keywords="online health information", doi="10.2196/45571", url="https://www.jmir.org/2023/1/e45571", url="http://www.ncbi.nlm.nih.gov/pubmed/36912883" } @Article{info:doi/10.2196/44741, author="Mitsutake, Seigo and Takahashi, Yoshimitsu and Otsuki, Aki and Umezawa, Jun and Yaguchi-Saito, Akiko and Saito, Junko and Fujimori, Maiko and Shimazu, Taichi and ", title="Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan", journal="J Med Internet Res", year="2023", month="Mar", day="2", volume="25", pages="e44741", keywords="chronic diseases", keywords="cross-sectional study", keywords="eHealth literacy, health communication", keywords="internet, social networking", abstract="Background: In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users. Objective: This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs. Methods: This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use. Results: The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5\%, 10.1\%, 7.7\%, and 7.2\% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95\% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95\% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95\% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use. Conclusions: For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information. ", doi="10.2196/44741", url="https://www.jmir.org/2023/1/e44741", url="http://www.ncbi.nlm.nih.gov/pubmed/36862482" } @Article{info:doi/10.2196/41518, author="He, Zixuan and Wang, Zhijie and Song, Yihang and Liu, Yilong and Kang, Le and Fang, Xue and Wang, Tongchang and Fan, Xuanming and Li, Zhaoshen and Wang, Shuling and Bai, Yu", title="The Reliability and Quality of Short Videos as a Source of Dietary Guidance for Inflammatory Bowel Disease: Cross-sectional Study", journal="J Med Internet Res", year="2023", month="Feb", day="9", volume="25", pages="e41518", keywords="inflammatory bowel disease", keywords="diet", keywords="information quality", keywords="social media", keywords="gastroenterology", keywords="nutrition", keywords="videos", keywords="health communication", abstract="Background: Dietary management is considered a potential adjunctive treatment for inflammatory bowel disease (IBD). Short-video sharing platforms have enabled patients to obtain dietary advice more conveniently. However, accessing useful resources while avoiding misinformation is not an easy task for most patients. Objective: This study aimed to evaluate the quality of the information in IBD diet--related videos on Chinese short-video sharing platforms. Methods: We collected and extracted information from a total of 125 video samples related to the IBD diet on the 3 Chinese short-video sharing platforms with the most users: TikTok, Bilibili, and Kwai. Two independent physicians evaluated each video in terms of content comprehensiveness, quality (rated by Global Quality Score), and reliability (rated by a modified DISCERN tool). Finally, comparative analyses of the videos from different sources were conducted. Results: The videos were classified into 6 groups based on the identity of the uploaders, which included 3 kinds of medical professionals (ie, gastroenterologists, nongastroenterologists, and clinical nutritionists) and 3 types of non--medical professionals (ie, nonprofit organizations, individual science communicators, and IBD patients). The overall quality of the videos was poor. Further group comparisons demonstrated that videos from medical professionals were more instructive in terms of content comprehensiveness, quality, and reliability than those from non--medical professionals. Moreover, IBD diet--related recommendations from clinical nutritionists and gastroenterologists were of better quality than those from nongastroenterologists, while recommendations from nonprofit organizations did not seem to be superior to other groups of uploaders. Conclusions: The overall quality of the information in IBD diet-related videos is unsatisfactory and varies significantly depending on the source. Videos from medical professionals, especially clinical nutritionists and gastroenterologists, may provide dietary guidance with higher quality for IBD patients. ", doi="10.2196/41518", url="https://www.jmir.org/2023/1/e41518", url="http://www.ncbi.nlm.nih.gov/pubmed/36757757" } @Article{info:doi/10.2196/39162, author="Sun, Fei and Zheng, Shusen and Wu, Jian", title="Quality of Information in Gallstone Disease Videos on TikTok: Cross-sectional Study", journal="J Med Internet Res", year="2023", month="Feb", day="8", volume="25", pages="e39162", keywords="hepatobiliary", keywords="gallstone", keywords="gallbladder", keywords="TikTok", keywords="social media", keywords="video quality", keywords="DISCERN", keywords="Journal of American Medical Association", keywords="JAMA", keywords="Global Quality Score", keywords="GQS", keywords="content analysis", keywords="health information", keywords="online health information", keywords="digital health", keywords="disease knowledge", keywords="medical information", keywords="misinformation", keywords="infodemiology", keywords="patient education", keywords="dissemination", keywords="accuracy", keywords="credibility", keywords="credible", keywords="reliability", keywords="reliable", keywords="information quality", abstract="Background: TikTok was an important channel for consumers to access and adopt health information. But the quality of health content in TikTok remains underinvestigated. Objective: Our study aimed to identify upload sources, contents, and feature information of gallstone disease videos on TikTok and further evaluated the factors related to video quality. Methods: We investigated the first 100 gallstone-related videos on TikTok and analyzed these videos' upload sources, content, and characteristics. The quality of videos was evaluated using quantitative scoring tools such as DISCERN instrument, the Journal of American Medical Association (JAMA) benchmark criteria, and Global Quality Scores (GQS). Moreover, the correlation between video quality and video characteristics, including duration, likes, comments, and shares, was further investigated. Results: According to video sources, 81\% of the videos were posted by doctors. Furthermore, disease knowledge was the most dominant video content, accounting for 56\% of all the videos. The mean DISCERN, JAMA, and GQS scores of all 100 videos are 39.61 (SD 11.36), 2.00 (SD 0.40), and 2.76 (SD 0.95), respectively. According to DISCERN and GQS, gallstone-related videos' quality score on TikTok is not high, mainly at fair (43/100, 43\%,) and moderate (46/100, 46\%). The total DISCERN scores of doctors were significantly higher than that of individuals and news agencies, surgery techniques were significantly higher than lifestyle and news, and disease knowledge was significantly higher than news, respectively. DISCERN scores and video duration were positively correlated. Negative correlations were found between DISCERN scores and likes and shares of videos. In GQS analysis, no significant differences were found between groups based on different sources or different contents. JAMA was excluded in the video quality and correlation analysis due to a lack of discrimination and inability to evaluate the video quality accurately. Conclusions: Although the videos of gallstones on TikTok are mainly provided by doctors and contain disease knowledge, they are of low quality. We found a positive correlation between video duration and video quality. High-quality videos received low attention, and popular videos were of low quality. Medical information on TikTok is currently not rigorous enough to guide patients to make accurate judgments. TikTok was not an appropriate source of knowledge to educate patients due to the low quality and reliability of the information. ", doi="10.2196/39162", url="https://www.jmir.org/2023/1/e39162", url="http://www.ncbi.nlm.nih.gov/pubmed/36753307" } @Article{info:doi/10.2196/40466, author="Bergmo, Strand Trine and Sandsdalen, Vilde and Manskow, Sollid Unn and Sm{\aa}brekke, Lars and Waaseth, Marit", title="Internet Use for Obtaining Medicine Information: Cross-sectional Survey", journal="JMIR Form Res", year="2023", month="Feb", day="2", volume="7", pages="e40466", keywords="credibility", keywords="credible", keywords="cross-sectional", keywords="eHealth", keywords="health information", keywords="information behavior", keywords="information retrieval", keywords="information science", keywords="information seeking", keywords="internet", keywords="medication", keywords="medicine information", keywords="misinformation", keywords="patient education", keywords="pharmaceutical", keywords="pharmacist", keywords="pharmacy", keywords="survey", keywords="trust", keywords="web-based information", abstract="Background: The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. Objective: The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. Methods: This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Troms{\o}, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ?16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. Results: A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3\%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5\% per year of age (odds ratio 0.95, 95\% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63\%), pharmacy personnel (n=142, 47\%), and medication package leaflets (n=124, 42\%), while 36 (12\%) respondents did not obtain medicine information from any sources. Note that 272 (91\%) respondents trusted health professionals as a source of medicine information, whereas 58 (46\%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. Conclusions: Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities. ", doi="10.2196/40466", url="https://formative.jmir.org/2023/1/e40466", url="http://www.ncbi.nlm.nih.gov/pubmed/36729577" } @Article{info:doi/10.2196/40291, author="Kaplan, Samantha and von Isenburg, Megan and Waldrop, Lucy", title="Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites", journal="JMIR Form Res", year="2023", month="Jan", day="11", volume="7", pages="e40291", keywords="antivaccination behavior", keywords="web archiving", keywords="content analysis", keywords="COVID-19 vaccines", keywords="COVID-19", keywords="vaccine", keywords="website", keywords="web", keywords="pandemic", keywords="safety", keywords="science", keywords="content", abstract="Background: The onset of the COVID-19 pandemic and the concurrent development of vaccines offered a rare and somewhat unprecedented opportunity to study antivaccination behavior as it formed over time via the use of archived versions of websites. Objective: This study aims to assess how existing antivaccination websites modified their content to address COVID-19 vaccines and pandemic restrictions. Methods: Using a preexisting collection of 25 antivaccination websites curated by the IvyPlus Web Collection Program prior to the pandemic and crawled every 6 months via Archive-It, we conducted a content analysis to see how these websites acknowledged or ignored COVID-19 vaccines and pandemic restrictions. Websites were assessed for financial behaviors such as having storefronts, mention of COVID-19 vaccines in general or by manufacturer name, references to personal freedom such as masking, safety concerns like side effects, and skepticism of science. Results: The majority of websites addressed COVID-19 vaccines in a negative fashion, with more websites making appeals to personal freedom or expressing skepticism of science than questioning safety. This can potentially be attributed to the lack of available safety data about the vaccines at the time of data collection. Many of the antivaccination websites we evaluated actively sought donations and had a membership option, evidencing these websites have financial motivations and actively build a community around these issues. The content analysis also offered the opportunity to test the viability of archived websites for use in scholarly research. The archived versions of the websites had significant shortcomings, particularly in search functionality, and required supplementation with the live websites. For web archiving to be a viable source of stand-alone content for research, the technology needs to make significant improvements in its capture abilities. Conclusions: In summary, we found antivaccination websites existing prior to the COVID-19 pandemic largely adapted their messaging to address COVID-19 vaccines with very few sites ignoring the pandemic altogether. This study also demonstrated the timely and significant need for more robust web archiving capabilities as web-based environments become more ephemeral and unstable. ", doi="10.2196/40291", url="https://formative.jmir.org/2023/1/e40291", url="http://www.ncbi.nlm.nih.gov/pubmed/36548948" } @Article{info:doi/10.2196/39220, author="Montagni, Ilaria and Pouymayou, Aude and Pereira, Edwige and Tzourio, Christophe and Sch{\"u}ck, St{\'e}phane and Texier, Nathalie and Gonz{\'a}lez-Caballero, Luis Juan and ", title="Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale", journal="J Med Internet Res", year="2022", month="Dec", day="14", volume="24", number="12", pages="e39220", keywords="Internet", keywords="literacy", keywords="measurement", keywords="vaccination", keywords="vaccine", keywords="health information", keywords="health literacy", keywords="online", keywords="content", keywords="validity", keywords="reliability", keywords="digital literacy", abstract="Background: The use of the internet to look for information about vaccines has skyrocketed in the last years, especially with the COVID-19 pandemic. Digital vaccine literacy (DVL) refers to understanding, trust, appraisal, and application of vaccine-related information online. Objective: This study aims to develop a tool measuring DVL and assess its psychometric properties. Methods: A 7-item online questionnaire was administered to 848 French adults. Different psychometric analyses were performed, including descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity. Results: We developed the 7-item DVL scale composed of 3 factors (understanding and trust official information; understanding and trust information in social media; and appraisal of vaccine information online in terms of evaluation of the information and its application for decision making). The mean DVL score of the baseline sample of 848 participants was 19.5 (SD 2.8) with a range of 7-28. The median score was 20. Scores were significantly different by gender (P=.24), age (P=.03), studying or working in the field of health (P=.01), and receiving regular seasonal flu shots (P=.01). Conclusions: The DVL tool showed good psychometric proprieties, resulting in a promising measure of DVL. ", doi="10.2196/39220", url="https://www.jmir.org/2022/12/e39220", url="http://www.ncbi.nlm.nih.gov/pubmed/36515982" } @Article{info:doi/10.2196/37036, author="Etling, Ann Mary and Musili, Michael and Eastes, Kaytlin and Oyungu, Eren and McHenry, S. Megan", title="Creating the Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA) Project: Tutorial for the Novel Use of a Store Locator App", journal="Interact J Med Res", year="2022", month="Dec", day="8", volume="11", number="2", pages="e37036", keywords="map", keywords="virtual", keywords="interactive", keywords="disability", keywords="resources", keywords="inclusion", keywords="mHealth", keywords="Kenya", keywords="global health", keywords="public health", abstract="Background: An estimated 15\% of the global population is living with a disability. In Kenya, children with disabilities remain among the most vulnerable populations, experiencing substantial barriers to wellness and inclusion. Smartphone ownership and internet access have been increasing across sub-Saharan Africa, including in Kenya. Despite these advances, online or mobile resources remain limited and difficult to find and navigate. Objective: This paper aims to describe the novel use of a store locator app to develop an interactive map of organizations that provide medical, educational, and socioeconomic resources to individuals with disabilities in Kenya. The target audience is individuals with disabilities, medical professionals, and organization leaders. Methods: A comprehensive list of organizations, government county offices, educational assessment and resource centers, and institutions was compiled. Organizations were contacted via email, WhatsApp, or in person for semistructured interviews. Based on the services offered, each organization was assigned categorical search tags. The data were entered into a third-party store locator app. The resulting map was inserted into a page on the Academic Model Providing Access to Healthcare (AMPATH) website. Results: The Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA; this abbreviation is also Swahili for ``help'') was launched in July 2020 in both English and Swahili. The map included 89 organizations across Kenya. Of these, 51 were reached for an interview (for a 57\% response rate). Interviewees cited limited paid staff and dependence on grant-based funding as primary challenges to growth and sustainability. Conclusions: MSAADA is an interactive, virtual map that aims to connect individuals with disabilities, medical professionals, and organization leaders to resources in Kenya. The novel use of a store locator app to compile resources in remote settings has the potential to improve access to health care for a wide variety of specialties and patient populations. Innovators in global health should consider the use of store locator apps to connect individuals to resources in regions with limited mapping. ", doi="10.2196/37036", url="https://www.i-jmr.org/2022/2/e37036", url="http://www.ncbi.nlm.nih.gov/pubmed/36480245" } @Article{info:doi/10.2196/41219, author="?ulea, M. Cristina and N?d??an, Valentin and Ursachi, Tatiana and Toboltoc, Paul-C?t?lin and Benedek, Theodora", title="What Patients Find on the Internet When Looking for Information About Percutaneous Coronary Intervention: Multilanguage Cross-sectional Assessment", journal="J Med Internet Res", year="2022", month="Dec", day="6", volume="24", number="12", pages="e41219", keywords="percutaneous coronary intervention", keywords="consumer health informatics", keywords="internet", keywords="health education", keywords="health information", keywords="quality", keywords="reliability", keywords="informed decision-making", keywords="credibility", keywords="content quality", keywords="medical information", abstract="Background: The internet provides general users with wide access to medical information. However, regulating and controlling the quality and reliability of the considerable volume of available data is challenging, thus generating concerns about the consequences of inaccurate health care--related documentation. Several tools have been proposed to increase the transparency and overall trustworthiness of medical information present on the web. Objective: We aimed to analyze and compare the quality and reliability of information about percutaneous coronary intervention on English, German, Hungarian, Romanian, and Russian language websites. Methods: Following a rigorous protocol, 125 websites were selected, 25 for each language sub-sample. The websites were assessed concerning their general characteristics, compliance with a set of eEurope 2002 credibility criteria, and quality of the informational content (namely completeness and accuracy), based on a topic-specific benchmark. Completeness and accuracy were graded independently by 2 evaluators. Scores were reported on a scale from 0 to 10. The 5 language subsamples were compared regarding credibility, completeness, and accuracy. Correlations between credibility scores on the one hand, and completeness and accuracy scores, on the other hand, were tested within each language subsample. Results: The websites' compliance with credibility criteria was average at best with scores between 3.0 and 6.0. In terms of completeness and accuracy, the website subsets qualified as poor or average, with scores ranging from 2.4 to 4.6 and 3.6 to 5.3, respectively. English language websites scored significantly higher in all 3 aspects, followed by German and Hungarian language websites. Only German language websites showed a significant correlation between credibility and information quality. Conclusions: The quality of websites in English, German, Hungarian, Romanian, and Russian languages about percutaneous coronary intervention was rather inadequate and may raise concerns regarding their impact on informed decision-making. Using credibility criteria as indicators of information quality may not be warranted, as credibility scores were only exceptionally correlated with content quality. The study brings valuable descriptive data on the quality of web-based information regarding percutaneous coronary intervention in multiple languages and raises awareness about the need for responsible use of health-related web resources. ", doi="10.2196/41219", url="https://www.jmir.org/2022/12/e41219", url="http://www.ncbi.nlm.nih.gov/pubmed/36472906" } @Article{info:doi/10.2196/42245, author="Basch, H. Corey and Hillyer, C. Grace and Yalamanchili, Bhavya and Morris, Aldean", title="How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis", journal="JMIR Cancer", year="2022", month="Dec", day="6", volume="8", number="4", pages="e42245", keywords="TikTok", keywords="breast cancer", keywords="social media", keywords="short video apps", keywords="social support", keywords="content analysis", keywords="video", keywords="patient support", keywords="medical information", keywords="health information", keywords="peer support", keywords="online conversation", keywords="online health information", abstract="Background: Acknowledging the popularity of TikTok, how quickly medical information can spread, and how users seek support on social media, there is a clear lack of research on breast cancer conversations on TikTok. There is a paucity of information on how these videos can advocate for those impacted by breast cancer as a means to provide support and information as well as raise awareness. Objective: The purpose of this cross-sectional content analysis was to describe the content of videos from the hashtag \#breastcancer on TikTok. Content related to breast cancer support and coping, cancer education, and heightening the awareness of breast cancer early detection, prevention, and treatment was evaluated. Methods: This study included 100 of the most viewed TikTok videos related to breast cancer through June 30, 2022. Videos were excluded if they were not in the English language or relevant to the topic being studied. Content was deductively coded into categories related to video characteristics and content topics using a screener based on expert breast cancer information sheets. Univariable analyses were conducted to evaluate differences in video characteristics and content when stratified as advocating or not advocating for breast cancer (yes or no) support, education, and awareness. Results: The cumulative number of views of the videos included in this study was 369,504,590. The majority (n=81, 81\%) of videos were created by patients and loved ones of individuals with breast cancer, and the most commonly discussed topic was breast cancer support (n=88, 88\%), followed by coping with the myriad issues surrounding breast cancer (n=79, 79\%). Overall, <50\% of the videos addressed important issues such as body image (n=48, 48\%), surgery (n=46, 46\%), medication and therapy (n=41, 41\%), or the stigma associated with a breast cancer diagnosis (n=44, 44\%); however, in videos that were advocacy oriented, body image (40/62, 64\% vs 8/38, 21\%; P<.001), stigma associated with breast cancer (33/62, 53\% vs 11/38, 29\%; P=.02), and breast cancer surgery (36/62, 58\% vs 10/38, 26\%; P=.002) were discussed significantly more often than in videos that did not specifically advocate for breast cancer. Conclusions: The use of videos to display health journeys can facilitate engagement by patients, family members, and loved ones interested in information about challenging conditions. Collectively, these findings highlight the level of peer-to-peer involvement on TikTok and may provide insights for designing breast cancer educational campaigns. ", doi="10.2196/42245", url="https://cancer.jmir.org/2022/4/e42245", url="http://www.ncbi.nlm.nih.gov/pubmed/36472899" } @Article{info:doi/10.2196/42126, author="Shaveet, Eden and Urquhart, Catherine and Gallegos, Marissa and Dammann, Olaf and Corlin, Laura", title="Web-Based Health Information--Seeking Methods and Time Since Provider Engagement: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Nov", day="30", volume="6", number="11", pages="e42126", keywords="internet", keywords="social media", keywords="information-seeking behavior", keywords="consumer health information", keywords="physician-patient relations", keywords="trust", abstract="Background: The use of web-based methods to seek health information is increasing in popularity. As web-based health information (WHI)--seeking affects health-related decision support and chronic symptom self-management, WHI-seeking from online sources may impact health care decisions and outcomes, including care-seeking decisions. Patients who are routinely connected to physicians are more likely to receive better and more consistent care. Little is known about whether WHI-seeking impacts the frequency at which patients engage with health care providers. Objective: Our primary objective was to describe the associations between the use of web-based methods to seek information about one's own health and the time since last engaging with a health care provider about one's own health. Additionally, we aimed to assess participants' trust in health care organizations to contextualize our findings. Methods: We analyzed data from US adults participating in the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Survey (N=1034). Bivariate associations between demographic characteristics and health information--seeking methods were assessed with Pearson chi-squared tests. Bivariate associations of Medical Mistrust Index (MMI) scores with each health information--seeking method and time since provider engagement were assessed with F tests and adjusted Wald tests. We fit a multivariable logistic regression model to assess the association between WHI-seeking within the 12 months prior to survey (alone or in combination with provider-based methods versus provider only) and engagement with a provider more than 1 year prior to the time of survey, adjusting for age, race and ethnicity, sex, education, insurance coverage, and MMI. Results: Age, race and ethnicity, educational attainment, health insurance source, MMI, and time since provider engagement were each significantly associated with the health information--seeking method in bivariate analyses. Compared to using only provider-based health information seeking methods, WHI-based methods alone or in combination with provider-based methods were associated with a 51\% lower likelihood (odds ratio 0.49, 95\% CI 0.27-0.87) of engaging with a provider within the previous year. Participants who used WHI-seeking methods alone and those who had not engaged with a health care provider within the previous year demonstrated a higher mean MMI score; however, MMI was not a significant predictor of time since engagement with a provider in the multivariable analysis. Conclusions: Our findings from a nationally representative survey suggest that for those who use WHI-seeking methods (alone or in combination with provider-based information-seeking methods), there is a statistically significant lower likelihood of engaging with a provider in a year compared to those who only use provider-based methods. Future research should consider the intent of a person's visit with a provider, trust in health care systems, methods of provider engagement, and specific web-based platforms for health information. ", doi="10.2196/42126", url="https://formative.jmir.org/2022/11/e42126", url="http://www.ncbi.nlm.nih.gov/pubmed/36449328" } @Article{info:doi/10.2196/39312, author="Tan, Jin Rayner Kay and Lim, Mingjie Jane and Neo, Min Pearlyn Hui and Ong, Ee Suan", title="Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study", journal="JMIR Hum Factors", year="2022", month="Nov", day="22", volume="9", number="4", pages="e39312", keywords="health communication", keywords="infodemic", keywords="SARS-CoV-2", keywords="coronavirus", keywords="Singapore", keywords="WhatsApp", keywords="COVID-19", keywords="health information", keywords="misinformation", keywords="mobile health", keywords="smartphone", keywords="information quality", keywords="online health information", abstract="Background: Misinformation related to the COVID-19 pandemic has accelerated global public concern and panic. The glut of information, or ``infodemic,'' has caused concern for authorities due to its negative impacts on COVID-19 prevention and control, spurring calls for a greater scholarly focus on health literacy during the pandemic. Nevertheless, few studies have sought to qualitatively examine how individuals interpreted and assimilated health information at the initial wave of COVID-19 restrictions. Objective: We developed this qualitative study adopting chat-based focus group discussions to investigate how individuals interpreted COVID-19 health information during the first wave of COVID-19 restrictions. Methods: We conducted a qualitative study in Singapore to investigate how individuals perceive and interpret information that they receive on COVID-19. Data were generated through online focus group discussions conducted on the mobile messaging smartphone app WhatsApp. From March 28 to April 13, 2020, we held eight WhatsApp-based focus groups (N=60) with participants stratified by age groups, namely 21-30 years, 31-40 years, 41-50 years, and 51 years and above. Data were thematically analyzed. Results: A total of four types of COVID-19 health information were generated from the thematic analysis, labeled as formal health information, informal health information, suspicious health information, and fake health information, respectively. How participants interpreted these categories of information depended largely on the perceived trustworthiness of the information source as well as the perceived veracity of information. Both factors were instrumental in determining individuals' perceptions, and their subsequent treatment and assimilation of COVID-19--related information. Conclusions: Both perceived trustworthiness of the information source and perceived veracity of information were instrumental concepts in determining one's perception, and thus subsequent treatment and assimilation of such information for one's knowledge of COVID-19 or the onward propagation to their social networks. These findings have implications for how policymakers and health authorities communicate with the public and deal with fake health information in the context of COVID-19. ", doi="10.2196/39312", url="https://humanfactors.jmir.org/2022/4/e39312", url="http://www.ncbi.nlm.nih.gov/pubmed/36099011" } @Article{info:doi/10.2196/38425, author="Ackleh-Tingle, V. Jonathan and Jordan, M. Natalie and Onwubiko, N. Udodirim and Chandra, Christina and Harton, E. Paige and Rentmeester, T. Shelby and Chamberlain, T. Allison", title="Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices' Websites in the United States: Cross-sectional Website Content Analysis", journal="JMIR Form Res", year="2022", month="Nov", day="17", volume="6", number="11", pages="e38425", keywords="primary care", keywords="vaccine hesitancy", keywords="COVID-19", keywords="health communications", keywords="health information", keywords="health website", keywords="family practice", keywords="vaccine information", keywords="online health", keywords="health platform", keywords="online information", abstract="Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices' website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10\% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8\%) had ?10 distinct locations, were unaffiliated with a university (n=838, 87.2\%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1\%). In total, 550 (57.1\%) practices mentioned COVID-19 vaccines on their practices' website home page, specifically, and 726 (75.3\%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7\% among single-location practices, n=114, 52.5\% among practices with 2-9 locations, n=66, 56.4\% among practices with 10-19 locations, and n=304, 77.6\% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95\% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers' influence on established and prospective patients who search the internet for information about COVID-19 vaccines. ", doi="10.2196/38425", url="https://formative.jmir.org/2022/11/e38425", url="http://www.ncbi.nlm.nih.gov/pubmed/36343211" } @Article{info:doi/10.2196/39571, author="Yoon, Young Ho and You, Han Kyung and Kwon, Hye Jung and Kim, Sun Jung and Rha, Young Sun and Chang, Jung Yoon and Lee, Sang-Cheol", title="Understanding the Social Mechanism of Cancer Misinformation Spread on YouTube and Lessons Learned: Infodemiological Study", journal="J Med Internet Res", year="2022", month="Nov", day="14", volume="24", number="11", pages="e39571", keywords="cancer misinformation", keywords="social media health misinformation", keywords="fenbendazole", keywords="self-administration", keywords="complex contagion", keywords="YouTube", keywords="social media factual information delivery strategy", abstract="Background: A knowledge gap exists between the list of required actions and the action plan for countering cancer misinformation on social media. Little attention has been paid to a social media strategy for disseminating factual information while also disrupting misinformation on social media networks. Objective: The aim of this study was to, first, identify the spread structure of cancer misinformation on YouTube. We asked the question, ``How do YouTube videos play an important role in spreading information about the self-administration of anthelmintics for dogs as a cancer medicine for humans?'' Second, the study aimed to suggest an action strategy for disrupting misinformation diffusion on YouTube by exploiting the network logic of YouTube information flow and the recommendation system. We asked the question, ``What would be a feasible and effective strategy to block cancer misinformation diffusion on YouTube?'' Methods: The study used the YouTube case of the self-administration of anthelmintics for dogs as an alternative cancer medicine in South Korea. We gathered Korean YouTube videos about the self-administration of fenbendazole. Using the YouTube application programming interface for the query ``fenbendazole,'' 702 videos from 227 channels were compiled. Then, videos with at least 50,000 views, uploaded between September 2019 and September 2020, were selected from the collection, resulting in 90 videos. Finally, 10 recommended videos for each of the 90 videos were compiled, totaling 573 videos. Social network visualization for the recommended videos was used to identify three intervention strategies for disrupting the YouTube misinformation network. Results: The study found evidence of complex contagion by human and machine recommendation systems. By exposing stakeholders to multiple information sources on fenbendazole self-administration and by linking them through a recommendation algorithm, YouTube has become the perfect infrastructure for reinforcing the belief that fenbendazole can cure cancer, despite government warnings about the risks and dangers of self-administration. Conclusions: Health authorities should upload pertinent information through multiple channels and should exploit the existing YouTube recommendation algorithm to disrupt the misinformation network. Considering the viewing habits of patients and caregivers, the direct use of YouTube hospital channels is more effective than the indirect use of YouTube news media channels or government channels that report public announcements and statements. Reinforcing through multiple channels is the key. ", doi="10.2196/39571", url="https://www.jmir.org/2022/11/e39571", url="http://www.ncbi.nlm.nih.gov/pubmed/36374534" } @Article{info:doi/10.2196/38865, author="Howes, Jared and Denier, Yvonne and Gastmans, Chris", title="Electronic Tracking Devices for People With Dementia: Content Analysis of Company Websites", journal="JMIR Aging", year="2022", month="Nov", day="11", volume="5", number="4", pages="e38865", keywords="dementia", keywords="wandering", keywords="electronic tracking devices", keywords="bioethics", keywords="locators", keywords="monitors", keywords="surveillance devices", keywords="management", keywords="technology", keywords="care tool", keywords="caregiver", keywords="device", keywords="vulnerable", keywords="elderly", abstract="Background: Electronic tracking devices, also known as locators, monitors, or surveillance devices, are increasingly being used to manage dementia-related wandering and, subsequently, raising various ethical questions. Despite the known importance technology design has on the ethics of technologies, little research has focused on the companies responsible for the design and development of electronic tracking devices. This paper is the first to perform a qualitative analysis of the ethically related content of the websites of companies that design and develop electronic tracking devices. Objective: The aim of this study was to understand how companies that design, develop, and market electronic tracking devices for dementia care frame, through textual marketing content, the vulnerabilities and needs of persons with dementia and caregivers, the way in which electronic tracking devices respond to these vulnerabilities and needs, and the ethical issues and values at stake. Methods: Electronic tracking device company websites were identified via a Google search, 2 device recommendation lists (Alzheimer's Los Angeles and the Canadian Agency for Drugs and Technologies in Health), and the 2 recent reviews of wander management technology by Neubauer et al and Ray et al. To be included, websites must be official representations of companies (not market or third-party websites) developing and selling electronic tracking devices for use in dementia care. The search was conducted on December 22, 2020, returning 199 websites excluding duplicates. Data synthesis and analysis were conducted on the textual content of the included websites using a modified form of the Qualitative Analysis Guide of Leuven. Results: In total, 29 websites met the inclusion criteria. Most (15/29, 52\%) companies were in the United States. The target audience of the websites was largely caregivers. A range of intertwined vulnerabilities facing persons with dementia and their caregivers were identified, and the companies addressed these via care tools that centered on certain values such as providing information while preserving privacy. Life after device implementation was characterized as a world aspired to that sees increased safety for persons with dementia and peace of mind for caregivers. Conclusions: The way electronic tracking device content is currently conveyed excludes persons with dementia as a target audience. In presenting their products as a response to vulnerabilities, particular values are linked to design elements. A limitation of the results is the opaque nature of website content origins. How or when values arise in the process of design, development, and marketing is unknown. Therefore, further research should explore the process companies use to identify vulnerabilities, how values are decided upon and integrated into the design of products, and the perceptions of developers regarding the ethics of electronic tracking devices. ", doi="10.2196/38865", url="https://aging.jmir.org/2022/4/e38865", url="http://www.ncbi.nlm.nih.gov/pubmed/36367765" } @Article{info:doi/10.2196/39946, author="Lin, Michelle and Phipps, Mina and Yilmaz, Yusuf and Nash, J. Christopher and Gisondi, A. Michael and Chan, M. Teresa", title="A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study", journal="JMIR Med Educ", year="2022", month="Oct", day="28", volume="8", number="4", pages="e39946", keywords="open educational resource", keywords="free open-access meducation", keywords="FOAM", keywords="meducation", keywords="open-access", keywords="internet based", keywords="web based", keywords="website", keywords="social media", keywords="medical education", keywords="disruptive innovation", keywords="blog", keywords="podcast", keywords="emergency", keywords="critical care", abstract="Background: Free open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown. Objective: This study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework. Methods: The authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework. Results: The authors identified 109 emergency medicine and critical care websites, which comprised 45.9\% (n=50) blogs, 22.9\% (n=25) podcasts, and 31.2\% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5\% (n=30) sold products, 18.3\% (n=20) used advertisements, 44.0\% (n=48) had institutional funding, and 27.5\% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9\%) to ?5 (n=60, 55\%) individuals. Conclusions: There was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4\% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education. ", doi="10.2196/39946", url="https://mededu.jmir.org/2022/4/e39946", url="http://www.ncbi.nlm.nih.gov/pubmed/36306167" } @Article{info:doi/10.2196/38567, author="Yang, Yuting and Hou, Mengchi and Gong, Xue and Guo, Rui and Feng, Lin Xing and Tian, Rui", title="Quality Assessment of Hypertension Treatment--Related Information on WeChat: Cross-sectional Study", journal="J Med Internet Res", year="2022", month="Oct", day="26", volume="24", number="10", pages="e38567", keywords="quality assessment", keywords="hypertension", keywords="WeChat", keywords="DISCERN instrument", abstract="Background: The WeChat platform has become a primary source for medical information in China. However, no study has been conducted to explore the quality of information on WeChat for the treatment of hypertension, the leading chronic condition. Objective: This study aimed to explore the quality of information in articles on WeChat that are related to hypertension treatment from the aspects of credibility, concreteness, accuracy, and completeness. Methods: We searched for all information related to hypertension treatment on WeChat based on several inclusion and exclusion criteria. We used 2 tools to evaluate information quality, and 2 independent reviewers performed the assessment with the 2 tools separately. First, we adopted the DISCERN instrument to assess the credibility and concreteness of the treatment information, with the outcomes classified into five grades: excellent, good, fair, poor, and very poor. Second, we applied the Chinese Guidelines for Prevention and Treatment of Hypertension (2018 edition) to evaluate the accuracy and completeness of the article information with regard to specific medical content. Third, we combined the results from the 2 assessments to arrive at the overall quality of the articles and explored the differences between, and associations of, the 2 independent assessments. Results: Of the 223 articles that were retrieved, 130 (58.3\%) full texts were included. Of these 130 articles, 81 (62.3\%) described therapeutic measures for hypertension. The assessment based on the DISCERN instrument reported a mean score of 31.22 (SD 8.46). There were no articles rated excellent (mean score >63); most (111/130, 85.4\%) of the articles did not refer to the consequences---in particular, quality of life---of no treatment. For specific medical content, adherence to the Chinese Guidelines for Prevention and Treatment of Hypertension was generally low in terms of accuracy and completeness, and there was much erroneous information. The overall mean quality score was 10.18 (SD 2.22) for the 130 articles, and the scores differed significantly across the 3 types (P=.03) and 5 sources (P=.02). Articles with references achieved higher scores for quality than those reporting none (P<.001). The results from the DISCERN assessment and the medical content scores were highly correlated ($\rho$=0.58; P<.001). Conclusions: The quality of hypertension treatment--related information on the WeChat platform is low. Future work is warranted to regulate information sources and strengthen references. For the treatment of hypertension, crucial information on the consequences of no treatment is urgently needed. ", doi="10.2196/38567", url="https://www.jmir.org/2022/10/e38567", url="http://www.ncbi.nlm.nih.gov/pubmed/36287598" } @Article{info:doi/10.2196/38316, author="van Kampen, Katherine and Laski, Jeremi and Herman, Gabrielle and Chan, M. Teresa", title="Investigating COVID-19 Vaccine Communication and Misinformation on TikTok: Cross-sectional Study", journal="JMIR Infodemiology", year="2022", month="Oct", day="25", volume="2", number="2", pages="e38316", keywords="TikTok", keywords="COVID-19 vaccines", keywords="vaccinations", keywords="misinformation", keywords="COVID-19", keywords="Infodemiology", keywords="social media", keywords="health information", keywords="content analysis", keywords="vaccine hesitancy", keywords="public health", keywords="web-based health information", abstract="Background: The COVID-19 pandemic has highlighted the need for reliable information, especially around vaccines. Vaccine hesitancy is a growing concern and a great threat to broader public health. The prevalence of social media within our daily lives emphasizes the importance of accurately analyzing how health information is being disseminated to the public. TikTok is of particular interest, as it is an emerging social media platform that young adults may be increasingly using to access health information. Objective: The objective of this study was to examine and describe the content within the top 100 TikToks trending with the hashtag \#covidvaccine. Methods: The top 250 most viewed TikToks with the hashtag \#covidvaccine were batch downloaded on July 1, 2021, with their respective metadata. Each TikTok was subsequently viewed and encoded by 2 independent reviewers. Coding continued until 100 TikToks could be included based on language and content. Descriptive features were recorded including health care professional (HCP) status of creator, verification of HCP status, genre, and misinformation addressed. Primary inclusion criteria were any TikToks in English with discussion of a COVID-19 vaccine. Results: Of 102 videos included, the median number of plays was 1,700,000, with median shares of 9224 and 62,200 followers. Upon analysis, 14.7\% (15/102) of TikToks included HCPs, of which 80\% (12/102) could be verified via social media or regulatory body search; 100\% (15/15) of HCP-created TikToks supported vaccine use, and overall, 81.3\% (83/102) of all TikToks (created by either a layperson or an HCP) supported vaccine use. Conclusions: As the pandemic continues, vaccine hesitancy poses a threat to lifting restrictions, and discovering reasons for this hesitancy is important to public health measures. This study summarizes the discourse around vaccine use on TikTok. Importantly, it opens a frank discussion about the necessity to incorporate new social media platforms into medical education, so we might ensure our trainees are ready to engage with patients on novel platforms. ", doi="10.2196/38316", url="https://infodemiology.jmir.org/2022/2/e38316", url="http://www.ncbi.nlm.nih.gov/pubmed/36338548" } @Article{info:doi/10.2196/42759, author="Gallo Marin, Benjamin and Ezemma, Ogechi and Frech, Stefano Fabio and Flores Servin, C. Julio and Rhee, S. Ben and Mulligan, M. Kathleen and O' Connell, A. Katie and Moseley, Isabelle and Wambier, G. Carlos", title="An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study", journal="JMIR Dermatol", year="2022", month="Oct", day="25", volume="5", number="4", pages="e42759", keywords="tattoo", keywords="tattoo removal", keywords="laser", keywords="internet", keywords="YouTube", keywords="misinformation", keywords="Food and Drug Administration", keywords="FDA", keywords="professional information", keywords="digital", keywords="research", keywords="skin", keywords="skin care", keywords="skincare", keywords="care", keywords="consultation", keywords="safe", keywords="evidence", keywords="dermatologist", abstract="Background: The American Academy of Dermatology and the Food and Drug Administration recommend consultation with a dermatologist prior to undergoing laser tattoo removal. However, non--health care professionals offer tattoo removal. Understanding the information available on the internet for patients regarding tattoo removal is important given that individuals are increasingly consulting digital sources to make decisions regarding skin care. Prior research has identified that YouTube contains misinformation on dermatologic health. Objective: Here, we present a cross-sectional study that determined the sources of information in YouTube videos that discuss tattoo removal and described the content presented to viewers. Methods: Using the query ``tattoo removal,'' we reviewed English-language YouTube videos that explicitly discussed tattoo removal. The following data were recorded: profession of the presenter, tattoo removal method discussed, whether an explicit recommendation to see a dermatologist or physician was present in the video, and number of views. Results: We analyzed 162 YouTube videos. We found that the majority were presented by non--health care professionals (n=125, 77\%), with only 4 (3.7\%) records of this subset recommending viewers to seek consultation from a dermatologist to ensure safe and adequate tattoo removal. Conclusions: Based on our findings, we recommend that dermatologists and other health care professionals provide high-quality, evidence-based information to viewers on tattoo removal and encourage dermatology societies to share via their social media platforms information about the importance of consulting a dermatologist for tattoo removal. ", doi="10.2196/42759", url="https://derma.jmir.org/2022/4/e42759", url="http://www.ncbi.nlm.nih.gov/pubmed/36419716" } @Article{info:doi/10.2196/38759, author="Seto, Noah and Beach, Jeffrey and Calvano, Joshua and Lu, Shu and He, Shuhan", title="American Anesthesiology Residency Programs: Website Usability Analysis", journal="Interact J Med Res", year="2022", month="Oct", day="20", volume="11", number="2", pages="e38759", keywords="medical student education", keywords="education in anesthesia", keywords="technology in education", keywords="quality improvement", keywords="communication", abstract="Background: The Association of American Medical Colleges has recently issued recommendations for the upcoming 2022-2023 application cycle that residency programs should conduct all interviews for this upcoming application cycle over the web. In light of these recommendations, many students will have limited exposure to anesthesiology programs and will rely on information gleaned digitally. This change means that the aspects of program websites used to provide information, such as size, structure, location, requirements, and contact information, will be crucial in helping prospective residents decide where and how to apply in the future. An evaluation of website usability, which includes initial appearance along with factors that influence its ease of navigation and convenience of use, can thus be applied to anesthesiology residency websites. Areas of need can be targeted to increase web presence and provide effective pathways to exhibit the different attributes of their programs to future applicants. Objective: This study aimed to compile a list of US anesthesiology residency programs and their websites while objectively analyzing the websites using a formally published usability scoring system, as well as to identify positive and negative trends to offer areas of improvement among anesthesiology residency websites. Methods: We included only 114 US anesthesiology residency program websites in our sample set, since some websites we analyzed showed errors or inconclusive. Website usability was separated into 4 distinct categories for analysis based on methodology outlined in previous literature on both health care website usability and residency website usability. The 4 categories were Accessibility, Marketing, Content Quality, and Technology. Each website was then analyzed and scored based on key components highlighted within the 4 categories. The multiple factors were then graded using a percentage system to create a comprehensive score for each program. Results: The highest scoring category was Content Quality (mean 4.7, SD 2.48, SE 0.23). The lowest scoring category was Technology (mean 0.9, SD 0.38, SE 0.04). Conclusions: Through the application of a health care website usability framework, multiple anesthesiology residency programs were analyzed and scored in the areas of Accessibility, Marketing, Content Quality, and Technology, which allowed us to determine the effectiveness of the usability of these websites to convey information to their end user. Websites must communicate vital information, with usability at the forefront, to continue to grow, especially as the United States faces challenges due to the COVID-19 pandemic. Our recommendation is that anesthesiology programs should strive to improve website usability to increase the ease by which applicants can collect vital information about anesthesiology programs. A few proposed solutions include making changes such as decreasing error pages on websites, migrating away from using in-line cascading style sheets, and improving web page loading speeds to improve the Technology category. ", doi="10.2196/38759", url="https://www.i-jmr.org/2022/2/e38759", url="http://www.ncbi.nlm.nih.gov/pubmed/36264625" } @Article{info:doi/10.2196/40408, author="Melton, A. Chad and White, M. Brianna and Davis, L. Robert and Bednarczyk, A. Robert and Shaban-Nejad, Arash", title="Fine-tuned Sentiment Analysis of COVID-19 Vaccine--Related Social Media Data: Comparative Study", journal="J Med Internet Res", year="2022", month="Oct", day="17", volume="24", number="10", pages="e40408", keywords="sentiment analysis", keywords="DistilRoBERTa", keywords="natural language processing", keywords="social media", keywords="Twitter", keywords="Reddit", keywords="COVID-19", keywords="vaccination", keywords="vaccine", keywords="content analysis", keywords="public health", keywords="surveillance", keywords="misinformation", keywords="infodemiology", keywords="information quality", abstract="Background: The emergence of the novel coronavirus (COVID-19) and the necessary separation of populations have led to an unprecedented number of new social media users seeking information related to the pandemic. Currently, with an estimated 4.5 billion users worldwide, social media data offer an opportunity for near real-time analysis of large bodies of text related to disease outbreaks and vaccination. These analyses can be used by officials to develop appropriate public health messaging, digital interventions, educational materials, and policies. Objective: Our study investigated and compared public sentiment related to COVID-19 vaccines expressed on 2 popular social media platforms---Reddit and Twitter---harvested from January 1, 2020, to March 1, 2022. Methods: To accomplish this task, we created a fine-tuned DistilRoBERTa model to predict the sentiments of approximately 9.5 million tweets and 70 thousand Reddit comments. To fine-tune our model, our team manually labeled the sentiment of 3600 tweets and then augmented our data set through back-translation. Text sentiment for each social media platform was then classified with our fine-tuned model using Python programming language and the Hugging Face sentiment analysis pipeline. Results: Our results determined that the average sentiment expressed on Twitter was more negative (5,215,830/9,518,270, 54.8\%) than positive, and the sentiment expressed on Reddit was more positive (42,316/67,962, 62.3\%) than negative. Although the average sentiment was found to vary between these social media platforms, both platforms displayed similar behavior related to the sentiment shared at key vaccine-related developments during the pandemic. Conclusions: Considering this similar trend in shared sentiment demonstrated across social media platforms, Twitter and Reddit continue to be valuable data sources that public health officials can use to strengthen vaccine confidence and combat misinformation. As the spread of misinformation poses a range of psychological and psychosocial risks (anxiety and fear, etc), there is an urgency in understanding the public perspective and attitude toward shared falsities. Comprehensive educational delivery systems tailored to a population's expressed sentiments that facilitate digital literacy, health information--seeking behavior, and precision health promotion could aid in clarifying such misinformation. ", doi="10.2196/40408", url="https://www.jmir.org/2022/10/e40408", url="http://www.ncbi.nlm.nih.gov/pubmed/36174192" } @Article{info:doi/10.2196/39555, author="Alexander, Shelley and Seenan, Chris", title="Credibility, Accuracy, and Comprehensiveness of Readily Available Internet-Based Information on Treatment and Management of Peripheral Artery Disease and Intermittent Claudication: Review", journal="J Med Internet Res", year="2022", month="Oct", day="17", volume="24", number="10", pages="e39555", keywords="peripheral artery disease", keywords="intermittent claudication", keywords="health information", keywords="education", keywords="internet", keywords="eHealth", keywords="digital health", abstract="Background: Peripheral artery disease (PAD) affects millions of people worldwide, and a core component of management of the condition is self-management. The internet is an important source of health information for many people. However, the content of websites regarding treatment recommendations for PAD has not been fully evaluated. Objective: This study aimed to assess the credibility, accuracy, and comprehensiveness of websites found via a common search engine, by comparing the content to current guidelines for treatment and management of PAD and intermittent claudication (IC). Methods: A review of websites from hospitals, universities, governments, consumer organizations, and professional associations in the United States and the United Kingdom was conducted. Website recommendations for the treatment of PAD and IC were coded in accordance with the guidelines of the National Institute for Health and Care Excellence (NICE) and the American Heart Association (AHA). Primary outcomes were website credibility (4-item Journal of the American Medical Association benchmark), website accuracy (in terms of the percentage of accurate recommendations), and comprehensiveness of website recommendations (in terms of the percentage of guideline recommendations that were appropriately covered). Secondary outcomes were readability (Flesch--Kincaid grade level) and website quality (Health On the Net Foundation's code of conduct). Results: After screening, 62 websites were included in this analysis. Only 45\% (28/62) of websites met the credibility requirement by stating they were updated after the NICE guidelines were published. Declaration of authorship and funding and the presence of reference lists were less commonly reported. Regarding accuracy, 81\% (556/685) of website recommendations were deemed accurate on following NICE's and the AHA's recommendations. Comprehensiveness was low, with an average of 40\% (25/62) of guideline treatment recommendations being appropriately covered by websites. In most cases, readability scores revealed that the websites were too complex for web-based consumer health information. Conclusions: Web-based information from reputable sources about the treatment and management of PAD and IC are generally accurate but have low comprehensiveness, credibility, and readability. ", doi="10.2196/39555", url="https://www.jmir.org/2022/10/e39555", url="http://www.ncbi.nlm.nih.gov/pubmed/36251363" } @Article{info:doi/10.2196/38641, author="Jawad, Danielle and Cheng, Heilok and Wen, Ming Li and Rissel, Chris and Baur, Louise and Mihrshahi, Seema and Taki, Sarah", title="Interactivity, Quality, and Content of Websites Promoting Health Behaviors During Infancy: 6-Year Update of the Systematic Assessment", journal="J Med Internet Res", year="2022", month="Oct", day="7", volume="24", number="10", pages="e38641", keywords="breastfeeding", keywords="bottle feeding", keywords="websites", keywords="web-based platform", keywords="infant food", keywords="readability", keywords="accuracy", keywords="consumer", keywords="health information", keywords="interactivity", keywords="solid food", keywords="quality", keywords="grading", keywords="comprehensibility", keywords="infant", keywords="baby", keywords="babies", keywords="feeding", keywords="food", keywords="eating", keywords="nutrition", keywords="health behavior", keywords="web-based information", keywords="health website", keywords="sleep", keywords="screen time", keywords="rating", abstract="Background: As of 2021, 89\% of the?Australian population are active internet users. Although the internet is widely used, there are concerns about the quality, accuracy, and credibility of health-related websites. A 2015 systematic assessment of infant feeding websites and apps available in Australia found that 61\% of websites were of poor quality and readability, with minimal coverage of infant feeding topics and lack of author credibility. Objective: We aimed to systematically assess the quality, interactivity, readability, and comprehensibility of information targeting infant health behaviors on websites globally and provide an update of the 2015 systematic assessment. Methods: Keywords related to infant milk feeding behaviors, solid feeding behaviors, active play, screen time, and sleep were used to identify websites targeting infant health behaviors on the Google search engine on Safari. The websites were assessed by a subset of the authors using predetermined criteria between July 2021 and February 2022 and assessed for information content based on the Australian Infant Feeding Guidelines and National Physical Activity Recommendations. The Suitability Assessment of Materials, Quality Component Scoring System, the Health-Related Website Evaluation Form, and the adherence to the Health on the Net code were used to evaluate the suitability and quality of information. Readability was assessed using 3 web-based readability tools. Results: Of the 450 websites screened, 66 were included based on the selection criteria and evaluated. Overall, the quality of websites was mostly adequate. Media-related sources, nongovernmental organizations, hospitals, and privately owned websites had the highest median quality scores, whereas university websites received the lowest median score (35\%). The information covered within the websites was predominantly poor: 91\% (60/66) of the websites received an overall score of ?74\% (mean 53\%, SD 18\%). The suitability of health information was mostly rated adequate for literacy demand, layout, and learning and motivation of readers. The median readability score for the websites was grade 8.5, which is higher than the government recommendations (