%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63360 %T Podcasts in Mental, Physical, or Combined Health Interventions for Adults: Scoping Review %A Dascombe,Elizabeth M %A Morgan,Philip J %A Drew,Ryan J %A Regan,Casey P %A Turner-McGrievy,Gabrielle M %A Young,Myles D %+ School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 49216096, myles.young@newcastle.edu.au %K podcast %K mental health %K physical health %K health behavior %K health promotion %K co-design %K end user %K intervention %K scoping review %D 2025 %7 7.5.2025 %9 Review %J J Med Internet Res %G English %X Background: The increasing prevalence of poor mental and physical health in adults is a global health concern. Given the scope of this problem, scalable and effective treatment interventions are needed. While podcasts (online digital audio files) are becoming more popular, the extent of podcast use in mental, physical, or combined health interventions has not been reviewed. Objective: This scoping review primarily aims to summarize the available evidence regarding the use of podcasts in health promotion interventions. A series of 5 research questions was designed to systematically review and accurately represent podcast use in current research interventions. Methods: We conducted a search of electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Scopus, and CENTRAL), gray literature articles, and relevant journals reported in the English language. Eligible studies targeted adults (aged ≥18 y), included a podcast in at least 1 intervention, and measured a mental or physical health outcome. Results: Overall, 51 articles (published studies: n=26, 51% and gray literature articles: n=25, 49%) were deemed eligible. In total, 58% (15/26) of the included peer-reviewed studies were published in the last 5 years, suggesting that the use of podcasts as an intervention approach is increasing. On average, 85.6% (n=2104) of the participants included in these research studies were women. In total, 31% (8/26) of the studies contained a female-only sample. In contrast, no research studies contained a male-only sample. Most peer-reviewed published studies (19/26, 73%) and gray literature sources (22/25, 88%) of the podcasts were used within multicomponent interventions, with most targeting physical health outcomes (peer-reviewed publications: 14/26, 54% and gray literature sources: 13/25, 52%). Results pertaining to podcast design, sources, theoretical principles, and thorough process evaluation indicators were heterogeneous. Conclusions: The versatility that podcasts can offer as a medium for reaching and engaging with participants and end users was evident in this scoping review. While research using podcasts is growing, many (18/26, 69%) studies included in this scoping review were conducted in the United States and sampled female participants, highlighting the need to diversify the field. As expected, there was a high level of variation across the included studies in relation to how podcasts were used and designed within interventions. To address this, a standardized approach would be valuable in guiding researchers and practitioners through both the development and reporting phases of future podcast research, including aspects such as theoretical framework, a description of podcast development (eg, co-design and end-user engagement), objective podcast use, and process evaluation data. %R 10.2196/63360 %U https://www.jmir.org/2025/1/e63360 %U https://doi.org/10.2196/63360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69170 %T Digital Health Literacy of Children and Adolescents and Its Association With Sociodemographic Factors: Representative Study Findings From Germany %A Stauch,Lisa %A Renninger,Denise %A Rangnow,Pia %A Hartmann,Anja %A Fischer,Lisa %A Dadaczynski,Kevin %A Okan,Orkan %+ Department of Sport and Health Sciences, TUM School of Medicine and Health, Technical University of Munich, TUM Campus Olympia Park, Connollystraße 32, Munich, 80809, Germany, 49 89 289 24660, lisa.stauch@tum.de %K digital health literacy %K sociodemographic %K health promotion %K child and adolescent health %K cross-sectional %D 2025 %7 5.5.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 40324766 %R 10.2196/69170 %U https://www.jmir.org/2025/1/e69170 %U https://doi.org/10.2196/69170 %U http://www.ncbi.nlm.nih.gov/pubmed/40324766 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62884 %T Development and Validation of the Media Health Literacy Scale: Assessment Tool Development Study %A Shin,Sangyoon %A Kim,Seungyeon %A Song,Youngshin %A Jeong,Hyesun %A Yu,Yun Mi %A Lee,Euni %+ Research Institute of Pharmaceutical Sciences, Natural Products Research Institute, College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 740 8588, eunilee@snu.ac.kr %K media %K internet %K media health literacy %K ehealth literacy %K survey development %K validation %K health-related information %K communication %D 2025 %7 5.5.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 α. 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 χ2/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 α 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. %M 40323645 %R 10.2196/62884 %U https://www.jmir.org/2025/1/e62884 %U https://doi.org/10.2196/62884 %U http://www.ncbi.nlm.nih.gov/pubmed/40323645 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59037 %T Media Discourse, Influence, and Reflection: Content Analysis and Text-Mining Study of Suicides and Homicides in Long-Term Care %A Wang,Charlotte %A Fang,Hsiu-Ju %A Lu,Hsin-Yang %A Chen,Chen-Fen %+ Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, No 365, Mingde Road, Peitou District, Taipei, 112303, Taiwan, 886 2 28227101 ext 1290, chenfen@ntunhs.edu.tw %K family caregiver %K news framing %K homicide %K suicide %K text mining %D 2025 %7 28.4.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 40293785 %R 10.2196/59037 %U https://www.jmir.org/2025/1/e59037 %U https://doi.org/10.2196/59037 %U http://www.ncbi.nlm.nih.gov/pubmed/40293785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67129 %T A Social Media Study of Portrayals of Bipolar Disorders on YouTube: Content and Thematic Analyses %A Mayor,Eric %A Bietti,Lucas M %+ Department of Psychology, Norwegian University of Science and Technology, Dragvoll Campus, Edvard Bulls veg 1, Trondheim, 7491, Norway, 47 73 59 19 60, lucas.bietti@ntnu.no %K bipolar disorder %K YouTube %K social media %K content analysis %K thematic analysis %D 2025 %7 25.4.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 40279634 %R 10.2196/67129 %U https://www.jmir.org/2025/1/e67129 %U https://doi.org/10.2196/67129 %U http://www.ncbi.nlm.nih.gov/pubmed/40279634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e68724 %T Assessing the Dissemination of Federal Risk Communication by News Media Outlets During Enteric Illness Outbreaks: Canadian Content Analysis %A Shereefdeen,Hisba %A Grant,Lauren Elizabeth %A Patel,Vayshali %A MacKay,Melissa %A Papadopoulos,Andrew %A Cheng,Leslie %A Phypers,Melissa %A McWhirter,Jennifer Elizabeth %K risk communication %K health communication %K enteric illness %K foodborne illness %K zoonotic disease %K media %K content analysis %K health belief model %K public health %K Canada %D 2025 %7 10.4.2025 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/68724 %U https://publichealth.jmir.org/2025/1/e68724 %U https://doi.org/10.2196/68724 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e55065 %T Evolutionary Trend of Dental Health Care Information on Chinese Social Media Platforms During 2018-2022: Retrospective Observational Study %A Zhu,Zhiyu %A Ye,Zhiyun %A Wang,Qian %A Li,Ruomei %A Li,Hairui %A Guo,Weiming %A Li,Zhenxia %A Xia,Lunguo %A Fang,Bing %+ Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No 500, Quxi Rd, Shanghai, 200011, China, 86 021 23271699, fangbing@sjtu.edu.cn %K social media %K dental health education %K natural language processing %K information quality assessment %K dental care %K dental hygiene %K dentistry %K orthodontic %K health care information %K retrospective study %K observational study %K user engagement %K Chinese %K dental practitioner %K WeChat %K health information %K preventive care %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Infodemiology %G English %X 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 [τb]=–0.45, P=.01; WeChat τb=–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. %M 40209216 %R 10.2196/55065 %U https://infodemiology.jmir.org/2025/1/e55065 %U https://doi.org/10.2196/55065 %U http://www.ncbi.nlm.nih.gov/pubmed/40209216 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e59767 %T Online Information About Side Effects and Safety Concerns of Semaglutide: Mixed Methods Study of YouTube Videos %A Yeung,Andy Wai Kan %A Hammerle,Fabian Peter %A Behrens,Sybille %A Matin,Maima %A Mickael,Michel-Edwar %A Litvinova,Olena %A Parvanov,Emil D %A Kletecka-Pulker,Maria %A Atanasov,Atanas G %+ Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, 852, China, 86 28590403, ndyeung@hku.hk %K YouTube %K semaglutide %K social media %K Ozempic %K Wegovy %K Rybelsus %K safety %K knowledge exchange %K side effects %K online information %K online %K videos %K health issues %K drugs %K weight loss %K assessment %K long-term data %K consultation %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 40198905 %R 10.2196/59767 %U https://infodemiology.jmir.org/2025/1/e59767 %U https://doi.org/10.2196/59767 %U http://www.ncbi.nlm.nih.gov/pubmed/40198905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56080 %T Promoting Health Literacy With Human-in-the-Loop Video Understandability Classification of YouTube Videos: Development and Evaluation Study %A Liu,Xiao %A Susarla,Anjana %A Padman,Rema %+ Heinz College of Information Systems and Public Policy, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 412 268 2180, rpadman@andrew.cmu.edu %K patient education %K video analysis %K video understandability %K machine learning %K cotraining %K human-in-the-loop %K augmented intelligence %K artificial intelligence %K AI %D 2025 %7 8.4.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %R 10.2196/56080 %U https://www.jmir.org/2025/1/e56080 %U https://doi.org/10.2196/56080 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e66812 %T Breast Cancer Vlogs on YouTube: Descriptive and Content Analyses %A Morena,Nina %A Htite,Elly Dimya %A Ahisar,Yitzchok %A Hayman,Victoria %A Rentschler,Carrie A %A Meguerditchian,Ari N %K breast cancer vlog %K YouTube %K social media %K experience %K video %K content analysis %K breast %K cancer %K women %K oncology %K descriptive analysis %D 2025 %7 31.3.2025 %9 %J JMIR Infodemiology %G English %X 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. %R 10.2196/66812 %U https://infodemiology.jmir.org/2025/1/e66812 %U https://doi.org/10.2196/66812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56147 %T Use of Mukbang in Health Promotion: Scoping Review %A Wang,Xiao %A Xiao,Yuxue %A Nam,Sujin %A Zhong,Ting %A Tang,Dongyan %A Li,William Ho Cheung %A Song,Peige %A Xia,Wei %+ School of Nursing, Sun Yat-Sen University, North Campus, No 74, 2nd Yat-Sen Road, Yuexiu District, Guangzhou, 510080, China, 86 02087334851, xiaw23@mail.sysu.edu.cn %K mukbang %K health promotion %K eating behaviors %K appetite %K scoping review %D 2025 %7 27.3.2025 %9 Review %J J Med Internet Res %G English %X 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/ %M 40146986 %R 10.2196/56147 %U https://www.jmir.org/2025/1/e56147 %U https://doi.org/10.2196/56147 %U http://www.ncbi.nlm.nih.gov/pubmed/40146986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66683 %T Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study %A Li,Hongmin %A Li,Dongxu %A Zhai,Min %A Lin,Li %A Cao,ZhiHeng %+ School of Public Health, Jining Medical University, No 133 Hehua Road, Taibaihu District, Shandong, Jining, 272067, China, 86 05373616333, lidongxu0602@126.com %K online health information seeking (OHIS) %K online health information perception (OHIP) %K mediating effect %K health service utilization %K health information %K health perception %K data %K China %K Chinese General Social Survey (CGSS) %K database %K medical information %K survey %D 2025 %7 14.3.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=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 (β=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 (β=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. %M 40085841 %R 10.2196/66683 %U https://www.jmir.org/2025/1/e66683 %U https://doi.org/10.2196/66683 %U http://www.ncbi.nlm.nih.gov/pubmed/40085841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58855 %T The Reliability and Quality of Videos as Guidance for Gastrointestinal Endoscopy: Cross-Sectional Study %A Liu,Jinpei %A Qiu,Yifan %A Liu,Yilong %A Xu,Wenping %A Ning,Weichen %A Shi,Peimei %A Yuan,Zongli %A Wang,Fang %A Shi,Yihai %+ Department of Gastroenterology, Gongli Hospital of Shanghai Pudong New Area, Pudong New Area 219 Miaopu Road, Shanghai, 200135, China, 86 5885873, syh01206@163.com %K gastrointestinal endoscopy %K YouTube %K patient education %K social media gastrointestinal %K large language model %K LLM %K reliability %K quality %K video %K cross-sectional study %K endoscopy-related videos %K health information %K endoscopy %K gastroscopy %K colonoscopy %D 2025 %7 11.3.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 40068165 %R 10.2196/58855 %U https://www.jmir.org/2025/1/e58855 %U https://doi.org/10.2196/58855 %U http://www.ncbi.nlm.nih.gov/pubmed/40068165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64307 %T Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study %A Shao,Anqi %A Chen,Kaiping %A Johnson,Branden %A Miranda,Shaila %A Xing,Qidi %+ Department of Life Sciences Communication, University of Wisconsin - Madison, 1545 Observatory Drive, Madison, WI, 53706, United States, 1 6083389939, anqi.shao@wisc.edu %K risk communication %K panel study %K computational method %K intermedia agenda setting %K protective behaviors %K infectious disease %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=.057; P<.001 for household benefits; β=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks (β=–.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. %M 40063934 %R 10.2196/64307 %U https://www.jmir.org/2025/1/e64307 %U https://doi.org/10.2196/64307 %U http://www.ncbi.nlm.nih.gov/pubmed/40063934 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e66634 %T Identifying Strategies for Home Management of Ostomy Care: Content Analysis of YouTube %A Haughey,Marketa %A Neyens,David M %A Hopkins,Casey S %A Gonzaga,Christofer %A Harman,Melinda %+ Department of Bioengineering, Clemson University, 301 Rhodes Engineering Research Center, Clemson, SC, 29634, United States, 1 8646564140, harman2@clemson.edu %K medical device usability %K digital health %K online support groups %K living with chronic medical conditions %K ostomy self-care %K YouTube %K patient education %K user needs assessment %K users experience %K social media %K ostomates %K colostomy %K ileostomy %K usability %K usefulness %K utility %K wearable device %K medical device %K support group %K socials %K social network %K ostomy %K digital %K digital technology %K digital intervention %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 40053741 %R 10.2196/66634 %U https://humanfactors.jmir.org/2025/1/e66634 %U https://doi.org/10.2196/66634 %U http://www.ncbi.nlm.nih.gov/pubmed/40053741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59387 %T Engagement With and Use of Health Information on Social Media Among US Latino Individuals: National Cross-Sectional Survey Study %A Rivera,Yonaira M %A Corpuz,Kathryna %A Karver,Tahilin Sanchez %+ Department of Communication, School of Communication and Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901, United States, 1 8489327612, yonaira.rivera@rutgers.edu %K Latinos %K health misinformation %K engagement %K utilization %K social media %K health information %K United States %K national %K trends %K survey %K pandemic %K non-Latino whites %D 2025 %7 24.2.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39993286 %R 10.2196/59387 %U https://www.jmir.org/2025/1/e59387 %U https://doi.org/10.2196/59387 %U http://www.ncbi.nlm.nih.gov/pubmed/39993286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53087 %T Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study %A Krewulak,Karla %A Strayer,Kathryn %A Jaworska,Natalia %A Spence,Krista %A Foster,Nadine %A Kupsch,Scotty %A Sauro,Khara %A Fiest,Kirsten M %+ , Department of Critical Care Medicine, University of Calgary, MT 04111, 3260 Hospital Drive NW, Calgary, AB, , Canada, 1 9448768, kmfiest@ucalgary.ca %K education %K health information %K internet %K delirium %K patient %K caregiver %K brain lesions %K confusion %K inattentiveness %K disorientation %K family education %K information seeking %K readability %K high-quality websites %K accessibility %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39977019 %R 10.2196/53087 %U https://www.jmir.org/2025/1/e53087 %U https://doi.org/10.2196/53087 %U http://www.ncbi.nlm.nih.gov/pubmed/39977019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66446 %T Spatiotemporal Characteristics and Influential Factors of Electronic Cigarette Web-Based Attention in Mainland China: Time Series Observational Study %A Zhang,Zhongmin %A Xu,Hengyi %A Pan,Jing %A Song,Fujian %A Chen,Ting %+ Healthy Hubei Development and Social Progress Research Center of the Key Research Base of Humanities and Social Sciences in Hubei Province, School of Public Health, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan, 430065, China, 86 18120237582, chent41@wust.edu.cn %K electronic cigarettes %K Baidu index %K web-based attention %K spatiotemporal characteristics %K China %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39928402 %R 10.2196/66446 %U https://www.jmir.org/2025/1/e66446 %U https://doi.org/10.2196/66446 %U http://www.ncbi.nlm.nih.gov/pubmed/39928402 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e58615 %T Assessment of Reliability and Validity of Celiac Disease–Related YouTube Videos: Content Analysis %A Polat,Yunus Halil %A Cankurtaran,Rasim Eren %+ Department of Gastroenterology, Ankara Training and Research Hospital, bağlıca neighbourhood 1336 street no:7/7 Etimesgut, PO:06870, Ankara, 06870, Turkey, 90 5556801815, yunushpolat@gmail.com %K gastroenterology %K celiac %K YouTube %K internet-based information %K medical information %K health-related %K reliability %K validity %K quality %K videos %K celiac sprue %K sprue %K gluten enteropathy %K cross-sectional %D 2025 %7 4.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 39756057 %R 10.2196/58615 %U https://infodemiology.jmir.org/2025/1/e58615 %U https://doi.org/10.2196/58615 %U http://www.ncbi.nlm.nih.gov/pubmed/39756057 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55275 %T Evaluating Reaction Videos of Young People Watching Edutainment Media (MTV Shuga): Qualitative Observational Study %A Baker,Venetia %A Mulwa,Sarah %A Khanyile,David %A Arnold,Georgia %A Cousens,Simon %A Cawood,Cherie %A Birdthistle,Isolde %+ Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 020 7636 8636, venetia.baker1@lshtm.ac.uk %K mass media %K edutainment %K adolescents %K sexual health %K HIV prevention %K participatory research %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39889281 %R 10.2196/55275 %U https://formative.jmir.org/2025/1/e55275 %U https://doi.org/10.2196/55275 %U http://www.ncbi.nlm.nih.gov/pubmed/39889281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66896 %T Assessing the Adherence of ChatGPT Chatbots to Public Health Guidelines for Smoking Cessation: Content Analysis %A Abroms,Lorien C %A Yousefi,Artin %A Wysota,Christina N %A Wu,Tien-Chin %A Broniatowski,David A %+ Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, United States, 1 202 9943518, lorien@gwu.edu %K ChatGPT %K large language models %K chatbots %K tobacco %K smoking cessation %K cigarettes %K artificial intelligence %D 2025 %7 30.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39883917 %R 10.2196/66896 %U https://www.jmir.org/2025/1/e66896 %U https://doi.org/10.2196/66896 %U http://www.ncbi.nlm.nih.gov/pubmed/39883917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64993 %T Accuracy and Safety of AI-Enabled Scribe Technology: Instrument Validation Study %A Biro,Joshua %A Handley,Jessica L %A Cobb,Nathan K %A Kottamasu,Varsha %A Collins,Jeffrey %A Krevat,Seth %A Ratwani,Raj M %+ , National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St NW, Washington, DC, 20008, United States, 1 3015423073, joshua.m.biro@medstar.net %K artificial intelligence %K AI %K patient safety %K ambient digital scribe %K AI-enabled scribe technology %K AI scribe technology %K scribe technology %K accuracy %K safety %K ambient scribe %K digital scribe %K patient-clinician %K patient-clinician communication %K doctor-patient relationship %K doctor-patient communication %K patient engagement %K patient safety %K dialogue script %K scribe %D 2025 %7 27.1.2025 %9 Research Letter %J J Med Internet Res %G English %X Artificial intelligence–enabled ambient digital scribes may have many potential benefits, yet results from our study indicate that there are errors that must be evaluated to mitigate safety risks. %M 39869899 %R 10.2196/64993 %U https://www.jmir.org/2025/1/e64993 %U https://doi.org/10.2196/64993 %U http://www.ncbi.nlm.nih.gov/pubmed/39869899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58310 %T From Stories to Solutions: A Research Cycle Framework for Enhancing Trustworthiness in Studies of Online Patient Narratives %A Lamprell,Klay %A Pulido,Diana Fajardo %A Arnolda,Gaston %A Easpaig,Bróna Nic Giolla %A Tran,Yvonne %A Braithwaite,Jeffrey %+ Macquarie University, Australian Institute of Health Innovations, Level 6, 75 Talavera Rd, North Ryde, Sydney, 2109, Australia, 61 02 9850 2455, klay.lamprell@mq.edu.au %K online research %K exploratory study %K patient experience %K patient narratives %K narrative analysis %K mixed methods %K young-onset colorectal cancer %K cancer %K oncology %K internal medicine %D 2025 %7 23.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X Personal accounts of health care experiences posted to online platforms are a rich source of patient-reported data. Noninteractive narratives, published as one-off accounts, often describe an entire patient journey in one story, featuring transitions through health care settings from prediagnosis to outcome. These coherent perspectives may not be visible or captured in fragmented social media posts or episodic blogs. For researchers seeking patient-reported accounts of care quality across a clinical trajectory, noninteractive online narratives can be an invaluable, easily accessible resource. The challenges and limitations of research utilizing these data may differ from working with interactive patient narratives and include source transparency and credibility, limited or no information about authors, and ambiguity about the health care context and time frames. We outline a framework for addressing these issues in 5 key phases of the research cycle: the conceptual-theoretical approach; locating sources of data; accessing and collecting the data; quantitative profiling to establish demographics, health care events, and time frames; and qualitative analysis utilizing multiple modes of narrative inquiry. We explain the use of this framework in a real-world example: our study of 273 online patient narratives describing health care trajectories in early-onset bowel cancer.International Registered Report Identifier (IRRID): RR2-10.2196/25056 %M 39847425 %R 10.2196/58310 %U https://www.jmir.org/2025/1/e58310 %U https://doi.org/10.2196/58310 %U http://www.ncbi.nlm.nih.gov/pubmed/39847425 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e41175 %T Digital Health Intervention (SANGYAN Podcast) to Enhance Knowledge Related to COVID-19 and Other Health Conditions: Protocol for an Implementation and Evaluation Study %A Joshi,Ashish %A Mohan,Surapaneni Krishna %A Pandya,Apurva Kumar %A Grover,Ashoo %A Saggu,Sofia Rani %A Revathi,Saravanavel Kalpana %A Sharma,Shruti %+ , School of Public Health, University of Memphis, Robison Hall 3825 DeSoto Avenue, Memphis, TN, 38152, United States, 1 443 570 6018, ashish1875@gmail.com %K podcast %K human-centered behavior %K pandemic %K coronavirus %K intervention %K digital health %K usefulness %K effectiveness %K usability %D 2025 %7 20.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39832172 %R 10.2196/41175 %U https://www.researchprotocols.org/2025/1/e41175 %U https://doi.org/10.2196/41175 %U http://www.ncbi.nlm.nih.gov/pubmed/39832172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63489 %T Evaluating Online and Offline Health Information With the Patient Education Materials Assessment Tool: Protocol for a Systematic Review %A Furukawa,Emi %A Okuhara,Tsuyoshi %A Liu,Mingxin %A Okada,Hiroko %A Kiuchi,Takahiro %+ , University hospital Medical Information Network (UMIN) Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9754, efurukawa-tho@umin.ac.jp %K patient education %K health communication %K health information %K behavior change %K understandability %K actionability Patient Education Materials Assessment Tool %K PEMAT %K medical information %K health literacy %K patient education materials %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39813665 %R 10.2196/63489 %U https://www.researchprotocols.org/2025/1/e63489 %U https://doi.org/10.2196/63489 %U http://www.ncbi.nlm.nih.gov/pubmed/39813665 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53057 %T Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study %A Isaac,Sarah Mohsen %A Dawes,Mark %A Howell,Emily Ruth %A Oladipo,Antonia Francis %K OBGYN %K transgender %K nonbinary %K pregnancy %K maternity %K transmasculine %K observational study %K gestational %K perinatal care %K communication %K labor %K USA %K United States %K New York City %K sexual orientation %K inclusion %K parents %K obstetrician gynecologist %K delivery %D 2025 %7 6.1.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/53057 %U https://humanfactors.jmir.org/2025/1/e53057 %U https://doi.org/10.2196/53057 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64343 %T “Crying in the Wilderness”—The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis %A Pearce,Emily Eidenier %A Majid,Alina %A Brown,Toniya %A Shepherd,Rowan Forbes %A Rising,Camella %A Wilsnack,Catherine %A Thompson,Ashley S %A Gilkey,Melissa B %A Ribisl,Kurt M %A Lazard,Allison J %A Han,Paul KJ %A Werner-Lin,Allison %A Hutson,Sadie P %A Savage,Sharon A %+ Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 6E578, Rockville, MD, 20850, United States, 1 919 699 2547, emily.pearce@nih.gov %K social media %K dyskeratosis congenita %K telomere biology disorder %K health communication %K qualitative %K thematic analysis %K web-based information %K web-based support %K telomere %K biology disorder %K social support %K emotional support %K genetic %K internet-based %K information-seeking %K descriptive study %K semistructured interview %K adult %K illness experience %K psychosocial %K digital health %K health intervention %K health informatics %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39680438 %R 10.2196/64343 %U https://formative.jmir.org/2024/1/e64343 %U https://doi.org/10.2196/64343 %U http://www.ncbi.nlm.nih.gov/pubmed/39680438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60033 %T Quality of Pancreatic Neuroendocrine Tumor Videos Available on TikTok and Bilibili: Content Analysis %A Niu,Zheyu %A Hao,Yijie %A Yang,Faji %A Jiang,Qirong %A Jiang,Yupeng %A Zhang,Shizhe %A Song,Xie %A Chang,Hong %A Zhou,Xu %A Zhu,Huaqiang %A Gao,Hengjun %A Lu,Jun %K pancreatic neuroendocrine tumors %K short videos %K quality analysis %K TikTok %K Bilibili %K social media %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/60033 %U https://formative.jmir.org/2024/1/e60033 %U https://doi.org/10.2196/60033 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51701 %T Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach %A Almenara,Carlos A %A Gulec,Hayriye %+ School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos 11, Lima, 15067, Peru, 51 3133333 ext 2803, carlos.almenara@upc.pe %K consumer health informatics %K cyberattack risk %K data mining %K Google %K information seeking %K weight loss %K online health information %K website analysis %K digital health %K internet search %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 39661980 %R 10.2196/51701 %U https://infodemiology.jmir.org/2024/1/e51701 %U https://doi.org/10.2196/51701 %U http://www.ncbi.nlm.nih.gov/pubmed/39661980 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60283 %T Alternative Health and Conventional Medicine Discourse About Cancer on TikTok: Computer Vision Analysis of TikTok Videos %A Muenster,Roxana Mika %A Gangi,Kai %A Margolin,Drew %+ Department of Communication, Cornell University, 450 Mann Library, 237 Mann Drive, Ithaca, NY, 14853, United States, 1 (607) 255 2601, rm858@cornell.edu %K misinformation %K social media %K TikTok %K alternative health %K cancer %K computer vision %D 2024 %7 9.12.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39652864 %R 10.2196/60283 %U https://www.jmir.org/2024/1/e60283 %U https://doi.org/10.2196/60283 %U http://www.ncbi.nlm.nih.gov/pubmed/39652864 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63281 %T Health-Related Messages About Herbs, Spices, and Other Botanicals Appearing in Print Issues and Websites of Legacy Media: Content Analysis and Evaluation %A Gaba,Ann %A Bennett,Richard %+ Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, United States, 1 (646) 364 9512, Ann.Gaba@sph.cuny.edu %K legacy media %K health applications %K health communication %K botanical products %K content analysis %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39631062 %R 10.2196/63281 %U https://formative.jmir.org/2024/1/e63281 %U https://doi.org/10.2196/63281 %U http://www.ncbi.nlm.nih.gov/pubmed/39631062 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e63410 %T Extent and Nature of Television Food and Nonalcoholic Beverage Marketing in 9 Asian Countries: Cross-Sectional Study Using a Harmonized Approach %A Karupaiah,Tilakavati %A Rahman,Shah Md Mahfuzur %A Zhang,Juan %A Kumar,Naveen %A Jamiyan,Batjargal %A Pokharel,Raj Kumar %A Borazon,Elaine Quintana %A Thoradeniya,Tharanga %A Tho,Nguyen Thi Thi %A Mackay,Sally %A Kelly,Bridget %A Swinburn,Boyd %A Chinna,Karuthan %A Dashzeveg,Enkhmyagmar %A Ong,Gild Rick %A Narayanan,Sreelakshmi Sankara %A Sameeha,Mohd Jamil %A Uddin,Mohammad Ahsan %A Tang,Yuxiang %A Sharma,Naresh Kumar %A Pokharel,Rishav %A Rome,Anna Christine %A Wickramasinghe,V Pujitha %A Huy,Phan Thanh %+ School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 1, Jln Taylors, Subang Jaya, 47500, Malaysia, 60 192731400, tilakavati.karupaiah@taylors.edu.my %K children %K Asian food marketing %K television %K unhealthy food %K WHO nutrient profile model %K World Health Organization %K pediatrics %K commercial %K Asia %K unhealthy %K nutrition %K diet %K market %K advertisement %K food %K beverage %K consumption %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 39630493 %R 10.2196/63410 %U https://pediatrics.jmir.org/2024/1/e63410 %U https://doi.org/10.2196/63410 %U http://www.ncbi.nlm.nih.gov/pubmed/39630493 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53440 %T 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 %A Blank,Carol Ann %A Biedka,Sarah %A Montalmant,Abigail %A Saft,Katelyn %A Lape,Miranda %A Mao,Kate %A Bradt,Joke %A Liou,Kevin T %K music-based interventions %K cancer %K oncology %K symptom management %K music therapy %K music services %K National Cancer Institute %D 2024 %7 22.11.2024 %9 %J JMIR Cancer %G English %X 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. %R 10.2196/53440 %U https://cancer.jmir.org/2024/1/e53440 %U https://doi.org/10.2196/53440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58088 %T Toward Guidelines for Designing Holistic Integrated Information Visualizations for Time-Critical Contexts: Systematic Review %A Patel,Ahmed Mohammed %A Baxter,Weston %A Porat,Talya %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington, London, SW7 2DB, United Kingdom, 44 07990035581, ap19@ic.ac.uk %K visualization %K design %K holistic %K integrated %K time-critical %K guidelines %K pre-attentive processing %K gestalt theory %K situation awareness %K decision-making %K mobile phone %D 2024 %7 20.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39566050 %R 10.2196/58088 %U https://www.jmir.org/2024/1/e58088 %U https://doi.org/10.2196/58088 %U http://www.ncbi.nlm.nih.gov/pubmed/39566050 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49761 %T #TraumaTok—TikTok Videos Relating to Trauma: Content Analysis %A Woolard,Alix %A Paciente,Rigel %A Munro,Emily %A Wickens,Nicole %A Wells,Gabriella %A Ta,Daniel %A Mandzufas,Joelie %A Lombardi,Karen %+ The Kids Research Institute Australia, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 63191823, alix.woolard@thekids.org.au %K trauma %K traumatic events %K traumatic stress %K TikTok %K public health %K social media %K content analysis %D 2024 %7 7.11.2024 %9 Short Paper %J JMIR Form Res %G English %X 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. %M 39509697 %R 10.2196/49761 %U https://formative.jmir.org/2024/1/e49761 %U https://doi.org/10.2196/49761 %U http://www.ncbi.nlm.nih.gov/pubmed/39509697 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64221 %T Video Abstracts in Research %A Nachman,Sophie %A Ortiz-Prado,Esteban %A Tucker,Joseph D %+ Institute for Global Health and Infectious Diseases, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC, 27599, United States, 1 9199662536, jdtucker@med.unc.edu %K video abstract %K abstract %K dissemination %K public engagement %K online %K videos %K public audience %K communication %K infographics %K health literacy %K patient education %K public health %D 2024 %7 4.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X Video abstracts can be useful in health research. A video abstract provides key messages about a research article and can increase public engagement, spark conversations, and may increase academic attention. A growing number of open source software programs make it easier to develop a video abstract. This viewpoint provides practical tips for creating a video abstract for health research. %M 39496154 %R 10.2196/64221 %U https://www.jmir.org/2024/1/e64221 %U https://doi.org/10.2196/64221 %U http://www.ncbi.nlm.nih.gov/pubmed/39496154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60291 %T Accuracy of Prospective Assessments of 4 Large Language Model Chatbot Responses to Patient Questions About Emergency Care: Experimental Comparative Study %A Yau,Jonathan Yi-Shin %A Saadat,Soheil %A Hsu,Edmund %A Murphy,Linda Suk-Ling %A Roh,Jennifer S %A Suchard,Jeffrey %A Tapia,Antonio %A Wiechmann,Warren %A Langdorf,Mark I %+ Department of Emergency Medicine, University of California - Irvine, 101 the City Drive, Route 128-01, Orange, CA, 92868, United States, 1 7147452663, milangdo@hs.uci.edu %K artificial intelligence %K AI %K chatbots %K generative AI %K natural language processing %K consumer health information %K patient education %K literacy %K emergency care information %K chatbot %K misinformation %K health care %K medical consultation %D 2024 %7 4.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %R 10.2196/60291 %U https://www.jmir.org/2024/1/e60291 %U https://doi.org/10.2196/60291 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60939 %T Ensuring Accuracy and Equity in Vaccination Information From ChatGPT and CDC: Mixed-Methods Cross-Language Evaluation %A Joshi,Saubhagya %A Ha,Eunbin %A Amaya,Andee %A Mendoza,Melissa %A Rivera,Yonaira %A Singh,Vivek K %+ School of Communication & Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 848 932 7588, v.singh@rutgers.edu %K vaccination %K health equity %K multilingualism %K language equity %K health literacy %K online health information %K conversational agents %K artificial intelligence %K large language models %K health information %K public health %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39476380 %R 10.2196/60939 %U https://formative.jmir.org/2024/1/e60939 %U https://doi.org/10.2196/60939 %U http://www.ncbi.nlm.nih.gov/pubmed/39476380 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51655 %T Videos in Short-Video Sharing Platforms as Sources of Information on Colorectal Polyps: Cross-Sectional Content Analysis Study %A Guan,Jia-Lun %A Xia,Su-Hong %A Zhao,Kai %A Feng,Li-Na %A Han,Ying-Ying %A Li,Ji-Yan %A Liao,Jia-Zhi %A Li,Pei-Yuan %+ Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China, 86 27 83662831, pyli@tjh.tjmu.edu.cn %K colorectal polyps %K short videos %K health information %K quality assessment %K reliability %D 2024 %7 29.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 “肠息肉” (intestinal polyps) or “结肠息肉” (colonic polyps) or “直肠息肉” (rectal polyps) or “结直肠息肉” (colorectal polyps) or “大肠息肉” (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. %M 39470708 %R 10.2196/51655 %U https://www.jmir.org/2024/1/e51655 %U https://doi.org/10.2196/51655 %U http://www.ncbi.nlm.nih.gov/pubmed/39470708 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57720 %T Oral Diabetes Medication Videos on Douyin: Analysis of Information Quality and User Comment Attitudes %A Zhang,Baolu %A Kalampakorn,Surintorn %A Powwattana,Arpaporn %A Sillabutra,Jutatip %A Liu,Gang %+ Department of Public Health Nursing, Faculty of Public Health, Mahidol University, 420/1 Rajavithi Rd, Bangkok, 10400, Thailand, 66 96 646 2696, surintorn.kal@mahidol.ac.th %K diabetes %K oral diabetes medication %K information quality %K user comment attitude %K video analysis %K Douyin %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39423367 %R 10.2196/57720 %U https://formative.jmir.org/2024/1/e57720 %U https://doi.org/10.2196/57720 %U http://www.ncbi.nlm.nih.gov/pubmed/39423367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54135 %T Online Health Information Seeking, eHealth Literacy, and Health Behaviors Among Chinese Internet Users: Cross-Sectional Survey Study %A Liu,Diyi %A Yang,Shuhang %A Cheng,Calvin Yixiang %A Cai,Lin %A Su,Jing %+ School of Humanities, Tsinghua University, 314A7 Mingli Building, Beijing, 100084, China, 86 13520625867, sujingxw@tsinghua.edu.cn %K eHealth literacy %K online health information seeking %K health behavior %K perceived information quality %K health promotion %K China %K mobile phone %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ2404=4183.6, χ2404=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. %M 39423374 %R 10.2196/54135 %U https://www.jmir.org/2024/1/e54135 %U https://doi.org/10.2196/54135 %U http://www.ncbi.nlm.nih.gov/pubmed/39423374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57698 %T The Quality and Cultural Safety of Online Osteoarthritis Information for Affected Persons and Health Care Professionals: Content Analysis %A Dhakal,Smita %A Merani,Shermeen %A Ahluwalia,Vandana %A Battistella,Marisa %A Borkhoff,Cornelia M %A Hazlewood,Glen Stewart %A Lofters,Aisha %A Marshall,Deborah A %A MacKay,Crystal %A Gagliardi,Anna R %+ University Health Network, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada, 1 416 340 4800, anna.gagliardi@uhnresearch.ca %K osteoarthritis %K women’s health %K equity %K educational materials %K internet %K content analysis %K Canada %K persons living with osteoarthritis %K healthcare professionals %K OA care %K ethno-culturally women %K immigrant women %K diverse women %K online materials %K health information %K prevention %K management %K misinformation %K cultural safety %K educational materials %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39422989 %R 10.2196/57698 %U https://www.jmir.org/2024/1/e57698 %U https://doi.org/10.2196/57698 %U http://www.ncbi.nlm.nih.gov/pubmed/39422989 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62807 %T Virtual Reality–Based Food and Beverage Marketing: Potential Implications for Young People of Color, Knowledge Gaps, and Future Research Directions %A Cassidy,Omni %A Bragg,Marie %A Elbel,Brian %K virtual reality %K VR %K digital food and beverage marketing %K obesity %K marketing %K food %K consumption %K beverage %K immersive %K market %K consumer %D 2024 %7 17.10.2024 %9 %J JMIR Public Health Surveill %G English %X Exposure to unhealthy food and beverage marketing is a major contributor to excessive weight gain among young people and it may disproportionately affect Black and Latinx communities. Appropriate and comprehensive regulations on food and beverage companies are essential, particularly as companies expand their reach and leverage the latest technologies to create marketing experiences using immersive virtual reality (VR). Although immersive VR technology is in its infancy, the potential effects of immersive VR food and beverage marketing on consumption, coupled with the history of racially targeted marketing by food and beverage corporations toward Black and Latinx communities, and the heightened burden of diet-related illnesses in Black and Latinx communities underscore a critical need to investigate immersive VR marketing targeting young people of color. This viewpoint will provide a brief description of VR food and beverage marketing as the newest food and beverage marketing frontier, highlight key concerns and knowledge gaps, and underscore future directions in research. %R 10.2196/62807 %U https://publichealth.jmir.org/2024/1/e62807 %U https://doi.org/10.2196/62807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50057 %T Impact of Concurrent Media Exposure on Professional Identity: Cross-Sectional Study of 1087 Medical Students During Long COVID %A Wu,Manli %A Yan,Jun %A Qiao,Chongming %A Yan,Chu %+ School of Journalism and Information Communication, Huazhong University of Science and Technology, School of Journalism and Information Communication, HUST, Number 1037, Luoyu Road, Wuhan, 430074, China, 86 18971629738, junyan@hust.edu.cn %K COVID-19 %K media exposure %K social support %K professional identity %K medical students %K Stimulus-Organism-Response framework %D 2024 %7 17.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=.163; P<.001) and emotional support (β=.084; P=.007). Similarly, social media exposure showed positive associations with informational support (β=.122; P<.001) and emotional support (β=.235; P<.001). Thereafter, informational support (β=.228; P<.001) and emotional support (β=.344; P<.001) were positively associated with students’ sense of belonging. Meanwhile, both informational support (β=.245; P<.001) and emotional support (β=.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. %M 39418080 %R 10.2196/50057 %U https://www.jmir.org/2024/1/e50057 %U https://doi.org/10.2196/50057 %U http://www.ncbi.nlm.nih.gov/pubmed/39418080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56354 %T Selling Misleading “Cancer Cure” Books on Amazon: Systematic Search on Amazon.com and Thematic Analysis %A Zenone,Marco %A van Schalkwyk,May %A Hartwell,Greg %A Caulfield,Timothy %A Maani,Nason %+ Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, marco.zenone@lshtm.ac.uk %K cancer %K Amazon %K misinformation %K e-commerce %K cancer cure %K cancer misinformation %K misleading %K cancer information %K treatment %K cancer treatment %K thematic analysis %K misleading %K online information %D 2024 %7 8.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39378429 %R 10.2196/56354 %U https://www.jmir.org/2024/1/e56354 %U https://doi.org/10.2196/56354 %U http://www.ncbi.nlm.nih.gov/pubmed/39378429 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e58378 %T 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 %A Chimukuche,Rujeko Samanthia %A Ndlazi,Julia %A Mtolo,Lucky Thembani %A Bird,Kristien %A Seeley,Janet %+ Social Sciences Core, Africa Health Research Institute, Nelson R Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Durban, 4013, South Africa, 27 31 521 0038, rujeko.chidawanyika@ahri.org %K drug advertising %K internet %K social media %K ethical guidelines %K traditional medicine %K COVID-19 %D 2024 %7 18.9.2024 %9 Original Paper %J Online J Public Health Inform %G English %X 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. %M 39293046 %R 10.2196/58378 %U https://ojphi.jmir.org/2024/1/e58378 %U https://doi.org/10.2196/58378 %U http://www.ncbi.nlm.nih.gov/pubmed/39293046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56854 %T Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis %A Ho,Shirley S %A Chuah,Agnes S F %A Ho,Vanessa S %A Rosenthal,Sonny %A Kim,Hye Kyung %A Soh,Shannon S H %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, WKWSCI Building, 31 Nanyang Link, Singapore, 637718, Singapore, tsyho@ntu.edu.sg %K COVID-19 %K crisis and emergency risk communication %K CERC %K emotional appeal %K content analysis %K public health %K Facebook %K social media %K Singapore %D 2024 %7 17.9.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39288399 %R 10.2196/56854 %U https://www.jmir.org/2024/1/e56854 %U https://doi.org/10.2196/56854 %U http://www.ncbi.nlm.nih.gov/pubmed/39288399 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48257 %T Quality Measurement of Consumer Health Questions: Content and Language Perspectives %A Alasmari,Ashwag %A Zhou,Lina %+ Computer Science Department, King Khalid University, King Khalid Road, Guraiger, Abha, 61421, Saudi Arabia, 966 2418000, aasmry@kku.edu.sa %K question quality %K quality measurement %K health questions %K %K information needs %K information behavior %K information sharing %K consumer %K health information %K health information consumers %K quality %D 2024 %7 12.9.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39265162 %R 10.2196/48257 %U https://www.jmir.org/2024/1/e48257 %U https://doi.org/10.2196/48257 %U http://www.ncbi.nlm.nih.gov/pubmed/39265162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47562 %T Quality of Male and Female Medical Content on English-Language Wikipedia: Quantitative Content Analysis %A Farič,Nuša %A Potts,Henry WW %A Heilman,James M %+ University College London, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 0207679200, h.potts@ucl.ac.uk %K Wikipedia %K wikis %K writing %K internet %K health information %K sex %K sex bias %K consumer health information %K health communication %K public education %K social media %D 2024 %7 12.9.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %R 10.2196/47562 %U https://www.jmir.org/2024/1/e47562 %U https://doi.org/10.2196/47562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51513 %T The Quality of Short Videos as a Source of Coronary Heart Disease Information on TikTok: Cross-Sectional Study %A Gong,Xun %A Chen,Meijuan %A Ning,Lihong %A Zeng,Lingzhong %A Dong,Bo %+ Department of Cardiology and Cardiac Rehabilitation Center, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61 West Jiefang Road, Furong District, Changsha, China, 86 18874832298, dt2008bj@sina.com %K coronary heart disease %K content quality %K social media %K short-video platform %K TikTok %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39226540 %R 10.2196/51513 %U https://formative.jmir.org/2024/1/e51513 %U https://doi.org/10.2196/51513 %U http://www.ncbi.nlm.nih.gov/pubmed/39226540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54072 %T Assessment of the Quality and Readability of Web-Based Arabic Health Information on Halitosis: Infodemiological Study %A Aboalshamat,Khalid %+ Preventative Dentistry Department, College of Dental Medicine, Umm Al-Qura University, Taif Road, Makkah, 21955, Saudi Arabia, 966 125270000, ktaboalshamat@uqu.edu.sa %K halitosis %K bad breath %K malodor, Arabic web-based %K infodemiological study %K oral malodor %K readability %K infodemiology %K health information %K Arabic mouth medical information %K reliable information %K odor treatment %D 2024 %7 28.8.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39196637 %R 10.2196/54072 %U https://www.jmir.org/2024/1/e54072 %U https://doi.org/10.2196/54072 %U http://www.ncbi.nlm.nih.gov/pubmed/39196637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55535 %T Evaluation of the Quality and Readability of Web-Based Information Regarding Foreign Bodies of the Ear, Nose, and Throat: Qualitative Content Analysis %A Ko,Tsz Ki %A Tan,Denise Jia Yun %A Fan,Ka Siu %+ Department of Surgery, Royal Stoke Hospital, Newcastle Road, Stoke, United Kingdom, 44 7378977812, tszkiko95@gmail.com %K foreign body %K quality of internet information %K readability of internet information %K EQIP %K Ensuring Quality Information for Patients %K medical informatics %K readability %K readable %K health information %K online information %K information resource %K information resources %K website %K websites %K quality %K evaluation %K evaluations %K reading level %K grade level %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39145998 %R 10.2196/55535 %U https://formative.jmir.org/2024/1/e55535 %U https://doi.org/10.2196/55535 %U http://www.ncbi.nlm.nih.gov/pubmed/39145998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55937 %T Cancer Prevention and Treatment on Chinese Social Media: Machine Learning–Based Content Analysis Study %A Zhao,Keyang %A Li,Xiaojing %A Li,Jingyang %+ School of Media & Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd., Minhang District, Shanghai, 200240, China, 86 13918611103, lixiaojing@sjtu.edu.cn %K social media %K cancer information %K text mining %K supervised machine learning %K content analysis %D 2024 %7 14.8.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39141911 %R 10.2196/55937 %U https://www.jmir.org/2024/1/e55937 %U https://doi.org/10.2196/55937 %U http://www.ncbi.nlm.nih.gov/pubmed/39141911 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57823 %T Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany %A Erbas,Mert Ege %A Ziehfreund,Stefanie %A Wecker,Hannah %A Biedermann,Tilo %A Zink,Alexander %+ Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Biedersteiner Str 29, Munich, 80802, Germany, 49 8941403176, alexander.zink@tum.de %K psoriasis %K dermatology %K digital health %K digital media %K internet use %K questionnaire %K physician-patient relationship %D 2024 %7 7.8.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39110972 %R 10.2196/57823 %U https://www.jmir.org/2024/1/e57823 %U https://doi.org/10.2196/57823 %U http://www.ncbi.nlm.nih.gov/pubmed/39110972 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e51740 %T How to Develop an Online Video for Teaching Health Procedural Skills: Tutorial for Health Educators New to Video Production %A Srinivasa,Komal %A Charlton,Amanda %A Moir,Fiona %A Goodyear-Smith,Felicity %+ Department of General Practice & Primary Health Care, The University of Auckland, Private Bag 92019, Auckland, 1010, New Zealand, 64 9 923 1975, komal.srinivasa@auckland.ac.nz %K online video %K developing video %K procedural video %K medical education %K clinician educator %K health education %D 2024 %7 7.8.2024 %9 Tutorial %J JMIR Med Educ %G English %X 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. %M 39110488 %R 10.2196/51740 %U https://mededu.jmir.org/2024/1/e51740 %U https://doi.org/10.2196/51740 %U http://www.ncbi.nlm.nih.gov/pubmed/39110488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52058 %T A Multidimensional Approach for Evaluating Reality in Social Media: Mixed Methods Study %A Cho,HyunYi %A Li,Wenbo %A Lopez,Rachel %+ The Ohio State University, 154 N Oval Mall, Columbus, OH, 43210, United States, 1 6142923400, cho.919@osu.edu %K fake %K fact %K misinformation %K reality %K social media %K scale %K measure %K instrument %K user-centric %K tailoring %K digital media literacy %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39106092 %R 10.2196/52058 %U https://www.jmir.org/2024/1/e52058 %U https://doi.org/10.2196/52058 %U http://www.ncbi.nlm.nih.gov/pubmed/39106092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55680 %T Using Twitter (X) to Mobilize Knowledge for First Contact Physiotherapists: Qualitative Study %A Campbell,Laura %A Quicke,Jonathan %A Stevenson,Kay %A Paskins,Zoe %A Dziedzic,Krysia %A Swaithes,Laura %+ Impact Accelerator Unit, School of Medicine, Keele University, David Weatherall Building, Staffordshire, ST5 5BG, United Kingdom, 44 01782734727, l.campbell@keele.ac.uk %K Twitter %K X %K social media %K first contact physiotherapy %K musculoskeletal %K knowledge mobilisation %K primary care %K mindlines %K qualitative %K physiotherapy %K implementation %D 2024 %7 8.7.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38742615 %R 10.2196/55680 %U https://www.jmir.org/2024/1/e55680 %U https://doi.org/10.2196/55680 %U http://www.ncbi.nlm.nih.gov/pubmed/38742615 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52992 %T Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study %A Huo,Weixue %A He,Mengwei %A Zeng,Zhaoxiang %A Bao,Xianhao %A Lu,Ye %A Tian,Wen %A Feng,Jiaxuan %A Feng,Rui %+ Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, 650 New Song Jiang Road, Songjiang District, Shanghai, 201600, China, 86 19174227674, rui.feng@shgh.cn %K patient satisfaction %K physician-patient relationship %K ChatGPT %K patient concern %K COVID-19 %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38954461 %R 10.2196/52992 %U https://www.jmir.org/2024/1/e52992 %U https://doi.org/10.2196/52992 %U http://www.ncbi.nlm.nih.gov/pubmed/38954461 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49077 %T Nutrients and Foods Recommended for Blood Pressure Control on Twitter in Japan: Content Analysis %A Terada,Marina %A Okuhara,Tsuyoshi %A Yokota,Rie %A Kiuchi,Takahiro %A Murakami,Kentaro %+ Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 358006549, marimomo@g.ecc.u-tokyo.ac.jp %K Twitter %K food %K nutrition %K misinformation %K salt %K content analysis %K hypertension %K blood pressure %K sodium %K salt reduction %D 2024 %7 20.6.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38901016 %R 10.2196/49077 %U https://www.jmir.org/2024/1/e49077 %U https://doi.org/10.2196/49077 %U http://www.ncbi.nlm.nih.gov/pubmed/38901016 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50698 %T Online Visibility and Scientific Relevance of Strabismus Research: Bibliometric Analysis %A Stupnicki,Aleksander %A Suresh,Basil %A Jain,Saurabh %+ University College London Medical School, 4 Huntley Street, London, WC1E 6DE, United Kingdom, 44 02031088235, zchatup@ucl.ac.uk %K strabismus research %K squint %K social media %K scientific relevance %K altmetrics %K accuracy %K medical knowledge %K metric %K bibliometric analysis %K research %K strabismus %K online visibility %K platform %K evidence-based information %K accessibility %D 2024 %7 12.6.2024 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 38865170 %R 10.2196/50698 %U https://www.i-jmr.org/2024/1/e50698 %U https://doi.org/10.2196/50698 %U http://www.ncbi.nlm.nih.gov/pubmed/38865170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47620 %T Physician Perspectives on Internet-Informed Patients: Systematic Review %A Lu,Qianfeng %A Schulz,Peter Johannes %+ Faculty of Communication, Culture and Society, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 586664724, schulzp@usi.ch %K internet-informed patients %K physician-patient communication %K health information–seeking %K misinformation %K digital health %D 2024 %7 6.6.2024 %9 Review %J J Med Internet Res %G English %X 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 %M 38842920 %R 10.2196/47620 %U https://www.jmir.org/2024/1/e47620 %U https://doi.org/10.2196/47620 %U http://www.ncbi.nlm.nih.gov/pubmed/38842920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51496 %T Reporting of Ethical Considerations in Qualitative Research Utilizing Social Media Data on Public Health Care: Scoping Review %A Zhang,Yujie %A Fu,Jiaqi %A Lai,Jie %A Deng,Shisi %A Guo,Zihan %A Zhong,Chuhan %A Tang,Jianyao %A Cao,Wenqiong %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 02061641192, yanniwuSMU@126.com %K qualitative research %K informed consent %K ethics approval %K privacy %K internet community %D 2024 %7 17.5.2024 %9 Review %J J Med Internet Res %G English %X 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. %M 38758590 %R 10.2196/51496 %U https://www.jmir.org/2024/1/e51496 %U https://doi.org/10.2196/51496 %U http://www.ncbi.nlm.nih.gov/pubmed/38758590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55847 %T Leveraging Large Language Models for Improved Patient Access and Self-Management: Assessor-Blinded Comparison Between Expert- and AI-Generated Content %A Lv,Xiaolei %A Zhang,Xiaomeng %A Li,Yuan %A Ding,Xinxin %A Lai,Hongchang %A Shi,Junyu %+ Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Quxi Road No 500, Shanghai, 200011, China, 86 21 23271699 ext 5298, sakyamuni_jin@163.com %K large language model %K artificial intelligence %K public oral health %K health care access %K patient education %D 2024 %7 25.4.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38663010 %R 10.2196/55847 %U https://www.jmir.org/2024/1/e55847 %U https://doi.org/10.2196/55847 %U http://www.ncbi.nlm.nih.gov/pubmed/38663010 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51211 %T Evaluating the Disease-Related Experiences of TikTok Users With Lupus Erythematosus: Qualitative and Content Analysis %A Wanberg,Lindsey J %A Pearson,David R %+ University of Minnesota Medical School, 516 Delaware St SE, Minneapolis, MN, MMC 98, United States, 1 612 626 8625, pearsond@umn.edu %K lupus %K TikTok %K autoimmune disease %K qualitative research %K quality of life %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 38631030 %R 10.2196/51211 %U https://infodemiology.jmir.org/2024/1/e51211 %U https://doi.org/10.2196/51211 %U http://www.ncbi.nlm.nih.gov/pubmed/38631030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49163 %T Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review %A Bene,Benard Ayaka %A Ibeneme,Sunny %A Fadahunsi,Kayode Philip %A Harri,Bala Isa %A Ukor,Nkiruka %A Mastellos,Nikolaos %A Majeed,Azeem %A Car,Josip %+ Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London, W6 8RP, United Kingdom, 44 7598439185, b.bene15@imperial.ac.uk %K regulation %K standard %K framework %K guidance %K guideline %K health app %K self-management %K World Health Organization %K WHO African Region %K sub-Saharan Africa %D 2024 %7 11.4.2024 %9 Review %J J Med Internet Res %G English %X 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 %M 38602718 %R 10.2196/49163 %U https://www.jmir.org/2024/1/e49163 %U https://doi.org/10.2196/49163 %U http://www.ncbi.nlm.nih.gov/pubmed/38602718 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e53373 %T The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review %A Haff,Priscilla L %A Jacobson,Alli %A Taylor,Madison M %A Schandua,Hayden P %A Farris,David P %A Doan,Hung Q %A Nelson,Kelly C %+ McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX, 77030, United States, 1 2108678712, priscilla.l.haff@uth.tmc.edu %K social media %K communication %K skin cancer %K melanoma %K misinformation %K scoping review %D 2024 %7 8.4.2024 %9 Review %J JMIR Dermatol %G English %X 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. %M 38587890 %R 10.2196/53373 %U https://derma.jmir.org/2024/1/e53373 %U https://doi.org/10.2196/53373 %U http://www.ncbi.nlm.nih.gov/pubmed/38587890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48130 %T Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study %A Chlabicz,Małgorzata %A Nabożny,Aleksandra %A Koszelew,Jolanta %A Łaguna,Wojciech %A Szpakowicz,Anna %A Sowa,Paweł %A Budny,Wojciech %A Guziejko,Katarzyna %A Róg-Makal,Magdalena %A Pancewicz,Sławomir %A Kondrusik,Maciej %A Czupryna,Piotr %A Cudowska,Beata %A Lebensztejn,Dariusz %A Moniuszko-Malinowska,Anna %A Wierzbicki,Adam %A Kamiński,Karol A %+ Department of Software Engineering, Gdańsk University of Technology, ul. Gabriela Narutowicza 11/12, Gdańsk, 80-233, Poland, 48 58 348 67 00, alenaboz@pg.edu.pl %K infodemic %K fake news %K information credibility %K online health information %K evidence based medicine %K EBM %K false %K credibility %K credible %K health information %K online information %K information quality %K infoveillance %K infodemiology %K misinformation %K disinformation %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38551638 %R 10.2196/48130 %U https://www.jmir.org/2024/1/e48130 %U https://doi.org/10.2196/48130 %U http://www.ncbi.nlm.nih.gov/pubmed/38551638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45855 %T Youth is Prized in Medicine, Old Age is Valued in Law: Analysis of Media Narratives Over 200 Years %A Ng,Reuben %A Indran,Nicole %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore, 65 66013967, spprng@nus.edu.sg %K older professionals %K ageism %K media %K historical analysis %K reframe aging %K learned professions %K psychomics %D 2024 %7 26.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 × occupation (eg, younger doctor or physician) and old age × 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. %M 38530338 %R 10.2196/45855 %U https://www.jmir.org/2024/1/e45855 %U https://doi.org/10.2196/45855 %U http://www.ncbi.nlm.nih.gov/pubmed/38530338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49198 %T Arabic Web-Based Information on Oral Lichen Planus: Content Analysis %A AlMeshrafi,Azzam %A AlHamad,Arwa F %A AlKuraidees,Hamoud %A AlNasser,Lubna A %+ Dental Services, Ministry of National Gaurd Health Affairs, Prince Mutib bin Abdullah bin Abdulaziz Rd, Riyadh, 11426, Saudi Arabia, 966 118011111, hamadar@mngha.med.sa %K oral lichen planus %K health information %K Arabic %K medical information %K information seeking %K quality %K online information %K Arab %K oral %K inflammatory %K inflammation %K chronic %K mouth %K mucous membrane %K mucous membranes %K reliable %K reliability %K credible %K credibility %K periodontology %K dental %K dentist %K dentistry %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38502161 %R 10.2196/49198 %U https://formative.jmir.org/2024/1/e49198 %U https://doi.org/10.2196/49198 %U http://www.ncbi.nlm.nih.gov/pubmed/38502161 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e42849 %T Evaluation of the Accuracy, Credibility, and Readability of Statin-Related Websites: Cross-Sectional Study %A Ling,Eunice %A de Pieri,Domenico %A Loh,Evenne %A Scott,Karen M %A Li,Stephen C H %A Medbury,Heather J %+ Vascular Biology Research Centre, Surgery, Westmead Hospital, REN Building, Westmead, 2145, Australia, 61 8890 3668, heather.medbury@sydney.edu.au %K statins %K consumer health information %K readability %K credibility %K accuracy %K digital health, health information seeking %K cardiovascular %K mortality %K management %K pharmacotherapy %K risk %K medication %D 2024 %7 14.3.2024 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 38483461 %R 10.2196/42849 %U https://www.i-jmr.org/2024/1/e42849 %U https://doi.org/10.2196/42849 %U http://www.ncbi.nlm.nih.gov/pubmed/38483461 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54107 %T Generation Z’s Health Information Avoidance Behavior: Insights From Focus Group Discussions %A Jia,Chenjin %A Li,Pengcheng %+ School of Communication, Universiti Sains Malaysia, 11800 USM, Penang, Gelugor, Malaysia, 60 174564739, DaPeng0605@outlook.com %K information avoidance %K health information %K Generation Z %K information overload %K planned risk information avoidance model %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38457223 %R 10.2196/54107 %U https://www.jmir.org/2024/1/e54107 %U https://doi.org/10.2196/54107 %U http://www.ncbi.nlm.nih.gov/pubmed/38457223 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50031 %T Web-Based Information on Spinal Cord Stimulation: Qualitative Assessment of Publicly Accessible Online Resources %A Miller,Tiev %A Hosseinzadeh,Ali %A Thordarson,Thomas %A Kalimullina,Tamila %A Samejima,Soshi %A Shackleton,Claire %A Malik,Raza %A Calderón-Juárez,Martín %A Sachdeva,Rahul %A Krassioukov,Andrei %+ International Collaboration on Repair Discoveries, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 604 675 8810, andrei.krassioukov@vch.ca %K access to information %K consumer health information %K internet %K spinal cord stimulation %K web-based information %K communication %K quality %K readability %K Google Trends %K misinformation %K synthesis %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38393781 %R 10.2196/50031 %U https://publichealth.jmir.org/2024/1/e50031 %U https://doi.org/10.2196/50031 %U http://www.ncbi.nlm.nih.gov/pubmed/38393781 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54805 %T 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 %A Murakami,Kentaro %A Shinozaki,Nana %A Okuhara,Tsuyoshi %A McCaffrey,Tracy A %A Livingstone,M Barbara E %+ Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113 0033, Japan, 81 3 5841 7872, kenmrkm@m.u-tokyo.ac.jp %K nutrition %K diet %K information seeking %K health literacy %K food literacy %K diet quality %K Japan %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38354021 %R 10.2196/54805 %U https://publichealth.jmir.org/2024/1/e54805 %U https://doi.org/10.2196/54805 %U http://www.ncbi.nlm.nih.gov/pubmed/38354021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50561 %T Tumor Immunotherapy–Related Information on Internet-Based Videos Commonly Used by the Chinese Population: Content Quality Analysis %A Ni,Chen-xu %A Fei,Yi-bo %A Wu,Ran %A Cao,Wen-xiang %A Liu,Wenhao %A Huang,Fang %A Shen,Fu-ming %A Li,Dong-jie %+ Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 021 66302570, djli@tongji.edu.cn %K immunotherapy %K internet videos %K quality %K misinformation %K health informatics %K Chinese %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38324352 %R 10.2196/50561 %U https://formative.jmir.org/2024/1/e50561 %U https://doi.org/10.2196/50561 %U http://www.ncbi.nlm.nih.gov/pubmed/38324352 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49514 %T Quality of Patient-Centered eHealth Information on Erosive Tooth Wear: Systematic Search and Evaluation of Websites and YouTube Videos %A Holland,Lena %A Kanzow,Amelie Friederike %A Wiegand,Annette %A Kanzow,Philipp %+ Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str 40, Göttingen, 37075, Germany, 49 551 3960870, philipp.kanzow@med.uni-goettingen.de %K consumer health information %K dental erosion %K dental sciences %K digital media %K erosive tooth wear %K evidence-based dentistry %K health education %K information quality %K internet %K shared decision making %D 2024 %7 31.1.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38167299 %R 10.2196/49514 %U https://www.jmir.org/2024/1/e49514 %U https://doi.org/10.2196/49514 %U http://www.ncbi.nlm.nih.gov/pubmed/38167299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48599 %T Examining the Type, Quality, and Content of Web-Based Information for People With Chronic Pain Interested in Spinal Cord Stimulation: Social Listening Study %A Moens,Maarten %A Van Doorslaer,Leen %A Billot,Maxime %A Eeckman,Edgard %A Roulaud,Manuel %A Rigoard,Philippe %A Fobelets,Maaike %A Goudman,Lisa %+ STIMULUS (reSearch and TeachIng neuroModULation Uz bruSsel) Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 472412507, lisa.goudman@gmail.com %K online information %K social listening %K neuromodulation %K patient care %K chronic pain %K web-based data %D 2024 %7 30.1.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38289645 %R 10.2196/48599 %U https://www.jmir.org/2024/1/e48599 %U https://doi.org/10.2196/48599 %U http://www.ncbi.nlm.nih.gov/pubmed/38289645 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49749 %T Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context %A Garg,Ashvita %A Nyitray,Alan G %A Roberts,James R %A Shungu,Nicholas %A Ruggiero,Kenneth J %A Chandler,Jessica %A Damgacioglu,Haluk %A Zhu,Yenan %A Brownstein,Naomi C %A Sterba,Katherine R %A Deshmukh,Ashish A %A Sonawane,Kalyani %+ Medical University of South Carolina, 132 Cannon St, Charleston, SC, 29425, United States, 1 8438761100, sonawane@musc.edu %K awareness %K health awareness %K health information %K health videos %K HINTS %K HPV vaccine %K HPV %K information behavior %K information behaviors %K information seeking %K online information %K reproductive health %K rural %K sexual health %K sexually transmitted %K social media %K STD %K STI %K urban %K video %K videos %K YouTube %D 2024 %7 15.1.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38224476 %R 10.2196/49749 %U https://www.jmir.org/2024/1/e49749 %U https://doi.org/10.2196/49749 %U http://www.ncbi.nlm.nih.gov/pubmed/38224476 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48243 %T High-Quality eHealth Websites for Information on Endometriosis: Systematic Search %A Sirohi,Diksha %A Ng,Cecilia Hoi Man %A Bidargaddi,Niranjan %A Slater,Helen %A Parker,Melissa A %A Hull,Mary Louise %A O'Hara,Rebecca %+ Robinson Research Institute, Adelaide Medical School, University of Adelaide, 55 Ground Floor, King William Road, North Adelaide, 5006, Australia, 61 0883131527, d.sirohi@uqconnect.edu.au %K digital health %K endometriosis %K eHealth websites %K eHealth %K pelvic pain %K adenomyosis %D 2024 %7 10.1.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 38198205 %R 10.2196/48243 %U https://www.jmir.org/2024/1/e48243 %U https://doi.org/10.2196/48243 %U http://www.ncbi.nlm.nih.gov/pubmed/38198205 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48402 %T The Effects of a Parent-Focused Social Media Intervention on Child Sun Safety: Pilot and Feasibility Study %A Manne,Sharon %A Wu,Yelena %A Buller,David %A Heckman,Carolyn %A Devine,Katie %A Frederick,Sara %A Solleder,Justin %A Schaefer,Alexis %A Lu,Shou-En %+ Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 120 Albany Street Tower II, New Brunswick, NJ, 08901, United States, 1 7323577978, mannesl@cinj.rutgers.edu %K health behavior %K health promotion and prevention %K parenting %K prevention science %K parents %K parent %K Facebook %K social media %K sun %K prevention %K skin %K dermatology %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38064250 %R 10.2196/48402 %U https://formative.jmir.org/2023/1/e48402 %U https://doi.org/10.2196/48402 %U http://www.ncbi.nlm.nih.gov/pubmed/38064250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47849 %T Scoping the Priorities and Concerns of Parents: Infodemiology Study of Posts on Mumsnet and Reddit %A Thornton,Christopher %A Lanyi,Kate %A Wilkins,Georgina %A Potter,Rhiannon %A Hunter,Emily %A Kolehmainen,Niina %A Pearson,Fiona %+ National Institute for Health and Care Research Innovation Observatory, Population Health Sciences Institute, Newcastle University, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, NE4 5TG, United Kingdom, 44 191 208 2259, chris.thornton@newcastle.ac.uk %K childhood %K child %K toddler %K infant %K behavior %K parent %K parenting %K topic modeling %K data mining %K social media %K infodemiology %K Reddit %K web-based forum %K well-being %K children %K data %K family health %D 2023 %7 28.11.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38015600 %R 10.2196/47849 %U https://www.jmir.org/2023/1/e47849 %U https://doi.org/10.2196/47849 %U http://www.ncbi.nlm.nih.gov/pubmed/38015600 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e45101 %T Content Quality of YouTube Videos About Metastatic Breast Cancer in Young Women: Systematic Assessment %A Morena,Nina %A Ahisar,Yitzchok %A Wang,Xena %A Nguyen,Diana %A Rentschler,Carrie A %A Meguerditchian,Ari N %+ Art History and Communication Studies, Faculty of Arts, McGill University, McCall McBain Arts Building, 853 Sherbrooke Street W., Montreal, QC, H3A 0G5, Canada, 1 514 398 2850, nina.morena@mail.mcgill.ca %K social media %K YouTube %K metastatic breast cancer %K breast cancer %K patient education %K health education %K patient literacy %K media literacy %K health literacy %K consumer health information %K assessment tool %K treatment %K false information %K women %K videos %K web-based %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 37737837 %R 10.2196/45101 %U https://cancer.jmir.org/2023/1/e45101 %U https://doi.org/10.2196/45101 %U http://www.ncbi.nlm.nih.gov/pubmed/37737837 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e47714 %T Description of the Content and Quality of Publicly Available Information on the Internet About Inhaled Volatile Anesthesia and Total Intravenous Anesthesia: Descriptive Study %A Hu,Xinwen %A Pennington,Bethany R Tellor %A Avidan,Michael S %A Kheterpal,Sachin %A deBourbon,Nastassjia G %A Politi,Mary C %+ Department of Anesthesiology, Washington University in St Louis School of Medicine, 660 S Euclid Avenue, MSC 8054-0043-12, St Louis, MO, 63110, United States, 1 3143628649, huxinwen@wustl.edu %K internet %K general anesthesia %K inhaled volatile anesthesia %K total intravenous anesthesia %K patient education %K shared decision-making %K surgery %K information %K decision-making %K web-based %K anesthesia %K anesthesiology %K anesthesiologist %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Perioper Med %G English %X 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. %M 37917148 %R 10.2196/47714 %U https://periop.jmir.org/2023/1/e47714 %U https://doi.org/10.2196/47714 %U http://www.ncbi.nlm.nih.gov/pubmed/37917148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49962 %T Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: Multicenter Cross-Sectional Study %A Montero-Pons,Laura %A Rodríguez-Martín,Dolors %A Esquinas,Cristina %A García-Sierra,Rosa %A Manresa-Domínguez,Josep Maria %A Reyes-Lacalle,Azahara %A Cabedo-Ferreiro,Rosa %A Vicente-Hernández,MªMercedes %A Gómez Masvidal,Míriam %A Toran-Monserrat,Pere %A Falguera-Puig,Gemma %+ Sexual and Reproductive Healthcare Santa Coloma de Gramenet, Primary Care Management Metropolitana Nord, Catalan Institute of Health, 49, 53 Major St, Santa Coloma de Gramenet, 08921, Spain, 34 936 932 736, lmontero.ics@gencat.cat %K sex education %K adolescent %K young adult %K internet %K cross-sectional studies %K program evaluation %K gender mainstreaming %D 2023 %7 26.10.2023 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 37883153 %R 10.2196/49962 %U https://www.jmir.org/2023/1/e49962 %U https://doi.org/10.2196/49962 %U http://www.ncbi.nlm.nih.gov/pubmed/37883153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48905 %T Investigating Substance Use via Reddit: Systematic Scoping Review %A Chi,Yu %A Chen,Huai-yu %+ School of Information Science, University of Kentucky, 160 Patterson Dr, Lexington, KY, 40506, United States, 1 4125396621, yu.chi@uky.edu %K substance use %K systematic scoping review %K Reddit %K social media %K drug use %K tobacco use %K alcohol use %D 2023 %7 25.10.2023 %9 Review %J J Med Internet Res %G English %X 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. %M 37878361 %R 10.2196/48905 %U https://www.jmir.org/2023/1/e48905 %U https://doi.org/10.2196/48905 %U http://www.ncbi.nlm.nih.gov/pubmed/37878361 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48508 %T Examining the Persuasive Effects of Health Communication in Short Videos: Systematic Review %A Zhu,Zicheng %A Liu,Shiyu %A Zhang,Renwen %+ Department of Communications and New Media, Faculty of Arts & Social Sciences, National University of Singapore, Blk AS6, #03-41, 11 Computing Drive, Singapore, Singapore, 65 83762508, r.zhang@nus.edu.sg %K short video %K persuasion %K health %K systematic review %K mobile phone %D 2023 %7 13.10.2023 %9 Review %J J Med Internet Res %G English %X 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. %M 37831488 %R 10.2196/48508 %U https://www.jmir.org/2023/1/e48508 %U https://doi.org/10.2196/48508 %U http://www.ncbi.nlm.nih.gov/pubmed/37831488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43060 %T Approaches to Research Ethics in Health Research on YouTube: Systematic Review %A Tanner,Joshua P %A Takats,Courtney %A Lathan,Hannah Stuart %A Kwan,Amy %A Wormer,Rachel %A Romero,Diana %A Jones,Heidi E %+ CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St, #7th Fl, New York, NY, 10027, United States, 1 646 364 9529, Heidi.Jones@sph.cuny.edu %K data anonymization %K research ethics %K ethics %K informed consent %K public health %K research %K social media %K YouTube %D 2023 %7 4.10.2023 %9 Short Paper %J J Med Internet Res %G English %X 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 %M 37792443 %R 10.2196/43060 %U https://www.jmir.org/2023/1/e43060 %U https://doi.org/10.2196/43060 %U http://www.ncbi.nlm.nih.gov/pubmed/37792443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46488 %T Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels %A Uhawenimana,Thierry Claudien %A Musabwasoni,Marie Grace Sandra %A Nsengiyumva,Richard %A Mukamana,Donatilla %+ Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, PO Box: 3286, Kigali, Rwanda, 250 788586768, tcuhawenimana@gmail.com %K sexuality %K sexual and reproductive health %K Kinyarwanda YouTube channels %K content analysis %K social media %K media platform %K COVID-19 %D 2023 %7 27.9.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37756040 %R 10.2196/46488 %U https://www.jmir.org/2023/1/e46488 %U https://doi.org/10.2196/46488 %U http://www.ncbi.nlm.nih.gov/pubmed/37756040 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45433 %T Development of a Core Set of Quality Criteria for Virtual Reality Applications Designed for Older Adults: Multistep Qualitative Study %A Napetschnig,Alina %A Brixius,Klara %A Deiters,Wolfgang %+ Department of Community Health, Hochschule für Gesundheit Bochum, Gesundheitscampus 6-8, Bochum, 44801, Germany, 49 234 77727 764, alina.napetschnig@gmail.com %K virtual reality %K older adults %K quality criteria %K user-centered %D 2023 %7 27.9.2023 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 37756112 %R 10.2196/45433 %U https://www.i-jmr.org/2023/1/e45433 %U https://doi.org/10.2196/45433 %U http://www.ncbi.nlm.nih.gov/pubmed/37756112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44656 %T The “Loci” of Misinformation and Its Correction in Peer- and Expert-Led Online Communities for Mental Health: Content Analysis %A Bizzotto,Nicole %A Schulz,Peter Johannes %A de Bruijn,Gert-Jan %+ Faculty of Communication, Culture and Society, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 58 666 4724, schulzp@usi.ch %K online communities %K social media %K mental health %K misinformation %K empowerment %K content analysis %K online community %K infodemiology %K information seeking %K help seeking %K information behavior %K online search %K search query %K information quality %K information accuracy %D 2023 %7 18.9.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37721800 %R 10.2196/44656 %U https://www.jmir.org/2023/1/e44656 %U https://doi.org/10.2196/44656 %U http://www.ncbi.nlm.nih.gov/pubmed/37721800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49061 %T Exploring YouTube’s Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories %A Ng,Yee Man Margaret %A Hoffmann Pham,Katherine %A Luengo-Oroz,Miguel %+ Department of Journalism & Institute of Communications Research, University of Illinois at Urbana-Champaign, 810 S Wright St, Champaign, IL, 61801, United States, 1 217 300 8186, margaretnym@gmail.com %K algorithmic auditing %K antivaccine sentiment %K crowdsourcing %K recommendation systems %K watch history %K YouTube %D 2023 %7 15.9.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37713243 %R 10.2196/49061 %U https://www.jmir.org/2023/1/e49061 %U https://doi.org/10.2196/49061 %U http://www.ncbi.nlm.nih.gov/pubmed/37713243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46346 %T Assessing the Readability of Online Patient Education Materials in Obstetrics and Gynecology Using Traditional Measures: Comparative Analysis and Limitations %A Nattam,Anunita %A Vithala,Tripura %A Wu,Tzu-Chun %A Bindhu,Shwetha %A Bond,Gregory %A Liu,Hexuan %A Thompson,Amy %A Wu,Danny T Y %+ Department of Computer Science, University of Cincinnati, 2610 University Circle, Cincinnati, OH, 45221, United States, 1 5135564307, wutz@ucmail.uc.edu %K obstetrics and gynecology %K online patient education materials %K readability %K online education %K education %K health literacy %K literature %K medical documents %K tool %K utilization %K online content %K health education %K education material %K assessment %K obstetrics %K gynecology %D 2023 %7 30.8.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37647115 %R 10.2196/46346 %U https://www.jmir.org/2023/1/e46346 %U https://doi.org/10.2196/46346 %U http://www.ncbi.nlm.nih.gov/pubmed/37647115 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40003 %T YouTube Videos on Nutrition and Dental Caries: Content Analysis %A Long,Memphis %A Forbes,Laura E %A Papagerakis,Petros %A Lieffers,Jessica R L %+ College of Pharmacy and Nutrition, University of Saskatchewan, 105 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada, 1 3069668594, jessica.lieffers@usask.ca %K dental caries %K diet %K nutrition %K YouTube %K internet %K consumer health information %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 37561564 %R 10.2196/40003 %U https://infodemiology.jmir.org/2023/1/e40003 %U https://doi.org/10.2196/40003 %U http://www.ncbi.nlm.nih.gov/pubmed/37561564 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45731 %T Defining Misinformation and Related Terms in Health-Related Literature: Scoping Review %A El Mikati,Ibrahim K %A Hoteit,Reem %A Harb,Tarek %A El Zein,Ola %A Piggott,Thomas %A Melki,Jad %A Mustafa,Reem A %A Akl,Elie A %+ Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS, 66160, United States, 1 913 588 6048, rmustafa@kumc.edu %K misinformation %K disinformation %K infodemic %K fake news %K malinformation %K health %K COVID-19 %K scoping review %K health-related literature %K electronic database %K misleading %K related term %K systematic review %D 2023 %7 9.8.2023 %9 Review %J J Med Internet Res %G English %X 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. %M 37556184 %R 10.2196/45731 %U https://www.jmir.org/2023/1/e45731 %U https://doi.org/10.2196/45731 %U http://www.ncbi.nlm.nih.gov/pubmed/37556184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47582 %T The Characteristics, Uses, and Biases of Studies Related to Malignancies Using Google Trends: Systematic Review %A Kamiński,Mikołaj %A Czarny,Jakub %A Skrzypczak,Piotr %A Sienicki,Krzysztof %A Roszak,Magdalena %+ Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego St. 62, Poznań, 60-569, Poland, 48 661962498, piotr.j.skrzypczak@gmail.com %K Google Trends %K oncology %K malignancies %K prophylaxis %K celebrity %K infodemiology %K infoveillance %K cancer %K carcinoma %K lymphoma %K leukemia %K multiple myeloma %K sarcoma %K internet %K tumor %K bias %K quality %D 2023 %7 4.8.2023 %9 Review %J J Med Internet Res %G English %X 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. %M 37540544 %R 10.2196/47582 %U https://www.jmir.org/2023/1/e47582 %U https://doi.org/10.2196/47582 %U http://www.ncbi.nlm.nih.gov/pubmed/37540544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46421 %T Effects of Excluding Those Who Report Having “Syndomitis” or “Chekalism” on Data Quality: Longitudinal Health Survey of a Sample From Amazon’s Mechanical Turk %A Hays,Ron D %A Qureshi,Nabeel %A Herman,Patricia M %A Rodriguez,Anthony %A Kapteyn,Arie %A Edelen,Maria Orlando %+ Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Avenue Suite 800, Los Angeles, CA, 90024, United States, 1 310 794 2294, drhays@ucla.edu %K misrepresentation %K survey %K data quality %K MTurk %K Amazon Mechanical Turk %D 2023 %7 4.8.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37540543 %R 10.2196/46421 %U https://www.jmir.org/2023/1/e46421 %U https://doi.org/10.2196/46421 %U http://www.ncbi.nlm.nih.gov/pubmed/37540543 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43901 %T A Study on User-Oriented Subjects of Child Abuse on Wikipedia: Temporal Analysis of Wikipedia History Versions and Traffic Data %A Wang,Yanyan %A Zhang,Jin %+ School of Information Resource Management, Renmin University of China, 59th Zhongguancun Street, Haidian, Beijing, 100872, China, 86 01082500675, yanyanwangruc@ruc.edu.cn %K child abuse %K user-oriented subject %K subject schema %K subject change %K popularity trend %K temporal analysis %K Wikipedia %D 2023 %7 17.7.2023 %9 Original Paper %J J Med Internet Res %G English %X 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 × 108) was the most popular facet viewed by users, while people and environment (number of total views = 2.42 × 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. %M 37459149 %R 10.2196/43901 %U https://www.jmir.org/2023/1/e43901 %U https://doi.org/10.2196/43901 %U http://www.ncbi.nlm.nih.gov/pubmed/37459149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47210 %T Quality and Reliability of Liver Cancer–Related Short Chinese Videos on TikTok and Bilibili: Cross-Sectional Content Analysis Study %A Zheng,Shusen %A Tong,Xinyu %A Wan,Dalong %A Hu,Chen %A Hu,Qing %A Ke,Qinghong %+ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, China, 86 13805749805, shusenzheng@zju.edu.cn %K liver cancer %K short videos %K information quality %K social media %K TikTok %K Bilibili %K GQS %K global quality score %K DISCERN %K reliability %D 2023 %7 5.7.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37405825 %R 10.2196/47210 %U https://www.jmir.org/2023/1/e47210 %U https://doi.org/10.2196/47210 %U http://www.ncbi.nlm.nih.gov/pubmed/37405825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47343 %T Content Quality of Web-Based Short-Form Videos for Fire and Burn Prevention in China: Content Analysis %A Qin,Lang %A Zheng,Ming %A Schwebel,David C %A Li,Li %A Cheng,Peixia %A Rao,Zhenzhen %A Peng,Ruisha %A Ning,Peishan %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K fire %K burn %K prevention %K first aid %K short video %K content quality %K public impact %K China %D 2023 %7 30.6.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37389906 %R 10.2196/47343 %U https://www.jmir.org/2023/1/e47343 %U https://doi.org/10.2196/47343 %U http://www.ncbi.nlm.nih.gov/pubmed/37389906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45550 %T Evaluating the Supporting Evidence of Medical Cannabis Claims Made on Clinic Websites: Cross-Sectional Study %A O'Neill,Braden %A Ferguson,Jacob %A Dalueg,Lauren %A Yusuf,Abban %A Kirubarajan,Abirami %A Lloyd,Taryn %A Mollanji,Eisi %A Persaud,Navindra %+ Department of Family and Community Medicine, St. Michael’s Hospital, Unity Health Toronto, Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, ON, M5B 1T8, Canada, 1 416 860 6000, Braden.ONeill@unityhealth.to %K cannabis %K evidence-based medicine %K adverse effects %K consumer health information %D 2023 %7 29.6.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37384372 %R 10.2196/45550 %U https://www.jmir.org/2023/1/e45550 %U https://doi.org/10.2196/45550 %U http://www.ncbi.nlm.nih.gov/pubmed/37384372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45024 %T Crowdsourcing Knowledge Production of COVID-19 Information on Japanese Wikipedia in the Face of Uncertainty: Empirical Analysis %A Yang,Kunhao %A Tanaka,Mikihito %+ Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 2-16-1 Tokiwa-dai, Ube, 755-8611, Japan, 81 07038477887, yangkunhao93@gmail.com %K scientific uncertainty %K COVID-19 %K Wikipedia %K crowdsourcing information production %D 2023 %7 29.6.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37384371 %R 10.2196/45024 %U https://www.jmir.org/2023/1/e45024 %U https://doi.org/10.2196/45024 %U http://www.ncbi.nlm.nih.gov/pubmed/37384371 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40802 %T Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis %A Squires,Natalie A %A Soyemi,Elizabeth %A Yee,Lynn M %A Birch,Eleanor M %A Badreldin,Nevert %+ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Suite 05-2149, 250 E. Superior Street, Chicago, IL, 60611, United States, 1 312 472 4685, nevert.badreldin@northwestern.edu %K health information %K internet %K YouTube %K cesarean section %K cesarean %K C-section %K postpartum %K social media %K web-based video %K maternal %K postnatal %K pain %K systematic search %K patient education %K information quality %K accuracy %K credibility %K health education %K educational video %K education resource %K health video %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 37351938 %R 10.2196/40802 %U https://infodemiology.jmir.org/2023/1/e40802 %U https://doi.org/10.2196/40802 %U http://www.ncbi.nlm.nih.gov/pubmed/37351938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45787 %T Trends in Media Coverage During the Monkeypox Outbreak: Content Analysis %A Kato,Mio %A Yoshimatsu,Fumi %A Saito,Tomoya %+ Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan, 81 3 5285 1111, mio-kato@niid.go.jp %K risk perception %K protection motivation theory %K agenda setting %K news media %K media %K infectious disease %K monkeypox %D 2023 %7 19.6.2023 %9 Research Letter %J J Med Internet Res %G English %X %M 37335596 %R 10.2196/45787 %U https://www.jmir.org/2023/1/e45787 %U https://doi.org/10.2196/45787 %U http://www.ncbi.nlm.nih.gov/pubmed/37335596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44307 %T The Effect of Monetary Incentives on Health Care Social Media Content: Study Based on Topic Modeling and Sentiment Analysis %A Maleki,Negar %A Padmanabhan,Balaji %A Dutta,Kaushik %+ School of Information Systems and Management, University of South Florida, 4202 E Fowler Ave., Tampa, FL, 33620, United States, 1 8132918583, negarmaleki@usf.edu %K health care analytics %K social media %K incentive mechanisms %K content analysis %K contrastive topic modeling %D 2023 %7 11.5.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37166952 %R 10.2196/44307 %U https://www.jmir.org/2023/1/e44307 %U https://doi.org/10.2196/44307 %U http://www.ncbi.nlm.nih.gov/pubmed/37166952 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43001 %T The Quality, Readability, and Accuracy of the Information on Google About Cannabis and Driving: Quantitative Content Analysis %A Josey,Maria %A Gaid,Dina %A Bishop,Lisa D %A Blackwood,Michael %A Najafizada,Maisam %A Donnan,Jennifer R %+ School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, 1 709 864 3587, jennifer.donnan@mun.ca %K cannabis %K driving %K quality %K readability %K accuracy %K public education %K internet %K Google search %K analysis %K accessibility %K information %K evaluation %K tool %K data %K misinterpretation %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %R 10.2196/43001 %U https://infodemiology.jmir.org/2023/1/e43001 %U https://doi.org/10.2196/43001 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40043 %T How People Use Web-Based Parenting Information to Support Others in Their Social Circle: Qualitative Descriptive Study %A El Sherif,Reem %A Pluye,Pierre %A Paquet,Virginie %A Ibekwe,Fidelia %A Grad,Roland %+ Department of Family Medicine, McGill University, Suite 300, Ch Cotes-des-neiges, Montreal, QC, H3S 1Z1, Canada, 1 5143987375, reem.elsherif@mail.mcgill.ca %K consumer health information %K information seeking behavior %K child development %K child health %K information outcomes %K health information %K digital health %K parenting %K web-based information %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 37115603 %R 10.2196/40043 %U https://pediatrics.jmir.org/2023/1/e40043 %U https://doi.org/10.2196/40043 %U http://www.ncbi.nlm.nih.gov/pubmed/37115603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44010 %T Critical Analysis and Cross-Comparison Between English and Chinese Websites Providing Online Medical Information for Patients With Adenoid Hypertrophy: Cross-sectional Study %A Jiang,Zheng %A Yang,Xin %A Chen,Fei %A Liu,Jun %+ Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, 37 Guoxue Ln, Wu Hou Qu, Chengdu, 610041, China, 86 18980602242, hxheadneckjunl@163.com %K adenoid hypertrophy %K website quality %K critical analysis %K English and Chinese %K English %K Chinese %K patient %K internet %K online %K decisions %K medical issues %K airway obstruction %K airway %K accessibility %K quality %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Form Res %G English %X 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 κ 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. %M 37093621 %R 10.2196/44010 %U https://formative.jmir.org/2023/1/e44010 %U https://doi.org/10.2196/44010 %U http://www.ncbi.nlm.nih.gov/pubmed/37093621 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e42218 %T Influence of User Profile Attributes on e-Cigarette–Related Searches on YouTube: Machine Learning Clustering and Classification %A Murthy,Dhiraj %A Lee,Juhan %A Dashtian,Hassan %A Kong,Grace %+ Computational Media Lab, School of Journalism and Media, Moody College of Communication, The University of Texas at Austin, 300 W Dean Keeton (A0900), Austin, TX, 78712, United States, 1 512 471 5775, dhiraj.murthy@austin.utexas.edu %K electronic cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco products %K YouTube %K social media %K minority groups %K exposure %K youth %K behavior %K user %K machine learning %K policy %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 37124246 %R 10.2196/42218 %U https://infodemiology.jmir.org/2023/1/e42218 %U https://doi.org/10.2196/42218 %U http://www.ncbi.nlm.nih.gov/pubmed/37124246 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45147 %T News Media Coverage of the Problem of Purchasing Fake Prescription Medicines on the Internet: Thematic Analysis %A Almomani,Hamzeh %A Patel,Nilesh %A Donyai,Parastou %+ School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6AP, United Kingdom, 44 118 378 8462, h.q.m.almomani@pgr.reading.ac.uk %K prescription medicine %K internet %K online pharmacy %K fake medicine %K media %K newspaper article %K Theory of Planned Behavior %K thematic analysis %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36943354 %R 10.2196/45147 %U https://formative.jmir.org/2023/1/e45147 %U https://doi.org/10.2196/45147 %U http://www.ncbi.nlm.nih.gov/pubmed/36943354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45571 %T Attitudes and (Mis)information About Cognitive Behavioral Therapy on TikTok: An Analysis of Video Content %A Lorenzo-Luaces,Lorenzo %A Dierckman,Clare %A Adams,Sydney %+ Psychological and Brain Sciences, Indiana University-Bloomington, 1101 E 10TH ST, Bloomington, IN, 47401, United States, 1 8128560866, lolorenz@indiana.edu %K social media %K cognitive behavioral therapy %K misinformation %K public health %K mental health %K TikTok %K psychotherapy %K content analysis %K therapist %K misinformation %K online health information %D 2023 %7 13.3.2023 %9 Research Letter %J J Med Internet Res %G English %X %M 36912883 %R 10.2196/45571 %U https://www.jmir.org/2023/1/e45571 %U https://doi.org/10.2196/45571 %U http://www.ncbi.nlm.nih.gov/pubmed/36912883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44741 %T Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan %A Mitsutake,Seigo %A Takahashi,Yoshimitsu %A Otsuki,Aki %A Umezawa,Jun %A Yaguchi-Saito,Akiko %A Saito,Junko %A Fujimori,Maiko %A Shimazu,Taichi %A , %+ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Tokyo, 173-0015, Japan, 81 339643241 ext 4229, mitsu@tmig.or.jp %K chronic diseases %K cross-sectional study %K eHealth literacy, health communication %K internet, social networking %D 2023 %7 2.3.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36862482 %R 10.2196/44741 %U https://www.jmir.org/2023/1/e44741 %U https://doi.org/10.2196/44741 %U http://www.ncbi.nlm.nih.gov/pubmed/36862482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41518 %T The Reliability and Quality of Short Videos as a Source of Dietary Guidance for Inflammatory Bowel Disease: Cross-sectional Study %A He,Zixuan %A Wang,Zhijie %A Song,Yihang %A Liu,Yilong %A Kang,Le %A Fang,Xue %A Wang,Tongchang %A Fan,Xuanming %A Li,Zhaoshen %A Wang,Shuling %A Bai,Yu %+ Department of Gastroenterology, Changhai Hospital, Naval Medical University, No 168 Changhai Road, Shanghai, 200433, China, 86 02161354, md.baiyu@foxmail.com %K inflammatory bowel disease %K diet %K information quality %K social media %K gastroenterology %K nutrition %K videos %K health communication %D 2023 %7 9.2.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36757757 %R 10.2196/41518 %U https://www.jmir.org/2023/1/e41518 %U https://doi.org/10.2196/41518 %U http://www.ncbi.nlm.nih.gov/pubmed/36757757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39162 %T Quality of Information in Gallstone Disease Videos on TikTok: Cross-sectional Study %A Sun,Fei %A Zheng,Shusen %A Wu,Jian %+ Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, China, 86 13858005706, drwujian@zju.edu.cn %K hepatobiliary %K gallstone %K gallbladder %K TikTok %K social media %K video quality %K DISCERN %K Journal of American Medical Association %K JAMA %K Global Quality Score %K GQS %K content analysis %K health information %K online health information %K digital health %K disease knowledge %K medical information %K misinformation %K infodemiology %K patient education %K dissemination %K accuracy %K credibility %K credible %K reliability %K reliable %K information quality %D 2023 %7 8.2.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36753307 %R 10.2196/39162 %U https://www.jmir.org/2023/1/e39162 %U https://doi.org/10.2196/39162 %U http://www.ncbi.nlm.nih.gov/pubmed/36753307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40466 %T Internet Use for Obtaining Medicine Information: Cross-sectional Survey %A Bergmo,Trine Strand %A Sandsdalen,Vilde %A Manskow,Unn Sollid %A Småbrekke,Lars %A Waaseth,Marit %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Sykehusveien 23, Tromsø, N-9019, Norway, 47 48003565, trine.bergmo@ehealthresearch.no %K credibility %K credible %K cross-sectional %K eHealth %K health information %K information behavior %K information retrieval %K information science %K information seeking %K internet %K medication %K medicine information %K misinformation %K patient education %K pharmaceutical %K pharmacist %K pharmacy %K survey %K trust %K web-based information %D 2023 %7 2.2.2023 %9 Original Paper %J JMIR Form Res %G English %X 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 Tromsø, 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. %M 36729577 %R 10.2196/40466 %U https://formative.jmir.org/2023/1/e40466 %U https://doi.org/10.2196/40466 %U http://www.ncbi.nlm.nih.gov/pubmed/36729577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40291 %T Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites %A Kaplan,Samantha %A von Isenburg,Megan %A Waldrop,Lucy %+ Duke University Medical Center Library & Archives, 10 Searle Drive, Durham, NC, 27710, United States, 1 919 660 1124, samantha.kaplan@duke.edu %K antivaccination behavior %K web archiving %K content analysis %K COVID-19 vaccines %K COVID-19 %K vaccine %K website %K web %K pandemic %K safety %K science %K content %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36548948 %R 10.2196/40291 %U https://formative.jmir.org/2023/1/e40291 %U https://doi.org/10.2196/40291 %U http://www.ncbi.nlm.nih.gov/pubmed/36548948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39220 %T Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale %A Montagni,Ilaria %A Pouymayou,Aude %A Pereira,Edwige %A Tzourio,Christophe %A Schück,Stéphane %A Texier,Nathalie %A González-Caballero,Juan Luis %A , %+ Bordeaux Population Health UMRS1219, University of Bordeaux, Institut national de la santé et de la recherche médicale, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 0642193363, ilaria.montagni@u-bordeaux.fr %K Internet %K literacy %K measurement %K vaccination %K vaccine %K health information %K health literacy %K online %K content %K validity %K reliability %K digital literacy %D 2022 %7 14.12.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36515982 %R 10.2196/39220 %U https://www.jmir.org/2022/12/e39220 %U https://doi.org/10.2196/39220 %U http://www.ncbi.nlm.nih.gov/pubmed/36515982 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e37036 %T Creating the Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA) Project: Tutorial for the Novel Use of a Store Locator App %A Etling,Mary Ann %A Musili,Michael %A Eastes,Kaytlin %A Oyungu,Eren %A McHenry,Megan S %+ Department of Pediatrics, Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN, 46202, United States, 1 317 274 8157, maetling@iu.edu %K map %K virtual %K interactive %K disability %K resources %K inclusion %K mHealth %K Kenya %K global health %K public health %D 2022 %7 8.12.2022 %9 Tutorial %J Interact J Med Res %G English %X 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. %M 36480245 %R 10.2196/37036 %U https://www.i-jmr.org/2022/2/e37036 %U https://doi.org/10.2196/37036 %U http://www.ncbi.nlm.nih.gov/pubmed/36480245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e41219 %T What Patients Find on the Internet When Looking for Information About Percutaneous Coronary Intervention: Multilanguage Cross-sectional Assessment %A Șulea,Cristina M %A Nădășan,Valentin %A Ursachi,Tatiana %A Toboltoc,Paul-Cătălin %A Benedek,Theodora %+ George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, Targu Mures, 540142, Romania, 40 265215551, valentin.nadasan@umfst.ro %K percutaneous coronary intervention %K consumer health informatics %K internet %K health education %K health information %K quality %K reliability %K informed decision-making %K credibility %K content quality %K medical information %D 2022 %7 6.12.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36472906 %R 10.2196/41219 %U https://www.jmir.org/2022/12/e41219 %U https://doi.org/10.2196/41219 %U http://www.ncbi.nlm.nih.gov/pubmed/36472906 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e42245 %T How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis %A Basch,Corey H %A Hillyer,Grace C %A Yalamanchili,Bhavya %A Morris,Aldean %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K TikTok %K breast cancer %K social media %K short video apps %K social support %K content analysis %K video %K patient support %K medical information %K health information %K peer support %K online conversation %K online health information %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 36472899 %R 10.2196/42245 %U https://cancer.jmir.org/2022/4/e42245 %U https://doi.org/10.2196/42245 %U http://www.ncbi.nlm.nih.gov/pubmed/36472899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42126 %T Web-Based Health Information–Seeking Methods and Time Since Provider Engagement: Cross-sectional Study %A Shaveet,Eden %A Urquhart,Catherine %A Gallegos,Marissa %A Dammann,Olaf %A Corlin,Laura %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 7000, eden.shaveet@tufts.edu %K internet %K social media %K information-seeking behavior %K consumer health information %K physician-patient relations %K trust %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36449328 %R 10.2196/42126 %U https://formative.jmir.org/2022/11/e42126 %U https://doi.org/10.2196/42126 %U http://www.ncbi.nlm.nih.gov/pubmed/36449328 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39312 %T Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study %A Tan,Rayner Kay Jin %A Lim,Jane Mingjie %A Neo,Pearlyn Hui Min %A Ong,Suan Ee %+ University of North Carolina Project-China, 2 Lujing Road, Guangzhou, 510095, China, 65 91878576, rayner.tan@nus.edu.sg %K health communication %K infodemic %K SARS-CoV-2 %K coronavirus %K Singapore %K WhatsApp %K COVID-19 %K health information %K misinformation %K mobile health %K smartphone %K information quality %K online health information %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 36099011 %R 10.2196/39312 %U https://humanfactors.jmir.org/2022/4/e39312 %U https://doi.org/10.2196/39312 %U http://www.ncbi.nlm.nih.gov/pubmed/36099011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38425 %T Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices’ Websites in the United States: Cross-sectional Website Content Analysis %A Ackleh-Tingle,Jonathan V %A Jordan,Natalie M %A Onwubiko,Udodirim N %A Chandra,Christina %A Harton,Paige E %A Rentmeester,Shelby T %A Chamberlain,Allison T %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 727 6159, jonathan.tingle@emory.edu %K primary care %K vaccine hesitancy %K COVID-19 %K health communications %K health information %K health website %K family practice %K primary care %K vaccine information %K online health %K health platform %K online information %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36343211 %R 10.2196/38425 %U https://formative.jmir.org/2022/11/e38425 %U https://doi.org/10.2196/38425 %U http://www.ncbi.nlm.nih.gov/pubmed/36343211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39571 %T Understanding the Social Mechanism of Cancer Misinformation Spread on YouTube and Lessons Learned: Infodemiological Study %A Yoon,Ho Young %A You,Kyung Han %A Kwon,Jung Hye %A Kim,Jung Sun %A Rha,Sun Young %A Chang,Yoon Jung %A Lee,Sang-Cheol %+ Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, 20, Bodeum 7-Ro, Sejong-Si, 30099, Republic of Korea, 82 44 995 4781, Kwonjhye.onco@gmail.com %K cancer misinformation %K social media health misinformation %K fenbendazole %K self-administration %K complex contagion %K YouTube %K social media factual information delivery strategy %D 2022 %7 14.11.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36374534 %R 10.2196/39571 %U https://www.jmir.org/2022/11/e39571 %U https://doi.org/10.2196/39571 %U http://www.ncbi.nlm.nih.gov/pubmed/36374534 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e38865 %T Electronic Tracking Devices for People With Dementia: Content Analysis of Company Websites %A Howes,Jared %A Denier,Yvonne %A Gastmans,Chris %+ Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35, Box 7001, Leuven, 3000, Belgium, 32 16372182, jaredmichael.howes@kuleuven.be %K dementia %K wandering %K electronic tracking devices %K bioethics %K locators %K monitors %K surveillance devices %K management %K technology %K care tool %K caregiver %K device %K vulnerable %K elderly %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Aging %G English %X 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. %M 36367765 %R 10.2196/38865 %U https://aging.jmir.org/2022/4/e38865 %U https://doi.org/10.2196/38865 %U http://www.ncbi.nlm.nih.gov/pubmed/36367765 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e39946 %T A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study %A Lin,Michelle %A Phipps,Mina %A Yilmaz,Yusuf %A Nash,Christopher J %A Gisondi,Michael A %A Chan,Teresa M %+ Department of Emergency Medicine, University of California San Francisco, 1001 Potrero Avenue, Suite 6A, UCSF Department of Emergency Medicine, San Francisco, CA, 94110, United States, 1 415 206 5758, michelle.lin@ucsf.edu %K open educational resource %K free open-access meducation %K FOAM %K meducation %K open-access %K internet based %K web based %K website %K social media %K medical education %K disruptive innovation %K blog %K podcast %K emergency %K critical care %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Med Educ %G English %X 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. %M 36306167 %R 10.2196/39946 %U https://mededu.jmir.org/2022/4/e39946 %U https://doi.org/10.2196/39946 %U http://www.ncbi.nlm.nih.gov/pubmed/36306167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38567 %T Quality Assessment of Hypertension Treatment–Related Information on WeChat: Cross-sectional Study %A Yang,Yuting %A Hou,Mengchi %A Gong,Xue %A Guo,Rui %A Feng,Xing Lin %A Tian,Rui %+ School of Public Health, Capital Medical University, No 10 Youanmenwai, Xitoutiao, Beijing, 100069, China, 86 01083911573, guorui@ccmu.edu.cn %K quality assessment %K hypertension %K WeChat %K DISCERN instrument %D 2022 %7 26.10.2022 %9 Original Paper %J J Med Internet Res %G English %X 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 (ρ=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. %M 36287598 %R 10.2196/38567 %U https://www.jmir.org/2022/10/e38567 %U https://doi.org/10.2196/38567 %U http://www.ncbi.nlm.nih.gov/pubmed/36287598 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38316 %T Investigating COVID-19 Vaccine Communication and Misinformation on TikTok: Cross-sectional Study %A van Kampen,Katherine %A Laski,Jeremi %A Herman,Gabrielle %A Chan,Teresa M %+ Division of Emergency Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, 100 Main St W, Room 5003, Hamilton, ON, L8P 1H6, Canada, 1 905 525 9140, teresa.chan@medportal.ca %K TikTok %K COVID-19 vaccines %K vaccinations %K misinformation %K COVID-19 %K Infodemiology %K social media %K health information %K content analysis %K vaccine hesitancy %K public health %K web-based health information %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 36338548 %R 10.2196/38316 %U https://infodemiology.jmir.org/2022/2/e38316 %U https://doi.org/10.2196/38316 %U http://www.ncbi.nlm.nih.gov/pubmed/36338548 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e42759 %T An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study %A Gallo Marin,Benjamin %A Ezemma,Ogechi %A Frech,Fabio Stefano %A Flores Servin,Julio C %A Rhee,Ben S %A Mulligan,Kathleen M %A O' Connell,Katie A %A Moseley,Isabelle %A Wambier,Carlos G %+ Department of Dermatology, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02904, United States, 1 6099376474, ben_gallo@brown.edu %K tattoo %K tattoo removal %K laser %K internet %K YouTube %K misinformation %K Food and Drug Administration %K FDA %K professional information %K digital %K research %K skin %K skin care %K skincare %K care %K consultation %K safe %K evidence %K dermatologist %D 2022 %7 25.10.2022 %9 Short Paper %J JMIR Dermatol %G English %X 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. %M 36419716 %R 10.2196/42759 %U https://derma.jmir.org/2022/4/e42759 %U https://doi.org/10.2196/42759 %U http://www.ncbi.nlm.nih.gov/pubmed/36419716 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38759 %T American Anesthesiology Residency Programs: Website Usability Analysis %A Seto,Noah %A Beach,Jeffrey %A Calvano,Joshua %A Lu,Shu %A He,Shuhan %+ College of Osteopathic Medicine, Rocky Vista University, 8401 S Chambers Rd, Parker, CO, 80134, United States, 1 303 373 2008, nlseto@salud.unm.edu %K medical student education %K education in anesthesia %K technology in education %K quality improvement %K communication %D 2022 %7 20.10.2022 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 36264625 %R 10.2196/38759 %U https://www.i-jmr.org/2022/2/e38759 %U https://doi.org/10.2196/38759 %U http://www.ncbi.nlm.nih.gov/pubmed/36264625 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40408 %T Fine-tuned Sentiment Analysis of COVID-19 Vaccine–Related Social Media Data: Comparative Study %A Melton,Chad A %A White,Brianna M %A Davis,Robert L %A Bednarczyk,Robert A %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, 492R, Memphis, TN, 38103, United States, 1 9012875836, ashabann@uthsc.edu %K sentiment analysis %K DistilRoBERTa %K natural language processing %K social media %K Twitter %K Reddit %K COVID-19 %K vaccination %K vaccine %K content analysis %K public health %K surveillance %K misinformation %K infodemiology %K information quality %D 2022 %7 17.10.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36174192 %R 10.2196/40408 %U https://www.jmir.org/2022/10/e40408 %U https://doi.org/10.2196/40408 %U http://www.ncbi.nlm.nih.gov/pubmed/36174192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39555 %T Credibility, Accuracy, and Comprehensiveness of Readily Available Internet-Based Information on Treatment and Management of Peripheral Artery Disease and Intermittent Claudication: Review %A Alexander,Shelley %A Seenan,Chris %+ Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 1413318151, chris.seenan@gcu.ac.uk %K peripheral artery disease %K intermittent claudication %K health information %K education %K internet %K eHealth %K digital health %D 2022 %7 17.10.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 36251363 %R 10.2196/39555 %U https://www.jmir.org/2022/10/e39555 %U https://doi.org/10.2196/39555 %U http://www.ncbi.nlm.nih.gov/pubmed/36251363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38641 %T Interactivity, Quality, and Content of Websites Promoting Health Behaviors During Infancy: 6-Year Update of the Systematic Assessment %A Jawad,Danielle %A Cheng,Heilok %A Wen,Li Ming %A Rissel,Chris %A Baur,Louise %A Mihrshahi,Seema %A Taki,Sarah %+ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, A27 Fisher road, Camperdown, Sydney, 2006, Australia, 61 2 9515 9895, danielle.jawad@sydney.edu.au %K breastfeeding %K bottle feeding %K websites %K web-based platform %K infant food %K readability %K accuracy %K consumer %K health information %K interactivity %K solid food %K quality %K grading %K comprehensibility %K infant %K baby %K babies %K feeding %K food %K eating %K nutrition %K health behavior %K web-based information %K health website %K sleep %K screen time %K rating %D 2022 %7 7.10.2022 %9 Original Paper %J J Med Internet Res %G English %X 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 (1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (rs=−0.39, P=.01), stress after the search (rs=−0.33, P=.02), and the number of search queries (rs=−0.29, P=.04) but was not significantly associated with eHealth literacy (rs=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (rs=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (rs=0.08, P=.56), number of performed search queries (rs=0.20, P=.17), or total clicks (rs=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child’s symptoms. Conclusions: This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public. %M 35532970 %R 10.2196/29618 %U https://pediatrics.jmir.org/2022/2/e29618 %U https://doi.org/10.2196/29618 %U http://www.ncbi.nlm.nih.gov/pubmed/35532970 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33320 %T Publicly Available, Interactive Web-Based Tools to Support Advance Care Planning: Systematic Review %A Dupont,Charlèss %A Smets,Tinne %A Monnet,Fanny %A Pivodic,Lara %A De Vleminck,Aline %A Van Audenhove,Chantal %A Van den Block,Lieve %+ End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 484 433 257, charless.dupont@vub.be %K advance care planning %K systematic review %K web-based tools %K health communication %K quality of online content %D 2022 %7 20.4.2022 %9 Review %J J Med Internet Res %G English %X Background: There is an increasing number of interactive web-based advance care planning (ACP) support tools, which are web-based aids in any format encouraging reflection, communication, and processing of publicly available information, most of which cannot be found in the peer-reviewed literature. Objective: This study aims to conduct a systematic review of web-based ACP support tools to describe the characteristics, readability, and quality of content and investigate whether and how they are evaluated. Methods: We systematically searched the web-based gray literature databases OpenGrey, ClinicalTrials.gov, ProQuest, British Library, Grey Literature in the Netherlands, and Health Services Research Projects in Progress, as well as Google and app stores, and consulted experts using the following eligibility criteria: web-based, designed for the general population, accessible to everyone, interactive (encouraging reflection, communication, and processing of information), and in English or Dutch. The quality of content was evaluated using the Quality Evaluation Scoring Tool (score 0-28—a higher score indicates better quality). To synthesize the characteristics of the ACP tools, readability and quality of content, and whether and how they were evaluated, we used 4 data extraction tables. Results: A total of 30 tools met the eligibility criteria, including 15 (50%) websites, 10 (33%) web-based portals, 3 (10%) apps, and 2 (7%) with a combination of formats. Of the 30 tools, 24 (80%) mentioned a clear aim, including 7 (23%) that supported reflection or communication, 8 (27%) that supported people in making decisions, 7 (23%) that provided support to document decisions, and 2 (7%) that aimed to achieve all these aims. Of the 30 tools, 7 (23%) provided information on the development, all of which were developed in collaboration with health care professionals, and 3 (10%) with end users. Quality scores ranged between 11 and 28, with most of the lower-scoring tools not referring to information sources. Conclusions: A variety of ACP support tools are available on the web, varying in the quality of content. In the future, users should be involved in the development process of ACP support tools, and the content should be substantiated by scientific evidence. Trial Registration: PROSPERO CRD42020184112; https://tinyurl.com/mruf8b43 %M 35442207 %R 10.2196/33320 %U https://www.jmir.org/2022/4/e33320 %U https://doi.org/10.2196/33320 %U http://www.ncbi.nlm.nih.gov/pubmed/35442207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e28291 %T Methodological Guidelines for Systematic Assessments of Health Care Websites Using Web Analytics: Tutorial %A Fundingsland Jr,Edwin Lauritz %A Fike,Joseph %A Calvano,Joshua %A Beach,Jeffrey %A Lai,Deborah %A He,Shuhan %+ Center for Innovation in Digital HealthCare, Lab of Computer Science, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, United States, 1 (617) 726 2000, she@mgh.harvard.edu %K Google Analytics %K website usability %K conversion rate %K website engagement %K user demographics %K website traffic %K website content %K internet browsers %K healthcare websites %K web analytics %K healthcare industry %K usability %D 2022 %7 15.4.2022 %9 Tutorial %J J Med Internet Res %G English %X With the growing importance of communicating with the public via the web, many industries have used web analytics to provide information that organizations can use to better achieve their goals. Although the importance of health care websites has also grown, the health care industry has been slower to adopt the use of web analytics. Web analytics are the measurement, collection, analysis, and reporting of internet data used to measure direct user interaction. Our objective is to provide generalized methods for using web analytics as key performance metrics to evaluate websites and outline actionable recommendations for improvement. By deconstructing web analytic categories such as engagement, users, acquisition, content, and platform, we describe how web analytics are used to evaluate websites and how improvements can be made using this information. Engagement is how a user interacts with a website. It can be evaluated using the daily active users to monthly active users (DAU/MAU) ratio, bounce rate, pages viewed, and time on site. Poor engagement indicates potential problems with website usability. Users pertains to demographic information regarding the users interacting with a website. This data can help administrators understand who is engaging with their website. Acquisition refers to the overall website traffic and the method of traffic, which allows administrators to see how people are accessing their website. This information helps websites expand their methods of attracting users. Content refers to the overall relevancy, accuracy, and trustworthiness of a website’s content. If a website has poor content, it will likely experience difficulty with user engagement. Finally, platform refers to the technical aspects of how people access a website. It includes both the internet browsers and devices used. By providing detailed descriptions of these categories, we have identified how web administrators can use web analytics to systematically assess their websites. We have also provided generalized recommendations for actionable improvements. By introducing the potential of web analytics to augment usability and the conversion rate, we hope to assist health care organizations in better communicating with the public and therefore accomplishing the goals of their websites. %M 35436216 %R 10.2196/28291 %U https://www.jmir.org/2022/4/e28291 %U https://doi.org/10.2196/28291 %U http://www.ncbi.nlm.nih.gov/pubmed/35436216 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e35067 %T Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach %A Fleary,Sasha A %+ Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, United States, 1 646 3640282, sasha.fleary@sph.cuny.edu %K adolescents %K health communications %K health literacy %K measurement %K media health literacy %K Rasch %K mobile phone %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: High media use has been implicated in negative social and health outcomes among adolescents. Therefore, it is critical that adolescents develop skills to healthily engage with media content. Media health literacy (MHL), skills for assessing and responding to health-related media content, and potentially targetable moderators for the relationship between media use and health-related outcomes are understudied in adolescents. The lack of MHL assessment tools may have contributed to this research gap. Objective: This study aimed to develop and validate test-based scales of adolescents’ MHL. Methods: The items developed were vetted iteratively via community reviews and cognitive interviews to establish content and face validity. Adolescents (N=355) completed a questionnaire that included the revised MHL items. The scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) were validated using Rasch measurement models. Convergent validity was assessed by correlating the summed scores of the three scales with existing functional and internet-related health literacy measures. Criterion validity was assessed by modeling logistic regressions for predicting health literacy–related behaviors from each scale after controlling for demographics. Effect sizes were estimated, and a short form was also validated. Results: The final MHL scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) fit their Rasch models. The 9-item Recognition/Identification and 9-item Influence/Critical Analysis scales had good convergent validity with functional and internet-related health literacy measures and were positively related to reading instructions before taking medicines and questioning the truthfulness of health information found online. The 12-item MHL Scales-Short Form also had good convergent and criterion validity. However, convergent and criterion validity were not established for the 3-item Action/Reaction Scale. Conclusions: The Recognition/Identification and Influence/Critical Analysis scales and the MHL Scales-Short Form may be used to determine the impact of MHL on media use and health outcome relationships and ultimately inform the development of interventions and policies to affect these relationships in multiple settings. %M 35436219 %R 10.2196/35067 %U https://pediatrics.jmir.org/2022/2/e35067 %U https://doi.org/10.2196/35067 %U http://www.ncbi.nlm.nih.gov/pubmed/35436219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e28135 %T The Quality of Internet Websites for People Experiencing Psychosis: Pilot Expert Assessment %A Wilhelm,Kay %A Handley,Tonelle %A McHugh,Catherine %A Lowenstein,David %A Arrold,Kristy %+ Discipline of Psychiatry, School of Medicine, University of Notre Dame, O'Brien Centre, St Vincent's Hospital, Sydney, 2010, Australia, 61 416 143 717, kwilhelm@bigpond.net.au %K psychosis %K schizophrenia %K DISCERN %K quality %K websites %K mental health %K Australia %K health information %K patients %K consumers %K accessibility %K patient empowerment %K reliability %K eHealth %K electronic health %K website %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinicians need to be able to assess the quality of the available information to aid clinical decision-making. The internet has become an important source of health information for consumers and their families. Objective: This study aimed to rate the quality of websites with psychosis-related information (to provide clinicians with a basis for recommending material to guide clinical decision-making with consumers and their families), using a validated instrument as well as a purpose-developed checklist, and consider improvement in quality over a 4-year period. Methods: Two measures of website quality were used: the DISCERN scale and the Psychosis Website Quality Checklist (PWQC). Terms related to psychosis, including “psychotic,” “psychosis,” “schizophrenia,” “delusion,” and “hallucination,” were entered into Google, and the first 25 results were analyzed. In total, 6 raters with varying health professional backgrounds were used to evaluate the websites across two time points: January-March 2014 and January-March 2018. Results: Of the 25 websites rated, only the 6 highest ranked websites achieved a DISCERN score, indicating that they were of “good” quality (51-62 out of a possible 75), while the mean score of the websites (mean 43.96, SD 12.08) indicated an overall “fair” quality. The PWQC revealed that websites scored highly on “availability and usability” (mean 16.82, SD 3.96) but poorly on “credibility” (mean 20.99, SD 6.68), “currency” (mean 5.16, SD 2.62), and “breadth and accuracy” (mean 77.87, SD 23.20). Most sites lacked information about early intervention, recreational drug use and suicide risk, with little change in content over time. Stating an editorial or review process on the website (found in 56% of websites) was significantly associated with a higher quality score on both scales (the DISCERN scale, P=.002; the PWQC, P=.006). Conclusions: The information on the internet available for clinicians to recommend to people affected by psychosis tended to be of “fair” quality. While higher-quality websites exist, it is generally not easy way to assess this on face value. Evidence of an editorial or review process was one indicator of website quality. While sites generally provided basic clinical information, most lacked material addressing weighing up risks and benefits of medication and alternatives, the role of coercive treatment and other more contentious issues. Insufficient emphasis is placed on detailed information on early intervention and importance of lifestyle modifications or how families and friends can contribute. These are likely to be the very answers that consumers and carers are seeking and this gap contributes to unmet needs among this group. We suggest that clinicians should be aware of what is available and where there are gaps. %M 35436206 %R 10.2196/28135 %U https://formative.jmir.org/2022/4/e28135 %U https://doi.org/10.2196/28135 %U http://www.ncbi.nlm.nih.gov/pubmed/35436206 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e30156 %T Content Quality of YouTube Videos About Gestational Diabetes: Systematic Evaluation %A Birch,Eleanor M %A Leziak,Karolina %A Jackson,Jenise %A Dahl,Emma %A Niznik,Charlotte M %A Yee,Lynn M %+ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, United States, 1 312 472 4685, lynn.yee@northwestern.edu %K diabetes %K gestational diabetes %K health information %K internet %K web-based %K pregnancy %K YouTube %D 2022 %7 7.4.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: People with gestational diabetes have enhanced learning requirements during pregnancy, and management of their disease often requires the translation of health information into new health behavior changes. Seeking information from the internet to augment learning from health professionals is becoming more common during pregnancy. YouTube is a popular free and accessible web-based resource, which may be particularly useful for individuals with low health literacy or other barriers to receiving high-quality health care; however, the quality and content of YouTube videos varies, and little is known about those covering gestational diabetes. Objective: We aimed to systematically evaluate the quality, content, and reliability of YouTube videos about gestational diabetes. Methods: A systematic search of YouTube videos was conducted over the course of 1 week in April 2020 using the following keywords: “gestational diabetes,” “gestational diabetes management,” “gestational diabetes treatment,” and “pregnancy and diabetes.” The search results were displayed by relevance, replicating a default YouTube search attempt. The first 60 results from each keyword were reviewed (n=240). Exclusion criteria were videos unrelated to gestational diabetes, videos not in English, and those for which the full video was not available at the time of review. For each unique video, a gestational diabetes content score was used to rate video comprehensiveness and accuracy, and the DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of information presented. Videos were further categorized by quality: videos with DISCERN scores lower than 3 (out of 5) or a content score less than 4 (out of 7) were categorized as low quality, and all others were designated high quality. We performed descriptive analysis and compared video characteristics by source and quality rating. Results: For 115 unique videos, the mean content score (out of 7) was 3.5 (SD 2.0) , and the mean DISCERN score (out of 5) was 2.7 (SD 0.7), representing low to moderate information comprehensiveness and reliability respectively. Video sources were categorized as personal vlog (12/115, 10.4%), web-based education (37/115, 32.2%), medical (52/115, 45.2%), business or company (13/115, 11.3%), and media clip (1/115, 0.9%). DISCERN and content scores trended higher among medical and web-based education videos. The majority of videos (n=88) were categorized as low quality, while 27 videos were categorized as high quality. Video duration was longer for high-quality videos (P<.001); high- and low-quality videos otherwise had similar views and viewer interaction numbers. Conclusions: Although high-quality videos about gestational diabetes exist, reliability, accuracy, and comprehensiveness were low overall, and higher quality was not associated with increased viewer interaction. It is important to acknowledge the limitations of this platform and to assist patients in accessing high quality content and differentiating the quality of information sources. %M 35389355 %R 10.2196/30156 %U https://diabetes.jmir.org/2022/2/e30156 %U https://doi.org/10.2196/30156 %U http://www.ncbi.nlm.nih.gov/pubmed/35389355 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e25005 %T Web-Based Patient Educational Material on Osteosarcoma: Quantitative Assessment of Readability and Understandability %A Gulbrandsen,Trevor Robert %A Skalitzky,Mary Kate %A Shamrock,Alan Gregory %A Gao,Burke %A Hasan,Obada %A Miller,Benjamin James %+ Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, United States, 1 435 659 4221, trevor-gulbrandsen@uiowa.edu %K osteosarcoma %K patient education %K health literacy %K web-based health information %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients often turn to web-based resources following the diagnosis of osteosarcoma. To be fully understood by average American adults, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend web-based health information to be written at a 6th grade level or lower. Previous analyses of osteosarcoma resources have not measured whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT) is a validated measurement of understandability and actionability. Objective: The purpose of this study was to evaluate web-based osteosarcoma resources using measures of readability, understandability, and actionability. Methods: Using the search term “osteosarcoma,” two independent Google searches were performed on March 7, 2020 (by AGS), and March 11, 2020 (by TRG). The top 50 results were collected. Websites were included if they were directed at providing patient education on osteosarcoma. Readability was quantified using validated algorithms: Flesh-Kincaid Grade Ease (FKGE), Flesch-Kincaid Grade-Level (FKGL). A higher FKGE score indicates that the material is easier to read. All other readability scores represent the US school grade level. Two independent PEMAT assessments were performed with independent scores assigned for both understandability and actionability. A PEMAT score of 70% or below is considered poorly understandable or poorly actionable. Statistical significance was defined as P≤.05. Results: Two searches yielded 53 unique websites, of which 37 (70%) met the inclusion criteria. The mean FKGE and FKGL scores were 40.8 (SD 13.6) and 12.0 (SD 2.4), respectively. No website scored within the acceptable NIH or AHA recommended reading level. Only 4 (11%) and 1 (3%) website met the acceptable understandability and actionability threshold. Both understandability and actionability were positively correlated with FKGE (ρ=0.55, P<.001; ρ=0.60, P<.001), but were otherwise not significantly associated with other readability scores. There were no associations between readability (P=.15), understandability (P=.20), or actionability (P=.31) scores and Google rank. Conclusions: Overall, web-based osteosarcoma patient educational materials scored poorly with respect to readability, understandability, and actionability. None of the web-based resources scored at the recommended reading level. Only 4 achieved the appropriate score to be considered understandable by the general public. Authors of patient resources should incorporate PEMAT and readability criteria to improve web-based resources to support patient understanding. %M 35323117 %R 10.2196/25005 %U https://cancer.jmir.org/2022/1/e25005 %U https://doi.org/10.2196/25005 %U http://www.ncbi.nlm.nih.gov/pubmed/35323117 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e34003 %T Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis %A Yeung,Andy Wai Kan %A Wochele-Thoma,Thomas %A Eibensteiner,Fabian %A Klager,Elisabeth %A Hribersek,Mojca %A Parvanov,Emil D %A Hrg,Dalibor %A Völkl-Kernstock,Sabine %A Kletecka-Pulker,Maria %A Schaden,Eva %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Spitalgasse 23, Vienna, 1090, Austria, 43 664 1929 852, atanas.atanasov@univie.ac.at %K COVID-19 %K coronavirus %K SARS-CoV-2 %K vaccine %K readability %K content quality %K online health information %K side effect %K public health %K medicine %K quality %K perception %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online information on COVID-19 vaccination may influence people’s perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. Objective: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. Methods: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The “frequently asked questions” or “questions and answers” section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. Results: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46% (23/50) of the websites stated that they do not know, and another 40% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78%), headache (36/50, 72%), fatigue (33/50, 66%), and muscle/joint pain (31/50, 62%). Conclusions: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented. %M 35073276 %R 10.2196/34003 %U https://publichealth.jmir.org/2022/3/e34003 %U https://doi.org/10.2196/34003 %U http://www.ncbi.nlm.nih.gov/pubmed/35073276 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32452 %T COVID-19 and Vitamin D Misinformation on YouTube: Content Analysis %A Quinn,Emma K %A Fenton,Shelby %A Ford-Sahibzada,Chelsea A %A Harper,Andrew %A Marcon,Alessandro R %A Caulfield,Timothy %A Fazel,Sajjad S %A Peters,Cheryl E %+ Department of Occupational and Environmental Hygiene, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, T2T 1Z3, Canada, 1 403 809 1289, equinn99@student.ubc.ca %K COVID-19 %K vitamin D %K misinformation %K YouTube %K content analysis %K social media %K video %K infodemic %K risk %K prevention %K health information %K immunity %K immune system %K supplements %K natural medicine %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The “infodemic” accompanying the SARS-CoV-2 virus pandemic has the potential to increase avoidable spread as well as engagement in risky health behaviors. Although social media platforms, such as YouTube, can be an inexpensive and effective method of sharing accurate health information, inaccurate and misleading information shared on YouTube can be dangerous for viewers. The confusing nature of data and claims surrounding the benefits of vitamin D, particularly in the prevention or cure of COVID-19, influences both viewers and the general “immune boosting” commercial interest. Objective: The aim of this study was to ascertain how information on vitamin D and COVID-19 was presented on YouTube in 2020. Methods: YouTube video results for the search terms “COVID,” “coronavirus,” and “vitamin D” were collected and analyzed for content themes and deemed useful or misleading based on the accuracy or inaccuracy of the content. Qualitative content analysis and simple statistical analysis were used to determine the prevalence and frequency of concerning content, such as confusing correlation with causation regarding vitamin D benefits. Results: In total, 77 videos with a combined 10,225,763 views (at the time of data collection) were included in the analysis, with over three-quarters of them containing misleading content about COVID-19 and vitamin D. In addition, 45 (58%) of the 77 videos confused the relationship between vitamin D and COVID-19, with 46 (85%) of 54 videos stating that vitamin D has preventative or curative abilities. The major contributors to these videos were medical professionals with YouTube accounts. Vitamin D recommendations that do not align with the current literature were frequently suggested, including taking supplementation higher than the recommended safe dosage or seeking intentional solar UV radiation exposure. Conclusions: The spread of misinformation is particularly alarming when spread by medical professionals, and existing data suggesting vitamin D has immune-boosting abilities can add to viewer confusion or mistrust in health information. Further, the suggestions made in the videos may increase the risks of other poor health outcomes, such as skin cancer from solar UV radiation. %M 35310014 %R 10.2196/32452 %U https://infodemiology.jmir.org/2022/1/e32452 %U https://doi.org/10.2196/32452 %U http://www.ncbi.nlm.nih.gov/pubmed/35310014 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29581 %T Assessment of the Quality, Understandability, and Reliability of YouTube Videos as a Source of Information on Basal Cell Carcinoma: Web-Based Analysis %A Steeb,Theresa %A Reinhardt,Lydia %A Harlaß,Matthias %A Heppt,Markus Vincent %A Meier,Friedegund %A Berking,Carola %+ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8545852, Theresa.Steeb@uk-erlangen.de %K basal cell carcinoma %K YouTube %K videos %K patient education %K shared decision-making %K quality %K reliability %K internet %K information %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with skin cancer increasingly watch online videos to acquire disease-related information. Until now, no scientific evaluation of the quality of videos available for German-speaking patients with basal cell carcinoma (BCC) has been performed. Objective: In this study, we aimed to identify and evaluate videos about BCC provided on YouTube. Methods: A video search on YouTube was conducted in July 2020, using German BCC-related keywords (eg, “Basalzellkarzinom,” “Basaliom,” “weißer hautkrebs,” and “heller hautkrebs”). The first three pages (ie, 60 videos) were searched by two independent researchers for each keyword. Two authors evaluated videos that met the predefined eligibility criteria. The quality of the information of the videos was evaluated using the DISCERN tool and the Global Quality Scale (GQS). The understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). The reliability was assessed with the JAMA (Journal of the American Medical Association) criteria score. Subgroup differences were identified using the Kruskal-Wallis test. Results: A total of 41 videos were included in the evaluation. The mean assessment scores were as follows: DISCERN, 3.3 (SD 0.80); GQS, 3.8 (SD 1.1); JAMA, 27.74% (SD 22.1%); understandability, 70.8% (SD 13.3%); and actionability, 45.9% (SD 43.7%). These values indicated that the videos were of medium to good quality and had good understandability, low actionability, and poor reliability. The quality of videos provided by health professionals was significantly higher than that of videos provided by laypersons. Conclusions: Optimization of health-related videos about BCC is desirable. In particular, adaptation to reliability criteria is necessary to support patient education and increase transparency. %M 35275067 %R 10.2196/29581 %U https://cancer.jmir.org/2022/1/e29581 %U https://doi.org/10.2196/29581 %U http://www.ncbi.nlm.nih.gov/pubmed/35275067 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28942 %T Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines %A Martinengo,Laura %A Stona,Anne-Claire %A Tudor Car,Lorainne %A Lee,Jimmy %A Griva,Konstadina %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047017, josip.car@ntu.edu.sg %K health literacy %K mental health literacy %K depression %K mobile apps %K apps %K telemedicine %K mHealth %K self-management %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non–evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user’s support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non–evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. %M 35262489 %R 10.2196/28942 %U https://www.jmir.org/2022/3/e28942 %U https://doi.org/10.2196/28942 %U http://www.ncbi.nlm.nih.gov/pubmed/35262489 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32406 %T Proxy Information Seeking by Users of a Parenting Information Website: Quantitative Observational Study %A El Sherif,Reem %A Pluye,Pierre %A Schuster,Tibor %A Grad,Roland %+ Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada, 1 5143987375, reem.elsherif@mail.mcgill.ca %K consumer health information %K information seeking behavior %K child development %K child health %K information outcomes %K health information %K digital health %K parenting %K online information %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: One of the largest groups of consumers who seek health information on the internet are parents of young children, as well as people in their social circle. The concept of proxy seeking (on behalf of others) has been explored in the literature, yet little is known about the outcomes. Objective: The main aim of this study was to describe consumer health information outcomes reported by proxy seekers using a parenting website. Methods: We conducted a 2-year quantitative observational study. Participants were parents of 0- to 8-year-old children and members of their entourage in Canada who had accessed Naître et Grandir through the website or through a weekly newsletter. For each Naître et Grandir webpage, participants’ perceptions regarding the outcomes of seeking and using specific webpages were gathered using a content-validated Information Assessment Method questionnaire. We compared the outcomes reported by parents with those reported by members of their entourage after consulting a parenting information website and explored if the method of accessing the information by the proxy seekers (website or weekly newsletter) changed the outcomes reported. For key primary survey items, the chi-square test was conducted, and differences in relative frequencies of responses were computed along with confidence intervals. Results: A total of 51,325 completed questionnaires were included in the analysis, pertaining to 1079 Naître et Grandir webpages (mean 48; range 1-637). Compared to parents, individuals in the entourage are more likely to report using the information in discussion with others (mean difference 0.166, 95% CI 0.155-0.176). Parents, on the other hand, were more likely than the entourage to report using the information to better understand (mean difference 0.084, 95% CI 0.073-0.094), to decide to do something (mean difference 0.156, 95% CI 0.146-0.166), or to do something in a different manner (mean difference 0.052, 95% CI 0.042-0.061). In addition, results suggest that the differences in perceived benefits of parenting information by the entourage depend on how they access the information. Respondents who were actively seeking the information (through the website) were more likely to report that the information would help them be less worried (mean difference 0.047; 95% CI 0.024-0.069), handle a problem (mean difference 0.083; 95% CI 0.062-0.104), and decide what to do with someone else (mean difference 0.040, 95% CI 0.020-0.058). Respondents who passively acquired the information (through the newsletter) were more likely to report that the information would help improve the health or well-being of a child (mean difference 0.090; 95% CI 0.067-0.112). Conclusions: By better understanding how consumers and their entourages use information, information providers can adapt information to meet both individual and group needs, and health care practitioners can target patients’ entourages with web-based health information resources for dissemination and use. %M 35254283 %R 10.2196/32406 %U https://pediatrics.jmir.org/2022/1/e32406 %U https://doi.org/10.2196/32406 %U http://www.ncbi.nlm.nih.gov/pubmed/35254283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30085 %T Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %A Cho,Yoon Jeong %+ Department of Family Medicine, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K health literacy %K readability %K public health %K health equity %K consumer health information %K information dissemination %K health education %K eHealth %K online %K social media %K pandemic %K infodemic %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7%; prevention: 6/97, 6.2%; test: 0/5, 0%; treatment: 1/8, 12.5%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. %M 35072633 %R 10.2196/30085 %U https://formative.jmir.org/2022/3/e30085 %U https://doi.org/10.2196/30085 %U http://www.ncbi.nlm.nih.gov/pubmed/35072633 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e35234 %T The Behavior Change Techniques Used in Canadian Online Smoking Cessation Programs: Content Analysis %A Struik,Laura %A Rodberg,Danielle %A Sharma,Ramona H %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508078000, laura.struik@ubc.ca %K content analysis %K smoking cessation %K internet %K behavior change technique %K mental health %K smoking %K online program %K website %K government %K federal %K provincial %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Smoking rates in Canada remain unacceptably high, and cessation rates have stalled in recent years. Online cessation programs, touted for their ability to reach many different populations anytime, have shown promise in their efficacy. The Government of Canada has therefore funded provincial and national smoking cessation websites countrywide. However, little is known about the behavior change techniques (BCTs) that underpin the content of these websites, which is key to establishing the quality of the websites, as well as a way forward for evaluation. Objective: The purpose of this study, therefore, is to apply the BCTTv1 taxonomy to Canadian provincial and federal websites, and to determine which BCTs they use. Methods: A total of 12 government-funded websites across Canada were included for analysis. Using deductive content analysis and through training in applying the BCTTv1 taxonomy, the website content was coded according to the 93 BCTs across the 16 BCT categories. Results: Of the 16 BCT categories, 14 were present within the websites. The most widely represented BCT categories (used in all 12 websites) included goals and planning, social support, natural consequences, and regulation. Implementation of BCTs within these categories varied across the sites. Conclusions: Analyzing the content of online smoking cessation websites using the BCTTv1 taxonomy is an appropriate method for identifying the behavior change content of these programs. The findings offer programmers and researchers tangible directions for prioritizing and enhancing provincial and national smoking cessation programs, and an evaluation framework to assess smoking cessation outcomes in relation to the web-based content. %M 35230253 %R 10.2196/35234 %U https://mental.jmir.org/2022/3/e35234 %U https://doi.org/10.2196/35234 %U http://www.ncbi.nlm.nih.gov/pubmed/35230253 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e33340 %T An Analysis of Skin of Color Content on TikTok %A Pulsipher,Kayd J %A Concilla,Anthony %A Presley,Colby L %A Laughter,Melissa R %A Anderson,Jaclyn %A Chea,Emily %A Lim,Kristina %A Rundle,Chandler W %A Szeto,Mindy D %A Dellavalle,Robert %+ Dermatology Service, Rocky Mountain Regional Medical Center, US Department of Veteran Affairs, 1700 N Wheeling St, Rm E1-342, Aurora, CO, 80045, United States, 1 720 857 5562, robert.dellavalle@cuanschutz.edu %K internet %K social media %K TikTok %K skin of color %K SoC %K influencer %K user engagement %K hashtag %K dermatologist %D 2022 %7 1.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 39499586 %R 10.2196/33340 %U https://derma.jmir.org/2022/1/e33340 %U https://doi.org/10.2196/33340 %U http://www.ncbi.nlm.nih.gov/pubmed/39499586 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e31943 %T The Dermatologist on Social Media: When the Pros Outweigh the Cons. Comment on “Risks and Benefits of Using Social Media in Dermatology: Cross-sectional Questionnaire Study” %A Concilla,Anthony %A Laughter,Melissa R %A Presley,Colby L %A Anderson,Jaclyn %A Rundle,Chandler W %+ Department of Dermatology, Duke University, 40 Duke Medicine Circle, Durham, NC, 27705, United States, 1 9196843432, chandler.rundle@duke.edu %K Instagram %K Twitter %K TikTok %K Facebook %K internet %K social media %K dermatologist %K generational differences %K information quality %K patient education %K online content %K risk %K benefit %K dermatology %K cross-sectional %K survey %K online health information %D 2022 %7 25.2.2022 %9 Letter to the Editor %J JMIR Dermatol %G English %X %M 37632875 %R 10.2196/31943 %U https://derma.jmir.org/2022/1/e31943 %U https://doi.org/10.2196/31943 %U http://www.ncbi.nlm.nih.gov/pubmed/37632875 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31793 %T (Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic %A Kreps,Sarah %A George,Julie %A Watson,Noah %A Cai,Gloria %A Ding,Keyi %+ Department of Government, Cornell University, 313 White Hall, Ithaca, NY, 14853, United States, 1 703 403 6550, sarah.kreps@cornell.edu %K internet %K social media %K misinformation %K COVID-19 %K Twitter %K Weibo %K prevalence %K discourse %K content %K communication %K public health %K context %K content analysis %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Misinformation about COVID-19 on social media has presented challenges to public health authorities during the pandemic. This paper leverages qualitative and quantitative content analysis on cross-platform, cross-national discourse and misinformation in the context of COVID-19. Specifically, we investigated COVID-19-related content on Twitter and Sina Weibo—the largest microblogging sites in the United States and China, respectively. Objective: Using data from 2 prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, we compared the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. Methods: A total of 3,579,575 posts were scraped from both Sina Weibo and Twitter, focusing on content from January 30, 2020, within 24 hours of when WHO declared COVID-19 a “public health emergency of international concern,” and a week later, on February 6, 2020. We examined how the use and engagement measured by keyword frequencies and hashtags differ across the 2 platforms. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags and the Viterbi algorithm. We manually coded a random selection of 5%-7% of the content to identify misinformation on each platform and compared posts using the WHO fact-check page to adjudicate accuracy of content. Results: Both platforms posted about the outbreak and transmission, but posts on Sina Weibo were less likely to reference topics such as WHO, Hong Kong, and death and more likely to cite themes of resisting, fighting, and cheering against coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Sina Weibo content—almost 4 times as much on Twitter compared to Sina Weibo. Conclusions: Quantitative and qualitative analysis of content on both platforms points to lower degrees of misinformation, more content designed to bolster morale, and less reference to topics such as WHO, death, and Hong Kong on Sina Weibo than on Twitter. %M 36406147 %R 10.2196/31793 %U https://infodemiology.jmir.org/2022/1/e31793 %U https://doi.org/10.2196/31793 %U http://www.ncbi.nlm.nih.gov/pubmed/36406147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29275 %T The Effects of Website Traits and Medical Skepticism on Patients’ Willingness to Follow Web-Based Medical Advice: Web-Based Experiment %A Claggett,Jennifer %A Kitchens,Brent %A Paino,Maria %A Beisecker Levin,Kaitlyn %+ School of Business, Wake Forest University, 1834 Wake Forest Rd, Farrel Hall, Winston-Salem, NC, 27109, United States, 1 1336302799, claggett@gmail.com %K web-based information credibility assessment %K website traits %K medical skepticism %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: As people increasingly turn to web-based sources for medical information, we offer some insight into what website traits influence patients’ credibility assessment. Specifically, we control for brand and content length, while manipulating three website traits: authorship, format, and tone. Furthermore, we focus on medical skepticism to understand how patients with high levels of medical skepticism may react to web-based medical information differently. Medical skepticism is related to a patient’s doubts about the value of conventional medical care; therefore, skeptics may have different practices and criteria when conducting their own web-based medical searches. Objective: The aim of this study is to evaluate how website traits affect the likelihood that patients follow web-based medical advice and how this varies among patients with differing levels of medical skepticism. Methods: This web-based experiment presented participants with a hypothetical medical situation about leg cramps and offered a website with treatment advice. We varied the websites the participants observed across three traits: authorship (patient or physician), format (article or discussion forum), and tone (objective or experience-based). The 2305 participants were randomly assigned to 1 of 8 possible conditions and then asked the extent to which they would follow the advice. Health care patterns and coverage, demographics, and the participants’ level of medical skepticism were captured. Results: Our participants were selected to be demographically representative of the population of internet users in the United States. The 2305 complete responses were analyzed with ordinary least squares regression. Our analysis reveals that people are more likely to accept web-based medical advice authored by a physician (P<.001) and presented with an objective tone (P=.006), but these preferences erode as the levels of medical skepticism increase. Medical skepticism was measured by means of a previously established index on a 0 to 4 scale, and the average score was 2.26 (SD 0.84). Individuals with higher levels of medical skepticism were more likely to follow web-based medical advice in our experiment (P<.001). Individuals with low levels of medical skepticism found the discussion forum format more credible, whereas those with high levels of medical skepticism preferred the article format (P=.03). We discuss the interactions between medical skepticism and all 3 website traits manipulated in the experiment. Conclusions: Our findings suggest that, generally, physician authorship and an objective tone create more persuasive web-based medical advice. However, there are differences in how patients with high levels of medical skepticism react to web-based medical resources. Medical skeptics are less discerning regarding the author’s credentials and the presentation tone of the information. Furthermore, patients with higher levels of medical skepticism prefer article format presentations, whereas those with lower levels of medical skepticism prefer discussion forum–style formatting. %M 35179506 %R 10.2196/29275 %U https://www.jmir.org/2022/2/e29275 %U https://doi.org/10.2196/29275 %U http://www.ncbi.nlm.nih.gov/pubmed/35179506 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33651 %T Usage and Usability of a National e-Library for Chemotherapy Regimens: Mixed Methods Study %A Fyhr,AnnSofie %A Persson,Johanna %A Ek,Åsa %+ Regional Cancer Centre South, Region Skåne, Medicon Village, Scheeletorget 1, Lund, SE-223 81, Sweden, 46 46 275 23 51, ann-sofie.fyhr@skane.se %K chemotherapy regimens %K user evaluation %K standardization %K patient safety %K chemotherapy %K safety %K usability %K e-library %K medication errors %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Accurate information about chemotherapy drugs and regimens is needed to reduce chemotherapy errors. A national e-library, as a common knowledge source with standardized chemotherapy nomenclature and content, was developed. Since the information in the library is both complex and extensive, it is central that the users can use the resource as intended. Objective: The aim of this study was to evaluate the usage and usability of an extensive e-library for chemotherapy regimens developed to reduce medication errors, support the health care staff in their work, and increase patient safety. Methods: To obtain a comprehensive evaluation, a mixed methods study was performed for a broad view of the usage, including a compilation of subjective views of the users (web survey, spontaneous user feedback, and qualitative interviews), analysis of statistics from the website, and an expert evaluation of the usability of the webpage. Results: Statistics from the website show an average of just over 2500 visits and 870 unique visitors per month. Most visits took place Mondays to Fridays, but there were 5-10 visits per day on weekends. The web survey, with 292 answers, shows that the visitors were mainly physicians and nurses. Almost 80% (224/292) of respondents searched for regimens and 90% (264/292) found what they were looking for and were satisfied with their visit. The expert evaluation shows that the e-library follows many existing design principles, thus providing some useful improvement suggestions. A total of 86 emails were received in 2020 with user feedback, most of which were from nurses. The main part (78%, 67/86) contained a question, and the rest had discovered errors mainly in some regimen. The interviews reveal that most hospitals use a computerized physician order entry system, and they use the e-library in various ways, import XML files, transfer information, or use it as a reference. One hospital without a system uses the administration schedules from the library. Conclusions: The user evaluation indicates that the e-library is used in the intended manner and that the users can interact without problems. Users have different needs depending on their profession and their workplace, and these can be supported. The combination of methods applied ensures that the design and content comply with the users’ needs and serves as feedback for continuous design and learning. With a broad national usage, the e-library can become a source for organizational and national learning and a source for continuous improvement of cancer care in Sweden. %M 35175199 %R 10.2196/33651 %U https://humanfactors.jmir.org/2022/1/e33651 %U https://doi.org/10.2196/33651 %U http://www.ncbi.nlm.nih.gov/pubmed/35175199 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34176 %T The Accessibility of YouTube Fitness Videos for Individuals Who Are Disabled Before and During the COVID-19 Pandemic: Preliminary Application of a Text Analytics Approach %A Kadakia,Shevali %A Stratton,Catherine %A Wu,Yinfei %A Feliciano,Josemari %A Tuakli-Wosornu,Yetsa A %+ Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, 3471 Fifth Ave, Pittsburgh, PA, 15213, United States, 1 4436104322, yetsa.tuakli-wosornu@yale.edu %K persons with disabilities %K disability %K exercise %K physical activity %K digital health %K YouTube %K accessibility %K fitness %K COVID-19 %K text analysis %K social media %K video %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with disabilities face barriers to in-person physical activity (PA), including a lack of adaptive equipment and knowledgeable instructors. Given this and the increased need for digital resources due to widespread COVID-19 lockdowns, it is necessary to assess the accessibility of digital fitness resources for people with disabilities. To investigate whether YouTube fitness content creators have made videos accessible to people with disabilities would be informative about access to PA during COVID-19 and could also provide insight into the feasibility of individuals who are disabled relying on YouTube for PA in a post–COVID-19 world. Objective: This study aims to ascertain if disability-friendly PA videos on YouTube are accessible through searching general fitness terms and whether a change in the availability of accessible fitness resources for people with disabilities occurred on YouTube between before and during the COVID-19 pandemic on “Hospital/Medical Institutions,” “Individual(s),” and “Other(s)” channels. Secondary aims are to investigate if different categories of YouTube channels produce more accessible fitness content and highlight any disparities in disability-friendly PA content on YouTube. Methods: A cross-sectional text analysis of exercise-related YouTube videos was conducted. The authors used Python (version 3.0) to access the YouTube database via its data application programming interface. Terms pertaining to PA that were searched on YouTube were at-home exercise, exercise at home, exercise no equipment, home exercise, home-based exercise, no equipment workout, and workout no equipment. Various elements (eg, view count and content generation) of the videos published between January 1 and June 30, 2019 (n=700), were compared to the elements of videos published between January 1 and June 30, 2020 (n=700). To capture a broad idea of disability-friendly videos on YouTube, videos were labeled “accessible” if they were found in the first 100 video results and if their title, description, or tags contained the following terms: para, paralympic, adaptive, adapted, disabled, disability, differently abled, disability-friendly, wheelchair accessible, and inclusive. Each video and channel were categorized as “Hospitals/Medical Institutions,” “Individuals,” or “Other(s).” Results: The analysis revealed a statistically significant increase in viewership of fitness content on YouTube (P=.001) and in fitness content generated by Hospitals/Medical Institutions (P=.004). Accessible terms applicable to people with disabilities had minimal appearances in 2019 (21 videos) and 2020 (19 videos). None of the top viewed fitness videos that populated on YouTube from 2019 or 2020 were accessible. Conclusions: The proportion of accessible disability-friendly videos remains diminutive relative to the prevalence of disability in the general population, revealing that disability-friendly videos are seldom findable on YouTube. Thus, the need for disability-friendly fitness content to be easily searched and found remains urgent if access to digital fitness resources is to improve. %M 35044305 %R 10.2196/34176 %U https://formative.jmir.org/2022/2/e34176 %U https://doi.org/10.2196/34176 %U http://www.ncbi.nlm.nih.gov/pubmed/35044305 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32443 %T Assessing COVID-19 Health Information on Google Using the Quality Evaluation Scoring Tool (QUEST): Cross-sectional and Readability Analysis %A Bachu,Vismaya S %A Mahjoub,Heba %A Holler,Albert E %A Crihalmeanu,Tudor %A Bachu,Dheevena M %A Ayyaswami,Varun %A Parker,Pearman D %A Prabhu,Arpan V %+ Department of Radiation Oncology, University of Arkansas for Medical Sciences, Winthrop P Rockefeller Cancer Institute, 4130 Shuffield Dr, Little Rock, AR, 72205, United States, 1 5016644568, avprabhu@uams.edu %K COVID-19 %K COVID-19 pandemic %K health literacy %K readability %K QUEST %K online health information %K cross-sectional %K trend %K internet %K spread %K symptom %K quality %K United States %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic spurred an increase in online information regarding disease spread and symptomatology. Objective: Our purpose is to systematically assess the quality and readability of articles resulting from frequently Google-searched COVID-19 terms in the United States. Methods: We used Google Trends to determine the 25 most commonly searched health-related phrases between February 29 and April 30, 2020. The first 30 search results for each term were collected, and articles were analyzed using the Quality Evaluation Scoring Tool (QUEST). Three raters scored each article in authorship, attribution, conflict of interest, currency, complementarity, and tone. A readability analysis was conducted. Results: Exactly 709 articles were screened, and 195 fulfilled inclusion criteria. The mean article score was 18.4 (SD 2.6) of 28, with 7% (14/189) scoring in the top quartile. National news outlets published the largest share (70/189, 36%) of articles. Peer-reviewed journals attained the highest average QUEST score compared to national/regional news outlets, national/state government sites, and global health organizations (all P<.05). The average reading level was 11.7 (SD 1.9, range 5.4-16.9). Only 3 (1.6%) articles were written at the recommended sixth grade level. Conclusions: COVID-19–related articles are vastly varied in their attributes and levels of bias, and would benefit from revisions for increased readability. %M 34995206 %R 10.2196/32443 %U https://formative.jmir.org/2022/2/e32443 %U https://doi.org/10.2196/32443 %U http://www.ncbi.nlm.nih.gov/pubmed/34995206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35164 %T Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos %A Tang,Hao %A Kim,Sungwoo %A Laforet,Priscila E %A Tettey,Naa-Solo %A Basch,Corey H %+ Department of Health and Behavior Studies, Teachers College, Columbia University, 528 West 121st Street, New York, NY, 10027, United States, 1 2126783964, ht2489@tc.columbia.edu %K COVID-19 %K quarantine %K weight loss %K weight gain %K social media %K YouTube %D 2022 %7 9.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people experienced unintended weight gain during the COVID-19 pandemic, which has been discussed widely on social media. Objective: This study aims to describe the content of weight loss videos on YouTube (Google LLC) during the COVID-19 pandemic. Methods: By using the keywords weight loss during quarantine, the 100 most viewed English-language videos were identified and coded for content related to losing weight gained during the COVID-19 pandemic. Results: In total, 9 videos were excluded due to having non-English content or posting data before the COVID-19 pandemic. The 91 videos included in the study sample acquired 407,326 views at the time of study and were roughly 14 minutes long. A total of 48% (44/91) of the sample videos included graphic comparisons to illustrate weight change. Videos that included a graphic comparison were more likely to have content related to trigger warnings (χ21=6.05; P=.01), weight loss (χ21=13.39; P<.001), negative feelings during quarantine (χ21=4.75; P=.03), instructions for losing weight (χ21=9.17; P=.002), self-love (χ21=6.01; P=.01), body shaming (χ21=4.36; P=.04), and special dietary practices (χ21=11.10; P<.001) but were less likely to include food recipes (χ21=5.05; P=.03). Our regression analysis results suggested that mentioning quarantine (P=.05), fat-gaining food (P=.04), self-care and self-love (P=.05), and body shaming (P=.008) and having presenters from both sexes (P<.001) are significant predictors for a higher number of views. Our adjusted regression model suggested that videos with content about routine change have significantly lower view counts (P=.03) than those of videos without such content. Conclusions: The findings of this study indicate the ways in which YouTube is being used to showcase COVID-19–related weight loss in a pre-post fashion. The use of graphic comparisons garnered a great deal of attention. Additional studies are needed to understand the role of graphic comparisons in social media posts. Further studies that focus on people’s attitudes and behaviors toward weight change during the COVID-19 pandemic and the implications of social media on these attitudes and behaviors are warranted. %M 34978534 %R 10.2196/35164 %U https://formative.jmir.org/2022/2/e35164 %U https://doi.org/10.2196/35164 %U http://www.ncbi.nlm.nih.gov/pubmed/34978534 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26308 %T The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study %A Wang,Zhuoxin %A Fan,Yanyan %A Lv,Hekai %A Deng,Shanshan %A Xie,Hui %A Zhang,Li %A Luo,Aijing %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600# Donghai Rd, Bengbu, Anhui Province, PRC, Bengbu, 233030, China, 86 18855202156, wfz.bbmc@foxmail.com %K online %K health information %K barriers to acquisition %K middle-aged patients with chronic diseases %K rural community %K chronic conditions %K chronic %K rural %K literacy %K information seeking %D 2022 %7 31.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China. Objective: In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet. Methods: Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants’ behavior during the web-based operational tasks. Results: A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91% (64/70) of the respondents could find health websites, and 93% (65/70) of the respondents could find information on treatment that they thought was the best, 35% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet. Conclusions: Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information. %M 35099401 %R 10.2196/26308 %U https://www.jmir.org/2022/1/e26308 %U https://doi.org/10.2196/26308 %U http://www.ncbi.nlm.nih.gov/pubmed/35099401 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30679 %T An Exploration of e-Cigarette–Related Search Items on YouTube: Network Analysis %A Dashtian,Hassan %A Murthy,Dhiraj %A Kong,Grace %+ The Computational Media Lab and School of Journalism and Media, The University of Texas at Austin, 300 W. Dean Keeton (A0900), Austin, TX, 78712-1069, United States, 1 512 471 5775, Dhiraj.Murthy@austin.utexas.edu %K electronic nicotine delivery systems %K vaping %K social media %K search engine %K natural language processing %K social network analysis %D 2022 %7 27.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette use among youth is high, which may be due in part to pro–e-cigarette content on social media such as YouTube. YouTube is also a valuable resource for learning about e-cigarette use, trends, marketing, and e-cigarette user perceptions. However, there is a lack of understanding on how similar e-cigarette–related search items result in similar or relatively mutually exclusive search results. This study uses novel methods to evaluate the relationship between e-cigarette–related search items and results. Objective: The aim of this study is to apply network modeling and rule-based classification to characterize the relationships between e-cigarette–related search items on YouTube and gauge the level of importance of each search item as part of an e-cigarette information network on YouTube. Methods: We used 16 fictitious YouTube profiles to retrieve 4201 distinct videos from 18 keywords related to e-cigarettes. We used network modeling to represent the relationships between the search items. Moreover, we developed a rule-based classification approach to classify videos. We used betweenness centrality (BC) and correlations between nodes (ie, search items) to help us gain knowledge of the underlying structure of the information network. Results: By modeling search items and videos as a network, we observed that broad search items such as e-cig had the most connections to other search items, and specific search items such as cigalike had the least connections. Search items with similar words (eg, vape and vaping) and search items with similar meaning (eg, e-liquid and e-juice) yielded a high degree of connectedness. We also found that each node had 18 (SD 34.8) connections (common videos) on average. BC indicated that general search items such as electronic cigarette and vaping had high importance in the network (BC=0.00836). Our rule-based classification sorted videos into four categories: e-cigarette devices (34%-57%), cannabis vaping (16%-28%), e-liquid (14%-37%), and other (8%-22%). Conclusions: Our findings indicate that search items on YouTube have unique relationships that vary in strength and importance. Our methods can not only be used to successfully identify the important, overlapping, and unique e-cigarette–related search items but also help determine which search items are more likely to act as a gateway to e-cigarette–related content. %M 35084353 %R 10.2196/30679 %U https://www.jmir.org/2022/1/e30679 %U https://doi.org/10.2196/30679 %U http://www.ncbi.nlm.nih.gov/pubmed/35084353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28152 %T Medical and Health-Related Misinformation on Social Media: Bibliometric Study of the Scientific Literature %A Yeung,Andy Wai Kan %A Tosevska,Anela %A Klager,Elisabeth %A Eibensteiner,Fabian %A Tsagkaris,Christos %A Parvanov,Emil D %A Nawaz,Faisal A %A Völkl-Kernstock,Sabine %A Schaden,Eva %A Kletecka-Pulker,Maria %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 664 1929 852, Atanas.Atanasov@dhps.lbg.ac.at %K COVID-19 %K Twitter %K health %K social media %K bibliometric %K dissemination %K knowledge exchange %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has been extensively used for the communication of health-related information and consecutively for the potential spread of medical misinformation. Conventional systematic reviews have been published on this topic to identify original articles and to summarize their methodological approaches and themes. A bibliometric study could complement their findings, for instance, by evaluating the geographical distribution of the publications and determining if they were well cited and disseminated in high-impact journals. Objective: The aim of this study was to perform a bibliometric analysis of the current literature to discover the prevalent trends and topics related to medical misinformation on social media. Methods: The Web of Science Core Collection electronic database was accessed to identify relevant papers with the following search string: ALL=(misinformati* OR “wrong informati*” OR disinformati* OR “misleading informati*” OR “fake news*”) AND ALL=(medic* OR illness* OR disease* OR health* OR pharma* OR drug* OR therap*) AND ALL=(“social media*” OR Facebook* OR Twitter* OR Instagram* OR YouTube* OR Weibo* OR Whatsapp* OR Reddit* OR TikTok* OR WeChat*). Full records were exported to a bibliometric software, VOSviewer, to link bibliographic information with citation data. Term and keyword maps were created to illustrate recurring terms and keywords. Results: Based on an analysis of 529 papers on medical and health-related misinformation on social media, we found that the most popularly investigated social media platforms were Twitter (n=90), YouTube (n=67), and Facebook (n=57). Articles targeting these 3 platforms had higher citations per paper (>13.7) than articles covering other social media platforms (Instagram, Weibo, WhatsApp, Reddit, and WeChat; citations per paper <8.7). Moreover, social media platform–specific papers accounted for 44.1% (233/529) of all identified publications. Investigations on these platforms had different foci. Twitter-based research explored cyberchondria and hypochondriasis, YouTube-based research explored tobacco smoking, and Facebook-based research studied vaccine hesitancy related to autism. COVID-19 was a common topic investigated across all platforms. Overall, the United States contributed to half of all identified papers, and 80% of the top 10 most productive institutions were based in this country. The identified papers were mostly published in journals of the categories public environmental and occupational health, communication, health care sciences services, medical informatics, and medicine general internal, with the top journal being the Journal of Medical Internet Research. Conclusions: There is a significant platform-specific topic preference for social media investigations on medical misinformation. With a large population of internet users from China, it may be reasonably expected that Weibo, WeChat, and TikTok (and its Chinese version Douyin) would be more investigated in future studies. Currently, these platforms present research gaps that leave their usage and information dissemination warranting further evaluation. Future studies should also include social platforms targeting non-English users to provide a wider global perspective. %M 34951864 %R 10.2196/28152 %U https://www.jmir.org/2022/1/e28152 %U https://doi.org/10.2196/28152 %U http://www.ncbi.nlm.nih.gov/pubmed/34951864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e22122 %T Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study %A Martínez Silvagnoli,Leia %A Shepherd,Caroline %A Pritchett,James %A Gardner,Jason %+ CMC Connect, McCann Health Medical Communications, Complete House, 19–21 King Edward Street, Macclesfield, SK10 1AQ, United Kingdom, 44 1625 62 4000, Caroline.Shepherd@connect-cmc.com %K biomedical research %K health literacy %K multiple sclerosis %K plain language summary %K psoriasis %K rheumatoid arthritis %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Plain language summaries (PLSs) are intended to provide readers with a clear, nontechnical, and easily understandable overview of medical and scientific literature; however, audience preferences for specific PLS formats have yet to be fully explored. Objective: This study aims to evaluate the preferred readability level and format for PLSs of medical research articles of different disease states via a web-based survey of audiences of different age groups. Methods: Articles describing phase III clinical trials published in top-level, peer-reviewed journals between May 2016 and May 2018 were identified for 3 chronic disease states representing a range of adult patient age groups: (1) psoriasis, a skin disease representative of younger patients; (2) multiple sclerosis (MS), a neurological disease representative of middle-aged patients; and (3) rheumatoid arthritis (RA), a painful joint disease representative of older patients. Four PLSs were developed for each research article, of which 3 were text-only summaries (written with high, medium, and low complexity) and 1 was an infographic. To evaluate each of the 4 PLS formats, a 20-question open survey (specific to one of the 3 diseases) was sent to a representative sample selected via UK-based patient association websites, Twitter, and Facebook patient groups. A weighted-average calculation was applied to respondents’ ranked preferences for each PLS format. Results: For all 3 articles, the weighted-average preference scores showed that infographic (psoriasis 2.91, MS 2.71, and RA 2.78) and medium-complexity text-based PLS (reading age 14-17 years, US Grade 9-11; psoriasis 2.90; MS 2.47; RA 2.77) were the two most preferred PLS formats. Conclusions: Audience preferences should be accounted for when preparing PLSs to accompany peer-reviewed original research articles. Oversimplified text can be viewed negatively, and graphical summaries or medium-complexity text-based summaries appear to be the most popular. Plain Language Summary: Patients and caregivers should have the chance to read about medical research in a format they can understand. However, we do not know much about the formats that people with different illnesses or ages prefer. Researchers wanted to find out more about this. They selected 3 medical articles about illnesses that affect different age groups: psoriasis (younger patients), multiple sclerosis (middle-aged patients), and rheumatoid arthritis (older patients). They created 4 summaries of each article. One was a graphical summary, and the other 3 were words-only summaries of high, medium, and low complexity. Then, the researchers posted surveys on UK patient group websites and Facebook patient groups to ask people what they thought of the summaries. The surveys were taken by 167 people. These people were patients with psoriasis, multiple sclerosis, or rheumatoid arthritis, or their caregivers. Most were women, and about half had a university degree. For each illness, most people preferred the graphical summary. Among the word-only summaries, most people preferred the medium-complexity wording written for a reading age of 14 to 17 years. People felt that the graphical and medium-complexity summaries were clear and concise, while the others used jargon or were too simple. Authors of medical articles should remember these results when writing summaries for patients. More research is needed about the preferences of other people, such as those with other illnesses. (See Multimedia Appendix 1 for the graphical summary of the plain language summary.) %M 35014966 %R 10.2196/22122 %U https://www.jmir.org/2022/1/e22122 %U https://doi.org/10.2196/22122 %U http://www.ncbi.nlm.nih.gov/pubmed/35014966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27178 %T Understanding Health Empowerment From the Perspective of Information Processing: Questionnaire Study %A Jiang,Fei %A Liu,Yongmei %A Hu,Junhua %A Chen,Xiaohong %+ Business School of Central South University, No 932, Lushan South Road, Yuelu District, Changsha, 410083, China, 86 13974834821, liuyongmeicn@163.com %K online health information %K perceived argument quality %K perceived source credibility %K health literacy %K health empowerment %K information seeking %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Massive, easily accessible online health information empowers users to cope with health problems better. Most patients search for relevant online health information before seeing a doctor to alleviate information asymmetry. However, the mechanism of how online health information affects health empowerment is still unclear. Objective: To study how online health information processing affects health empowerment. Methods: We conducted a cross-sectional questionnaire study that included 343 samples from participants who had searched online health information before the consultation. Respondents' perceptions of online information cues, benefits, health literacy, and health empowerment were assessed. Results: Perceived argument quality and perceived source credibility have significant and positive effects on perceived information benefits, but only perceived argument quality has a significant effect on perceived decision-making benefits. Two types of perceived benefits, in turn, affect health empowerment. The effects of perceived argument quality on perceived informational benefits and perceived decision-making benefits on health empowerment are significantly stronger for the high health literacy group than the low health literacy group (t269=7.156, P<.001; t269=23.240, P<.001). While, the effects of perceived source credibility on perceived informational benefits and perceived informational benefits on health empowerment are significantly weaker for the high health literacy group than the low health literacy group (t269=–10.497, P<.001; t269=–6.344, P<.001). The effect of perceived argument quality on perceived informational benefits shows no significant difference between high and low health literacy groups. Conclusions:  In the context of online health information, perceived information benefits and perceived decision-making benefits are the antecedents of health empowerment, which in turn will be affected by perceived argument quality and perceived source credibility. Health literacy plays a moderating role in the relationship of some variables. To maximize health empowerment, online health information providers should strengthen information quality and provide differentiated information services based on users' health literacy. %M 35014957 %R 10.2196/27178 %U https://www.jmir.org/2022/1/e27178 %U https://doi.org/10.2196/27178 %U http://www.ncbi.nlm.nih.gov/pubmed/35014957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31284 %T Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment %A Pearson,Keon %A Ngo,Summer %A Ekpo,Eson %A Sarraju,Ashish %A Baird,Grayson %A Knowles,Joshua %A Rodriguez,Fatima %+ Department of Medicine, Stanford University, 300 Pasteur Drive, Room S102, Stanford, CA, 94305, United States, 1 6507236028, keonp@stanford.edu %K lipoprotein(a) %K readability %K online patient education material %K health education %K health literacy %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public. Objective: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association. Methods: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non–patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM. Results: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association. Conclusions: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a). %M 35014955 %R 10.2196/31284 %U https://www.jmir.org/2022/1/e31284 %U https://doi.org/10.2196/31284 %U http://www.ncbi.nlm.nih.gov/pubmed/35014955 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e27221 %T Internet-Based Patient Education Materials Regarding Diabetic Foot Ulcers: Readability and Quality Assessment %A Lee,David Michael %A Grose,Elysia %A Cross,Karen %+ Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, Room 3157, 1 King's College Circle, Toronto, ON, M5S 1A1, Canada, 1 4165582872, davidm.lee@mail.utoronto.ca %K diabetic foot ulcer %K patient education %K patient education materials %K online resources %K readability %K diabetic foot %K diabetes %K online eduction %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: While diabetic foot ulcers (DFU) are a common complication of diabetes, little is known about the content and readability of online patient education materials (PEM) for DFU. The recommended reading grade level for these materials is grades 6-8. Objective: The aim of this paper was to evaluate the quality and readability of online PEM on DFU. Methods: A Google search was performed using 4 different search terms related to DFU. Two readability formulas were used to assess the readability of the included PEM. These included the Flesch-Kincaid grade level and the Flesch-Reading ease score. The DISCERN tool was used to determine quality and reliability. Results: A total of 41 online PEM were included. The average Flesch-Reading ease score for all PEM was 63.43 (SD 14.21), indicating a standard difficulty level of reading. The average reading grade level was 7.85 (SD 2.38), which is higher than the recommended reading level for PEM. The mean DISCERN score was 45.66 (SD 3.34), and 27% (11/41) of the articles had DISCERN scores of less than 39, corresponding to poor or very poor quality. Conclusions: The majority of online PEM on DFU are written above the recommended reading levels and have significant deficiencies in quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients’ self-management. %M 35014960 %R 10.2196/27221 %U https://diabetes.jmir.org/2022/1/e27221 %U https://doi.org/10.2196/27221 %U http://www.ncbi.nlm.nih.gov/pubmed/35014960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30379 %T Social Media and Health Care (Part II): Narrative Review of Social Media Use by Patients %A Farsi,Deema %A Martinez-Menchaca,Hector R %A Ahmed,Mohammad %A Farsi,Nada %+ Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, PO Box 80200, Jeddah, 21589, Saudi Arabia, 966 16402000 ext 20388, dfarsi@kau.edu.sa %K social media %K social networking %K internet %K health care %K COVID-19 %K patient %K telemedicine %K mobile phone %D 2022 %7 7.1.2022 %9 Review %J J Med Internet Res %G English %X Background: People are now connected in a borderless web-based world. The modern public, especially the younger generation, relies heavily on the internet as the main source of health-related information. In health care, patients can use social media for more tailored uses such as telemedicine, finding a provider, and for peer support. Objective: The aim of this narrative review is to discuss how social media has been used in the health care industry from the perspective of patients and describe the main issues surrounding its use in health care. Methods: Between March and June 2020, a review of the literature was conducted on PubMed, Google Scholar, and Web of Science for English studies that were published since 2007 and discussed the use of social media in health care. In addition to only English publications that discussed the use of social media by patients, publications pertaining to ethical and legal considerations in the use of social media were included. The studies were then categorized as health information, telemedicine, finding a health care provider, peer support and sharing experiences, and influencing positive health behavior. In addition, two more sections were added to the review: issues pertaining to social media use in health care and ethical considerations. Results: Initially, 75 studies were included. As the study proceeded, more studies were included, and a total of 91 studies were reviewed, complemented by 1 textbook chapter and 13 web references. Approximately half of the studies were reviews. The first study was published in 2009, and the last was published in 2021, with more than half of the studies published in the last 5 years. The studies were mostly from the United States (n=40), followed by Europe (n=13), and the least from India (n=1). WhatsApp or WeChat was the most investigated social media platform. Conclusions: Social media can be used by the public and patients to improve their health and knowledge. However, due diligence must be practiced to assess the credibility of the information obtained and its source. Health care providers, patients, and the public need not forget the risks associated with the use of social media. The limitations and shortcomings of the use of social media by patients should be understood. %M 34994706 %R 10.2196/30379 %U https://www.jmir.org/2022/1/e30379 %U https://doi.org/10.2196/30379 %U http://www.ncbi.nlm.nih.gov/pubmed/34994706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30962 %T The Role of Recipient Characteristics in Health Video Communication Outcomes: Scoping Review %A Lungu,Daniel Adrian %A Røislien,Jo %A Wiig,Siri %A Shortt,Marie Therese %A Ferrè,Francesca %A Berg,Siv Hilde %A Thune,Henriette %A Brønnick,Kolbjørn Kallesten %+ SHARE – Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, PO Box 8600, Stavanger, 4036, Norway, 47 51831000, daniel.a.lungu@uis.no %K health communication %K video communication %K communication outcomes %K recipient characteristics %K recipient factors %K health video communication %D 2021 %7 30.12.2021 %9 Review %J J Med Internet Res %G English %X Background: The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. Objective: The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? Methods: A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. Results: Of the 1040 documents initially identified, 128 (12.31%) met the criteria for full-text assessment, and 39 (3.75%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. Conclusions: Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication. %M 34967758 %R 10.2196/30962 %U https://www.jmir.org/2021/12/e30962 %U https://doi.org/10.2196/30962 %U http://www.ncbi.nlm.nih.gov/pubmed/34967758 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e26644 %T Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries %A Ming,Wai-kit %A Huang,Fengqiu %A Chen,Qiuyi %A Liang,Beiting %A Jiao,Aoao %A Liu,Taoran %A Wu,Huailiang %A Akinwunmi,Babatunde %A Li,Jia %A Liu,Guan %A Zhang,Casper J P %A Huang,Jian %A Liu,Qian %+ School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, 601 Huangpu Dadao West, Guangzhou, 510632, China, 86 13302292599, tsusanliu@jnu.edu.cn %K COVID-19 %K Google Trends %K search peaks %K news coverage %K public concerns %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Due to the COVID-19 pandemic, health information related to COVID-19 has spread across news media worldwide. Google is among the most used internet search engines, and the Google Trends tool can reflect how the public seeks COVID-19–related health information during the pandemic. Objective: The aim of this study was to understand health communication through Google Trends and news coverage and to explore their relationship with prevention and control of COVID-19 at the early epidemic stage. Methods: To achieve the study objectives, we analyzed the public’s information-seeking behaviors on Google and news media coverage on COVID-19. We collected data on COVID-19 news coverage and Google search queries from eight countries (ie, the United States, the United Kingdom, Canada, Singapore, Ireland, Australia, South Africa, and New Zealand) between January 1 and April 29, 2020. We depicted the characteristics of the COVID-19 news coverage trends over time, as well as the search query trends for the topics of COVID-19–related “diseases,” “treatments and medical resources,” “symptoms and signs,” and “public measures.” The search query trends provided the relative search volume (RSV) as an indicator to represent the popularity of a specific search term in a specific geographic area over time. Also, time-lag correlation analysis was used to further explore the relationship between search terms trends and the number of new daily cases, as well as the relationship between search terms trends and news coverage. Results: Across all search trends in eight countries, almost all search peaks appeared between March and April 2020, and declined in April 2020. Regarding COVID-19–related “diseases,” in most countries, the RSV of the term “coronavirus” increased earlier than that of “covid-19”; however, around April 2020, the search volume of the term “covid-19” surpassed that of “coronavirus.” Regarding the topic “treatments and medical resources,” the most and least searched terms were “mask” and “ventilator,” respectively. Regarding the topic “symptoms and signs,” “fever” and “cough” were the most searched terms. The RSV for the term “lockdown” was significantly higher than that for “social distancing” under the topic “public health measures.” In addition, when combining search trends with news coverage, there were three main patterns: (1) the pattern for Singapore, (2) the pattern for the United States, and (3) the pattern for the other countries. In the time-lag correlation analysis between the RSV for the topic “treatments and medical resources” and the number of new daily cases, the RSV for all countries except Singapore was positively correlated with new daily cases, with a maximum correlation of 0.8 for the United States. In addition, in the time-lag correlation analysis between the overall RSV for the topic “diseases” and the number of daily news items, the overall RSV was positively correlated with the number of daily news items, the maximum correlation coefficient was more than 0.8, and the search behavior occurred 0 to 17 days earlier than the news coverage. Conclusions: Our findings revealed public interest in masks, disease control, and public measures, and revealed the potential value of Google Trends in the face of the emergence of new infectious diseases. Also, Google Trends combined with news media can achieve more efficient health communication. Therefore, both news media and Google Trends can contribute to the early prevention and control of epidemics. %M 34591781 %R 10.2196/26644 %U https://publichealth.jmir.org/2021/12/e26644 %U https://doi.org/10.2196/26644 %U http://www.ncbi.nlm.nih.gov/pubmed/34591781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27750 %T An Analysis of US Academic Medical Center Websites: Usability Study %A Gale,Jonathan James %A Black,Kameron Collin %A Calvano,Joshua David %A Fundingsland Jr,Edwin Lauritz %A Lai,Deborah %A Silacci,Sara %A He,Shuhan %+ Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Rd, Parker, CO, 80134, United States, 1 303 373 2008, jonathan.gale@rvu.edu %K website usability %K digital health %K health care website %K academic medical center %K usability testing %K web crawler %D 2021 %7 21.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out. Objective: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites. Methods: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital’s website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall “general usability” score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final “overall usability” ranking. Results: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category. Conclusions: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user’s experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability. %M 34932015 %R 10.2196/27750 %U https://www.jmir.org/2021/12/e27750 %U https://doi.org/10.2196/27750 %U http://www.ncbi.nlm.nih.gov/pubmed/34932015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e32161 %T Reliability of Commercial Voice Assistants’ Responses to Health-Related Questions in Noncommunicable Disease Management: Factorial Experiment Assessing Response Rate and Source of Information %A Bérubé,Caterina %A Kovacs,Zsolt Ferenc %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV G 214, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 633 8419, berubec@ethz.ch %K voice assistants %K conversational agents %K health literacy %K noncommunicable diseases %K mobile phone %K smart speaker %K smart display %K evaluation %K protocol %K assistant %K agent %K literacy %K audio %K health information %K management %K factorial %K information source %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Noncommunicable diseases (NCDs) constitute a burden on public health. These are best controlled through self-management practices, such as self-information. Fostering patients’ access to health-related information through efficient and accessible channels, such as commercial voice assistants (VAs), may support the patients’ ability to make health-related decisions and manage their chronic conditions. Objective: This study aims to evaluate the reliability of the most common VAs (ie, Amazon Alexa, Apple Siri, and Google Assistant) in responding to questions about management of the main NCD. Methods: We generated health-related questions based on frequently asked questions from health organization, government, medical nonprofit, and other recognized health-related websites about conditions associated with Alzheimer’s disease (AD), lung cancer (LCA), chronic obstructive pulmonary disease, diabetes mellitus (DM), cardiovascular disease, chronic kidney disease (CKD), and cerebrovascular accident (CVA). We then validated them with practicing medical specialists, selecting the 10 most frequent ones. Given the low average frequency of the AD-related questions, we excluded such questions. This resulted in a pool of 60 questions. We submitted the selected questions to VAs in a 3×3×6 fractional factorial design experiment with 3 developers (ie, Amazon, Apple, and Google), 3 modalities (ie, voice only, voice and display, display only), and 6 diseases. We assessed the rate of error-free voice responses and classified the web sources based on previous research (ie, expert, commercial, crowdsourced, or not stated). Results: Google showed the highest total response rate, followed by Amazon and Apple. Moreover, although Amazon and Apple showed a comparable response rate in both voice-and-display and voice-only modalities, Google showed a slightly higher response rate in voice only. The same pattern was observed for the rate of expert sources. When considering the response and expert source rate across diseases, we observed that although Google remained comparable, with a slight advantage for LCA and CKD, both Amazon and Apple showed the highest response rate for LCA. However, both Google and Apple showed most often expert sources for CVA, while Amazon did so for DM. Conclusions: Google showed the highest response rate and the highest rate of expert sources, leading to the conclusion that Google Assistant would be the most reliable tool in responding to questions about NCD management. However, the rate of expert sources differed across diseases. We urge health organizations to collaborate with Google, Amazon, and Apple to allow their VAs to consistently provide reliable answers to health-related questions on NCD management across the different diseases. %M 34932003 %R 10.2196/32161 %U https://www.jmir.org/2021/12/e32161 %U https://doi.org/10.2196/32161 %U http://www.ncbi.nlm.nih.gov/pubmed/34932003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28318 %T Short-Video Apps as a Health Information Source for Chronic Obstructive Pulmonary Disease: Information Quality Assessment of TikTok Videos %A Song,Shijie %A Xue,Xiang %A Zhao,Yuxiang Chris %A Li,Jinhao %A Zhu,Qinghua %A Zhao,Mingming %+ Department of Pulmonary and Critical Care Medicine, Gaochun People’s Hospital, Maoshan Rd 53, Economic Development Area, Gaochun District, Nanjing, 211300, China, 86 15951973800, mingtze80@163.com %K COPD %K information quality %K social media %K short-video apps %K TikTok %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) has become one of the most critical public health problems worldwide. Because many COPD patients are using video-based social media to search for health information, there is an urgent need to assess the information quality of COPD videos on social media. Recently, the short-video app TikTok has demonstrated huge potential in disseminating health information and there are currently many COPD videos available on TikTok; however, the information quality of these videos remains unknown. Objective: The aim of this study was to investigate the information quality of COPD videos on TikTok. Methods: In December 2020, we retrieved and screened 300 videos from TikTok and collected a sample of 199 COPD-related videos in Chinese for data extraction. We extracted the basic video information, coded the content, and identified the video sources. Two independent raters assessed the information quality of each video using the DISCERN instrument. Results: COPD videos on TikTok came mainly from two types of sources: individual users (n=168) and organizational users (n=31). The individual users included health professionals, individual science communicators, and general TikTok users, whereas the organizational users consisted of for-profit organizations, nonprofit organizations, and news agencies. For the 199 videos, the mean scores of the DISCERN items ranged from 3.42 to 4.46, with a total mean score of 3.75. Publication reliability (P=.04) and overall quality (P=.02) showed significant differences across the six types of sources, whereas the quality of treatment choices showed only a marginally significant difference (P=.053) across the different sources. Conclusions: The overall information quality of COPD videos on TikTok is satisfactory, although the quality varies across different sources and according to specific quality dimensions. Patients should be selective and cautious when watching COPD videos on TikTok. %M 34931996 %R 10.2196/28318 %U https://www.jmir.org/2021/12/e28318 %U https://doi.org/10.2196/28318 %U http://www.ncbi.nlm.nih.gov/pubmed/34931996 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30323 %T Factors Influencing Willingness to Share Health Misinformation Videos on the Internet: Web-Based Survey %A Keselman,Alla %A Arnott Smith,Catherine %A Leroy,Gondy %A Kaufman,David R %+ Office of Engagement and Training, National Library of Medicine, 8600 Rockville Pike, Bethesda, MD, 20894, United States, 1 301 827 5671, keselmana@nih.gov %K misinformation %K information literacy %K science literacy %K webcasts as topic %K YouTube %D 2021 %7 9.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapidly evolving digital environment of the social media era has increased the reach of both quality health information and misinformation. Platforms such as YouTube enable easy sharing of attractive, if not always evidence-based, videos with large personal networks and the public. Although much research has focused on characterizing health misinformation on the internet, it has not sufficiently focused on describing and measuring individuals’ information competencies that build resilience. Objective: This study aims to assess individuals’ willingness to share a non–evidence-based YouTube video about strengthening the immune system; to describe types of evidence that individuals view as supportive of the claim by the video; and to relate information-sharing behavior to several information competencies, namely, information literacy, science literacy, knowledge of the immune system, interpersonal trust, and trust in health authority. Methods: A web-based survey methodology with 150 individuals across the United States was used. Participants were asked to watch a YouTube excerpt from a morning TV show featuring a wellness pharmacy representative promoting an immunity-boosting dietary supplement produced by his company; answer questions about the video and report whether they would share it with a cousin who was frequently sick; and complete instruments pertaining to the information competencies outlined in the objectives. Results: Most participants (105/150, 70%) said that they would share the video with their cousins. Their confidence in the supplement would be further boosted by a friend’s recommendations, positive reviews on a crowdsourcing website, and statements of uncited effectiveness studies on the producer’s website. Although all information literacy competencies analyzed in this study had a statistically significant relationship with the outcome, each competency was also highly correlated with the others. Information literacy and interpersonal trust independently predicted the largest amount of variance in the intention to share the video (17% and 16%, respectively). Interpersonal trust was negatively related to the willingness to share the video. Science literacy explained 7% of the variance. Conclusions: People are vulnerable to web-based misinformation and are likely to propagate it on the internet. Information literacy and science literacy are associated with less vulnerability to misinformation and a lower propensity to spread it. Of the two, information literacy holds a greater promise as an intervention target. Understanding the role of different kinds of trust in information sharing merits further research. %M 34889750 %R 10.2196/30323 %U https://www.jmir.org/2021/12/e30323 %U https://doi.org/10.2196/30323 %U http://www.ncbi.nlm.nih.gov/pubmed/34889750 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e33330 %T Health Care Providers’ Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study %A Brauer,Eden %A Choi,Kristen %A Chang,John %A Luo,Yi %A Lewin,Bruno %A Munoz-Plaza,Corrine %A Bronstein,David %A Bruxvoort,Katia %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, Los Angeles, CA, United States, 1 3107947493, krchoi@ucla.edu %K health information %K trust %K health care provider %K COVID-19 %K vaccine %K mixed method %K communication %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines. Objective: The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients. Methods: This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines. Results: The survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ≥1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%; P<.001), and more physicians trusted their employer (n=1115, 84%) than advanced practice providers (n=95, 67%) and nurses (n=759, 64%; P=.002). Qualitative themes (n=32 participants) about trusted sources of COVID-19 vaccine information were identified: processing new COVID-19 information in a health care work context likened to a “war zone” during the pandemic and communicating information to patients. Some providers were hesitant to recommend vaccines to pregnant people and groups they perceived to be at low risk for COVID-19. Conclusions: Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources. %M 34926995 %R 10.2196/33330 %U https://infodemiology.jmir.org/2021/1/e33330 %U https://doi.org/10.2196/33330 %U http://www.ncbi.nlm.nih.gov/pubmed/34926995 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e25654 %T Audience of Academic Otolaryngology on Twitter: Cross-sectional Study %A Xie,Deborah X %A Boss,Emily F %A Stewart,C Matthew %+ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, 21231, United States, 1 410 955 3492, cstewa16@jhmi.edu %K Twitter %K otolaryngology %K residency %K medical education %K social media %K internet %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Despite the ubiquity of social media, the utilization and audience reach of this communication method by otolaryngology-head and neck surgery (OHNS) residency programs has not been investigated. Objective: The purpose of this study was to evaluate the content posted to a popular social media platform (Twitter) by OHNS residency programs. Methods: In this cross-sectional study, we identified Twitter accounts for accredited academic OHNS residency programs. Tweets published over a 6-month period (March to August 2019) were extracted. Tweets were categorized and analyzed for source (original versus retweet) and target audience (medical versus layman). A random sample of 100 tweets was used to identify patterns of content, which were then used to categorize additional tweets. We quantified the total number of likes or retweets by health care professionals. Results: Of the 121 accredited programs, 35 (28.9%) had Twitter accounts. Of the 2526 tweets in the 6-month period, 1695 (67.10%) were original-content tweets. The majority of tweets (1283/1695, 75.69%) were targeted toward health care workers, most of which did not directly contain medical information (954/1283, 74.36%). These tweets contained information about the department’s trainees and education (349/954, 36.6%), participation at conferences (263/954, 27.6%), and research publications (112/954, 11.7%). Two-thirds of all tweets did not contain medical information. Medical professionals accounted for 1249/1362 (91.70%) of retweets and 5616/6372 (88.14%) of likes on original-content tweets. Conclusions: The majority of Twitter usage by OHNS residency programs is for intra and interprofessional communication, and only a minority of tweets contain information geared toward the public. Communication and information sharing with patients is not the focus of OHNS departments on Twitter. %M 34889748 %R 10.2196/25654 %U https://mededu.jmir.org/2021/4/e25654 %U https://doi.org/10.2196/25654 %U http://www.ncbi.nlm.nih.gov/pubmed/34889748 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31791 %T Impact of the COVID-19 Pandemic on a Physician Group’s WhatsApp Chat: Qualitative Content Analysis %A Abdel-Razig,Sawsan %A Anglade,Pascale %A Ibrahim,Halah %+ Cleveland Clinic Abu Dhabi, PO box 112412, Abu Dhabi, United Arab Emirates, 971 25019999 ext 48460, razigs@clevelandclinicabudhabi.ae %K WhatsApp %K social media %K physician %K pandemic %K COVID-19 %K qualitative %K communication %K misinformation %K information-seeking behavior %K information seeking %K information sharing %K content analysis %K community %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has emerged as an effective means of information sharing and community building among health professionals. The utility of these platforms is likely heightened during times of health system crises and global uncertainty. Studies have demonstrated that physicians’ social media platforms serve to bridge the gap of information between on-the-ground experiences of health care workers and emerging knowledge. Objective: The primary aim of this study was to characterize the use of a physician WhatsApp (WhatsApp LLC) group chat during the early months of the COVID-19 pandemic. Methods: Through the lens of the social network theory, we performed a qualitative content analysis of the posts of a women physician WhatsApp group located in the United Arab Emirates between February 1, 2020, and May 31, 2020, that is, during the initial surge of COVID-19 cases. Results: There were 6101 posts during the study period, which reflected a 2.6-fold increase in platform use when compared with platform use in the year prior. A total of 8 themes and 9 subthemes were described. The top 3 uses of the platform were requests for information (posts: 2818/6101, 46.2%), member support and promotion (posts: 988/6101, 16.2%), and information sharing (posts: 896/6101, 14.7%). A substantial proportion of posts were related to COVID-19 (2653/6101, 43.5%), with the most popular theme being requests for logistical (nonmedical) information. Among posts containing COVID-19–related medical information, it was notable that two-thirds (571/868, 65.8%) of these posts were from public mass media or unverified sources. Conclusions: Health crises can potentiate the use of social media platforms among physicians. This reflects physicians’ tendency to turn to these platforms for information sharing and community building purposes. However, important questions remain regarding the accuracy and credibility of the information shared. Our findings suggest that the training of physicians in social media practices and information dissemination may be needed. %M 34784291 %R 10.2196/31791 %U https://formative.jmir.org/2021/12/e31791 %U https://doi.org/10.2196/31791 %U http://www.ncbi.nlm.nih.gov/pubmed/34784291 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29127 %T Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis %A Cruickshank,Iain %A Ginossar,Tamar %A Sulskis,Jason %A Zheleva,Elena %A Berger-Wolf,Tanya %+ Center for Computational Analysis of Social and Organizational Systems, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, 15201, United States, 1 7192371515, icruicks@andrew.cmu.edu %K COVID-19 %K agenda setting %K antivaccination %K cross-platform %K data mining of social media %K misinformation %K social media %K Twitter %K vaccinations %K vaccine hesitancy %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic and the consequent “infodemic” increased concerns about Twitter’s role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation. Objective: Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020. Methods: We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach. Results: Of 841,896 vaccination-related tweets identified, 185,994 (22.1%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links. Conclusions: The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its “bursty” pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation. %M 34665760 %R 10.2196/29127 %U https://www.jmir.org/2021/12/e29127 %U https://doi.org/10.2196/29127 %U http://www.ncbi.nlm.nih.gov/pubmed/34665760 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e26065 %T Active Annotation in Evaluating the Credibility of Web-Based Medical Information: Guidelines for Creating Training Data Sets for Machine Learning %A Nabożny,Aleksandra %A Balcerzak,Bartłomiej %A Wierzbicki,Adam %A Morzy,Mikołaj %A Chlabicz,Małgorzata %+ Department of Software Engineering, Gdańsk University of Technology, 11/12 Gabriela Narutowicza St, Gdańsk, 80-233, Poland, 48 602327778, aleksandra.nabozny@pja.edu.pl %K active annotation %K credibility %K web-based medical information %K fake news %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The spread of false medical information on the web is rapidly accelerating. Establishing the credibility of web-based medical information has become a pressing necessity. Machine learning offers a solution that, when properly deployed, can be an effective tool in fighting medical misinformation on the web. Objective: The aim of this study is to present a comprehensive framework for designing and curating machine learning training data sets for web-based medical information credibility assessment. We show how to construct the annotation process. Our main objective is to support researchers from the medical and computer science communities. We offer guidelines on the preparation of data sets for machine learning models that can fight medical misinformation. Methods: We begin by providing the annotation protocol for medical experts involved in medical sentence credibility evaluation. The protocol is based on a qualitative study of our experimental data. To address the problem of insufficient initial labels, we propose a preprocessing pipeline for the batch of sentences to be assessed. It consists of representation learning, clustering, and reranking. We call this process active annotation. Results: We collected more than 10,000 annotations of statements related to selected medical subjects (psychiatry, cholesterol, autism, antibiotics, vaccines, steroids, birth methods, and food allergy testing) for less than US $7000 by employing 9 highly qualified annotators (certified medical professionals), and we release this data set to the general public. We developed an active annotation framework for more efficient annotation of noncredible medical statements. The application of qualitative analysis resulted in a better annotation protocol for our future efforts in data set creation. Conclusions: The results of the qualitative analysis support our claims of the efficacy of the presented method. %M 34842547 %R 10.2196/26065 %U https://medinform.jmir.org/2021/11/e26065 %U https://doi.org/10.2196/26065 %U http://www.ncbi.nlm.nih.gov/pubmed/34842547 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e16006 %T Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey %A Seckin,Gul %A Hughes,Susan %+ Department of Sociology, University of North Texas, 1155 Union Circle #311157, Denton, TX, 76203, United States, 1 9405652296, gul.seckin@unt.edu %K internet %K information %K health %K communication %K strain %K education %K eHealth literacy %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients’ ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy. Objective: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes. Methods: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms. Results: Age (β=–.17; P=.02), gender (β=–.22; P=.01), and medical satisfaction (β=–.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=–.18; P=.03) and eHealth literacy (β=–.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=–.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=–.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=–.22; P=.01). Conclusions: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals. %M 34822340 %R 10.2196/16006 %U https://aging.jmir.org/2021/4/e16006 %U https://doi.org/10.2196/16006 %U http://www.ncbi.nlm.nih.gov/pubmed/34822340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25287 %T Understanding the Relationship Between Official and Social Information About Infectious Disease: Experimental Analysis %A Assaf,Elias %A Bond,Robert M %A Cranmer,Skyler J %A Kaizar,Eloise E %A Ratliff Santoro,Lauren %A Shikano,Susumu %A Sivakoff,David J %+ The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, United States, 1 9728836241, laurenratliffsantoro@utdallas.edu %K disease %K social information %K official information %K network experiments %D 2021 %7 23.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Communicating official public health information about infectious diseases is complicated by the fact that individuals receive much of their information from their social contacts, either via interpersonal interaction or social media, which can be prone to bias and misconception. Objective: This study aims to evaluate the effect of public health campaigns and the effect of socially communicated health information on learning about diseases simultaneously. Although extant literature addresses the effect of one source of information (official or social) or the other, it has not addressed the simultaneous interaction of official information (OI) and social information (SI) in an experimental setting. Methods: We used a series of experiments that exposed participants to both OI and structured SI about the symptoms and spread of hepatitis C over a series of 10 rounds of computer-based interactions. Participants were randomly assigned to receive a high, low, or control intensity of OI and to receive accurate or inaccurate SI about the disease. Results: A total of 195 participants consented to participate in the study. Of these respondents, 186 had complete responses across all ten experimental rounds, which corresponds to a 4.6% (9/195) nonresponse rate. The OI high intensity treatment increases learning over the control condition for all symptom and contagion questions when individuals have lower levels of baseline knowledge (all P values ≤.04). The accurate SI condition increased learning across experimental rounds over the inaccurate condition (all P values ≤.01). We find limited evidence of an interaction between official and SI about infectious diseases. Conclusions: This project demonstrates that exposure to official public health information increases individuals’ knowledge of the spread and symptoms of a disease. Socially shared information also facilitates the learning of accurate and inaccurate information, though to a lesser extent than exposure to OI. Although the effect of OI persists, preliminary results suggest that it can be degraded by persistent contradictory SI over time. %M 34817389 %R 10.2196/25287 %U https://www.jmir.org/2021/11/e25287 %U https://doi.org/10.2196/25287 %U http://www.ncbi.nlm.nih.gov/pubmed/34817389 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25783 %T Assessing the Quality of Online Health Information About Breast Cancer from Chinese Language Websites: Quality Assessment Survey %A Sun,Weiwei %A Luo,Aijing %A Bian,Zhiwei %A Zhao,Bin %A Liu,Peng %A Wang,Kai %A Liu,Yuwen %A Xie,Wenzhao %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600#, Donghai Rd, Anhui, Bengbu, 233000, China, 86 18855202156, wfz.bbmc@foxmail.com %K online health information %K breast cancer %K Chinese language websites %K quantitative evaluations %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: In China, the internet has become one of the most important ways to obtain information about breast cancer. However, quantitative evaluations of the quality of Chinese health websites and the breast cancer treatment information they publish are lacking. Objective: This study aimed to evaluate the quality of Chinese breast cancer websites and the value, suitability, and accuracy of the breast cancer treatment information they publish. Methods: Chinese breast cancer health websites were searched and manually screened according to their Alexa and Baidu search engine rankings. For each website included in the survey, which was conducted on April 8, 2019, the three most recently published papers on the website that met the inclusion criteria were included for evaluation. Three raters assessed all materials using the LIDA, DISCERN, and Suitability Assessment of Materials (SAM) tools and the Michigan Checklist. Data analysis was completed with the Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: This survey included 20 Chinese breast cancer websites and 60 papers on breast cancer treatment. The LIDA tool was used to evaluate the quality of the 20 websites. The LIDA’s scores of the websites (mean=54.85, SD 3.498; total possible score=81) were low. In terms of the layout, color scheme, search facility, browsing facility, integration of nontextual media, submission of comments, declaration of objectives, content production method, and robust method, more than half of the websites scored 0 (never) or 1 (sometimes). For the online breast cancer treatment papers, the scores were generally low. Regarding suitability, 32 (53.33%) papers were evaluated as presenting unsuitable material. Regarding accuracy, the problems were that the papers were largely not original (44/60, 73%) and lacked references (46/60, 77%). Conclusions: The quality of Chinese breast cancer websites is poor. The color schemes, text settings, user comment submission functions, and language designs should be improved. The quality of Chinese online breast cancer treatment information is poor; the information has little value to users, and pictorial information is scarcely used. The online breast cancer treatment information is accurate but lacks originality and references. Website developers, governments, and medical professionals should play a full role in the design of health websites, the regulation of online health information, and the use of online health information. %M 34792471 %R 10.2196/25783 %U https://cancer.jmir.org/2021/4/e25783 %U https://doi.org/10.2196/25783 %U http://www.ncbi.nlm.nih.gov/pubmed/34792471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e21462 %T The Online Patient Satisfaction Index for Patients With Low Back Pain: Development, Reliability, and Validation Study %A Afzali,Tamana %A Lauridsen,Henrik Hein %A Thomsen,Janus Laust %A Hartvigsen,Jan %A Jensen,Martin Bach %A Riis,Allan %+ Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, Aalborg, 9220, Denmark, 45 20823660, ariis@dcm.aau.dk %K data accuracy %K patient satisfaction %K rehabilitation %K low back pain %K internet-based intervention %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Low back pain is highly prevalent, and most often, a specific causative factor cannot be identified. Therefore, for most patients, their low back pain is labeled as nonspecific. Patient education and information are recommended for all these patients. The internet is an accessible source of medical information on low back pain. Approximately 50% of patients with low back pain search the internet for health and medical advice. Patient satisfaction with education and information is important in relation to patients’ levels of inclination to use web-based information and their trust in the information they find. Although patients who are satisfied with the information they retrieve use the internet as a supplementary source of information, dissatisfied patients tend to avoid using the internet. Consumers’ loyalty to a product is often applied to evaluate their satisfaction. Consumers have been shown to be good ambassadors for a service when they are willing to recommend the service to a friend or colleague. When consumers are willing to recommend a service to a friend or colleague, they are also likely to be future users of the service. To the best of our knowledge, no multi-item instrument exists to specifically evaluate satisfaction with information delivered on the web for people with low back pain. Objective: This study aims to report on the development, reliability testing, and construct validity testing of the Online Patient Satisfaction Index to measure patients’ satisfaction with web-based information for low back pain. Methods: This is a cross-sectional validation study of the Online Patient Satisfaction Index. The index was developed with experts and assessed for face validity. It was subsequently administered to 150 adults with nonspecific low back pain. Of these, 46% (70/150) were randomly assigned to participate in a reliability test using an intraclass correlation coefficient of agreement. Construct validity was evaluated by hypothesis testing based on a web app (MyBack) and Wikipedia on low back pain. Results: The index includes 8 items. The median score (range 0-24) based on the MyBack website was 20 (IQR 18-22), and the median score for Wikipedia was 12 (IQR 8-15). The entire score range was used. Overall, 53 participants completed a retest, of which 39 (74%) were stable in their satisfaction with the home page and were included in the analysis for reliability. Intraclass correlation coefficient of agreement was estimated to be 0.82 (95% CI 0.68-0.90). Two hypothesized correlations for construct validity were confirmed through an analysis using complete data. Conclusions: The index had good face validity, excellent reliability, and good construct validity and can be used to measure satisfaction with the provision of web-based information regarding nonspecific low back pain among people willing to access the internet to obtain health information. Trial Registration: ClinicalTrials.gov NCT03449004; https://clinicaltrials.gov/ct2/show/NCT03449004 %M 34779785 %R 10.2196/21462 %U https://formative.jmir.org/2021/11/e21462 %U https://doi.org/10.2196/21462 %U http://www.ncbi.nlm.nih.gov/pubmed/34779785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e32707 %T Patients’ and Health Care Workers’ Perception of Migraine Images on the Internet: Cross-sectional Survey Study %A Raffaelli,Bianca %A Kull,Pia %A Mecklenburg,Jasper %A Overeem,Lucas Hendrik %A Storch,Elisabeth %A Terhart,Maria %A Neeb,Lars %A Reuter,Uwe %+ Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450660888, bianca.raffaelli@charite.de %K migraine %K stigma %K mass media %K stock photos %K advocacy %K internet %K perception %K headache %K pain %K cross-sectional %K survey %K stereotype %K media %K awareness %D 2021 %7 12.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The representation of migraine in the media is stereotypical. Standard images of migraine attacks display stylish young women holding their head in a pain pose. This representation may contribute to the social stigmatization of patients with migraine. Objective: We aimed to analyze how patients with migraine and health care workers perceive online images of migraine. Methods: The study consisted of an anonymous web-based survey of patients with migraine at the Headache Center of Charité – Universitätsmedizin Berlin (migraine group) and employees and students at our university (health care group). A total of 10 frequently used Adobe Stock photos of migraine attacks were presented to the participants. Each photo was rated on a scale of 0% to 100% based on how closely it resembled a realistic migraine attack (realism score). Patients with migraine also indicated how much each photo corresponded to their own experience of migraine as a percentage (representation score). We calculated the mean realism and representation scores for all photos and conducted further analyses using the categories male or female models, younger or older models, and unilateral or bilateral pain pose. Results: A total of 367 patients with migraine and 331 health care employees and students completed the survey. In both groups, the mean realism score was <50% (migraine group: 47.8%, SD 18.3%; health care group: 46.0%, SD 16.2%). Patients with migraine identified their own migraine experience in these photos to a lesser degree (mean representation score 44.4%, SD 19.8%; P<.001 when compared to the realism score). Patients and health care workers considered photos with male models to be more realistic than photos with females (P<.001) and photos with older models to be more realistic than those with younger people (P<.001). In the health care group only, a bilateral pain posture was deemed more realistic than a unilateral pose (P<.001). Conclusions: Standard images of migraine attacks are considered only slightly or moderately realistic by patients and health care workers. Some characteristics perceived as more realistic such as male sex or older age are in contrast with migraine epidemiology. A more accurate representation of migraine in the media could help to raise awareness for migraine and reduce the associated stigma. %M 34766918 %R 10.2196/32707 %U https://www.jmir.org/2021/11/e32707 %U https://doi.org/10.2196/32707 %U http://www.ncbi.nlm.nih.gov/pubmed/34766918 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e25897 %T Online Newspaper Reports on Ambulance Accidents in Austria, Germany, and Switzerland: Retrospective Cross-sectional Review %A Boldt,Johanna %A Steinfort,Femke %A Müller,Martin %A Exadaktylos,Aristomenis K %A Klukowska-Roetzler,Jolanta %+ Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Freiburgerstrasse 16C, Berne, 3010, Switzerland, 41 31 632 33 96, jolanta.klukowska-roetzler@insel.ch %K ambulance accidents %K ambulance collisions %K ambulance crashes %K media-based %K media-based review %K newspaper review %K Austria %K Germany %K Switzerland %K German-speaking European countries %K retrospective %K cross-sectional %K review %K ambulance %K accident %K data %K media %K newspaper %D 2021 %7 12.11.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Ambulance accidents are an unfortunate indirect result of ambulance emergency calls, which create hazardous environments for personnel, patients, and bystanders. However, in European German-speaking countries, factors contributing to ambulance accidents have not been optimally researched and analyzed. Objective: The objective of this study was to extract, analyze, and compare data from online newspaper articles on ambulance accidents for Austria, Germany, and Switzerland. We hope to highlight future strategies to offset the deficit in research data and official registers for prevention of ambulance and emergency vehicle accidents. Methods: Ambulance accident data were collected from Austrian, German, and Swiss free web-based daily newspapers, as listed in Wikipedia, for the period between January 2014 and January 2019. All included newspapers were searched for articles reporting ambulance accidents using German terms representing “ambulance” and “ambulance accident.” Characteristics of the accidents were compiled and analyzed. Only ground ambulance accidents were covered. Results: In Germany, a total of 597 ambulance accidents were recorded, corresponding to 0.719 (95% CI 0.663-0.779) per 100,000 inhabitants; 453 of these accidents left 1170 people injured, corresponding to 1.409 (95% CI 1.330-1.492) per 100,000 inhabitants, and 28 of these accidents caused 31 fatalities, corresponding to 0.037 (95% CI 0.025-0.053) per 100,000 inhabitants. In Austria, a total of 62 ambulance accidents were recorded, corresponding to 0.698 (95% CI 0.535-0.894) per 100,000 inhabitants; 47 of these accidents left 115 people injured, corresponding to 1.294 (95% CI 1.068-1.553) per 100,000 inhabitants, and 6 of these accidents caused 7 fatalities, corresponding to 0.079 (95% CI 0.032-0.162) per 100,000 inhabitants. In Switzerland, a total of 25 ambulance accidents were recorded, corresponding to 0.293 (95% CI 0.189-0.432) per 100,000 inhabitants; 11 of these accidents left 18 people injured, corresponding to 0.211(95% CI 0.113-0.308) per 100,000 inhabitants. There were no fatalities. In each of the three countries, the majority of the accidents involved another car (77%-81%). In Germany and Switzerland, most accidents occurred at an intersection. In Germany, Austria, and Switzerland, 38.7%, 26%, and 4%, respectively, of ambulance accidents occurred at intersections for which the ambulance had a red light (P<.001). In all three countries, most of the casualties were staff and not uncommonly a third party. Most accidents took place on weekdays and during the daytime. Ambulance accidents were evenly distributed across the four seasons. The direction of travel was reported in 28%-37% of the accidents and the patient was in the ambulance approximately 50% of the time in all countries. The cause of the ambulance accidents was reported to be the ambulance itself in 125 (48.1% of accidents where the cause was reported), 22 (42%), and 8 (40%) accidents in Germany, Austria, and Switzerland, respectively (P=.02), and another vehicle in 118 (45.4%), 29 (56%), and 9 (45%) accidents, respectively (P<.001). A total of 292 accidents occurred while blue lights and sirens were used, which caused 3 deaths and 577 injuries. Conclusions: This study draws attention to much needed auxiliary sources of data that may allow for creation of a contemporary registry of all ambulance accidents in Austria, Germany, and Switzerland. To improve risk management and set European standards, it should be mandatory to collect standardized goal-directed and representative information using various sources (including the wide range presented by the press and social media), which should then be made available for audit, analysis, and research. %M 34766915 %R 10.2196/25897 %U https://publichealth.jmir.org/2021/11/e25897 %U https://doi.org/10.2196/25897 %U http://www.ncbi.nlm.nih.gov/pubmed/34766915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29146 %T Googling for Suicide–Content and Quality Analysis of Suicide-Related Websites: Thematic Analysis %A Chen,Wen %A Boggero,Andrea %A Del Puente,Giovanni %A Olcese,Martina %A Prestia,Davide %A Jahrami,Haitham %A Chalghaf,Nasr %A Guelmami,Noomen %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, bragazzi@yorku.ca %K suicide %K internet %K world wide web %K content analysis %K HONcode %K mental health %K webpage %K health information %K eHealth %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are “virtual pathways” facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals. Objective: The aim of this study is to characterize suicide-related webpages in the Italian language. Methods: The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term “suicidio” (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument Results: A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword “suicide.” Conclusions: Specialized mental health professionals should try to improve their presence online by providing high-quality material. %M 34689118 %R 10.2196/29146 %U https://formative.jmir.org/2021/11/e29146 %U https://doi.org/10.2196/29146 %U http://www.ncbi.nlm.nih.gov/pubmed/34689118 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31944 %T Seeking Mental Health Support Among College Students in Video-Based Social Media: Content and Statistical Analysis of YouTube Videos %A Choi,Bogeum %A Kim,Heejun %A Huh-Yoo,Jina %+ Department of Information Science, University of North Texas, 3940 North Elm, Suite E295G, Denton, TX, 76203, United States, 1 940 369 8285, heejun.kim@unt.edu %K mental health %K college student %K social media %K YouTube %K help-seeking %K experiential knowledge %K video types %K content analysis %K time distribution analysis %K depression %K anxiety %K student %K knowledge %K stigma %K strategy %K engagement %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health is a highly stigmatized disease, especially for young people. Due to its free, accessible format, college students increasingly use video-based social media for many aspects of information needs, including how-to tips, career, or health-related needs. The accessibility of video-based social media brings potential in supporting stigmatized contexts, such as college students’ mental health. Understanding which kinds of videos about college students’ mental health have increased viewer engagement will help build a foundation for exploring this potential. Little research has been done to identify video types systematically, how they have changed over time, and their associations on viewer engagement both short term and long term. Objective: This study aims to identify strategies for using video-based social media to combat stigmatized diseases, such as mental health, among college students. We identify who, with what perspective, purpose, and content, makes up the videos available on social media (ie, YouTube) about college students’ mental health and how these factors associate with viewer engagement. We then identify effective strategies for designing video-based social media content for supporting college students’ mental health. Methods: We performed inductive content analysis to identify different types of YouTube videos concerning college students’ mental health (N=452) according to video attributes, including poster, perspective, and purpose. Time analysis showed how video types have changed over time. Fisher’s exact test was used to examine the relationships between video attributes. The Mann-Whitney U test was used to test the association between video types and viewer engagement. Lastly, we investigated the difference in viewer engagement across time between two major types of videos (ie, individuals’ storytelling and organization’s informational videos). Results: Time trend analysis showed a notable increase in the number of (1) videos by individuals, (2) videos that represent students’ perspectives, and (3) videos that share stories and experiential knowledge over the recent years. Fisher’s exact test found all video attributes (ie, poster, perspective, and purpose) are significantly correlated with each other. In addition, the Mann-Whitney U test found that poster (individual vs organization) and purpose (storytelling vs sharing information) type has a significant association with viewer engagement (P<.001). Lastly, individuals’ storytelling videos had a greater engagement in the short term and the long term. Conclusions: The study shows that YouTube videos on college students’ mental health can be well differentiated by the types of posters and the purpose of the videos. Taken together, the videos where individuals share their personal stories, as well as experiential knowledge (ie, tips and advice), engaged more viewers in both the short term and long term. Individuals’ videos on YouTube showed the potential to support college students' mental health in unique ways, such as providing social support, validating experience, and sharing the positive experience of help-seeking. %M 34762060 %R 10.2196/31944 %U https://formative.jmir.org/2021/11/e31944 %U https://doi.org/10.2196/31944 %U http://www.ncbi.nlm.nih.gov/pubmed/34762060 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e29390 %T Discussion of Weight Loss Surgery in Instagram Posts: Successive Sampling Study %A Meleo-Erwin,Zoe C %A Basch,Corey H %A Fera,Joseph %A Smith,Bonnie %+ Department of Public Health, William Paterson University of New Jersey, 300 Pompton Rd, University Hall, Suite 359 – Office 370, Wayne, NJ, 07470, United States, 1 9737202394, erwinz@wpunj.edu %K bariatric surgery %K social media %K Instagram %K health promotion %K post-operative medicine %K Instagram %K online health information %K information accuracy %K surgery %K information quality %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The majority of American adults search for health and illness information on the internet. However, the quality and accuracy of this information are notoriously variable. With the advent of social media, US individuals have increasingly shared their own health and illness experiences, including those related to bariatric surgery, on social media platforms. Previous research has found that peer-to-peer requesting and giving of advice related to bariatric surgery on social media is common, that such advice is often presented in stark terms, and that the advice may not reflect patient standards of care. These previous investigations have helped to map bariatric surgery content on Facebook and YouTube. Objective: This objective of this study was to document and compare weight loss surgery (WLS)–related content on Instagram in the months leading up to the COVID-19 pandemic and 1 year later. Methods: We analyzed a total of 300 Instagram posts (50 posts per week for 3 consecutive weeks in late February and early March in both 2020 and 2021) uploaded using the hashtag #wls. Descriptive statistics were reported, and independent 1-tailed chi-square tests were used to determine if a post’s publication year statistically affected its inclusion of a particular type of content. Results: Overall, advice giving and personal responsibility for outcomes were emphasized by WLS posters on Instagram. However, social support was less emphasized. The safety, challenges, and risks associated with WLS were rarely discussed. The majority of posts did not contain references to facts from reputable medical sources. Posts published in 2021 were more likely to mention stress/hardships of living with WLS (45/150, 30%, vs 29/150, 19.3%; P=.03); however, those published in 2020 more often identified the importance of ongoing support for WLS success (35/150, 23.3%, vs 16/150, 10.7%; P=.004). Conclusions: Given that bariatric patients have low rates of postoperative follow-up, yet post-operative care and yet support are associated with improved health and weight loss outcomes, and given that health content on the web is of mixed accuracy, bariatric professionals may wish to consider including an online support forum moderated by a professional as a routine part of postoperative care. Doing so may not only improve follow-up rates but may offer providers the opportunity to counter inaccuracies encountered on social media. %M 34723828 %R 10.2196/29390 %U https://periop.jmir.org/2021/2/e29390 %U https://doi.org/10.2196/29390 %U http://www.ncbi.nlm.nih.gov/pubmed/34723828 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28098 %T Comparing the Impact of Online Ratings and Report Cards on Patient Choice of Cardiac Surgeon: Large Observational Study %A Li,Xuan %A Chou,Shin-Yi %A Deily,Mary E %A Qian,Mengcen %+ School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, Ministry of Health, 130 Dong’an Road, Shanghai, 200032, China, 86 13524622077, qianmengcen@fudan.edu.cn %K online physician reviews %K report cards %K cardiac surgeons %K patient choice %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients may use two information sources about a health care provider’s quality: online physician reviews, which are written by patients to reflect their subjective experience, and report cards, which are based on objective health outcomes. Objective: The aim of this study was to examine the impact of online ratings on patient choice of cardiac surgeon compared to that of report cards. Methods: We obtained ratings from a leading physician review platform, Vitals; report card scores from Pennsylvania Cardiac Surgery Reports; and information about patients’ choices of surgeons from inpatient records on coronary artery bypass graft (CABG) surgeries done in Pennsylvania from 2008 to 2017. We scraped all reviews posted on Vitals for surgeons who performed CABG surgeries in Pennsylvania during our study period. We linked the average overall rating and the most recent report card score at the time of a patient’s surgery to the patient’s record based on the surgeon’s name, focusing on fee-for-service patients to avoid impacts of insurance networks on patient choices. We used random coefficient logit models with surgeon fixed effects to examine the impact of receiving a high online rating and a high report card score on patient choice of surgeon for CABG surgeries. Results: We found that a high online rating had positive and significant effects on patient utility, with limited variation in preferences across individuals, while the impact of a high report card score on patient choice was trivial and insignificant. About 70.13% of patients considered no information on Vitals better than a low rating; the corresponding figure was 26.66% for report card scores. The findings were robust to alternative choice set definitions and were not explained by surgeon attrition, referral effect, or admission status. Our results also show that the interaction effect of rating information and a time trend was positive and significant for online ratings, but small and insignificant for report cards. Conclusions: A patient’s choice of surgeon is affected by both types of rating information; however, over the past decade, online ratings have become more influential, while the effect of report cards has remained trivial. Our findings call for information provision strategies that incorporate the advantages of both online ratings and report cards. %M 34709192 %R 10.2196/28098 %U https://www.jmir.org/2021/10/e28098 %U https://doi.org/10.2196/28098 %U http://www.ncbi.nlm.nih.gov/pubmed/34709192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30765 %T Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis %A Monselise,Michal %A Chang,Chia-Hsuan %A Ferreira,Gustavo %A Yang,Rita %A Yang,Christopher C %+ College of Computing and Informatics, Drexel University, 3675 Market St, 10th Floor, Philadelphia, PA, 19104, United States, 1 215 895 1631, chris.yang@drexel.edu %K health care informatics %K topic detection %K unsupervised sentiment analysis %K COVID-19 %K vaccine hesitancy %K sentiment %K concern %K vaccine %K social media %K trend %K trust %K health information %K Twitter %K discussion %K communication %K hesitancy %K emotion %K fear %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter. Objective: The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media. Methods: To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity. Results: After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy. Conclusions: This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust. %M 34581682 %R 10.2196/30765 %U https://www.jmir.org/2021/10/e30765 %U https://doi.org/10.2196/30765 %U http://www.ncbi.nlm.nih.gov/pubmed/34581682 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e29375 %T Health Communication About Hospice Care in Chinese Media: Digital Topic Modeling Study %A Liu,Qian %A Zheng,Zequan %A Chen,Jingsen %A Tsang,Winghei %A Jin,Shan %A Zhang,Yimin %A Akinwunmi,Babatunde %A Zhang,Casper JP %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Tat Chee Avenue, Kowloon, Hong Kong, China, 852 3442 6956, wkming@connect.hku.hk %K health communication %K hospice care %K mass media %K China %K topic modeling %K communication %K media %K model %K hospice %K end-of-life %K misconception %K health information %K news %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospice care, a type of end-of-life care provided for dying patients and their families, has been rooted in China since the 1980s. It can improve receivers’ quality of life as well as ease their economic burden. The Chinese mass media have continued to actively dispel misconceptions surrounding hospice care and deliver the latest information to citizens. Objective: This study aims to retrieve and analyze news reports on hospice care in order to gain insight into whether any differences existed in heath information delivered over time and to evaluate the role of mass media in health communication in recent years. Methods: We searched the Huike (WiseSearch) news database for relevant news reports from Chinese mass media released between 2014 and 2019. We defined two time periods for this study: (1) January 1, 2014, to December 31, 2016, and (2) January 1, 2017, to December 31, 2019. The data cleaning process was completed using Python. We determined appropriate topic numbers for these two periods based on the coherence score and applied latent Dirichlet allocation topic modeling. Keywords for each topic and corresponding topics’ names were then generated. The topics were plotted into different circles, and their distances on the 2D plane was represented by multidimensional scaling. Results: After removing duplicated and irrelevant news articles, we obtained a total of 2227 articles. We chose 8 as the suitable topic number for both study periods and generated topic names and associated keywords. The top 3 most reported topics in the first period were patient treatment, hospice care stories, and development of health care services and health insurance, accounting for 18.68% (178/953), 16.58% (158/953), and 14.17% (135/953) of the collected reports, respectively. The top 3 most reported topics in the second period were hospice care stories, patient treatment, and development of health care services, accounting for 15.62% (199/953), 15.38% (15.38/953), and 14.27% (182/953), respectively. Conclusions: Topic modeling of news reports gives us a better understanding of the patterns of health communication about hospice care by mass media. Chinese mass media frequently reported on hospice care in April of every year on account of a traditional Chinese festival. Moreover, an increase in coverage was observed in the second period. The two periods shared 6 similar topics, of which patient treatment outstrips hospice care stories was the most reported topic in the second period, implying the humanistic spirit behind the reports. Based on the findings of this study, we suggest stakeholders cooperate with the mass media when planning to update policies. %M 34673530 %R 10.2196/29375 %U https://publichealth.jmir.org/2021/10/e29375 %U https://doi.org/10.2196/29375 %U http://www.ncbi.nlm.nih.gov/pubmed/34673530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25497 %T Harnessing Machine Learning to Personalize Web-Based Health Care Content %A Guni,Ahmad %A Normahani,Pasha %A Davies,Alun %A Jaffer,Usman %+ Department of Surgery and Cancer, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom, 44 7803434969, ahmad.guni@nhs.net %K internet %K online health information %K personalized content %K patient education %K machine learning %D 2021 %7 19.10.2021 %9 Viewpoint %J J Med Internet Res %G English %X Web-based health care content has emerged as a primary source for patients to access health information without direct guidance from health care providers. The benefit of this approach is dependent on the ability of patients to access engaging high-quality information, but significant variability in the quality of web-based information often forces patients to navigate large quantities of inaccurate, incomplete, irrelevant, or inaccessible content. Personalization positions the patient at the center of health care models by considering their needs, preferences, goals, and values. However, the traditional methods used thus far in health care to determine the factors of high-quality content for a particular user are insufficient. Machine learning (ML) uses algorithms to process and uncover patterns within large volumes of data to develop predictive models that automatically improve over time. The health care sector has lagged behind other industries in implementing ML to analyze user and content features, which can automate personalized content recommendations on a mass scale. With the advent of big data in health care, which builds comprehensive patient profiles drawn from several disparate sources, ML can be used to integrate structured and unstructured data from users and content to deliver content that is predicted to be effective and engaging for patients. This enables patients to engage in their health and support education, self-management, and positive behavior change as well as to enhance clinical outcomes. %M 34665146 %R 10.2196/25497 %U https://www.jmir.org/2021/10/e25497 %U https://doi.org/10.2196/25497 %U http://www.ncbi.nlm.nih.gov/pubmed/34665146 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30695 %T The Content and Quality of Publicly Available Information About Congenital Diaphragmatic Hernia: Descriptive Study %A Soltys,Frank Coyle %A Spilo,Kimi %A Politi,Mary C %+ Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, United States, 1 3176750010, fsoltys@wustl.edu %K congenital diaphragmatic hernia %K prenatal counseling %K fetal care %K online information %K parental decision making %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making. Objective: We aimed to examine the content and quality of publicly available, internet-based CDH information. Methods: We conducted internet searches across 2 popular search engines (Google and Bing). Websites were included if they contained CDH information and were publicly available. We developed a coding instrument to evaluate websites. Two coders (FS and KS) were trained, achieved interrater reliability, and rated remaining websites independently. Descriptive statistics were performed. Results: Searches yielded 520 websites; 91 met inclusion criteria and were analyzed. Most websites provided basic CDH information including describing the defect (86/91, 95%), need for neonatal intensive care (77/91, 85%), and surgical correction (79/91, 87%). Few mentioned palliative care, decisions about pregnancy termination (13/91, 14%), or support resources (21/91, 23%). Conclusions: Findings highlight the variability of information about CDH on the internet. Clinicians should work to develop or identify reliable, comprehensive information about CDH to support parents. %M 34665147 %R 10.2196/30695 %U https://pediatrics.jmir.org/2021/4/e30695 %U https://doi.org/10.2196/30695 %U http://www.ncbi.nlm.nih.gov/pubmed/34665147 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30736 %T Critical Evaluation of the Efficiency of Colorectal Fellowship Websites: Cross-sectional Study %A Yan,Qi %A Jensen,Katherine %A Field,Alyssa %A Goei,Christian %A Dao Campi,Haisar E %A Logue,Alicia %A Perry,W Brian %A Davies,Mark G %+ Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 210 567 5715, daviesm@uthscsa.edu %K recruitment %K GME %K social media %K websites %K content %K accessibility %K online information %K fellowship information %K colorectal %K graduate education %K graduate medical education %D 2021 %7 15.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Websites are an important source of information for fellowship applicants, as they can influence ongoing interest and potential program selection. Objective: This study aims to evaluate the current state of colorectal fellowship websites. Methods: This cross-sectional study evaluates the quantity and quality of information available on websites of colorectal fellowship programs verified by the Accreditation Council for Graduate Medical Education in 2019. Results: A total of 63 colorectal fellowships were included for evaluation. Websites were surveyed for content items that previous studies have found to be influential to program applicants. The 58 (91%) programs with a functional website were evaluated using an information index (calculated as a function of availability of content items concerning education, application, personnel, and benefits) and an interactive index (calculated as a function of accessibility and usability of the webpage). Programs had a median total score of 27.8 (IQR 21.5-34.5) of 79. The median score for the interactive index was 7.5 of 15 and for the information index was 20 of 64. The median scores for website application, education, personnel, and benefits or life considerations were 5, 5.5, 3.3, and 4 of 13, 24, 13, and 14, respectively. There was no difference in total score between programs in different geographical regions (P=.46). Conclusions: Currently, colorectal surgery fellowship program websites do not provide enough content for applicants to make informed decisions. All training programs, regardless of specialty, should evaluate and improve their digital footprint to ensure their websites are accessible and provide the information desired by applicants. %M 34652282 %R 10.2196/30736 %U https://mededu.jmir.org/2021/4/e30736 %U https://doi.org/10.2196/30736 %U http://www.ncbi.nlm.nih.gov/pubmed/34652282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32425 %T Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Chen,Xiwei %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K infodemic %K misinformation %K trust in science %K COVID-19 %K RCT %K randomized controlled trial %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Trust in science meaningfully contributes to our understanding of people’s belief in misinformation and their intentions to take actions to prevent COVID-19. However, no experimental research has sought to intervene on this variable to develop a scalable response to the COVID-19 infodemic. Objective: Our study examined whether brief exposure to an infographic about the scientific process might increase trust in science and thereby affect belief in misinformation and intention to take preventive actions for COVID-19. Methods: This two-arm, parallel-group, randomized controlled trial aimed to recruit a US representative sample of 1000 adults by age, race/ethnicity, and gender using the Prolific platform. Participants were randomly assigned to view either an intervention infographic about the scientific process or a control infographic. The intervention infographic was designed through a separate pilot study. Primary outcomes were trust in science, COVID-19 narrative belief profile, and COVID-19 preventive behavioral intentions. We also collected 12 covariates and incorporated them into all analyses. All outcomes were collected using web-based assessment. Results: From January 22, 2021 to January 24, 2021, 1017 participants completed the study. The intervention slightly improved trust in science (difference-in-difference 0.03, SE 0.01, t1000=2.16, P=.031). No direct intervention effect was observed on belief profile membership, but there was some evidence of an indirect intervention effect mediated by trust in science (adjusted odds ratio 1.06, SE 0.03, 95% CI 1.00-1.12, z=2.01, P=.045) on membership in the “scientific” profile compared with the others. No direct nor indirect effects on preventive behaviors were observed. Conclusions: Briefly viewing an infographic about science appeared to cause a small aggregate increase in trust in science, which may have, in turn, reduced the believability of COVID-19 misinformation. The effect sizes were small but commensurate with our 60-second, highly scalable intervention approach. Researchers should study the potential for truthful messaging about how science works to serve as misinformation inoculation and test how best to do so. Trial Registration: NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241 International Registered Report Identifier (IRRID): RR2-10.2196/24383 %M 34581678 %R 10.2196/32425 %U https://www.jmir.org/2021/10/e32425 %U https://doi.org/10.2196/32425 %U http://www.ncbi.nlm.nih.gov/pubmed/34581678 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e20975 %T Identifying and Responding to Health Misinformation on Reddit Dermatology Forums With Artificially Intelligent Bots Using Natural Language Processing: Design and Evaluation Study %A Sager,Monique A %A Kashyap,Aditya M %A Tamminga,Mila %A Ravoori,Sadhana %A Callison-Burch,Christopher %A Lipoff,Jules B %+ Department of Dermatology, University of Pennsylvania, 3737 Market Street, Suite 1100, Penn Medicine University City, Philadelphia, PA, 19104, United States, 1 215 662 8060, jules.lipoff@pennmedicine.upenn.edu %K bots %K natural language processing %K artificial intelligence %K Reddit, medical misinformation %K health misinformation %K detecting misinformation %K dermatology %K misinformation %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Reddit, the fifth most popular website in the United States, boasts a large and engaged user base on its dermatology forums where users crowdsource free medical opinions. Unfortunately, much of the advice provided is unvalidated and could lead to the provision of inappropriate care. Initial testing has revealed that artificially intelligent bots can detect misinformation regarding tanning and essential oils on Reddit dermatology forums and may be able to produce responses to posts containing misinformation. Objective: To analyze the ability of bots to find and respond to tanning and essential oil–related health misinformation on Reddit’s dermatology forums in a controlled test environment. Methods: Using natural language processing techniques, we trained bots to target misinformation, using relevant keywords and to post prefabricated responses. By evaluating different model architectures across a held-out test set, we compared performances. Results: Our models yielded data test accuracies ranging 95%-100%, with a Bidirectional Encoder Representations from Transformers (BERT) fine-tuned model resulting in the highest level of test accuracy. Bots were then able to post corrective prefabricated responses to misinformation in a test environment. Conclusions: Using a limited data set, bots accurately detected examples of health misinformation within Reddit dermatology forums. Given that these bots can then post prefabricated responses, this technique may allow for interception of misinformation. Providing correct information does not mean that users will be receptive or find such interventions persuasive. Further studies should investigate this strategy’s effectiveness to inform future deployment of bots as a technique in combating health misinformation. %M 37632809 %R 10.2196/20975 %U https://derma.jmir.org/2021/2/e20975 %U https://doi.org/10.2196/20975 %U http://www.ncbi.nlm.nih.gov/pubmed/37632809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30161 %T Information Retrieval in an Infodemic: The Case of COVID-19 Publications %A Teodoro,Douglas %A Ferdowsi,Sohrab %A Borissov,Nikolay %A Kashani,Elham %A Vicente Alvarez,David %A Copara,Jenny %A Gouareb,Racha %A Naderi,Nona %A Amini,Poorya %+ Department of Radiology and Medical Informatics, University of Geneva, Campus Biotech G6-N3 - Chemin des Mines 9, Geneva, 1202, Switzerland, 41 022 379 0225, douglas.teodoro@unige.ch %K information retrieval %K multistage retrieval %K neural search %K deep learning %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K literature %K online information %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 global health crisis has led to an exponential surge in published scientific literature. In an attempt to tackle the pandemic, extremely large COVID-19–related corpora are being created, sometimes with inaccurate information, which is no longer at scale of human analyses. Objective: In the context of searching for scientific evidence in the deluge of COVID-19–related literature, we present an information retrieval methodology for effective identification of relevant sources to answer biomedical queries posed using natural language. Methods: Our multistage retrieval methodology combines probabilistic weighting models and reranking algorithms based on deep neural architectures to boost the ranking of relevant documents. Similarity of COVID-19 queries is compared to documents, and a series of postprocessing methods is applied to the initial ranking list to improve the match between the query and the biomedical information source and boost the position of relevant documents. Results: The methodology was evaluated in the context of the TREC-COVID challenge, achieving competitive results with the top-ranking teams participating in the competition. Particularly, the combination of bag-of-words and deep neural language models significantly outperformed an Okapi Best Match 25–based baseline, retrieving on average, 83% of relevant documents in the top 20. Conclusions: These results indicate that multistage retrieval supported by deep learning could enhance identification of literature for COVID-19–related questions posed using natural language. %M 34375298 %R 10.2196/30161 %U https://www.jmir.org/2021/9/e30161 %U https://doi.org/10.2196/30161 %U http://www.ncbi.nlm.nih.gov/pubmed/34375298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24515 %T Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study %A Wartenberg,Lisa %A Raber,Margaret %A Chandra,Joya %+ Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 853, Houston, TX, 77030-4000, United States, 1 17135635405, jchandra@mdanderson.org %K pediatric oncology %K web-based resources %K oncology nutrition %K culinary education %K oncology %K children %K pediatric %K nutrition %K culinary %K education %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. Objective: We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. Methods: We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research’s Healthy Recipes, The Children’s Hospital of San Antonio’s Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center’s Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. Results: Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. Conclusions: The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience. %M 34515643 %R 10.2196/24515 %U https://www.jmir.org/2021/9/e24515 %U https://doi.org/10.2196/24515 %U http://www.ncbi.nlm.nih.gov/pubmed/34515643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30409 %T TikTok as a Health Information Source: Assessment of the Quality of Information in Diabetes-Related Videos %A Kong,Wenwen %A Song,Shijie %A Zhao,Yuxiang Chris %A Zhu,Qinghua %A Sha,Ling %+ School of Information Management, Nanjing University, Xianlin Ave 163, Nanjing, 210023, China, 1 15951973800, ssong@smail.nju.edu.cn %K diabetes %K information quality %K infodemiology %K social media %K short video apps %K TikTok %D 2021 %7 1.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetes has become one of the most prevalent chronic diseases, and many people living with diabetes use social media to seek health information. Recently, an emerging social media app, TikTok, has received much interest owing to its popularity among general health consumers. We notice that there are many videos about diabetes on TikTok. However, it remains unclear whether the information in these videos is of satisfactory quality. Objective: This study aimed to assess the quality of the information in diabetes-related videos on TikTok. Methods: We collected a sample of 199 diabetes-related videos in Chinese. The basic information presented in the videos was coded and analyzed. First, we identified the source of each video. Next, 2 independent raters assessed each video in terms of the completeness of six types of content (the definition of the disease, symptoms, risk factors, evaluation, management, and outcomes). Then, the 2 raters independently assessed the quality of information in the videos, using the DISCERN instrument. Results: In regard to the sources of the videos, we found 6 distinct types of uploaders; these included 3 kinds of individual users (ie, health professionals, general users, and science communicators) and 3 types of organizational users (ie, news agencies, nonprofit organizations, and for-profit organizations). Regarding content, our results show that the videos were primarily about diabetes management and contained limited information on the definition of the disease, symptoms, risk factors, evaluation, and outcomes. The overall quality of the videos was acceptable, on average, although the quality of the information varied, depending on the sources. The videos created by nonprofit organizations had the highest information quality, while the videos contributed by for-profit organizations had the lowest information quality. Conclusions: Although the overall quality of the information in the diabetes videos on TikTok is acceptable, TikTok might not fully meet the health information needs of patients with diabetes, and they should exercise caution when using TikTok as a source of diabetes-related information. %M 34468327 %R 10.2196/30409 %U https://www.jmir.org/2021/9/e30409 %U https://doi.org/10.2196/30409 %U http://www.ncbi.nlm.nih.gov/pubmed/34468327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e27477 %T Informed Decision-making for Health Insurance Enrollment: Survey Study %A Colón-Morales,Coralys M %A Giang,Wayne C W %A Alvarado,Michelle %+ Department of Industrial and Systems Engineering, University of Florida, 303 Weil Hall, Gainesville, FL, 32603, United States, 1 (352) 392 1464, ccolonmorales@ufl.edu %K health insurance %K information %K sources %K survey %K literacy %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. Objective: This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. Methods: An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. Results: In terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. Conclusions: In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies. %M 34387555 %R 10.2196/27477 %U https://formative.jmir.org/2021/8/e27477 %U https://doi.org/10.2196/27477 %U http://www.ncbi.nlm.nih.gov/pubmed/34387555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e24994 %T Content Analysis and Quality Evaluation of Cesarean Delivery–Related Videos on YouTube: Cross-sectional Study %A Lee,Kyong-No %A Joo,Yeon Ji %A Choi,So Yeon %A Park,Sung Taek %A Lee,Keun-Young %A Kim,Youngmi %A Son,Ga-Hyun %+ Department of Obstetrics and Gynecology, Hallym University Kangnam Sacred Heart Hospital, Daelim-Dong, Yeoungdeungpo-Gu 948-1, Seoul, 07441, Republic of Korea, 82 2 829 5114, ntr5017@naver.com %K cesarean delivery %K YouTube %K internet %K quality of information %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: YouTube is one of the most popular open-access video-sharing websites, and it is also used to obtain health care information. Cesarean delivery is the most common major surgical intervention in many countries. Videos related to cesarean delivery have also been uploaded to YouTube. However, no study has explored the overall quality of cesarean delivery videos on the platform. Objective: The objective of this study was to analyze the content and evaluate the quality of the most frequently viewed videos related to cesarean delivery that are accessible on YouTube. Methods: We searched for a total of 18 terms by combining the 6 terms retrieved from Google AdWords and the 3 terms c section, cesarean section, and cesarean delivery, which are used interchangeably. Videos were sorted by view count, and the 100 videos with the highest view counts were chosen. The number of views, duration, likes and dislikes, content type, and source of each video were recorded. In evaluating the quality of the videos, we referred to a previous study. Additionally, we developed a detailed scoring method that comprehensively evaluates the videos related to cesarean delivery by including the necessary information for each element of the cesarean delivery and whether scientific evidence was presented. Results: Of the 100 videos analyzed, the most prevalent content (n=28) was videos that contained the actual surgical procedure of a cesarean delivery, and the most common source of cesarean delivery videos was physicians (n=30). Videos directly related to cesarean delivery, such as explanation of the surgery and the actual surgical procedure, were mainly uploaded by medical groups and scored higher than the videos indirectly related to cesarean delivery, which were mainly uploaded by nonmedical groups. In addition, videos directly related to cesarean delivery were more often uploaded earlier in time, with lower like ratios compared to indirect videos. Conclusions: YouTube is currently not an appropriate source for patients seeking information on cesarean delivery. %M 34328422 %R 10.2196/24994 %U https://www.jmir.org/2021/7/e24994 %U https://doi.org/10.2196/24994 %U http://www.ncbi.nlm.nih.gov/pubmed/34328422 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e24436 %T A Health Information Quality Assessment Tool for Korean Online Newspaper Articles: Development Study %A Lee,Naae %A Oh,Seung-Won %A Cho,Belong %A Myung,Seung-Kwon %A Hwang,Seung-Sik %A Yoon,Goo Hyeon %+ Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 38-40FL Gangnam Finance Center 152, Teheran-ro, Gangnam-gu, Seoul, 06236, Republic of Korea, 82 2 2112 5500, sw.oh@snu.ac.kr %K assessment tools %K information seeking %K newspaper articles %K online health information %K quality assessment %D 2021 %7 29.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Concern regarding the reliability and accuracy of the health-related information provided by online newspaper articles has increased. Numerous criteria and items have been proposed and published regarding the quality assessment of online information, but there is no standard quality assessment tool available for online newspapers. Objective: This study aimed to develop the Health Information Quality Assessment Tool (HIQUAL) for online newspaper articles. Methods: We reviewed previous health information quality assessment tools and related studies and accordingly developed and customized new criteria. The interrater agreement for the new assessment tool was assessed for 3 newspaper articles on different subjects (colorectal cancer, obesity genetic testing, and hypertension diagnostic criteria) using the Fleiss κ and Gwet agreement coefficient. To compare the quality scores generated by each pair of tools, convergent validity was measured using the Kendall τ ranked correlation. Results: Overall, the HIQUAL for newspaper articles comprised 10 items across 5 domains: reliability, usefulness, understandability, sufficiency, and transparency. The interrater agreement for the article on colorectal cancer was in the moderate to substantial range (Fleiss κ=0.48, SE 0.11; Gwet agreement coefficient=0.74, SE 0.13), while for the article introducing obesity genetic testing it was in the substantial range, with values of 0.63 (SE 0.28) and 0.86 (SE 0.10) for the two measures, respectively. There was relatively low agreement for the article on hypertension diagnostic criteria at 0.20 (SE 0.10) and 0.75 (SE 0.13), respectively. Validity of the correlation assessed with the Kendall τ showed good correlation between tools (HIQUAL vs DISCERN=0.72, HIQUAL vs QUEST [Quality Evaluation Scoring Tool]=0.69). Conclusions: We developed a new assessment tool to evaluate the quality of health information in online newspaper articles, to help consumers discern accurate sources of health information. The HIQUAL can help increase the accuracy and quality of online health information in Korea. %M 34326038 %R 10.2196/24436 %U https://www.jmir.org/2021/7/e24436 %U https://doi.org/10.2196/24436 %U http://www.ncbi.nlm.nih.gov/pubmed/34326038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e23174 %T Descriptive Review of Online Information Resources for People With Stroke: Protocol for a Scoping Review %A Inglis-Jassiem,Gakeemah %A Grimmer,Karen %A Conradie,Thandi %A Louw,Quinette %+ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg, Cape Town, 8000, South Africa, 27 0219389667, gakeemah@sun.ac.za %K stroke %K online resources %K content %K readability %K design %D 2021 %7 13.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with stroke and their caregivers experience numerous information needs; internet-based resources may offer cost-effective ways to improve access to information about this condition and its management, including the availability of resources and support. The quality of online health information is, therefore, an important consideration for both developers and consumers of these online resources. Objective: This study aims to map and evaluate the content, readability, understandability, design, and quality characteristics of freely available online information resources (ie, websites) that empower people with stroke and their caregivers with information and self-help strategies poststroke. Methods: This descriptive review will follow the five systematic and rigorous methodological steps that are recommended for scoping reviews, which include the following: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarizing, and reporting the results. Data will then be synthesized and analyzed thematically. Results: As of February 2021, the scoping review is in the data extraction stage. Data will be synthesized, and the first results are expected to be submitted for publication in an open-access peer-reviewed journal in August 2021. In addition, we will develop an accessible summary of the results for stakeholder meetings. Ethical approval is not required for this review, as it will only include publicly available information. Conclusions: This study is novel and will evaluate the typology, content, and design-related criteria, including accessibility, aesthetics, navigability, interactivity, privacy, and data protection, of online information resources for stroke. The review will be limited to online resources published in English. International Registered Report Identifier (IRRID): DERR1-10.2196/23174 %M 34255721 %R 10.2196/23174 %U https://www.researchprotocols.org/2021/7/e23174 %U https://doi.org/10.2196/23174 %U http://www.ncbi.nlm.nih.gov/pubmed/34255721 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29942 %T The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study %A Chan,Calvin %A Sounderajah,Viknesh %A Daniels,Elisabeth %A Acharya,Amish %A Clarke,Jonathan %A Yalamanchili,Seema %A Normahani,Pasha %A Markar,Sheraz %A Ashrafian,Hutan %A Darzi,Ara %+ Department of Surgery & Cancer, Imperial College London, 10th floor, Queen Elizabeth Queen Mother Building, St. Mary's Hospital, South Wharf Road, London, W2 1NY, United Kingdom, 44 02033126666, vs1108@imperial.ac.uk %K COVID-19 %K infodemiology %K public health %K quality %K reliability %K social media %K vaccination %K vaccine %K video %K web-based health information %K YouTube %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases “coronavirus vaccine” and “COVID-19 vaccine” were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. %M 34081599 %R 10.2196/29942 %U https://publichealth.jmir.org/2021/7/e29942 %U https://doi.org/10.2196/29942 %U http://www.ncbi.nlm.nih.gov/pubmed/34081599 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 3 %P e27302 %T Exploratory Analysis of Electronic Cigarette–Related Videos on YouTube: Observational Study %A Xie,Zidian %A Wang,Xueting %A Gu,Yu %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642, United States, 1 5852767285, dongmei_li@urmc.rochester.edu %K infodemiology %K infoveillance %K social listening %K electronic cigarettes %K e-cigarette %K YouTube %K user engagement %K provaping %K vaping-warning %D 2021 %7 6.7.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: Electronic cigarette (e-cigarette) use has become more popular than cigarette smoking, especially among youth. Social media platforms, including YouTube, are a popular means of sharing information about e-cigarette use (vaping). Objective: This study aimed to characterize the content and user engagement of e-cigarette–related YouTube videos. Methods: The top 400 YouTube search videos related to e-cigarettes were collected in January 2020. Among them, 340 valid videos were classified into provaping, vaping-warning, and neutral categories by hand coding. Additionally, the content of e-cigarette videos and their user engagement (including average views and likes) were analyzed and compared. Results: While provaping videos were dominant among e-cigarette–related YouTube videos from 2007 to 2017, vaping-warning videos started to emerge in 2013 and became dominant between 2018 and 2019. Compared to vaping-warning videos, provaping videos had higher average daily views (1077 vs 822) but lower average daily likes (12 vs 15). Among 161 provaping videos, videos on user demonstration (n=100, 62.11%) were dominant, and videos on comparison with smoking had the highest user engagement (2522 average daily views and 28 average daily likes). Conversely, among 141 vaping-warning videos, videos on potential health risks were the most popular topic (n=57, 40.42%) with the highest user engagement (1609 average daily views and 33 average daily likes). Conclusions: YouTube was dominated by provaping videos, with the majority of videos on user demonstrations before 2018. The vaping-warning videos became dominant between 2018 and 2019, with videos on potential health risks being the most popular topic. This study provides updated surveillance on e-cigarette–related YouTube videos and some important guidance on associated social media regulations. %M 34255663 %R 10.2196/27302 %U https://www.i-jmr.org/2021/3/e27302 %U https://doi.org/10.2196/27302 %U http://www.ncbi.nlm.nih.gov/pubmed/34255663 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e15551 %T Typology and Impact of YouTube Videos Posted in Response to a Student Suicide Crisis: Social Media Metrics and Content Analyses %A Cheng,Qijin %A Lui,Carrie %A Ip,Flora Wai Lam %A Yip,Paul Siu Fai %+ Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, 5 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 28315232, sfpyip@hku.hk %K suicide %K suicide prevention %K social media %K infodemiology %K internet %K digital health %K YouTube %K impact evaluation %K network visualization %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Videos relating to suicide are available on YouTube, but their characteristics and impacts have seldom been examined. Objective: This study aimed to examine YouTube videos posted in response to a sudden spate of student suicides in Hong Kong during the 2015-2016 school year and evaluate the impacts of those videos. Methods: Keyword search was performed on YouTube, and relevant videos were identified. Video typology was examined through content analysis, specifically grouping the videos by who uploaded the videos, what presentation formats were used in the videos, whether the videos were originally created by the uploaders, and whether the videos disclosed the uploaders’ personal experiences with suicide. Impacts of the videos were assessed in terms of reach (measured by view count), engagement (measured by comment count), and insights (measured as to what extent the comments to each video could reveal personal suicide risk and attitude toward help-seeking). Statistical analysis was conducted to compare the impacts of different types of videos. The 7 most impactful videos that were originally created by the YouTubers were selected for further analysis. They were compared with 7 videos uploaded by the same YouTubers right before the student suicide videos and 7 right after the student suicide videos. The comparison focused on their impacts and the network structure of the comments to those videos. Results: A total of 162 relevant YouTube videos were identified. They were uploaded by 7 types of stakeholders, and the most common format was one person talking to the camera. A total of 87.0% (141/162) of the videos were originally created by the uploaders and only 8.0% (13/162) of the videos disclosed uploader personal experiences with suicide. The uploader profiles being popular or top YouTubers and the video containing disclosure of the uploader’s personal experiences were found to be significantly correlated with greater impacts (P<.001). Focusing on the 7 most impactful original videos, it is found that those videos generated more engagement, especially more interactions between the viewers, and more insights than regular videos uploaded by the same YouTubers. Conclusions: When responding to a youth suicide crisis, videos made by key opinion leaders on YouTube sharing their own experiences of overcoming suicide risks could generate significant positive impacts. These types of videos offer a precious opportunity to craft online campaigns and activities to raise suicide prevention awareness and engage vulnerable youth. %R 10.2196/15551 %U https://mental.jmir.org/2021/6/e15551/ %U https://doi.org/10.2196/15551 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e29528 %T Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study %A Basch,Corey H %A Mohlman,Jan %A Fera,Joseph %A Tang,Hao %A Pellicane,Alessia %A Basch,Charles E %+ Department of Public Health, William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K social media %K COVID-19 %K testing %K disgust %K anxiety %K content analysis %K communication %K infodemiology %K infoveillance %K public health %K digital public health %K digital health %K community mitigation %D 2021 %7 10.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok—an emerging social media platform. Objective: The purpose of this study was to describe TikTok videos related to COVID-19 testing. Methods: The hashtag #covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50% of the views for all videos cataloged under the hashtag #covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor. Results: The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70% of the total cumulative number of views (73,479,400/103,071,900, 71.29%) and likes (9,354,691/12,872,505, 72.67%), and those that mentioned or suggested anxiety attracted about 60% of the total cumulative number of views (61,423,500/103,071,900, 59.59%) and more than 8 million likes (8,339,598/12,872,505, 64.79%). Independent one-tailed t tests (α=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes. Conclusions: Our finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos’ propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media. %M 34081591 %R 10.2196/29528 %U https://publichealth.jmir.org/2021/6/e29528 %U https://doi.org/10.2196/29528 %U http://www.ncbi.nlm.nih.gov/pubmed/34081591 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26481 %T YouTube Videos Related to the Fukushima Nuclear Disaster: Content Analysis %A Cui,Limeng %A Chu,Lijuan %+ Department of Radiation Protection, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No 16 Hepinglizhongjie, Dongcheng, Beijing, , China, 86 13910742374, cuilimeng1103@sina.com %K YouTube %K Fukushima nuclear disaster %K social media %K risk communication %K disaster %K video platform %K radiation %K public safety %K nuclear disaster %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: YouTube (Alphabet Incorporated) has become the most popular video-sharing platform in the world. The Fukushima Daiichi Nuclear Power Plant (FDNPP) disaster resulted in public anxiety toward nuclear power and radiation worldwide. YouTube is an important source of information about the FDNPP disaster for the world. Objective: This study's objectives were to examine the characteristics of YouTube videos related to the FDNPP disaster, analyze the content and comments of videos with a quantitative method, and determine which features contribute to making a video popular with audiences. This study is the first to examine FDNPP disaster–related videos on YouTube. Methods: We searched for the term “Fukushima nuclear disaster” on YouTube on November 2, 2019. The first 60 eligible videos in the relevance, upload date, view count, and rating categories were recorded. Videos that were irrelevant, were non-English, had inappropriate words, were machine synthesized, and were <3 minutes long were excluded. In total, 111 videos met the inclusion criteria. Parameters of the videos, including the number of subscribers, length, the number of days since the video was uploaded, region, video popularity (views, views/day, likes, likes/day, dislikes, dislikes/day, comments, comments/day), the tone of the videos, the top ten comments, affiliation, whether Japanese people participated in the video, whether the video recorder visited Fukushima, whether the video contained theoretical knowledge, and whether the video contained information about the recent situation in Fukushima, were recorded. By using criteria for content and technical design, two evaluators scored videos and grouped them into the useful (score: 11-14), slightly useful (score: 6-10), and useless (score: 0-5) video categories. Results: Of the 111 videos, 43 (38.7%) videos were useful, 43 (38.7%) were slightly useful, and 25 (22.5%) were useless. Useful videos had good visual and aural effects, provided vivid information on the Fukushima disaster, and had a mean score of 12 (SD 0.9). Useful videos had more views per day (P<.001), likes per day (P<.001), and comments per day (P=.02) than useless and slightly useful videos. The popularity of videos had a significant correlation with clear sounds (likes/day: P=.001; comments/day: P=.02), vivid information (likes/day: P<.001; comments/day: P=.007), understanding content (likes/day: P=.001; comments/day: P=.04). There was no significant difference in likes per day (P=.72) and comments per day (P=.11) between negative and neutral- and mixed-tone videos. Videos about the recent situation in Fukushima had more likes and comments per day. Video recorders who personally visited Fukushima Prefecture had more subscribers and received more views and likes. Conclusions: The possible features that made videos popular to the public included video quality, videos made in Fukushima, and information on the recent situation in Fukushima. During risk communication on new forms of media, health institutes should increase publicity and be more approachable to resonate with international audiences. %M 34096880 %R 10.2196/26481 %U https://publichealth.jmir.org/2021/6/e26481 %U https://doi.org/10.2196/26481 %U http://www.ncbi.nlm.nih.gov/pubmed/34096880 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24199 %T Social Media Content of Idiopathic Pulmonary Fibrosis Groups and Pages on Facebook: Cross-sectional Analysis %A Kochan,Andrew %A Ong,Shaun %A Guler,Sabina %A Johannson,Kerri A %A Ryerson,Christopher J %A Goobie,Gillian C %+ Division of Cardiology, Department of Medicine, University of British Columbia, 9th Floor Gordon and Leslie and Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 (604) 875 4111 ext 69821, andrew.kochan@alumni.ubc.ca %K interstitial lung disease %K idiopathic pulmonary fibrosis %K patient education %K social media %K internet %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patients use Facebook as a resource for medical information. We analyzed posts on idiopathic pulmonary fibrosis (IPF)-related Facebook groups and pages for the presence of guideline content, user engagement, and usefulness. Objective: The objective of this study was to describe and analyze posts from Facebook groups and pages that primarily focus on IPF-related content. Methods: Cross-sectional analysis was performed on a single date, identifying Facebook groups and pages resulting from separately searching “IPF” and “idiopathic pulmonary fibrosis.” For inclusion, groups and pages needed to meet either search term and be in English, publicly available, and relevant to IPF. Every 10th post was assessed for general characteristics, source, focus, and user engagement metrics. Posts were analyzed for presence of IPF guideline content, useful scientific information (eg, scientific publications), useful support information (eg, information about support groups), and potentially harmful information. Results: Eligibility criteria were met by 12 groups and 27 pages, leading to analysis of 523 posts. Of these, 42% contained guideline content, 24% provided useful support, 20% provided useful scientific information, and 5% contained potentially harmful information. The most common post source was nonmedical users (85%). Posts most frequently focused on IPF-related news (29%). Posts containing any guideline content had fewer likes or comments and a higher likelihood of containing potentially harmful content. Posts containing useful supportive information had more likes, shares, and comments. Conclusions: Facebook contains useful information about IPF, but posts with misinformation and less guideline content have higher user engagement, making them more visible. Identifying ways to help patients with IPF discriminate between useful and harmful information on Facebook and other social media platforms is an important task for health care professionals. %M 34057425 %R 10.2196/24199 %U https://publichealth.jmir.org/2021/5/e24199 %U https://doi.org/10.2196/24199 %U http://www.ncbi.nlm.nih.gov/pubmed/34057425 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26933 %T Bots and Misinformation Spread on Social Media: Implications for COVID-19 %A Himelein-Wachowiak,McKenzie %A Giorgi,Salvatore %A Devoto,Amanda %A Rahman,Muhammad %A Ungar,Lyle %A Schwartz,H Andrew %A Epstein,David H %A Leggio,Lorenzo %A Curtis,Brenda %+ Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd, Suite 200, Baltimore, MD, 21224, United States, 1 443 740 2126, brenda.curtis@nih.gov %K COVID-19 %K coronavirus %K social media %K bots %K infodemiology %K infoveillance %K social listening %K infodemic %K spambots %K misinformation %K disinformation %K fake news %K online communities %K Twitter %K public health %D 2021 %7 20.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X As of March 2021, the SARS-CoV-2 virus has been responsible for over 115 million cases of COVID-19 worldwide, resulting in over 2.5 million deaths. As the virus spread exponentially, so did its media coverage, resulting in a proliferation of conflicting information on social media platforms—a so-called “infodemic.” In this viewpoint, we survey past literature investigating the role of automated accounts, or “bots,” in spreading such misinformation, drawing connections to the COVID-19 pandemic. We also review strategies used by bots to spread (mis)information and examine the potential origins of bots. We conclude by conducting and presenting a secondary analysis of data sets of known bots in which we find that up to 66% of bots are discussing COVID-19. The proliferation of COVID-19 (mis)information by bots, coupled with human susceptibility to believing and sharing misinformation, may well impact the course of the pandemic. %M 33882014 %R 10.2196/26933 %U https://www.jmir.org/2021/5/e26933 %U https://doi.org/10.2196/26933 %U http://www.ncbi.nlm.nih.gov/pubmed/33882014 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e25661 %T Tanning Misinformation Posted by Businesses on Social Media and Related Perceptions of Adolescent and Young Adult White Non-Hispanic Women: Mixed Methods Study %A Moreno,Megan Andreas %A Jenkins,Marina C %A Lazovich,DeAnn %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 608 512 2525, mamoreno@pediatrics.wisc.edu %K adolescent %K social media %K tanning %K technology %K media %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Indoor ultraviolet (UV) tanning is common and consequential, increasing the risk for cancers including melanoma and basal cell carcinoma. At-risk groups include adolescents and young adults, who often report beliefs about benefits of tanning. Adolescent and young adults are also among the most ubiquitous social media users. As previous studies support that content about tanning is common on social media, this may be a way that young women are exposed to influential content promoting tanning, including health misinformation. Objective: The purpose of this study was to evaluate health misinformation promoted by indoor tanning businesses via social media and to understand young women’s perceptions of this misinformation. Methods: This mixed methods study included (1) retrospective observational content analysis of indoor tanning salons’ content on Facebook over 1 year and (2) qualitative interviews with a purposeful national sample of 46 White non-Hispanic women, age 16 to 23 years, who had recently tanned indoors. We assessed experiences with tanning businesses’ posted content on social media through interviews. We used the constant comparative approach for qualitative analyses. Results: Content analysis findings included data from indoor tanning businesses (n=147) across 50 states, yielding 4956 total posts. Among 9 health misinformation topics identified, the most common was the promotion of UV tanning as a safe way to get Vitamin D (n=73, 1.5%). An example post was “Stop by Body and Sol to get your daily dose of Vitamin D.” Another misinformation topic was promoting tanning for health benefits (n=31, 0.62%), an example post was “the flu is not a season, it’s an inability to adapt due to decreased sun exposure…” A total of 46 participants completed interviews (age: mean 20 years, SD 2). Almost all participants (45/46, 98%) used Facebook, and 43.5% (20/46) followed an indoor tanning business on social media. Approximately half of participants reported seeing social media posts from tanning salons about Vitamin D, an example of a participant comment was “I have [seen that] a few times...” Among the participants, approximately half believed it was safe to get Vitamin D from indoor UV tanning; a participant stated: “I think it is a valid benefit to UV tanning.” Conclusions: Despite the low frequency (range 0.5%-1.5%) of social media posts promoting health misinformation, participants commonly reported viewing these posts, and their perceptions aligned with health misinformation. Health education campaigns, possibly using social media to target at-risk populations, may be an innovative approach for tanning prevention messages. %M 37632797 %R 10.2196/25661 %U https://derma.jmir.org/2021/1/e25661 %U https://doi.org/10.2196/25661 %U http://www.ncbi.nlm.nih.gov/pubmed/37632797 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e25357 %T The Value of Web-Based Patient Education Materials on Transarterial Chemoembolization: Systematic Review %A Sideris,Georgios Antonios %A Vyllioti,Aikaterini-Themis %A Dima,Danai %A Chill,Michael %A Njuguna,Njogu %+ Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, 759 Chestnut Street, Springfield, MA, 01199, United States, 1 4133029024, siderismd@gmail.com %K transarterial chemoembolization %K interventional radiology %K interventional oncology %K liver cancer %K hepatocellular carcinoma %K internet %K patient education %K systematic review %D 2021 %7 7.5.2021 %9 Review %J JMIR Cancer %G English %X Background: Thousands of web searches are performed related to transarterial chemoembolization (TACE), given its palliative role in the treatment of liver cancer. Objective: This study aims to assess the reliability, quality, completeness, readability, understandability, and actionability of websites that provide information on TACE for patients. Methods: The five most popular keywords pertaining to TACE were searched on Google, Yahoo, and Bing. General website characteristics and the presence of Health On the Net Foundation code certification were documented. Website assessment was performed using the following scores: DISCERN, Journal of the American Medical Association, Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Patient Education Materials Assessment Tool. A novel TACE content score was generated to evaluate website completeness. Results: The search yielded 3750 websites. In total, 81 website entities belonging to 78 website domains met the inclusion criteria. A medical disclaimer was not provided on 28% (22/78) of website domains. Health On the Net code certification was present on 12% (9/78) of website domains. Authorship was absent on 88% (71/81) of websites, and sources were absent on 83% (67/81) of websites. The date of publication or of the last update was not listed on 58% (47/81) of websites. The median DISCERN score was 47.0 (IQR 40.5-54.0). The median TACE content score was 35 (IQR 27-43). The median readability grade level was in the 11th grade. Overall, 61% (49/81) and 16% (13/81) of websites were deemed understandable and actionable, respectively. Not-for-profit websites fared significantly better on the Journal of the American Medical Association, DISCERN, and TACE content scores. Conclusions: The content referring to TACE that is currently available on the web is unreliable, incomplete, difficult to read, understandable but not actionable, and characterized by low overall quality. Websites need to revise their content to optimally educate consumers and support shared decision-making. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020202747; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020202747 %M 33960948 %R 10.2196/25357 %U https://cancer.jmir.org/2021/2/e25357 %U https://doi.org/10.2196/25357 %U http://www.ncbi.nlm.nih.gov/pubmed/33960948 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28352 %T YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Zagnit,Emily A %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K vaccination %K COVID-19 %K social media %K communication %K misinformation %K disinformation %K adverse reactions %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords “coronavirus vaccination,” we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. %M 33886487 %R 10.2196/28352 %U https://publichealth.jmir.org/2021/5/e28352 %U https://doi.org/10.2196/28352 %U http://www.ncbi.nlm.nih.gov/pubmed/33886487 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e26564 %T Tetrahydrocannabinol and Skin Cancer: Analysis of YouTube Videos %A Mamo,Andrina %A Szeto,Mindy D %A Mirhossaini,Roya %A Fortugno,Andrew %A Dellavalle,Robert P %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court, 3rd Floor, Mailstop F703, Aurora, CO, 80045, United States, 1 720 848 0500, mindy.szeto@cuanschutz.edu %K THC %K tetrahydrocannabinol %K skin cancer %K YouTube %K cannabis %K social media %K internet %D 2021 %7 4.5.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Cannabis oil is being used topically by patients with skin cancer as a homeopathic remedy, and has been promoted and popularized on social media, including YouTube. Although topical cannabinoids, especially tetrahydrocannabinol (THC), may have antitumor effects, results from a sparse number of clinical trials and peer-reviewed studies detailing safety and efficacy are still under investigation. Objective: We sought to assess the accuracy, quality, and reliability of THC oil and skin cancer information available on YouTube. Methods: The 10 most-viewed videos on THC oil and skin cancer were analyzed with the Global Quality Scale (GQS), DISCERN score, and useful/misleading criteria based on presentation of erroneous and scientifically unproven information. The videos were also inspected for source, length, and audience likes/dislikes. Top comments were additionally examined based on whether they were favorable, unfavorable, or neutral regarding the video content. Results: All analyzed videos (10/10, 100%) received a GQS score of 1, corresponding to poor quality of content, and 9/10 (90%) videos received a DISCERN score of 0, indicating poor reliability of information presented. All 10 videos were also found to be misleading and not useful according to established criteria. Top comments were largely either favorable (13/27, 48%) or neutral (13/27, 48%) toward the content of the videos, compared to unfavorable (1/27, 4%). Conclusions: Dermatologists should be aware that the spread of inaccurate information on skin cancer treatment currently exists on popular social media platforms and may lead to detrimental consequences for patients interested in pursuing alternative or homeopathic approaches. %M 37632811 %R 10.2196/26564 %U https://derma.jmir.org/2021/1/e26564 %U https://doi.org/10.2196/26564 %U http://www.ncbi.nlm.nih.gov/pubmed/37632811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25215 %T Patterns of Media Use, Strength of Belief in COVID-19 Conspiracy Theories, and the Prevention of COVID-19 From March to July 2020 in the United States: Survey Study %A Romer,Daniel %A Jamieson,Kathleen Hall %+ Annnenberg Public Policy Center, University of Pennsylvania, 202 S 36th St, Philadelphia, PA, 19104, United States, 1 610 202 7315, dan.romer@appc.upenn.edu %K COVID-19 %K conspiracy beliefs %K social media %K print news media %K broadcast news media %K conservative media %K vaccination %K mask wearing %K belief %K misinformation %K infodemic %K United States %K intention %K prevention %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Holding conspiracy beliefs regarding the COVID-19 pandemic in the United States has been associated with reductions in both actions to prevent the spread of the infection (eg, mask wearing) and intentions to accept a vaccine when one becomes available. Patterns of media use have also been associated with acceptance of COVID-19 conspiracy beliefs. Here we ask whether the type of media on which a person relies increased, decreased, or had no additional effect on that person’s COVID-19 conspiracy beliefs over a 4-month period. Objective: We used panel data to explore whether use of conservative and social media in the United States, which were previously found to be positively related to holding conspiracy beliefs about the origins and prevention of COVID-19, were associated with a net increase in the strength of those beliefs from March to July of 2020. We also asked whether mainstream news sources, which were previously found to be negatively related to belief in pandemic-related conspiracies, were associated with a net decrease in the strength of such beliefs over the study period. Additionally, we asked whether subsequent changes in pandemic conspiracy beliefs related to the use of media were also related to subsequent mask wearing and vaccination intentions. Methods: A survey that we conducted with a national US probability sample in March of 2020 and again in July with the same 840 respondents assessed belief in pandemic-related conspiracies, use of various types of media information sources, actions taken to prevent the spread of the disease and intentions to vaccinate, and various demographic characteristics. Change across the two waves was analyzed using path analytic techniques. Results: We found that conservative media use predicted an increase in conspiracy beliefs (β=.17, 99% CI .10-.25) and that reliance on mainstream print predicted a decrease in their belief (β=–.08, 99% CI –.14 to –.02). Although many social media platforms reported downgrading or removing false or misleading content, ongoing use of such platforms by respondents predicted growth in conspiracy beliefs as well (β=.072, 99% CI .018-.123). Importantly, conspiracy belief changes related to media use between the two waves of the study were associated with the uptake of mask wearing and changes in vaccination intentions in July. Unlike other media, use of mainstream broadcast television predicted greater mask wearing (β=.17, 99% CI .09-.26) and vaccination intention (β=.08, 95% CI .02-.14), independent of conspiracy beliefs. Conclusions: The findings point to the need for greater efforts on the part of commentators, reporters, and guests on conservative media to report verifiable information about the pandemic. The results also suggest that social media platforms need to be more aggressive in downgrading, blocking, and counteracting claims about COVID-19 vaccines, claims about mask wearing, and conspiracy beliefs that have been judged problematic by public health authorities. %M 33857008 %R 10.2196/25215 %U https://www.jmir.org/2021/4/e25215 %U https://doi.org/10.2196/25215 %U http://www.ncbi.nlm.nih.gov/pubmed/33857008 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24586 %T “Ask a Doctor About Coronavirus”: How Physicians on Social Media Can Provide Valid Health Information During a Pandemic %A Furstrand,Dorthe %A Pihl,Andreas %A Orbe,Elif Bayram %A Kingod,Natasja %A Søndergaard,Jens %+ Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 52675450, furstrand@gmail.com %K COVID-19 %K coronavirus %K digital health literacy %K eHealth literacy %K Facebook %K framework %K health information %K health literacy %K health promotion %K infodemic %K infodemiology %K mental health %K misinformation %K pandemic %K patient-physician relationship %K public health %K social media %K trust %K web-based community %D 2021 %7 20.4.2021 %9 Viewpoint %J J Med Internet Res %G English %X In the wake of the COVID-19 pandemic, the information stream has overflowed with accurate information, misinformation, and constantly changing guidelines. There is a great need for guidance on the identification of trustworthy health information, and official channels are struggling to keep pace with this infodemic. Consequently, a Facebook group was created where volunteer medical physicians would answer laypeople’s questions about the 2019 novel coronavirus. There is not much precedence in health care professional–driven Facebook groups, and the framework was thus developed continuously. We ended up with an approach without room for debate, which fostered a sense of calmness, trust, and safety among the questioners. Substantial moderator effort was needed to ensure high quality and consistency through collaboration among the presently >200 physicians participating in this group. At the time of writing, the group provides a much-needed service to >58,000 people in Denmark during this crisis. %M 33835935 %R 10.2196/24586 %U https://www.jmir.org/2021/4/e24586 %U https://doi.org/10.2196/24586 %U http://www.ncbi.nlm.nih.gov/pubmed/33835935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25323 %T Factors Associated With Perceived Trust of False Abortion Websites: Cross-sectional Online Survey %A Chaiken,Sarina Rebecca %A Han,Lisa %A Darney,Blair G %A Han,Leo %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 5034942999, chaiken@ohsu.edu %K abortion %K website trust %K internet use %K reproductive health %K misinformation %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most patients use the internet to search for health information. While there is a vast repository of searchable information online, much of the content is unregulated and therefore potentially incorrect, conflicting, or confusing. Abortion information online is particularly prone to being inaccurate as antichoice websites publish purposefully misleading information in formats that appear as neutral resources. To understand how antichoice websites appear neutral, we need to understand the specific website features of antichoice websites that impart an impression of trustworthiness. Objective: We sought to identify the characteristics of false or misleading abortion websites that make these websites appear trustworthy to the public. Methods: We conducted a cross-sectional study using Amazon’s Mechanical Turk platform. We used validated questionnaires to ask participants to rate 11 antichoice websites and one neutral website identified by experts, focusing on website content, creators, and design. We collected sociodemographic data and participant views on abortion. We used a composite measure of “mean overall trust” as our primary outcome. Using correlation matrices, we determined which website characteristics were most associated with mean overall trust. Finally, we used linear regression to identify participant characteristics associated with overall trust. Results: Our analytic sample included 498 participants aged from 22 to 70 years, and 50.1% (247/493) identified as female. Across 11 antichoice websites, creator confidence (“I believe that the creators of this website are honest and trustworthy”) had the highest correlation coefficient (strongest relationship) with mean overall trust (coefficient=0.70). Professional appearance (coefficient=0.59), look and feel (coefficient=0.59), perception that the information is created by experts (coefficient=0.59), association with a trustworthy organization (coefficient=0.58), valued features and functionalities (coefficient=0.54), and interactive capabilities (coefficient=0.52) all demonstrated strong relationships with mean overall trust. At the individual level, prochoice leaning was associated with higher overall trust of the neutral website (B=−0.43, 95% CI −0.87 to 0.01) and lower mean overall trust of the antichoice websites (B=0.52, 95% CI 0.05 to 0.99). Conclusions: The mean overall trust of antichoice websites is most associated with design characteristics and perceived trustworthiness of website creators. Those who believe that access to abortion should be limited are more likely to have higher mean overall trust for antichoice websites. %M 33871378 %R 10.2196/25323 %U https://www.jmir.org/2021/4/e25323 %U https://doi.org/10.2196/25323 %U http://www.ncbi.nlm.nih.gov/pubmed/33871378 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26331 %T Assessing Public Interest Based on Wikipedia’s Most Visited Medical Articles During the SARS-CoV-2 Outbreak: Search Trends Analysis %A Chrzanowski,Jędrzej %A Sołek,Julia %A Fendler,Wojciech %A Jemielniak,Dariusz %+ Department of Biostatistics and Translational Medicine, Medical University of Łódź, Mazowiecka 15, Łódź, 92-215, Poland, 48 422722585, wojciech.fendler@umed.lodz.pl %K COVID-19 %K pandemic %K media %K Wikipedia %K internet %K online health information %K information seeking %K interest %K retrospective %K surveillance %K infodemiology %K infoveillance %D 2021 %7 12.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current era of widespread access to the internet, we can monitor public interest in a topic via information-targeted web browsing. We sought to provide direct proof of the global population’s altered use of Wikipedia medical knowledge resulting from the new COVID-19 pandemic and related global restrictions. Objective: We aimed to identify temporal search trends and quantify changes in access to Wikipedia Medicine Project articles that were related to the COVID-19 pandemic. Methods: We performed a retrospective analysis of medical articles across nine language versions of Wikipedia and country-specific statistics for registered COVID-19 deaths. The observed patterns were compared to a forecast model of Wikipedia use, which was trained on data from 2015 to 2019. The model comprehensively analyzed specific articles and similarities between access count data from before (ie, several years prior) and during the COVID-19 pandemic. Wikipedia articles that were linked to those directly associated with the pandemic were evaluated in terms of degrees of separation and analyzed to identify similarities in access counts. We assessed the correlation between article access counts and the number of diagnosed COVID-19 cases and deaths to identify factors that drove interest in these articles and shifts in public interest during the subsequent phases of the pandemic. Results: We observed a significant (P<.001) increase in the number of entries on Wikipedia medical articles during the pandemic period. The increased interest in COVID-19–related articles temporally correlated with the number of global COVID-19 deaths and consistently correlated with the number of region-specific COVID-19 deaths. Articles with low degrees of separation were significantly similar (P<.001) in terms of access patterns that were indicative of information-seeking patterns. Conclusions: The analysis of Wikipedia medical article popularity could be a viable method for epidemiologic surveillance, as it provides important information about the reasons behind public attention and factors that sustain public interest in the long term. Moreover, Wikipedia users can potentially be directed to credible and valuable information sources that are linked with the most prominent articles. %M 33667176 %R 10.2196/26331 %U https://www.jmir.org/2021/4/e26331 %U https://doi.org/10.2196/26331 %U http://www.ncbi.nlm.nih.gov/pubmed/33667176 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e20721 %T Applying Website Rankings to Digital Health Centers in the United States to Assess Public Engagement: Website Usability Study %A Calvano,Joshua David %A Fundingsland Jr,Edwin Lauritz %A Lai,Deborah %A Silacci,Sara %A Raja,Ali S %A He,Shuhan %+ Department of Research, Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Rd, Parker, CO, 80134, United States, 1 3033732008, joshua.calvano@rvu.edu %K website usability %K digital health %K health care website %K usability testing %K web interventions %K digital health care %K web crawler %D 2021 %7 29.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As the public increasingly uses the internet to search for resources and information regarding health and medicine, it is important that health care organizations provide adequate web resources. Website usability refers to the ease of user experience on a website. In this study, we conducted usability analyses on digital health center websites. Objective: The primary aims of this study were to (1) replicate a preexisting usability scoring methodology for digital health centers; (2) apply and test this replicated usability scoring methodology on a sample set of digital health center websites; and (3) derive recommendations from the results on potential areas of improvements for our sample of digital health center websites. Methods: Website usability testing was conducted from March 1, 2020, to March 15, 2020. We replicated a methodology and scoring system from previous literature and applied them to digital health center websites. Our sample included 67 digital health centers that were affiliated with US universities or hospital systems. Usability was split into the following four broad categories: accessibility, marketing, content quality, and technology. Usability tools were used to score websites in each of the four categories. The composite of the key factors of each category was used to generate a general usability and overall usability score for each website. Results: The category with the highest average score (6.3) was content quality. The content quality score also had the highest SD (2.18) and an SE of 0.27. The lowest performing category was technology, which had an average score of 0.9. The technology score also had the smallest SD (0.07) and an SE of 0.01. Conclusions: Our data suggest that content quality, on average, was the highest scoring variable among digital health center websites. As content is crucial to digital health knowledge, it is justified that digital health centers invest more resources into creating quality content. The overall lowest scoring variable was technology. Potential reasons for this finding include designated funding for servers, a lack of regulatory frameworks for social media presence and liability, and infrequent website audits. An easy approach for improving this variable is increasing website speed. Accessibility is another area that organizations can potentially improve. We recommend that these organizations perform periodic audits of their web presence with usability tools. %M 33779564 %R 10.2196/20721 %U https://humanfactors.jmir.org/2021/1/e20721 %U https://doi.org/10.2196/20721 %U http://www.ncbi.nlm.nih.gov/pubmed/33779564 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22618 %T Using the Ensuring Quality Information for Patients Tool to Assess Patient Information on Appendicitis Websites: Systematic Search and Evaluation %A Ghani,Shahi %A Fan,Ka Siu %A Fan,Ka Hay %A Lenti,Lorenzo %A Raptis,Dimitri %+ St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, United Kingdom, 44 7772 075720, shahi92@hotmail.com %K appendicitis %K patient information %K EQIP tool %K quality %K tool %K surgery %K online health information %K internet %K health-seeking %K behavior %K review %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Appendicitis is a common surgical problem among the young adult population, who are likely to use the internet to obtain medical information. This information may determine the health-seeking behavior of an individual and may delay medical attention. Little is known regarding the quality of patient information on appendicitis on the internet, as this has not been previously studied. Objective: The aim of our study was to identify the quality of information regarding appendicitis on websites intended for the public. Methods: We conducted a systematic review of information on appendicitis available online using the following 4 search terms in google: “appendicitis,” “appendix,” “appendectomy,” and “appendicectomy”. The top 100 websites of each search term were assessed using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0-36). Results: A total of 119 websites met the eligibility criteria for evaluation. The overall median EQIP score for all websites was 20 (IQR 18-22). More than half the websites originated from the USA (65/119, 54.6%), and 45.4% (54/119) of all websites originated from hospitals, although 43% (23/54) of these did not mention qualitative risks from surgery. Incidence rates were only provided for complications and mortality in 12.6% (15/119) and 3.3% (4/119) of all websites, respectively. Conclusions: The assessment of the quality and readability of websites concerning appendicitis by the EQIP tool indicates that most sites online were of poor credibility, with minimal information regarding complication rates and mortality. To improve education and awareness of appendicitis, there is an immediate need for more informative and patient-centered websites that are more compatible with international quality standards. %M 33729160 %R 10.2196/22618 %U https://www.jmir.org/2021/3/e22618 %U https://doi.org/10.2196/22618 %U http://www.ncbi.nlm.nih.gov/pubmed/33729160 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e25602 %T Quality and Readability of Web-Based Information for Patients With Pancreatic Cysts: DISCERN and Readability Test Analysis %A Oman,Sven P %A Zaver,Himesh %A Waddle,Mark %A Corral,Juan E %+ Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, United States, 1 904 956 3032, oman.sven@mayo.edu %K internet %K pancreatic cyst %K health literacy %K patient education %K pancreas %K information seeking %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Pancreatic cysts are a complex medical problem with several treatment options. Patients use web-based health information to understand their conditions and to guide treatment choices. Objective: The goal of this study was to describe the quality and readability of publicly available web-based information on pancreatic cysts and to compare this information across website affiliations. Methods: A Google search for “pancreatic cysts” was performed and the first 30 websites were evaluated. Website affiliations were classified as academic, media, nonprofit, government, or not disclosed. Information describing cancer risk was recorded. The DISCERN instrument measured the quality of content regarding treatment choices. Four standardized tests were used to measure readability. Results: Twenty-one websites were included. The majority of the websites (20/21, 95%) described the cancer risk associated with pancreatic cysts. Nearly half of the websites were written by an academic hospital or organization. The average DISCERN score for all websites was 40.4 (range 26-65.5, maximum 80). Websites received low scores due to lack of references, failure to describe the risks of treatment, or lack of details on how treatment choices affect quality of life. The average readability score was 14.74 (range 5.76-23.85, maximum 19+), indicating a college reading level. There were no significant differences across website affiliation groups. Conclusions: Web-based information for patients with pancreatic cysts is of moderate quality and is written above the reading level of most Americans. Gastroenterological, cancer treatment organizations, and physicians should advocate for improving the available information by providing cancer risk stratification, treatment impact on quality of life, references, and better readability. %M 33724203 %R 10.2196/25602 %U https://cancer.jmir.org/2021/1/e25602 %U https://doi.org/10.2196/25602 %U http://www.ncbi.nlm.nih.gov/pubmed/33724203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24883 %T Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis %A Slavik,Catherine E %A Buttle,Charlotte %A Sturrock,Shelby L %A Darlington,J Connor %A Yiannakoulias,Niko %+ School of Earth, Environment and Society, McMaster University, General Science Building, 1280 Main Street West, Room 204, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 20118, yiannan@mcmaster.ca %K COVID-19 %K coronavirus %K pandemic %K public health %K Twitter %K social media %K engagement %K risk communication %K infodemiology %K content analysis %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms. Objective: This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement. Methods: We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type. Results: We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19–related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19–related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average). Conclusions: Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19. %M 33651705 %R 10.2196/24883 %U https://www.jmir.org/2021/3/e24883 %U https://doi.org/10.2196/24883 %U http://www.ncbi.nlm.nih.gov/pubmed/33651705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23097 %T Factors Affecting Public Adoption of COVID-19 Prevention and Treatment Information During an Infodemic: Cross-sectional Survey Study %A Han,Yangyang %A Jiang,Binshan %A Guo,Rui %+ School of Public Health, Capital Medical University, No.10 Youanmenwai, Xitoutiao, Beijing, China, 86 01083911573, guorui@ccmu.edu.cn %K information adoption %K infodemic %K China %K health information %K infodemiology %K COVID-19 %K public health %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the spread of COVID-19, an infodemic is also emerging. In public health emergencies, the use of information to enable disease prevention and treatment is incredibly important. Although both the information adoption model (IAM) and health belief model (HBM) have their own merits, they only focus on information or public influence factors, respectively, to explain the public’s intention to adopt online prevention and treatment information. Objective: The aim of this study was to fill this gap by using a combination of the IAM and the HBM as the framework for exploring the influencing factors and paths in public health events that affect the public’s adoption of online health information and health behaviors, focusing on both objective and subjective factors. Methods: We carried out an online survey to collect responses from participants in China (N=501). Structural equation modeling was used to evaluate items, and confirmatory factor analysis was used to calculate construct reliability and validity. The goodness of fit of the model and mediation effects were analyzed. Results: The overall fitness indices for the model developed in this study indicated an acceptable fit. Adoption intention was predicted by information characteristics (β=.266, P<.001) and perceived usefulness (β=.565, P<.001), which jointly explained nearly 67% of the adoption intention variance. Information characteristics (β=.244, P<.001), perceived drawbacks (β=–.097, P=.002), perceived benefits (β=.512, P<.001), and self-efficacy (β=.141, P<.001) jointly determined perceived usefulness and explained about 81% of the variance of perceived usefulness. However, social influence did not have a statistically significant impact on perceived usefulness, and self-efficacy did not significantly influence adoption intention directly. Conclusions: By integrating IAM and HBM, this study provided the insight and understanding that perceived usefulness and adoption intention of online health information could be influenced by information characteristics, people’s perceptions of information drawbacks and benefits, and self-efficacy. Moreover, people also exhibited proactive behavior rather than reactive behavior to adopt information. Thus, we should consider these factors when helping the informed public obtain useful information via two approaches: one is to improve the quality of government-based and other official information, and the other is to improve the public’s capacity to obtain information, in order to promote truth and fight rumors. This will, in turn, contribute to saving lives as the pandemic continues to unfold and run its course. %M 33600348 %R 10.2196/23097 %U https://www.jmir.org/2021/3/e23097 %U https://doi.org/10.2196/23097 %U http://www.ncbi.nlm.nih.gov/pubmed/33600348 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e24737 %T Risks and Benefits of Using Social Media in Dermatology: Cross-sectional Questionnaire Study %A Bressler,Moshe Y %A Grudnikoff,Eugene %A Bressler,Yaakov %A Tamez,Rebecca %A Zampella,John G %+ Ronald O Perelman Department of Dermatology, New York University, 555 Madison Ave, 4th Floor, New York, NY, 10022, United States, 1 646 754 2000, John.zampella@nyulangone.org %K social media %K dermatologist %K generational differences %K Instagram %K Facebook %K information quality %K patient education %K online content %K risk %K benefit %K dermatology %K cross-sectional %K survey %K online health information %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Dermatological information on social media is often presented by nondermatologists. Increasing the online engagement of trained dermatologists may improve information quality, patient education, and care. Objective: Our study assesses dermatologists’ perceptions of social media and patterns of use to identify barriers limiting engagement. Methods: In our cohort study, a 36-item online survey was distributed to dermatologists in the United States; responses were captured on a 1-100 sliding scale. Results: Of 166 initiated surveys, 128 valid responses were submitted. Dermatologists showed greater concern for social media risk-related issues (mean 77.9, SD 15.1) than potential benefits (mean 61.8, SD 16.4; P<.001). Leading concerns were poor patient care, nonevidence-based information, and breaching patient privacy. Benefits included interphysician collaboration, patient education, and public health awareness. The most avid and enthusiastic social media users were millennials (mean total optimism score 67.5, SD 14.9) and baby boomers (mean total optimism score 63.1, SD 11.2) compared with Generation X dermatologists (mean total optimism score 52.2, SD 16.3, P<.001). Of 128 dermatologists, 103 (82.4%) plan on increasing their social media use (P=.003). Predictors showing an intent to increase future social media use were younger age, integration into professional use, and an optimistic view (r2=.39; P<.001). Conclusions: Dermatologists perceive the risk of social media to be considerable but still intend to increase its use, likely recognizing the value and importance of social media to the field. %M 37632799 %R 10.2196/24737 %U https://derma.jmir.org/2021/1/e24737 %U https://doi.org/10.2196/24737 %U http://www.ncbi.nlm.nih.gov/pubmed/37632799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23957 %T Public Opinions and Concerns Regarding the Canadian Prime Minister’s Daily COVID-19 Briefing: Longitudinal Study of YouTube Comments Using Machine Learning Techniques %A Zheng,Chengda %A Xue,Jia %A Sun,Yumin %A Zhu,Tingshao %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang district, Beijing, 100101, China, 86 1064871661, tszhu@psych.ac.cn %K Canada %K PM Trudeau %K YouTube %K machine learning %K big data %K infodemiology %K infodemic %K public concerns %K communication %K concern %K social media %K video %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic in Canada, Prime Minister Justin Trudeau provided updates on the novel coronavirus and the government’s responses to the pandemic in his daily briefings from March 13 to May 22, 2020, delivered on the official Canadian Broadcasting Corporation (CBC) YouTube channel. Objective: The aim of this study was to examine comments on Canadian Prime Minister Trudeau’s COVID-19 daily briefings by YouTube users and track these comments to extract the changing dynamics of the opinions and concerns of the public over time. Methods: We used machine learning techniques to longitudinally analyze a total of 46,732 English YouTube comments that were retrieved from 57 videos of Prime Minister Trudeau’s COVID-19 daily briefings from March 13 to May 22, 2020. A natural language processing model, latent Dirichlet allocation, was used to choose salient topics among the sampled comments for each of the 57 videos. Thematic analysis was used to classify and summarize these salient topics into different prominent themes. Results: We found 11 prominent themes, including strict border measures, public responses to Prime Minister Trudeau’s policies, essential work and frontline workers, individuals’ financial challenges, rental and mortgage subsidies, quarantine, government financial aid for enterprises and individuals, personal protective equipment, Canada and China’s relationship, vaccines, and reopening. Conclusions: This study is the first to longitudinally investigate public discourse and concerns related to Prime Minister Trudeau’s daily COVID-19 briefings in Canada. This study contributes to establishing a real-time feedback loop between the public and public health officials on social media. Hearing and reacting to real concerns from the public can enhance trust between the government and the public to prepare for future health emergencies. %M 33544690 %R 10.2196/23957 %U https://www.jmir.org/2021/2/e23957 %U https://doi.org/10.2196/23957 %U http://www.ncbi.nlm.nih.gov/pubmed/33544690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26302 %T Using Tweets to Understand How COVID-19–Related Health Beliefs Are Affected in the Age of Social Media: Twitter Data Analysis Study %A Wang,Hanyin %A Li,Yikuan %A Hutch,Meghan %A Naidech,Andrew %A Luo,Yuan %+ Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Dr, Chicago, IL, 60611, United States, 1 312 503 5742, yuan.luo@northwestern.edu %K COVID-19 %K social media %K health belief %K Twitter %K infodemic %K infodemiology %K machine learning %K natural language processing %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2 (ie, COVID-19) has given rise to a global pandemic affecting 215 countries and over 40 million people as of October 2020. Meanwhile, we are also experiencing an infodemic induced by the overabundance of information, some accurate and some inaccurate, spreading rapidly across social media platforms. Social media has arguably shifted the information acquisition and dissemination of a considerably large population of internet users toward higher interactivities. Objective: This study aimed to investigate COVID-19-related health beliefs on one of the mainstream social media platforms, Twitter, as well as potential impacting factors associated with fluctuations in health beliefs on social media. Methods: We used COVID-19-related posts from the mainstream social media platform Twitter to monitor health beliefs. A total of 92,687,660 tweets corresponding to 8,967,986 unique users from January 6 to June 21, 2020, were retrieved. To quantify health beliefs, we employed the health belief model (HBM) with four core constructs: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. We utilized natural language processing and machine learning techniques to automate the process of judging the conformity of each tweet with each of the four HBM constructs. A total of 5000 tweets were manually annotated for training the machine learning architectures. Results: The machine learning classifiers yielded areas under the receiver operating characteristic curves over 0.86 for the classification of all four HBM constructs. Our analyses revealed a basic reproduction number R0 of 7.62 for trends in the number of Twitter users posting health belief–related content over the study period. The fluctuations in the number of health belief–related tweets could reflect dynamics in case and death statistics, systematic interventions, and public events. Specifically, we observed that scientific events, such as scientific publications, and nonscientific events, such as politicians’ speeches, were comparable in their ability to influence health belief trends on social media through a Kruskal-Wallis test (P=.78 and P=.92 for perceived benefits and perceived barriers, respectively). Conclusions: As an analogy of the classic epidemiology model where an infection is considered to be spreading in a population with an R0 greater than 1, we found that the number of users tweeting about COVID-19 health beliefs was amplifying in an epidemic manner and could partially intensify the infodemic. It is “unhealthy” that both scientific and nonscientific events constitute no disparity in impacting the health belief trends on Twitter, since nonscientific events, such as politicians’ speeches, might not be endorsed by substantial evidence and could sometimes be misleading. %M 33529155 %R 10.2196/26302 %U https://www.jmir.org/2021/2/e26302 %U https://doi.org/10.2196/26302 %U http://www.ncbi.nlm.nih.gov/pubmed/33529155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22668 %T A Clinical Tool (CUE-tool) for Health Care Professionals to Assess the Usability and Quality of the Content of Medical Information Websites: Electronic Delphi Study %A Klompstra,Leonie %A Liljeroos,Maria %A Lundgren,Johan %A Ingadottir,Brynja %+ Department of Health, Medicine and Caring Sciences, Linköping University, Campus Norrköping, Bredgatan 33, Norrköping, 60174, Sweden, 46 11363629, leonie.klompstra@liu.se %K self-care %K smartphone %K internet %K apps %K websites %K eDelphi %D 2021 %7 17.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As patients are increasingly searching for information about their medical condition on the internet, there is a need for health professionals to be able to guide patients toward reliable and suitable information sources on the internet. Objective: The aim of the study was to develop a clinical tool for health care professionals to assess the usability and quality of the content of websites containing medical information that could be recommended to patients. Methods: A 3-round modified electronic Delphi (eDelphi) study was conducted with 20 health care professionals. Results: In round one of the eDelphi study, of the 68 items initially created, 41 items (29 on usability and 12 on content) were rated as important or very important by more than half of the panel and thus selected for further evaluation in round two. In round two, of the 41 items chosen from round 1, 19 were selected (9 on usability and 10 on content) as important or very important by more than half of the panel for further evaluation. As a result of round three, 2 items were combined as a single item, leaving the instrument with 18 items in total (8 on usability and 10 on content). The tool is freely accessible online. Conclusions: The CUE-tool can be used to (1) evaluate the usability and reliability of the content of websites before recommending them to patients as a good information source; (2) identify websites that do not have reliable content or may be difficult for patients to use; (3) develop quality websites by using the criteria in the CUE-tool; and (4) identify different qualities between different websites. %M 33595439 %R 10.2196/22668 %U http://www.jmir.org/2021/2/e22668/ %U https://doi.org/10.2196/22668 %U http://www.ncbi.nlm.nih.gov/pubmed/33595439 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 1 %P e17063 %T Patient Empowerment and the Exclusion of Dietary Intervention Studies. Comment on “Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations” %A Wahls,Terry %A Titcomb,Tyler %A Bisht,Babita %A Ramanathan,Murali %+ Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, United States, 1 319 356 4421, terry-wahls@uiowa.edu %K multiple sclerosis %K dietary interventions %K clinical evidence %D 2021 %7 17.2.2021 %9 Letter to the Editor %J Interact J Med Res %G English %X %M 33595444 %R 10.2196/17063 %U https://www.i-jmr.org/2021/1/e17063 %U https://doi.org/10.2196/17063 %U http://www.ncbi.nlm.nih.gov/pubmed/33595444 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e26200 %T Instagram Content Addressing Pruritic Urticarial Papules and Plaques of Pregnancy: Observational Study %A Payton,Ashley %A Woo,Benjamin K P %+ Department of Psychiatry, Olive View Medical Center, University of California Los Angeles Medical Center, 14445 Olive View Drive, Cottage H1, Sylmar, CA, 91342, United States, 1 858 243 7816, aapayton16@gmail.com %K pruritic urticarial papules and plaques of pregnancy %K dermatology %K rash %K pregnancy %K obstetrics %K dermatosis %K Instagram %K social media %K patient education %D 2021 %7 11.2.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Pruritic urticarial papules and plaques of pregnancy (PUPPP) is the most commonly diagnosed pregnancy-specific dermatosis. It presents with intense pruritus and can be difficult to manage, which encourages mothers to look to social media for camaraderie and advice. Objective: This study aimed to characterize the sources and thematic content of Instagram posts in order to define influential groups of users. Our goal was to determine the status of online discourse surrounding PUPPP and elucidate any potential space for health care provider intervention via creation of Instagram accounts dedicated to information dissemination for patient populations. Methods: Three hashtag categories were selected (#PUPPP, #PUPPPs, and #PUPPPrash), and the top public posts from each were analyzed and organized by source and by thematic content. The numbers of likes and comments were also recorded. Results: Among the top 150 posts in each hashtag category, only 428 posts in total were eligible for this analysis. Majority (316/428, 73.8%) of posts were created by mothers who experienced PUPPP. These posts were testimonial accounts in nature. A small fraction of posts (14/428, 3.3%) were generated by physician accounts. Posts from blogs with extensive followings garnered the most attention in the form of likes and comments. Conclusions: Mothers experiencing PUPPP comprised the majority of accounts posting under the hashtags selected. The most common themes included pictures of the rash and personal testimonies. Posts under blog posts received the most likes and comments on average. There is space for physician and health care specialists to improve their social media presence when it comes to discourse surrounding PUPPP. Patients are seeking out communities on social media, like Instagram, in order to have questions answered and obtain advice on management. Accounts with large followings tend to have more likes and more comments, which encourages information dissemination and awareness. Thus, we suggest that physicians create content and potentially partner with blog-type accounts to improve outreach. %M 37632847 %R 10.2196/26200 %U http://derma.jmir.org/2021/1/e26200/ %U https://doi.org/10.2196/26200 %U http://www.ncbi.nlm.nih.gov/pubmed/37632847 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e24517 %T Content in YouTube Videos for Rosacea: Cross-sectional Study %A Basch,Corey H %A Laforet,Priscila E %A Hillyer,Grace C %A Seidel,Erica J %A Jaime,Christie %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K rosacea %K YouTube %K social media %K skin disease %K skin %K chronic %K dermatology %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Rosacea is an inflammatory skin disease that is chronic in nature. In addition to the physical symptoms, there are substantial quality of life issues that patients with rosacea experience, largely due to the visible nature in which rosacea manifests. Objective: The purpose of this study was to describe the content related to rosacea in highly viewed English- and Spanish-language videos on YouTube. Methods: We coded identifying information for each video and categories including characteristics of rosacea, clinical solutions, and alternative solutions. The 100 YouTube videos examined were viewed 18.5 million times between 2006 and 2020, and 57.3% (10,652,665/18,592,742) of these views were of consumer videos. Results: Videos posted by consumers more often promoted or were trying to sell a product or procedure (32/55, 58% of consumers vs 10/31, 32% of medical professionals and 4/14, 29% of television, internet, news, or entertainment sources; P=.03) and more frequently mentioned the use of makeup or other ways to cover up rosacea (30/55, 55% of consumers vs 6/31, 19% of medical professionals and 2/14, 14% of television, internet, news, or entertainment sources; P<.001). Videos sourced from medical professionals more often mentioned medication (17/31, 55%) than videos uploaded by consumers (14/55, 25%) or TV, internet, news, or entertainment sources (3/14, 21%) (P=.01). Conclusions: Given that rosacea is experienced differently for each person, consumer advice that works for one individual may not work for another. There is a need for reliable videos on rosacea to emphasize this and clarify misconceptions. %M 37632798 %R 10.2196/24517 %U http://derma.jmir.org/2021/1/e24517/ %U https://doi.org/10.2196/24517 %U http://www.ncbi.nlm.nih.gov/pubmed/37632798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21156 %T COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results %A Geronikolou,Styliani %A Chrousos,George %+ University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias 1, Athens, Greece, 30 2132013362, sgeronik@gmail.com %K COVID-19 %K social media %K misinformation %K infodemics %K infodemiology %K infoveillance %K fear %K meta-analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective: The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results: The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions: Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects. %M 33400681 %R 10.2196/21156 %U https://formative.jmir.org/2021/2/e21156 %U https://doi.org/10.2196/21156 %U http://www.ncbi.nlm.nih.gov/pubmed/33400681 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e19858 %T Demographic Factors Influencing the Impact of Coronavirus-Related Misinformation on WhatsApp: Cross-sectional Questionnaire Study %A Bapaye,Jay Amol %A Bapaye,Harsh Amol %+ Department Of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, United States, 1 5855370133, jaybapaye@gmail.com %K coronavirus %K COVID-19 %K SARS–CoV–2 %K WhatsApp %K social media %K misinformation %K infodemiology %K infodemic %K pandemic %K medical informatics %D 2021 %7 30.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The risks of misinformation on social networking sites is a global issue, especially in light of the COVID-19 infodemic. WhatsApp is being used as an important source of COVID-19–related information during the current pandemic. Unlike Facebook and Twitter, limited studies have investigated the role of WhatsApp as a source of communication, information, or misinformation during crisis situations. Objective: Our study aimed to evaluate the vulnerability of demographic cohorts in a developing country toward COVID-19–related misinformation shared via WhatsApp. We also aimed to identify characteristics of WhatsApp messages associated with increased credibility of misinformation. Methods: We conducted a web-based questionnaire survey and designed a scoring system based on theories supported by the existing literature. Vulnerability (K) was measured as a ratio of the respondent’s score to the maximum score. Respondents were stratified according to age and occupation, and Kmean was calculated and compared among each subgroup using single-factor analysis of variance and Hochberg GT2 tests. The questionnaire evaluated the respondents’ opinion of the veracity of coronavirus-related WhatsApp messages. The responses to the false-proven messages were compared using z test between the 2 groups: coronavirus-related WhatsApp messages with an attached link and/or source and those without. Results: We analyzed 1137 responses from WhatsApp users in India. Users aged over 65 years had the highest vulnerability (Kmean=0.38, 95% CI 0.341-0.419) to misinformation. Respondents in the age group 19-25 years had significantly lower vulnerability (Kmean=0.31, 95% CI 0.301-0.319) than those aged over 25 years (P<.05). The vulnerability of users employed in elementary occupations was the highest (Kmean=0.38, 95% CI 0.356-0.404), and it was significantly higher than that of professionals and students (P<.05). Interestingly, the vulnerability of healthcare workers was not significantly different from that of other occupation groups (P>.05). We found that false CRWMs with an attached link and/or source were marked true 6 times more often than false CRWMs without an attached link or source (P<.001). Conclusions: Our study demonstrates that in a developing country, WhatsApp users aged over 65 years and those involved in elementary occupations were found to be the most vulnerable to false information disseminated via WhatsApp. Health care workers, who are otherwise considered as experts with regard to this global health care crisis, also shared this vulnerability to misinformation with other occupation groups. Our findings also indicated that the presence of an attached link and/or source falsely validating an incorrect message adds significant false credibility, making it appear true. These results indicate an emergent need to address and rectify the current usage patterns of WhatsApp users. This study also provides metrics that can be used by health care organizations and government authorities of developing countries to formulate guidelines to contain the spread of WhatsApp-related misinformation. %M 33444152 %R 10.2196/19858 %U http://publichealth.jmir.org/2021/1/e19858/ %U https://doi.org/10.2196/19858 %U http://www.ncbi.nlm.nih.gov/pubmed/33444152 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e24124 %T Public Interest in a Potentially Harmful, Non–Evidence-Based “Wellness” Practice: Cross-Sectional Analysis of Perineum Sunning %A Ottwell,Ryan %A Hartwell,Micah %A Beswick,Tracy %A Rogers,Taylor Calli %A Ivy,Heather %A Goodman,Marcus %A Vassar,Matt %+ Oklahoma State University Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74017, United States, 1 918 582 1972, ryan.ottwell@okstate.edu %K general dermatology %K perineum sunning %K perineum tanning %K skin neoplasm %K public health %K social media %K infodemiology %K public interest %K Google Trends %K Twitter %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Perineum sunning/tanning is a potentially harmful yet popular new health trend cultivated by a viral social media post, famous public figures, and subsequent media coverage. Objective: Our primary objective is to evaluate public interest in perineum sunning/tanning. Methods: Using an observational study design, we extracted data from Google Trends for the terms “perineum sunning,” “perineum tanning,” “Metaphysical Meagan,” and “Josh Brolin”; and Twitter (via SproutSocial) for “perineum sunning” and “perineum tanning” from November 1, 2019, to December 31, 2019. UberSuggest was used to investigate monthly search volumes and user engagement. We used data from Google Trends and Twitter to construct autoregressive integrated moving average (ARIMA) models to forecast public interest in perineum sunning and perineum tanning had the post on social media never occurred. Next, we performed an integral function to calculate the cumulative increase in “perineum tanning” from the day after the post occurred to the end of the year as the area between the forecasted values and the actual values. Using Welch t tests, we compared forecasted and actual values for “perineum sunning” and “perineum tanning” using Twitter and Google Trends data over 1-, 2-, and 4-week periods after the social media post to determine if the increased volumes were statistically significant over time. Lastly, we monitored Google Trends for “perineum sunning” and “perineum tanning” through September 30, 2020, to capture trends during the summer months. Results: Before the Instagram post went viral, there was no search interest in perineum sunning. ARIMA modeling for perineum tanning forecasted no increase in searches (0.00) if the post had not gone viral, while actual interest conveyed a relative cumulative increase of 919.00% from the day the post went viral through December 31, 2020. The term “perineum sunning” was mentioned on average 804 (SD 766.1) times daily for this 7-day period, which was also significantly higher than predicted (P≤.03), totaling 5628 tweets for these 7 days. The increased volume of tweets and relative search interest from Google Trends remained significantly higher for both terms over the 1-, 2-, and 4-week intervals. User engagement showed that nearly 50% of people who searched for “perineum sunning” were likely to click a returned link for more information. Continued observance of search interest in perineum sunning demonstrated interest spikes in the summer months, June and July 2020. Conclusions: Google Trends and Twitter data demonstrated that one social media post claiming non–evidence-based health benefits of regular sun exposure—without the use of sunscreen—generated significant public interest. Medical journals, dermatologists, and other health care professionals are obligated to educate and correct public misperceptions about viral wellness trends such as perineum sunning. %M 37632796 %R 10.2196/24124 %U http://derma.jmir.org/2021/1/e24124/ %U https://doi.org/10.2196/24124 %U http://www.ncbi.nlm.nih.gov/pubmed/37632796 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e22273 %T Predictors of COVID-19 Information Sources and Their Perceived Accuracy in Nigeria: Online Cross-sectional Study %A Erinoso,Olufemi %A Wright,Kikelomo Ololade %A Anya,Samuel %A Kuyinu,Yetunde %A Abdur-Razzaq,Hussein %A Adewuya,Abiodun %+ Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, 1-5b Oba Akinjobi Road, GRA Ikeja, Lagos, 23401, Nigeria, 234 1 8950825, olufemierinoso@gmail.com %K COVID-19 %K communication %K health information %K public health %K infodemiology %K infodemic %K accuracy %K cross-sectional %K risk %K information source %K predictor %K Nigeria %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Effective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic. Objective: This study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources. Methods: We conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee. Results: A total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19–related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization. Conclusions: The internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic. %M 33428580 %R 10.2196/22273 %U http://publichealth.jmir.org/2021/1/e22273/ %U https://doi.org/10.2196/22273 %U http://www.ncbi.nlm.nih.gov/pubmed/33428580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23318 %T Adherence of Internet-Based Cancer Risk Assessment Tools to Best Practices in Risk Communication: Content Analysis %A Waters,Erika A %A Foust,Jeremy L %A Scherer,Laura D %A McQueen,Amy %A Taber,Jennifer M %+ Washington University School of Medicine, 600 S Euclid Ave, Campus Box 8100, Saint Louis, MO, 63110, United States, 1 3147475705, waterse@wustl.edu %K health communication %K personalized medicine %K internet %K risk assessment %D 2021 %7 25.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. Objective: This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. Methods: We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. Results: Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user’s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. Conclusions: Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors. %M 33492238 %U http://www.jmir.org/2021/1/e23318/ %U http://www.ncbi.nlm.nih.gov/pubmed/33492238 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e17187 %T Prevalence of Health Misinformation on Social Media: Systematic Review %A Suarez-Lledo,Victor %A Alvarez-Galvez,Javier %+ Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Av Ana de Viya, 52, Cadiz, 11009, Spain, 34 956019080, victor.sanz@uca.es %K social media %K health misinformation %K infodemiology %K infodemics %K social networks %K poor quality information %K social contagion %D 2021 %7 20.1.2021 %9 Review %J J Med Internet Res %G English %X Background: Although at present there is broad agreement among researchers, health professionals, and policy makers on the need to control and combat health misinformation, the magnitude of this problem is still unknown. Consequently, it is fundamental to discover both the most prevalent health topics and the social media platforms from which these topics are initially framed and subsequently disseminated. Objective: This systematic review aimed to identify the main health misinformation topics and their prevalence on different social media platforms, focusing on methodological quality and the diverse solutions that are being implemented to address this public health concern. Methods: We searched PubMed, MEDLINE, Scopus, and Web of Science for articles published in English before March 2019, with a focus on the study of health misinformation in social media. We defined health misinformation as a health-related claim that is based on anecdotal evidence, false, or misleading owing to the lack of existing scientific knowledge. We included (1) articles that focused on health misinformation in social media, including those in which the authors discussed the consequences or purposes of health misinformation and (2) studies that described empirical findings regarding the measurement of health misinformation on these platforms. Results: A total of 69 studies were identified as eligible, and they covered a wide range of health topics and social media platforms. The topics were articulated around the following six principal categories: vaccines (32%), drugs or smoking (22%), noncommunicable diseases (19%), pandemics (10%), eating disorders (9%), and medical treatments (7%). Studies were mainly based on the following five methodological approaches: social network analysis (28%), evaluating content (26%), evaluating quality (24%), content/text analysis (16%), and sentiment analysis (6%). Health misinformation was most prevalent in studies related to smoking products and drugs such as opioids and marijuana. Posts with misinformation reached 87% in some studies. Health misinformation about vaccines was also very common (43%), with the human papilloma virus vaccine being the most affected. Health misinformation related to diets or pro–eating disorder arguments were moderate in comparison to the aforementioned topics (36%). Studies focused on diseases (ie, noncommunicable diseases and pandemics) also reported moderate misinformation rates (40%), especially in the case of cancer. Finally, the lowest levels of health misinformation were related to medical treatments (30%). Conclusions: The prevalence of health misinformation was the highest on Twitter and on issues related to smoking products and drugs. However, misinformation on major public health issues, such as vaccines and diseases, was also high. Our study offers a comprehensive characterization of the dominant health misinformation topics and a comprehensive description of their prevalence on different social media platforms, which can guide future studies and help in the development of evidence-based digital policy action plans. %M 33470931 %R 10.2196/17187 %U http://www.jmir.org/2021/1/e17187/ %U https://doi.org/10.2196/17187 %U http://www.ncbi.nlm.nih.gov/pubmed/33470931 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e17680 %T Evaluation of the Liver Disease Information in Baidu Encyclopedia and Wikipedia: Longitudinal Study %A Sun,Fei %A Yang,Fuchun %A Zheng,Shusen %+ Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, China, 86 13805749805, shusenzheng@zju.edu.cn %K Baidu Encyclopedia %K Wikipedia %K internet %K website %K liver disease %K health information %K DISCERN instrument %K timeliness %D 2021 %7 18.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has changed the way of people acquiring health information. Previous studies have shown that Wikipedia is a reasonably reliable medical resource, and it has been ranked higher than other general websites in various search engines. Baidu Encyclopedia is one of the most popular encyclopedia websites in China. However, no studies have shown the quality of the content provided in the Baidu Encyclopedia. Objective: This study aimed to evaluate the quality of liver disease information provided by Wikipedia (in English) and Baidu Encyclopedia (in Chinese) and to perform a comparison of the quality and timeliness of the articles published in these two encyclopedias. Moreover, a 3-year follow-up study was conducted to compare if the information in both these websites was updated regularly over this period. Methods: We searched for information on liver diseases by using the International Statistical Classification of Diseases and Related Health Problems 10th Revision Version 2016 codes on Wikipedia (in English) and Baidu Encyclopedia (in Chinese). The quality of the articles was assessed using the DISCERN instrument, which consists of 3 sections. We recorded the latest editing date of the webpages and calculated the date interval to evaluate the update timeliness of these websites. Results: We found 22 entries on liver diseases in Baidu Encyclopedia and 15 articles in Wikipedia between September 15, 2016, and September 30, 2016, and we found 25 entries in Baidu Encyclopedia and 16 articles in Wikipedia between September 15, 2019, and September 30, 2019. In section 1 of the DISCERN instrument, the mean (SE) scores of Baidu Encyclopedia entries were significantly lower than those of Wikipedia articles. In section 2 and section 3 of the DISCERN instrument, the DISCERN scores of Baidu Encyclopedia entries were lower than those of Wikipedia articles, but the differences were not statistically significant. The total DISCERN scores of Baidu Encyclopedia entries were significantly lower than those of Wikipedia articles. The update interval of the entries in Baidu Encyclopedia was found to be significantly longer than that of the articles in Wikipedia. Conclusions: This study shows that the quality of articles and the reliability of the research content on liver diseases in Wikipedia are better than those of the entries in Baidu Encyclopedia. However, the quality of the treatment choices provided in both Wikipedia and Baidu Encyclopedia is not satisfactory. Wikipedia is updated more frequently than Baidu Encyclopedia, thereby ensuring that the information presented has the most recent research findings. The findings of our study suggest that in order to find accurate health information, it is important to seek the help of medical professionals instead of looking for a prescription amid the confusing information provided on the internet. %M 33459597 %R 10.2196/17680 %U http://www.jmir.org/2021/1/e17680/ %U https://doi.org/10.2196/17680 %U http://www.ncbi.nlm.nih.gov/pubmed/33459597 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24220 %T YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis %A Itamura,Kyohei %A Wu,Arthur %A Illing,Elisa %A Ting,Jonathan %A Higgins,Thomas %+ Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, University of Louisville, 6420 Dutchman's Parkway, STE 380, Louisville, KY, 40205, United States, 1 502 894 8441, thomas.higgins@louisville.edu %K COVID-19 %K coronavirus %K SARS-coV-2 %K nasopharyngeal swab %K viral testing %K PCR %K YouTube %K infodemiology %K digital epidemiology %K testing %K diagnostic %K content analysis %K video %K error %D 2021 %7 14.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates. Objective: The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures. Methods: We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique. Results: In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat–related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020). Conclusions: Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures. %M 33406478 %R 10.2196/24220 %U http://publichealth.jmir.org/2021/1/e24220/ %U https://doi.org/10.2196/24220 %U http://www.ncbi.nlm.nih.gov/pubmed/33406478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24069 %T Investigating and Improving the Accuracy of US Citizens’ Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study %A van Stekelenburg,Aart %A Schaap,Gabi %A Veling,Harm %A Buijzen,Moniek %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 024 3615723, a.vanstekelenburg@bsi.ru.nl %K infodemic %K infodemiology %K misinformation %K COVID-19 pandemic %K belief accuracy %K boosting %K trust in scientists %K political orientation %K media use %D 2021 %7 12.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 infodemic, a surge of information and misinformation, has sparked worry about the public’s perception of the coronavirus pandemic. Excessive information and misinformation can lead to belief in false information as well as reduce the accurate interpretation of true information. Such incorrect beliefs about the COVID-19 pandemic might lead to behavior that puts people at risk of both contracting and spreading the virus. Objective: The objective of this study was two-fold. First, we attempted to gain insight into public beliefs about the novel coronavirus and COVID-19 in one of the worst hit countries: the United States. Second, we aimed to test whether a short intervention could improve people’s belief accuracy by empowering them to consider scientific consensus when evaluating claims related to the pandemic. Methods: We conducted a 4-week longitudinal study among US citizens, starting on April 27, 2020, just after daily COVID-19 deaths in the United States had peaked. Each week, we measured participants’ belief accuracy related to the coronavirus and COVID-19 by asking them to indicate to what extent they believed a number of true and false statements (split 50/50). Furthermore, each new survey wave included both the original statements and four new statements: two false and two true statements. Half of the participants were exposed to an intervention aimed at increasing belief accuracy. The intervention consisted of a short infographic that set out three steps to verify information by searching for and verifying a scientific consensus. Results: A total of 1202 US citizens, balanced regarding age, gender, and ethnicity to approximate the US general public, completed the baseline (T0) wave survey. Retention rate for the follow-up waves— first follow-up wave (T1), second follow-up wave (T2), and final wave (T3)—was high (≥85%). Mean scores of belief accuracy were high for all waves, with scores reflecting low belief in false statements and high belief in true statements; the belief accuracy scale ranged from –1, indicating completely inaccurate beliefs, to 1, indicating completely accurate beliefs (T0 mean 0.75, T1 mean 0.78, T2 mean 0.77, and T3 mean 0.75). Accurate beliefs were correlated with self-reported behavior aimed at preventing the coronavirus from spreading (eg, social distancing) (r at all waves was between 0.26 and 0.29 and all P values were less than .001) and were associated with trust in scientists (ie, higher trust was associated with more accurate beliefs), political orientation (ie, liberal, Democratic participants held more accurate beliefs than conservative, Republican participants), and the primary news source (ie, participants reporting CNN or Fox News as the main news source held less accurate beliefs than others). The intervention did not significantly improve belief accuracy. Conclusions: The supposed infodemic was not reflected in US citizens’ beliefs about the COVID-19 pandemic. Most people were quite able to figure out the facts in these relatively early days of the crisis, calling into question the prevalence of misinformation and the public’s susceptibility to misinformation. %M 33351776 %R 10.2196/24069 %U http://www.jmir.org/2021/1/e24069/ %U https://doi.org/10.2196/24069 %U http://www.ncbi.nlm.nih.gov/pubmed/33351776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23805 %T COVID-19 Misinformation Trends in Australia: Prospective Longitudinal National Survey %A Pickles,Kristen %A Cvejic,Erin %A Nickel,Brooke %A Copp,Tessa %A Bonner,Carissa %A Leask,Julie %A Ayre,Julie %A Batcup,Carys %A Cornell,Samuel %A Dakin,Thomas %A Dodd,Rachael H %A Isautier,Jennifer M J %A McCaffery,Kirsten J %+ The University of Sydney, Rm 127A Edward Ford Building, Sydney, 2006, Australia, 61 93512064, kristen.pickles@sydney.edu.au %K COVID-19 %K coronavirus %K misinformation %K infodemic %K myths %K conspiracy %K digital health %K literacy %K social media %K trust %D 2021 %7 7.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. Objective: This study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. Methods: This prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. Results: Stronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home (P<.01 for all). After controlling for these variables, misinformation beliefs were significantly associated (P<.001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. Conclusions: The findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention. %M 33302250 %R 10.2196/23805 %U https://www.jmir.org/2021/1/e23805 %U https://doi.org/10.2196/23805 %U http://www.ncbi.nlm.nih.gov/pubmed/33302250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23262 %T “Down the Rabbit Hole” of Vaccine Misinformation on YouTube: Network Exposure Study %A Tang,Lu %A Fujimoto,Kayo %A Amith,Muhammad (Tuan) %A Cunningham,Rachel %A Costantini,Rebecca A %A York,Felicia %A Xiong,Grace %A Boom,Julie A %A Tao,Cui %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Suite 600, Houston, TX, 77030, United States, 1 713 500 3981, cui.tao@uth.tmc.edu %K vaccine %K misinformation %K infodemiology %K infodemic %K YouTube %K network analysis %D 2021 %7 5.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms such as YouTube are hotbeds for the spread of misinformation about vaccines. Objective: The aim of this study was to explore how individuals are exposed to antivaccine misinformation on YouTube based on whether they start their viewing from a keyword-based search or from antivaccine seed videos. Methods: Four networks of videos based on YouTube recommendations were collected in November 2019. Two search networks were created from provaccine and antivaccine keywords to resemble goal-oriented browsing. Two seed networks were constructed from conspiracy and antivaccine expert seed videos to resemble direct navigation. Video contents and network structures were analyzed using the network exposure model. Results: Viewers are more likely to encounter antivaccine videos through direct navigation starting from an antivaccine video than through goal-oriented browsing. In the two seed networks, provaccine videos, antivaccine videos, and videos containing health misinformation were all found to be more likely to lead to more antivaccine videos. Conclusions: YouTube has boosted the search rankings of provaccine videos to combat the influence of antivaccine information. However, when viewers are directed to antivaccine videos on YouTube from another site, the recommendation algorithm is still likely to expose them to additional antivaccine information. %M 33399543 %R 10.2196/23262 %U https://www.jmir.org/2021/1/e23262 %U https://doi.org/10.2196/23262 %U http://www.ncbi.nlm.nih.gov/pubmed/33399543 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19669 %T Availability and Quality of Web Resources for Parents of Children With Disability: Content Analysis and Usability Study %A Buteau-Poulin,Anabel %A Gosselin,Camille %A Bergeron-Ouellet,Andréa %A Kiss,Jocelyne %A Lamontagne,Marie-Ève %A Maltais,Désirée %A Trottier,Christiane %A Desmarais,Chantal %+ Rehabilitation Department, Université Laval, 2325 rue de l'Université, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 404632, chantal.desmarais@rea.ulaval.ca %K disabled child %K parents %K health knowledge %K internet-based intervention %K validation study %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The internet is a valuable resource for parents of typical children, who are looking for information about their children’s growth and development and how to boost them. However, for parents of children with special needs, especially for non–English-speaking parents, there are anecdotal reports stating that specific and accurate information is not available on the internet. Objective: This study aims to describe the type of information available on the internet for French-speaking parents of children with disability as well as assess the quality of the information collected. Methods: We carried out a search of the existing relevant websites targeted at parents of children with disability. We used a validated instrument to extract structural, textual, and visual characteristics of these websites and evaluate their usability. Results: In all, 42 websites were analyzed; of these, the information had been validated by a trustworthy source in only 18 (43%) websites. Networking opportunities for parents were available in only 7 (17%) websites. Most websites provided information related to autism spectrum disorder (20/42, 42%) and learning disabilities (19/42, 45%), and only a few websites discussed other disability types such as behavorial disorders and developmental language disorders (4/42, 10% each). Community, social, and civic life (9/42, 22%); domestic life (12/42, 29%); and mobility (15/42, 36%) were the less frequently covered topics. With regard to the usability evaluation, 22 of the 42 (52%) websites received a global score <70%, whereas 20 (48%) scored ≥70% Conclusions: Although the internet is an infinite source of information, it is not necessarily actionable for parents of children with disability. Some information remains difficult to find online, and networking opportunities with other parents dealing with similar challenges are scarce. %M 33170127 %R 10.2196/19669 %U http://pediatrics.jmir.org/2020/2/e19669/ %U https://doi.org/10.2196/19669 %U http://www.ncbi.nlm.nih.gov/pubmed/33170127 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 4 %P e23519 %T Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites %A Strauss,Shira %A Yacob,Michael %A Bhandari,Apoorva %A Jetty,Prasad %+ Division of Vascular Surgery, Queen's University, 76 Stuart St, Victory 3, Kingston, ON, K7L 2V7, Canada, 1 6135482573, michaelyacob@gmail.com %K patient information %K carotid artery disease %K carotid endarterectomy %K carotid stenting %K carotid stenosis %K carotid surgery %K Google %K quality %K readability %K treatment %K preference %K online health information %D 2020 %7 3.11.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: The internet is becoming increasingly more important in the new era of patient self-education. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are recognized interventions to treat patients with carotid artery stenosis. Using the Google search platform, patients encounter many websites with conflicting information, which are sometimes difficult to understand. This lack of accessibility creates uncertainty or bias toward interventions for carotid artery disease. The quality, readability, and treatment preference of carotid artery disease (CAD) websites have not yet been evaluated. Objective: This study aimed to explore the quality, readability, and treatment preference of CAD websites. Methods: We searched Google Canada for 10 CAD-related keywords. Returned links were assessed for publication date, medical specialty and industry affiliation, presence of randomized controlled trial data, differentiation by symptomatic status, and favored treatment. Website quality and readability were rated by the DISCERN instrument and Gunning Fog Index. Results: We identified 54 unique sites: 18 (33.3%) by medical societies or individual physicians, 11 (20.4%) by government organizations, 9 (16.7%) by laypersons, and 1 (1.9%) that was industry-sponsored. Of these sites, 26 (48.1%) distinguished symptomatic from asymptomatic CAD. A majority of sites overall (57.4%) and vascular-affiliated (72.7%) favored CEA. In contrast, radiology- and cardiology-affiliated sites demonstrated the highest proportion of sites favoring CAS, though they were equally likely to favor CEA. A large proportion (21/54, 38.9%) of sites received poor quality ratings (total DISCERN score <48), and the majority (41/54, 75.9%) required a reading level greater than a high school senior. Conclusions: CAD websites are often produced by government organizations, medical societies, or physicians, especially vascular surgeons. Sites ranged in quality, readability, and differentiation by symptomatic status. Google searches of CAD-related terms are more likely to yield sites favoring CEA. Future research should determine the extent of website influence on CAD patients’ treatment decisions. %M 33141097 %R 10.2196/23519 %U http://www.i-jmr.org/2020/4/e23519/ %U https://doi.org/10.2196/23519 %U http://www.ncbi.nlm.nih.gov/pubmed/33141097 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20619 %T The Abortion Web Ecosystem: Cross-Sectional Analysis of Trustworthiness and Bias %A Han,Leo %A Boniface,Emily R %A Han,Lisa Yin %A Albright,Jonathan %A Doty,Nora %A Darney,Blair G %+ Department of English, Arizona State University, Ross-Blakley Hall, 1102 S McAllister Ave, Tempe, AZ, 85281, United States, 1 720 201 1533, lyhan@asu.edu %K internet %K abortion %K media %K websites %K infodemiology %K infodemic %K quality of health information %K bias in patient education %D 2020 %7 26.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People use the internet as a primary source for learning about medical procedures and their associated safety profiles and risks. Although abortion is one of the most common procedures worldwide among women in their reproductive years, it is controversial and highly politicized. Substantial scientific evidence demonstrates that abortion is safe and does not increase a woman’s future risk for depressive disorders or infertility. The extent to which information found on the internet reflects these medical facts in a trustworthy and unbiased manner is not known. Objective: The purpose of this study was to collate and describe the trustworthiness and political slant or bias of web-based information about abortion safety and risks of depression and infertility following abortion. Methods: We performed a cross-sectional study of internet websites using 3 search topics: (1) is abortion safe?, (2) does abortion cause depression?, and (3) does abortion cause infertility? We used the Google Adwords tool to identify the search terms most associated with those topics and Google’s search engine to generate databases of websites related to each topic. We then classified and rated each website in terms of content slant (pro-choice, neutral, anti-choice), clarity of slant (obvious, in-between, or difficult/can’t tell), trustworthiness (rating scale of 1-5, 5=most trustworthy), type (forum, feature, scholarly article, resource page, news article, blog, or video), and top-level domain (.com, .net, .org, .edu, .gov, or international domain). We compared website characteristics by search topic (safety, depression, or infertility) using bivariate tests. We summarized trustworthiness using the median and IQR, and we used box-and-whisker plots to visually compare trustworthiness by slant and domain type. Results: Our search methods yielded a total of 111, 120, and 85 unique sites for safety, depression, and infertility, respectively. Of all the sites (n=316), 57.3% (181/316) were neutral, 35.4% (112/316) were anti-choice, and 7.3% (23/316) were pro-choice. The median trustworthiness score was 2.7 (IQR 1.7-3.7), which did not differ significantly across topics (P=.409). Anti-choice sites were less trustworthy (median score 1.3, IQR 1.0-1.7) than neutral (median score 3.3, IQR 2.7-4.0) and pro-choice (median score 3.7, IQR 3.3-4.3) sites. Anti-choice sites were also more likely to have slant clarity that was “difficult to tell” (41/112, 36.6%) compared with neutral (25/181, 13.8%) or pro-choice (4/23, 17.4%; P<.001) sites. A negative search term used for the topic of safety (eg, “risks”) produced sites with lower trustworthiness scores than search terms with the word “safety” (median score 1.7 versus 3.7, respectively; P<.001). Conclusions: People seeking information about the safety and potential risks of abortion are likely to encounter a substantial amount of untrustworthy and slanted/biased abortion information. Anti-choice sites are prevalent, often difficult to identify as anti-choice, and less trustworthy than neutral or pro-choice sites. Web searches may lead the public to believe abortion is riskier than it is. %M 33104002 %R 10.2196/20619 %U http://www.jmir.org/2020/10/e20619/ %U https://doi.org/10.2196/20619 %U http://www.ncbi.nlm.nih.gov/pubmed/33104002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22068 %T Topics, Delivery Modes, and Social-Epistemological Dimensions of Web-Based Information for Patients Undergoing Renal Transplant and Living Donors During the COVID-19 Pandemic: Content Analysis %A van Klaveren,Charlotte W %A de Jong,Peter G M %A Hendriks,Renée A %A Luk,Franka %A de Vries,Aiko P J %A van der Boog,Paul J M %A Reinders,Marlies E J %+ Division of Nephrology and Transplant Center, Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 (0)71 526512, c.w.van_klaveren@lumc.nl %K web-based information %K internet %K websites %K patient education %K COVID-19 %K renal transplantation %K eHealth %K constructivism %K social-epistemological dimensions %K teaching modes %K health communication %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients’ understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). Objective: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. Methods: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. Results: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. Conclusions: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed. %M 32946412 %R 10.2196/22068 %U http://www.jmir.org/2020/10/e22068/ %U https://doi.org/10.2196/22068 %U http://www.ncbi.nlm.nih.gov/pubmed/32946412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19668 %T Xigua Video as a Source of Information on Breast Cancer: Content Analysis %A Pan,Peng %A Yu,Changhua %A Li,Tao %A Zhou,Xilei %A Dai,Tingting %A Tian,Hanhan %A Xiong,Yaozu %+ Department of Radiation Oncology, The Affiliated Huaian No 1 People's Hospital of Nanjing Medical University, Jiangsu province, Radiotherapy Department Building, 4th floor, Huaian , China, 86 517 8490 7286, yu884443@sina.com %K breast cancer %K internet %K Xigua Video %K content analysis %D 2020 %7 29.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeking health information on the internet is a popular trend. Xigua Video, a short video platform in China, ranks among the most accessed websites in the country and hosts an increasing number of videos with medical information. However, the nature of these videos is frequently unscientific, misleading, or even harmful. Objective: Little is known about Xigua Video as a source of information on breast cancer. Thus, the study aimed to investigate the contents, quality, and reliability of breast cancer–related content on Xigua Video. Methods: On February 4, 2020, a Xigua Video search was performed using the keyword “breast cancer.” Videos were categorized by 2 doctors based on whether the video content provided useful or misleading information. Furthermore, the reliability and quality of the videos were assessed using the 5-point DISCERN tool and 5-point global quality score criteria. Results: Out of the 170 videos selected for the study, 64 (37.6%) were classified as useful, whereas 106 (62.4%) provided misleading information. A total of 41.8% videos (71/170) were generated by individuals compared to 19.4% videos (33/170) contributed by health care professionals. The topics mainly covered etiology, anatomy, symptoms, preventions, treatments, and prognosis. The top topic was “treatments” (119/170, 70%). The reliability scores and global quality scores of the videos in the useful information group were high (P<.001). No differences were observed between the 2 groups in terms of video length, duration in months, and comments. The number of total views was higher for the misleading information group (819,478.5 vs 647,940) but did not reach a level of statistical significance (P=.112). The uploading sources of the videos were mainly health care professionals, health information websites, medical advertisements, and individuals. Statistical differences were found between the uploading source groups in terms of reliability scores and global quality scores (P<.001). In terms of total views, video length, duration, and comments, no statistical differences were indicated among the said groups. However, a statistical difference was noted between the useful and misleading information video groups with respect to the uploading sources (P<.001). Conclusions: A large number of Xigua videos pertaining to breast cancer contain misleading information. There is a need for accurate health information to be provided on Xigua Video and other social media; health care professionals should address this challenge. %M 32883651 %R 10.2196/19668 %U http://www.jmir.org/2020/9/e19668/ %U https://doi.org/10.2196/19668 %U http://www.ncbi.nlm.nih.gov/pubmed/32883651 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e20338 %T Assessing YouTube as an Educational Tool for Shingles: Cross-Sectional Study %A Dunnsiri,Teevit %A Kawashita,Takumi %A Lee,Sharon C %A Monga,Aaron Kumar %A Woo,Benjamin K P %+ Western University of Health Sciences, 309 E 2nd St, Pomona, CA, United States, 1 909 623 6116, teevit@g.ucla.edu %K YouTube %K medical education %K online %K shingles %K herpes zoster %K peer review %K dermatology %K research background %K content quality %K views %D 2020 %7 3.9.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: YouTube is a popular platform with many videos, which have potential educational value for medical students. Due to the lack of peer review, other surrogates are necessary to determine the content quality of such educational videos. Few studies have analyzed the research background or academic affiliation of the physicians associated with the production of YouTube videos for medical education. The research background or academic affiliations of those physicians may be a reflection of the content quality of these educational videos. Objective: This study identifies physicians associated with the production of educational YouTube videos about shingles and analyzes those physicians based on their research background or academic affiliation, which may be good surrogates for video content quality. Methods: Using the YouTube search engine with default settings, the term “shingles” was searched on May 8, 2020. A cross-sectional study was performed using the first 50 search results. A search on Scopus for each identified physician was performed, and data regarding their research background and academic affiliation were recorded. Results: Of the 50 YouTube videos, 35 (70%) were categorized as academic. Of the 35 academic videos, 24 (71%) videos featured physicians, totaling 25 physicians overall. Out of these 25 physicians, 5 (20%) had at least 1 shingles-related publication and 8 (32%) had an h-index >10. A total of 21 (84%) physicians held an academic affiliation. Conclusions: These results ensure to a certain degree the quality of the content in academic videos on YouTube for medical education. However, further evaluation is needed for this growing platform. %R 10.2196/20338 %U http://derma.jmir.org/2020/1/e20338/ %U https://doi.org/10.2196/20338 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20673 %T Global Infodemiology of COVID-19: Analysis of Google Web Searches and Instagram Hashtags %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ Research and Disclosure Division, Mensana srls, Via Moro Aldo 5, Brescia, 25124, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K coronavirus %K Google %K Instagram %K infodemiology %K infodemic %K social media %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although “infodemiological” methods have been used in research on coronavirus disease (COVID-19), an examination of the extent of infodemic moniker (misinformation) use on the internet remains limited. Objective: The aim of this paper is to investigate internet search behaviors related to COVID-19 and examine the circulation of infodemic monikers through two platforms—Google and Instagram—during the current global pandemic. Methods: We have defined infodemic moniker as a term, query, hashtag, or phrase that generates or feeds fake news, misinterpretations, or discriminatory phenomena. Using Google Trends and Instagram hashtags, we explored internet search activities and behaviors related to the COVID-19 pandemic from February 20, 2020, to May 6, 2020. We investigated the names used to identify the virus, health and risk perception, life during the lockdown, and information related to the adoption of COVID-19 infodemic monikers. We computed the average peak volume with a 95% CI for the monikers. Results: The top six COVID-19–related terms searched in Google were “coronavirus,” “corona,” “COVID,” “virus,” “corona virus,” and “COVID-19.” Countries with a higher number of COVID-19 cases had a higher number of COVID-19 queries on Google. The monikers “coronavirus ozone,” “coronavirus laboratory,” “coronavirus 5G,” “coronavirus conspiracy,” and “coronavirus bill gates” were widely circulated on the internet. Searches on “tips and cures” for COVID-19 spiked in relation to the US president speculating about a “miracle cure” and suggesting an injection of disinfectant to treat the virus. Around two thirds (n=48,700,000, 66.1%) of Instagram users used the hashtags “COVID-19” and “coronavirus” to disperse virus-related information. Conclusions: Globally, there is a growing interest in COVID-19, and numerous infodemic monikers continue to circulate on the internet. Based on our findings, we hope to encourage mass media regulators and health organizers to be vigilant and diminish the use and circulation of these infodemic monikers to decrease the spread of misinformation. %M 32748790 %R 10.2196/20673 %U http://www.jmir.org/2020/8/e20673/ %U https://doi.org/10.2196/20673 %U http://www.ncbi.nlm.nih.gov/pubmed/32748790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19777 %T Online Japanese-Language Information on Lifestyle Factors Associated With Reduced Fertility: Content Analysis %A Yokota,Rie %A Okuhara,Tsuyoshi %A Ueno,Haruka %A Okada,Hiroko %A Furukawa,Emi %A Kiuchi,Takahiro %+ Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 358006549, yokotarie-tky@umin.ac.jp %K content analysis %K online information %K lifestyle factor %K fertility %K infertility %K reproductive health %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately one-third of Japanese couples currently worry or previously worried about infertility. To develop strategies for the primary prevention of infertility as a population approach, it is important for the general population to be knowledgeable about fertility and infertility. The internet may contribute to the dissemination of information regarding infertility and fertility. However, few studies have examined online information about fertility. Objective: This study aimed to quantitatively examine online Japanese-language information about lifestyle factors associated with reduced fertility. Methods: We conducted online searches, using the 10 search terms with the highest numbers of searches that people hoping to conceive are likely to input in two major search engines in Japan (Google Japan and Yahoo! Japan). From the 2200 retrieved websites, 1181 duplicates and 500 websites unrelated to our objective were excluded, resulting in a final dataset of 519 websites. Coding guidelines were developed for the following lifestyle factors associated with reduced fertility: sexually transmitted diseases, psychological stress, cigarette smoking, alcohol use, nutrition and diet, physical activity and exercise, underweight, overweight and obesity, and environmental pollutants. Results: In terms of the website author’s professional expertise, 69.6% of the coding instances for the selected lifestyle factors were mentioned by hospitals, clinics, or the media, whereas only 1.7% were mentioned by laypersons. Psychological stress (20.1%) and sexually transmitted diseases (18.8%) were the most frequently mentioned lifestyle factors associated with reduced fertility. In contrast, cigarette smoking, alcohol use, nutrition and diet, physical activity and exercise, underweight, overweight and obesity, and environmental pollutants were mentioned relatively infrequently. The association between reduced fertility and sexually transmitted diseases was mentioned significantly more frequently by hospitals and clinics than by the media (P<.001). The association between reduced fertility and nutrition and diet was mentioned significantly more frequently by the media than by hospitals and clinics (P=.008). With regard to the sex of the target audience for the information, female-specific references to psychological stress, sexually transmitted diseases, nutrition and diet, underweight, physical activity and exercise, and overweight and obesity were significantly more frequent than were male-specific references to these lifestyle factors (psychological stress: P=.002, sexually transmitted diseases: P<.001, nutrition and diet: P<.001, underweight: P<.001, physical activity and exercise: P<.001, overweight and obesity: P<.001). Conclusions: Of the lifestyle factors known to be related to reduced fertility, cigarette smoking, alcohol use, and male-specific lifestyle factors are mentioned relatively infrequently in online information sources in Japan, and these factors should be discussed more in information published on websites. %R 10.2196/19777 %U https://www.jmir.org/2020/8/e19777/ %U https://doi.org/10.2196/19777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20775 %T Evaluation of Korean-Language COVID-19–Related Medical Information on YouTube: Cross-Sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %+ Department of Family Medicine, School of Medicine, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K YouTube %K social media %K misinformation %K public health surveillance %K health communication %K consumer health information %K health education %K infectious disease outbreaks %K infodemiology %K infoveillance %K infodemic %K internet %K multimedia %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In South Korea, the number of coronavirus disease (COVID-19) cases has declined rapidly and much sooner than in other countries. South Korea is one of the most digitalized countries in the world, and YouTube may have served as a rapid delivery mechanism for increasing public awareness of COVID-19. Thus, the platform may have helped the South Korean public fight the spread of the disease. Objective: The aim of this study is to compare the reliability, overall quality, title–content consistency, and content coverage of Korean-language YouTube videos on COVID-19, which have been uploaded by different sources. Methods: A total of 200 of the most viewed YouTube videos from January 1, 2020, to April 30, 2020, were screened, searching in Korean for the terms “Coronavirus,” “COVID,” “Corona,” “Wuhan virus,” and “Wuhan pneumonia.” Non-Korean videos and videos that were duplicated, irrelevant, or livestreamed were excluded. Source and video metrics were collected. The videos were scored based on the following criteria: modified DISCERN index, Journal of the American Medical Association Score (JAMAS) benchmark criteria, global quality score (GQS), title–content consistency index (TCCI), and medical information and content index (MICI). Results: Of the 105 total videos, 37.14% (39/105) contained misleading information; independent user–generated videos showed the highest proportion of misleading information at 68.09% (32/47), while all of the government-generated videos were useful. Government agency–generated videos achieved the highest median score of DISCERN (5.0, IQR 5.0-5.0), JAMAS (4.0, IQR 4.0-4.0), GQS (4.0, IQR 3.0-4.5), and TCCI (5.0, IQR 5.0-5.0), while independent user–generated videos achieved the lowest median score of DISCERN (2.0, IQR 1.0-3.0), JAMAS (2.0, IQR 1.5-2.0), GQS (2.0, IQR 1.5-2.0), and TCCI (3.0, IQR 3.0-4.0). However, the total MICI was not significantly different among sources. “Transmission and precautionary measures” were the most commonly covered content by government agencies, news agencies, and independent users. In contrast, the most mentioned content by news agencies was “prevalence,” followed by “transmission and precautionary measures.” Conclusions: Misleading videos had more likes, fewer comments, and longer running times than useful videos. Korean-language YouTube videos on COVID-19 uploaded by different sources varied significantly in terms of reliability, overall quality, and title–content consistency, but the content coverage was not significantly different. Government-generated videos had higher reliability, overall quality, and title–content consistency than independent user–generated videos. %M 32730221 %R 10.2196/20775 %U http://www.jmir.org/2020/8/e20775/ %U https://doi.org/10.2196/20775 %U http://www.ncbi.nlm.nih.gov/pubmed/32730221 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17051 %T Wildfire-Like Effect of a WhatsApp Campaign to Mobilize a Group of Predominantly Health Professionals With a University Degree on a Health Issue: Infodemiology Study %A Kopilaš,Vanja %A Gajović,Srećko %+ Croatian Institute for Brain Research, University of Zagreb School of Medicine, Šalata 12, Zagreb, HR-10000, Croatia, 385 14566948, srecko.gajovic@hiim.hr %K instant messaging %K rumor %K 5G mobile networks %K participatory web %K virality %K infodemiology %K infodemic %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Online interactions within a closed WhatsApp group can influence the attitudes and behaviors of the users in relation to health issues. Objective: This study aimed to analyze the activity of the members of a WhatsApp group initiated to raise awareness of the possible health effects of 5G mobile networks and mobilize members to sign the related petition. Methods: We retrospectively analyzed data from the WhatsApp group of 205 members that was active during 4 consecutive days in August 2019. The messages exchanged were collected, anonymized, and analyzed according to their timing and content. Results: The WhatsApp group members were invited to the group from the administrator’s contacts; 91% (187/205) had a university degree, 68% (140/205) were medical professionals, and 24% (50/205) held academic positions. Approximately a quarter of the members (47/205, 23%) declared in their messages they signed the corresponding petition. The intense message exchange had wildfire-like features, and the majority of messages (126/133, 95%) were exchanged during the first 26 hours. Despite the viral activity and high rate of members openly declaring that they signed the petition, only 8 (8/133, 6%) messages from the group members, excluding the administrator, referred to the health issue, which was the topic of the group. No member expressed an opposite opinion to those presented by the administrator, and there was no debate in the form of exchanging opposite opinions. Conclusions: The wildfire-like activity of the WhatsApp group and open declaration of signing the petition as a result of the mobilization campaign were not accompanied by any form of a debate related to the corresponding health issue, although the group members were predominantly health professionals, with a quarter of holding academic positions. %M 32442138 %R 10.2196/17051 %U https://www.jmir.org/2020/8/e17051 %U https://doi.org/10.2196/17051 %U http://www.ncbi.nlm.nih.gov/pubmed/32442138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19018 %T Evaluating Smart Assistant Responses for Accuracy and Misinformation Regarding Human Papillomavirus Vaccination: Content Analysis Study %A Ferrand,John %A Hockensmith,Ryli %A Houghton,Rebecca Fagen %A Walsh-Buhi,Eric R %+ School of Public Health-Bloomington, Indiana University, 1025 E. 7th Street, Room 116, Department of Applied Health Science, Bloomington, IN, 47405, United States, 1 8128554867, erwals@iu.edu %K digital health %K human papillomavirus %K smart assistants %K chatbots %K conversational agents %K misinformation %K infodemiology %K vaccination %D 2020 %7 3.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Almost half (46%) of Americans have used a smart assistant of some kind (eg, Apple Siri), and 25% have used a stand-alone smart assistant (eg, Amazon Echo). This positions smart assistants as potentially useful modalities for retrieving health-related information; however, the accuracy of smart assistant responses lacks rigorous evaluation. Objective: This study aimed to evaluate the levels of accuracy, misinformation, and sentiment in smart assistant responses to human papillomavirus (HPV) vaccination–related questions. Methods: We systematically examined responses to questions about the HPV vaccine from the following four most popular smart assistants: Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. One team member posed 10 questions to each smart assistant and recorded all queries and responses. Two raters independently coded all responses (κ=0.85). We then assessed differences among the smart assistants in terms of response accuracy, presence of misinformation, and sentiment regarding the HPV vaccine. Results: A total of 103 responses were obtained from the 10 questions posed across the smart assistants. Google Assistant data were excluded owing to nonresponse. Over half (n=63, 61%) of the responses of the remaining three smart assistants were accurate. We found statistically significant differences across the smart assistants (N=103, χ22=7.807, P=.02), with Cortana yielding the greatest proportion of misinformation. Siri yielded the greatest proportion of accurate responses (n=26, 72%), whereas Cortana yielded the lowest proportion of accurate responses (n=33, 54%). Most response sentiments across smart assistants were positive (n=65, 64%) or neutral (n=18, 18%), but Cortana’s responses yielded the largest proportion of negative sentiment (n=7, 12%). Conclusions: Smart assistants appear to be average-quality sources for HPV vaccination information, with Alexa responding most reliably. Cortana returned the largest proportion of inaccurate responses, the most misinformation, and the greatest proportion of results with negative sentiments. More collaboration between technology companies and public health entities is necessary to improve the retrieval of accurate health information via smart assistants. %M 32744508 %R 10.2196/19018 %U https://www.jmir.org/2020/8/e19018 %U https://doi.org/10.2196/19018 %U http://www.ncbi.nlm.nih.gov/pubmed/32744508 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e19037 %T Quality Criteria for Serious Games: Serious Part, Game Part, and Balance %A Caserman,Polona %A Hoffmann,Katrin %A Müller,Philipp %A Schaub,Marcel %A Straßburg,Katharina %A Wiemeyer,Josef %A Bruder,Regina %A Göbel,Stefan %+ Multimedia Communications Lab, Technical University of Darmstadt, Rundeturmstraße 10, Darmstadt, 64289, Germany, 49 6151 16 20391, polona.caserman@kom.tu-darmstadt.de %K serious games %K educational games %K games for health %K exergames %K quality criteria %K video games %D 2020 %7 24.7.2020 %9 Viewpoint %J JMIR Serious Games %G English %X Serious games are digital games that have an additional goal beyond entertainment. Recently, many studies have explored different quality criteria for serious games, including effectiveness and attractiveness. Unfortunately, the double mission of serious games, that is, simultaneous achievement of intended effects (serious part) and entertainment (game part), is not adequately considered in these studies. This paper aims to identify essential quality criteria for serious games. The fundamental goal of our research is to identify important factors of serious games and to adapt the existing principles and requirements from game-related literature to effective and attractive serious games. In addition to the review of the relevant literature, we also include workshop results. Furthermore, we analyzed and summarized 22 state-of-the-art serious games for education and health. The selected best-practice serious games either prove their effectiveness through scientific studies or by winning game awards. For the analysis of these games, we refer to “DIN SPEC 91380 Serious Games Metadata Format.” A summarized text states quality criteria for both the serious and the game part, and especially the balance between them. We provide guidelines for high-quality serious games drawn from literature analysis and in close cooperation with domain experts. %M 32706669 %R 10.2196/19037 %U http://games.jmir.org/2020/3/e19037/ %U https://doi.org/10.2196/19037 %U http://www.ncbi.nlm.nih.gov/pubmed/32706669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16701 %T Web-Based Health Information Following the Renewal of the Cervical Screening Program in Australia: Evaluation of Readability, Understandability, and Credibility %A Mac,Olivia A %A Thayre,Amy %A Tan,Shumei %A Dodd,Rachael H %+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, Sydney, 2006, Australia, 61 293515102, rachael.dodd@sydney.edu.au %K cervical screening %K internet %K consumer health information %K Australia %K papillomavirus infections %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Three main changes were implemented in the Australian National Cervical Screening Program (NCSP) in December 2017: an increase in the recommended age to start screening, extended screening intervals, and change from the Papanicolaou (Pap) test to primary human papillomavirus screening (cervical screening test). The internet is a readily accessible source of information to explain the reasons for these changes to the public. It is important that web-based health information about changes to national screening programs is accessible and understandable for the general population. Objective: This study aimed to evaluate Australian web-based resources that provide information about the changes to the cervical screening program. Methods: The term cervical screening was searched in 3 search engines. The first 10 relevant results across the first 3 pages of each search engine were selected. Overall, 2 authors independently evaluated each website for readability (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook [SMOG] index), quality of information (Patient Education Materials Assessment Tool [PEMAT] for printable materials), credibility (Journal of the American Medical Association [JAMA] benchmark criteria and presence of Health on the Net Foundation code of conduct [HONcode] certification), website design, and usability with 5 simulation questions to assess the relevance of information. A descriptive analysis was conducted for the readability measures, PEMAT, and the JAMA benchmark criteria. Results: Of the 49 websites identified in the search, 15 were eligible for inclusion. The consumer-focused websites were classed as fairly difficult to read (mean FRE score 51.8, SD 13.3). The highest FRE score (easiest to read) was 70.4 (Cancer Council Australia Cervical Screening Consumer Site), and the lowest FRE score (most difficult to read) was 33.0 (NCSP Clinical Guidelines). A total of 9 consumer-focused websites and 4 health care provider–focused websites met the recommended threshold (sixth to eighth grade; SMOG index) for readability. The mean PEMAT understandability scores were 87.7% (SD 6.0%) for consumer-focused websites and 64.9% (SD 13.8%) for health care provider–focused websites. The mean actionability scores were 58.1% (SD 19.1%) for consumer-focused websites and 36.7% (SD 11.0%) for health care provider–focused websites. Moreover, 9 consumer-focused and 3 health care provider–focused websites scored above 70% for understandability, and 2 consumer-focused websites had an actionability score above 70%. A total of 3 websites met all 4 of the JAMA benchmark criteria, and 2 websites displayed the HONcode. Conclusions: It is important for women to have access to information that is at an appropriate reading level to better understand the implications of the changes to the cervical screening program. These findings can help health care providers direct their patients toward websites that provide information on cervical screening that is written at accessible reading levels and has high understandability. %M 32442134 %R 10.2196/16701 %U http://www.jmir.org/2020/6/e16701/ %U https://doi.org/10.2196/16701 %U http://www.ncbi.nlm.nih.gov/pubmed/32442134 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e18076 %T Wikipedia in Vascular Surgery Medical Education: Comparative Study %A Yacob,Michael %A Lotfi,Shamim %A Tang,Shannon %A Jetty,Prasad %+ Queen's University, 76 Stuart St, Victory 3, Kingston, ON, K7L 2V7, Canada, 1 6135482573, michaelyacob@gmail.com %K medical education %K Wikipedia %K vascular surgery %K medical student %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: Medical students commonly refer to Wikipedia as their preferred online resource for medical information. The quality and readability of articles about common vascular disorders on Wikipedia has not been evaluated or compared against a standard textbook of surgery. Objective: The aims of this study were to (1) compare the quality of Wikipedia articles to that of equivalent chapters in a standard undergraduate medical textbook of surgery, (2) identify any errors of omission in either resource, and (3) compare the readability of both resources using validated ease-of-reading and grade-level tools. Methods: Using the Medical Council of Canada Objectives for the Qualifying Examination, 8 fundamental topics of vascular surgery were chosen. The articles were found on Wikipedia using Wikipedia’s native search engine. The equivalent chapters were identified in Schwartz Principles of Surgery (ninth edition). Medical learners (n=2) assessed each of the texts on their original platforms to independently evaluate readability, quality, and errors of omission. Readability was evaluated with Flesch Reading Ease scores and 5 grade-level scores (Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index), quality was evaluated using the DISCERN instrument, and errors of omission were evaluated using a standardized scoring system that was designed by the authors. Results: Flesch Reading Ease scores suggested that Wikipedia (mean 30.5; SD 8.4) was significantly easier to read (P=.03) than Schwartz (mean 20.2; SD 9.0). The mean grade level (calculated using all grade-level indices) of the Wikipedia articles (mean 14.2; SD 1.3) was significantly different (P=.02) than the mean grade level of Schwartz (mean 15.9; SD 1.4). The quality of the text was also assessed using the DISCERN instrument and suggested that Schwartz (mean 71.4; SD 3.1) had a significantly higher quality (P=.002) compared to that of Wikipedia (mean 52.9; SD 11.4). Finally, the Wikipedia error of omission rate (mean 12.5; SD 6.8) was higher than that of Schwartz (mean 21.3; SD 1.9) indicating that there were significantly fewer errors of omission in the surgical textbook (P=.008). Conclusions: Online resources are increasingly easier to access but can vary in quality. Based on this comparison, the authors of this study recommend the use of vascular surgery textbooks as a primary source of learning material because the information within is more consistent in quality and has fewer errors of omission. Wikipedia can be a useful resource for quick reference, particularly because of its ease of reading, but its vascular surgery articles require further development. %M 32417754 %R 10.2196/18076 %U http://mededu.jmir.org/2020/1/e18076/ %U https://doi.org/10.2196/18076 %U http://www.ncbi.nlm.nih.gov/pubmed/32417754 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17104 %T Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Videos %A Massey,Zachary B %A Li,Yachao %A Holli,Jessica %A Churchill,Victoria %A Yang,Bo %A Henderson,Katherine %A Ashley,David L %A Huang,Jidong %A Popova,Lucy %+ School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States, 1 4044139338, lpopova1@gsu.edu %K ENDS modifications %K YouTube %K coils %K e-liquid %K vaping %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking. Objective: This study aimed to analyze the content of YouTube videos depicting modifications of ENDS. Methods: YouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos. Results: Videos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative). Conclusions: This study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications. %M 32348288 %R 10.2196/17104 %U https://www.jmir.org/2020/6/e17104 %U https://doi.org/10.2196/17104 %U http://www.ncbi.nlm.nih.gov/pubmed/32348288 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e14411 %T Information About Sunscreen on YouTube and Considerations for Sun Safety Promotion: Content Analysis %A Julian,Anne K %A Welch,Jessica %A Bean,Maddison M %A Shahid,Sarah %A Perna,Frank M %+ Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, Rockville, MD, 20877, United States, 1 240 276 6175, anne.julian@nih.gov %K sunscreen %K social media %K sun safety %K cancer prevention %D 2020 %7 2.6.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: Sunscreen use is a popular sun protection method; however, application of sunscreen rarely meets the standards recommended for effectiveness. Access to information about how to effectively use sunscreen may play a role in proper sunscreen application. The internet is a common health information source; however, the quality of sunscreen-related content varies. Objective: The objective of this study was to examine information about sunscreen in YouTube videos by video source. Methods: In November 2017, the authors identified the 20 most popular YouTube videos (sorted by view count and relevance) for each of these 5 search terms: sunscreen cancer, sunscreen health, sunscreen information, sunscreen ingredients, and sunscreen natural. The inclusion criteria were English language and view count >1000 (N=111 unique videos). We double-coded videos for standard recommendations for sunscreen use (eg, apply 20 minutes before sun exposure), use of outdated terminology, and recommendation of complementary sun safety strategies. Results: The view counts ranged from 1100 to 671,142 (median 17,774, SD 109,651) and the average daily views ranged from 1 to 1448 (median 23, SD 234). End users (46/111, 41.4%) and health care providers (24/111, 21.6%) were the most common sources, and none of the most popular videos were produced by federal agencies or cancer-related nongovernmental organizations. Health care provider videos included marginally more recommendations than end user videos (mean 1.46, SD 1.96 vs mean 1.05, SD 1.20), but few (19/111, 17.1%) mentioned reapplication. The videos were generally positive toward sunscreen (82/111, 73.9%); however, some videos were negative (29/111, 26.1%), with warnings about the health risks of chemical sunscreens and their ingredients. Do-it-yourself sunscreen tutorials represented 19/111 (17.1%) of the sample. Conclusions: YouTube is a potential source for disseminating sun safety messages; however, the quality of its sunscreen content varies. Most of the videos in our study failed to include important sunscreen use recommendations. Clinicians should be prepared to address the information needs of patients by discussing effective, evidence-based sunscreen application and recommending a combined sun safety approach. %R 10.2196/14411 %U http://derma.jmir.org/2020/1/e14411/ %U https://doi.org/10.2196/14411 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14826 %T Evaluating the Quality of Health-Related WeChat Public Accounts: Cross-Sectional Study %A Wang,Fuzhi %A Wang,Zhuoxin %A Sun,Weiwei %A Yang,Xiumu %A Bian,Zhiwei %A Shen,Lining %A Pan,Wei %A Liu,Peng %A Chen,Xingzhi %A Fu,Lianguo %A Zhang,Fan %A Luo,Dan %+ School of Health Management, Bengbu Medical College, 2600 Donghai Rd, Longzihu District, Bengbu, China, 86 13865073216, ld.bbmc@foxmail.com %K health-related WeChat Public Account %K HONcode %K suitability assessment of material %K evaluation %K social media %K mHealth %K app %K health information %K internet %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As representatives of health information communication platforms accessed through mobile phones and mobile terminals, health-related WeChat public accounts (HWPAs) have a large consumer base in the Chinese-speaking world. However, there is still a lack of general understanding of the status quo of HWPAs and the quality of the articles they release. Objective: The aims of this study were to assess the conformity of HWPAs to the Health on the Net Foundation Code of Conduct (HONcode) and to evaluate the suitability of articles disseminated by HWPAs. Methods: The survey was conducted from April 23 to May 5, 2019. Based on the monthly (March 1-31, 2019) WeChat Index provided by Qingbo Big Data, the top 100 HWPAs were examined to evaluate their HONcode compliance. The first four articles published by each HWPA on the survey dates were selected as samples to evaluate their suitability. All materials were assessed by three raters. The materials were assessed using the HONcode checklist and the Suitability Assessment of Materials (SAM) score sheet. Data analysis was performed with SPSS version 17.0 (SPSS Inc, Chicago, IL, USA) and Excel version 2013 (Microsoft Inc, Washington DC, USA). Results: A total of 93 HWPAs and 210 of their released articles were included in this study. For six of the eight principles, the 93 HWPAs nearly consistently did not meet the requirements of the HONcode. The HWPAs certified by Tencent Corporation (66/93, 71%) were generally slightly superior to those without such certification (27/93, 29%) in terms of compliance with HONcode principles. The mean SAM score for the 210 articles was 67.72 (SD 10.930), which indicated “adequate” suitability. There was no significant difference between the SAM scores of the articles published by certified and uncertified HWPAs (P=.07), except in the literacy requirements dimension (tdf=97=–2.418, P=.02). Conclusions: The HWPAs had low HONcode conformity. Although the suitability of health information released by HWPAs was at a moderate level, there were still problems identified, such as difficulty in tracing information sources, excessive implicit advertisements, and irregular usage of charts. In addition, the low approval requirements of HWPAs were not conducive to improvement of their service quality. %M 32383684 %R 10.2196/14826 %U https://mhealth.jmir.org/2020/5/e14826 %U https://doi.org/10.2196/14826 %U http://www.ncbi.nlm.nih.gov/pubmed/32383684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16206 %T Infodemiology and Infoveillance: Scoping Review %A Mavragani,Amaryllis %+ Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, University Campus, Stirling, FK9 4LA, United Kingdom, 44 7523 782711, amaryllis.mavragani1@stir.ac.uk %K big data %K infodemiology %K infoveillance %K internet %K review %K web-based data %D 2020 %7 28.4.2020 %9 Review %J J Med Internet Res %G English %X Background: Web-based sources are increasingly employed in the analysis, detection, and forecasting of diseases and epidemics, and in predicting human behavior toward several health topics. This use of the internet has come to be known as infodemiology, a concept introduced by Gunther Eysenbach. Infodemiology and infoveillance studies use web-based data and have become an integral part of health informatics research over the past decade. Objective: The aim of this paper is to provide a scoping review of the state-of-the-art in infodemiology along with the background and history of the concept, to identify sources and health categories and topics, to elaborate on the validity of the employed methods, and to discuss the gaps identified in current research. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to extract the publications that fall under the umbrella of infodemiology and infoveillance from the JMIR, PubMed, and Scopus databases. A total of 338 documents were extracted for assessment. Results: Of the 338 studies, the vast majority (n=282, 83.4%) were published with JMIR Publications. The Journal of Medical Internet Research features almost half of the publications (n=168, 49.7%), and JMIR Public Health and Surveillance has more than one-fifth of the examined studies (n=74, 21.9%). The interest in the subject has been increasing every year, with 2018 featuring more than one-fourth of the total publications (n=89, 26.3%), and the publications in 2017 and 2018 combined accounted for more than half (n=171, 50.6%) of the total number of publications in the last decade. The most popular source was Twitter with 45.0% (n=152), followed by Google with 24.6% (n=83), websites and platforms with 13.9% (n=47), blogs and forums with 10.1% (n=34), Facebook with 8.9% (n=30), and other search engines with 5.6% (n=19). As for the subjects examined, conditions and diseases with 17.2% (n=58) and epidemics and outbreaks with 15.7% (n=53) were the most popular categories identified in this review, followed by health care (n=39, 11.5%), drugs (n=40, 10.4%), and smoking and alcohol (n=29, 8.6%). Conclusions: The field of infodemiology is becoming increasingly popular, employing innovative methods and approaches for health assessment. The use of web-based sources, which provide us with information that would not be accessible otherwise and tackles the issues arising from the time-consuming traditional methods, shows that infodemiology plays an important role in health informatics research. %M 32310818 %R 10.2196/16206 %U http://www.jmir.org/2020/4/e16206/ %U https://doi.org/10.2196/16206 %U http://www.ncbi.nlm.nih.gov/pubmed/32310818 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15599 %T Fiction, Falsehoods, and Few Facts: Cross-Sectional Study on the Content-Related Quality of Atopic Eczema-Related Videos on YouTube %A Mueller,Simon M %A Hongler,Valentina N S %A Jungo,Pierre %A Cajacob,Lucian %A Schwegler,Simon %A Steveling,Esther H %A Manjaly Thomas,Zita-Rose %A Fuchs,Oliver %A Navarini,Alexander %A Scherer,Kathrin %A Brandt,Oliver %+ Department of Dermatology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland, 41 61 328 69 64, Simon.Mueller@usb.ch %K YouTube %K social media %K videos %K atopic eczema %K atopic dermatitis %K quality assessment %K Global Quality Scale %K DISCERN %D 2020 %7 24.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, YouTube has become a recognized source of medical information for health care consumers. Although YouTube has advantages in this context, there are potential dangers as videos may contain nonscientific, misleading, or even harmful information. Objective: As little is known about YouTube as a source of information on atopic dermatitis (AD), we investigated the content-related quality of AD videos and their perception among YouTube users. Methods: The quality of the 100 most viewed AD videos was assessed by using the Global Quality Scale (GQS) and the DISCERN instrument. Videos were classified as “useful,” “misleading,” and “potentially harmful,” and the correlations of viewers’ ratings (likes) with the GQS and DISCERN scores were assessed. Results: Among the 100 videos, 68.0% (68/100) and 62.0% (62/100) were of poor and very poor scientific quality, respectively. Additionally, 32.0% (32/100) of the videos were classified as useful, 48.0% (48/100) were classified as misleading, and 34.0% (34/100) were classified as potentially harmful. Viewers’ ratings did not correlate with the GQS and DISCERN scores. Overall, 50.0% (50/100) of the videos were posted by private individuals and promoters of complementary/alternative treatments, 42.0% (42/100) by therapeutical advertisers, and only 8.0% (8/100) by nonprofit organizations/universities. Conclusions: Our study demonstrated that two-thirds of the videos analyzed were below acceptable medical quality standards and that many videos were disseminating misleading or even dangerous content. Subjective and anecdotal content was overrepresented, and viewers did not appear to be able to distinguish between high- and low-quality videos. Health promotion strategies by professional medical organizations are needed to improve their presence and visibility on YouTube. %M 32329744 %R 10.2196/15599 %U https://www.jmir.org/2020/4/e15599 %U https://doi.org/10.2196/15599 %U http://www.ncbi.nlm.nih.gov/pubmed/32329744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e17250 %T Quality of Information Regarding Repair Restorations on Dentist Websites: Systematic Search and Analysis %A Kanzow,Philipp %A Büttcher,Amelie Friederike %A Wiegand,Annette %A Schwendicke,Falk %+ Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str 40, Göttingen, 37075, Germany, 49 551 3922877, philipp.kanzow@med.uni-goettingen.de %K evidence-based dentistry %K internet %K restoration repair %K shared decision making %D 2020 %7 15.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Repairing instead of replacing partially defective dental restorations represents a minimally invasive treatment concept, and repairs are associated with advantages over complete restoration replacement. To participate in the shared decision-making process when facing partially defective restorations, patients need to be aware of the indications, limitations, and advantages or disadvantages of repairs. Patients are increasingly using the internet to gain health information like this online. Objective: We aimed to assess the quality of German-speaking dentist websites on repairs of partially defective restorations. Methods: Three electronic search engines were used to identify German-speaking websites of dental practices mentioning repairs. Regarding information on repairs, websites were assessed for (1) technical and functional aspects, (2) comprehensiveness of information, and (3) generic quality and risk of bias. Domains 1 and 3 were scored using validated tools (LIDA and DISCERN). Comprehensiveness was assessed using a criterion checklist related to evidence, advantages and disadvantages, restorations and defects suitable for repairs, and information regarding technical implementation. Generalized linear modeling was used to assess the impact of practice-specific parameters (practice location, practice setting, dental society membership, and year of examination or license to practice dentistry) on the quality of information. An overall quality score was calculated by averaging the quality scores of all three domains and used as primary outcome parameter. Quality scores of all three domains were also assessed individually and used as secondary outcomes. Results: Fifty websites were included. The median score of quality of information was 23.2% (interquartile range [IQR] 21.7%-26.2%). Technical and functional aspects (55.2% [IQR 51.7%-58.6%]) showed significantly higher quality than comprehensiveness of information (8.3% [IQR 8.3%-16.7%]) and generic quality and risk of bias (3.6% [IQR 0.0%-7.1%]; P<.001/Wilcoxon). Quality scores were not related to practice-specific parameters (P>.05/generalized linear modeling). Conclusions: The quality of German-speaking dentist websites on repairs was limited. Despite sufficient technical and functional quality, the provided information was neither comprehensive nor trustworthy. There is great need to improve the quality of information to fully and reliably inform patients, thereby allowing shared decision making. %M 32062595 %R 10.2196/17250 %U http://www.jmir.org/2020/4/e17250/ %U https://doi.org/10.2196/17250 %U http://www.ncbi.nlm.nih.gov/pubmed/32062595 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18444 %T Misinformation of COVID-19 on the Internet: Infodemiology Study %A Cuan-Baltazar,Jose Yunam %A Muñoz-Perez,Maria José %A Robledo-Vega,Carolina %A Pérez-Zepeda,Maria Fernanda %A Soto-Vega,Elena %+ Medicine School, Universidad Anáhuac Puebla, Av Orion sn. Colonia Country Club, San Andres Cholula, 72810, Mexico, 52 2225415200, elenasoto_74@hotmail.com %K HONcode %K JAMA benchmarks %K DISCERN instrument %K Wuhan coronavirus %K COVID-19 %K nCoV %K epidemiology %K health information seeking %K information quality %K misinformation %K public health %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The internet has become an important source of health information for users worldwide. The novel coronavirus caused a pandemic search for information with broad dissemination of false or misleading health information. Objective: The aim of this study was to evaluate the quality and readability of online information about the coronavirus disease (COVID-19), which was a trending topic on the internet, using validated instruments and relating the quality of information to its readability. Methods: The search was based on the term “Wuhan Coronavirus” on the Google website (February 6, 2020). At the search time, the terms “COVID-19” or “SARS-CoV-2” (severe acute respiratory syndrome coronavirus 2) did not exist. Critical analysis was performed on the first 110 hits using the Health on the Net Foundation Code of Conduct (HONcode), the Journal of the American Medical Association (JAMA) benchmark, the DISCERN instrument, and Google ranking. Results: The first 110 websites were critically analyzed, and only 1.8% (n=2) of the websites had the HONcode seal. The JAMA benchmark showed that 39.1% (n=43) of the websites did not have any of the categories required by this tool, and only 10.0% (11/110) of the websites had the four quality criteria required by JAMA. The DISCERN score showed that 70.0% (n=77) of the websites were evaluated as having a low score and none were rated as having a high score. Conclusions: Nonhealth personnel and the scientific community need to be aware about the quality of the information they read and produce, respectively. The Wuhan coronavirus health crisis misinformation was produced by the media, and the misinformation was obtained by users from the internet. The use of the internet has a risk to public health, and, in cases like this, the governments should be developing strategies to regulate health information on the internet without censuring the population. By February 6, 2020, no quality information was available on the internet about COVID-19. %M 32250960 %R 10.2196/18444 %U http://publichealth.jmir.org/2020/2/e18444/ %U https://doi.org/10.2196/18444 %U http://www.ncbi.nlm.nih.gov/pubmed/32250960 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e15364 %T Medication Management Apps for Diabetes: Systematic Assessment of the Transparency and Reliability of Health Information Dissemination %A Huang,Zhilian %A Lum,Elaine %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building, Level 18, Singapore, 308322, Singapore, 65 65923945, ZHUANG014@e.ntu.edu.sg %K health apps %K digital health %K diabetes %K privacy %K evidence-based guidance %D 2020 %7 19.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies. Objective: This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles. Methods: English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ≥100,000 downloads and <100,000 downloads). Results: A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer’s email listed on the app store (Android: 75/81, 98%; and iOS: 52/62, 84%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88%; and low downloads: 33/64, 52%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82%; and low downloads: 32/64, 50%; P=.03) compared with apps with a low number of downloads. Conclusions: Gaps in the disclosure of the developer’s qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps. %M 32130163 %R 10.2196/15364 %U http://mhealth.jmir.org/2020/2/e15364/ %U https://doi.org/10.2196/15364 %U http://www.ncbi.nlm.nih.gov/pubmed/32130163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e14725 %T Online Information on Electronic Cigarettes: Comparative Study of Relevant Websites From Baidu and Google Search Engines %A Chen,Ting %A Gentry,Sarah %A Qiu,Dechao %A Deng,Yan %A Notley,Caitlin %A Cheng,Guangwen %A Song,Fujian %+ Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom, 44 1603 591253, fujian.song@uea.ac.uk %K electronic nicotine delivery system %K electronic cigarette %K online health information %K internet-based information %D 2020 %7 24.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Online information on electronic cigarettes (e-cigarettes) may influence people’s perception and use of e-cigarettes. Websites with information on e-cigarettes in the Chinese language have not been systematically assessed. Objective: The aim of this study was to assess and compare the types and credibility of Web-based information on e-cigarettes identified from Google (in English) and Baidu (in Chinese) search engines. Methods: We used the keywords vaping or e-cigarettes to conduct a search on Google and the equivalent Chinese characters for Baidu. The first 50 unique and relevant websites from each of the two search engines were included in this analysis. The main characteristics of the websites, credibility of the websites, and claims made on the included websites were systematically assessed and compared. Results: Compared with websites on Google, more websites on Baidu were owned by manufacturers or retailers (15/50, 30% vs 33/50, 66%; P<.001). None of the Baidu websites, compared to 24% (12/50) of Google websites, were provided by public or health professional institutions. The Baidu websites were more likely to contain e-cigarette advertising (P<.001) and less likely to provide information on health education (P<.001). The overall credibility of the included Baidu websites was lower than that of the Google websites (P<.001). An age restriction warning was shown on all advertising websites from Google (15/15) but only on 10 of the 33 (30%) advertising websites from Baidu (P<.001). Conflicting or unclear health and social claims were common on the included websites. Conclusions: Although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines, there was a lack of online information from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes. %M 32012069 %R 10.2196/14725 %U http://www.jmir.org/2020/1/e14725/ %U https://doi.org/10.2196/14725 %U http://www.ncbi.nlm.nih.gov/pubmed/32012069 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12424 %T Considerations for Improved Mobile Health Evaluation: Retrospective Qualitative Investigation %A Dick,Samantha %A O'Connor,Yvonne %A Thompson,Matthew J %A O'Donoghue,John %A Hardy,Victoria %A Wu,Tsung-Shu Joseph %A O'Sullivan,Timothy %A Chirambo,Griphin Baxter %A Heavin,Ciara %+ Health Information Systems Research Centre, Cork University Business School, University College Cork, Cork, Ireland, 353 21 420 5576, samantha.dick@ucc.ie %K telemedicine %K mHealth %K research design %K developing countries %D 2020 %7 22.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone use and, consequently, mobile health (mHealth) interventions have seen an exponential increase in the last decade. There is an excess of 318,000 health-related apps available free of cost for consumers to download. However, many of these interventions are not evaluated and are lacking appropriate regulations. Randomized controlled trials are often considered the gold standard study design in determining the effectiveness of interventions, but recent literature has identified limitations in the methodology when used to evaluate mHealth. Objective: The objective of this study was to investigate the system developers’ experiences of evaluating mHealth interventions in the context of a developing country. Methods: We employed a qualitative exploratory approach, conducting semistructured interviews with multidisciplinary members of an mHealth project consortium. A conventional content analysis approach was used to allow codes and themes to be identified directly from the data. Results: The findings from this study identified the system developers’ perceptions of mHealth evaluation, providing an insight into the requirements of an effective mHealth evaluation. This study identified social and technical factors which should be taken into account when evaluating an mHealth intervention. Conclusions: Contextual issues represented one of the most recurrent challenges of mHealth evaluation in the context of a developing country, highlighting the importance of a mixed method evaluation. There is a myriad of social, technical, and regulatory variables, which may impact the effectiveness of an mHealth intervention. Failure to account for these variables in an evaluation may limit the ability of the intervention to achieve long-term implementation and scale. %M 32012085 %R 10.2196/12424 %U https://mhealth.jmir.org/2020/1/e12424 %U https://doi.org/10.2196/12424 %U http://www.ncbi.nlm.nih.gov/pubmed/32012085 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e16154 %T Quality and Accuracy of Information Available on Websites for Distracted Driving: Qualitative Analysis %A Poon,Jeffrey %A Gjorgjievski,Marko %A Moga,Iustin %A Ristevski,Bill %+ Centre for Evidence-Based Orthopaedics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, L8L 8E7, Canada, 1 647 460 9692, markogjorgjievski@gmail.com %K distracted driving %K driver distraction %K driving while distracted %K inattentive driving %K Google %K car distractions %K texting and driving %K cell phones %D 2019 %7 20.12.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Distracted driving has become alarmingly widespread, and its prevalence continues to increase despite efforts by government and nongovernment organizations to educate the public about this pervasive problem. Every year, 1.35 million people die, and nearly 80 million people get injured in road traffic incidents. Motor vehicle crashes are the leading cause of death among young people, and distracted driving plays a huge role in road traffic fatalities and injuries. Considering that most people now use the internet as an information source and Google is the most visited website and number one online search engine in the world, we performed a qualitative analysis of information available through Google on distracted driving and its outcomes. Objective: The goal of this study was to analyze the quality and accuracy of the information on distracted driving and its consequences available to the general public when using Google as a search engine for distracted driving. Methods: In November 2018, a nonregional Google search on distracted driving was conducted. The first two pages of the Google search results were selected for analysis. Data were collected on the type of website, type of distraction, consequences of distracted driving described, presence and referencing of statistics, and orthopedic and nonorthopedic injuries described, with their acute and chronic sequelae. Results: In total, we analyzed 25 websites: 12 websites (48%) were from government bodies, which were the most common type of websites; 19 (76%) of the sites provided statistics; and 15 (60%) referenced the source of the statistic. Mobile phones were the most frequently cited type of distraction, with 17 (68%) sites discussing it, while death was the most commonly mentioned consequence of distracted driving, quoted in 15 (60%) of the websites. Additionally, 52% of the sites provided tips on how to avoid distracted driving. Only one website mentioned orthopedic injuries. Conclusions: The prevalence of distracted driving is increasing, and so are the consequences associated with it. Nevertheless, the information available online does not accurately describe the current circumstances regarding this issue. The National Highway Traffic Safety Administration attributed 391,000 injuries and 3477 deaths to distracted driving in 2015, which are 5000 more injuries and almost 150 more fatalities compared to 2011. However, despite these figures, most of the websites discussed death as a consequence of distracted driving and often overlooked injuries, even though injuries are over 100 times more likely to occur in distraction-affected crashes. The websites also largely fail to address other forms of driving distractions, like daydreaming or talking to a passenger, and mostly focus on mobile phone–related activities as distractions. More specific information on the dangers of distracted driving and nonlethal trauma may support an overall cultural shift to curb this behavior. %M 31859684 %R 10.2196/16154 %U http://www.i-jmr.org/2019/4/e16154/ %U https://doi.org/10.2196/16154 %U http://www.ncbi.nlm.nih.gov/pubmed/31859684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e16442 %T Quality Awareness and Its Influence on the Evaluation of App Meta-Information by Physicians: Validation Study %A Albrecht,Urs-Vito %A Framke,Theodor %A von Jan,Ute %+ Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Str 1, Hannover, 30625, Germany, 49 511532 ext 3508, albrecht.urs-vito@mh-hannover.de %K mobile health %K evaluation studies %K mobile apps %K quality principles %K usage decisions %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Meta-information provided about health apps on app stores is often the only readily available source of quality-related information before installation. Objective: The purpose of this study was to assess whether physicians deem a predefined set of quality principles as relevant for health apps; whether they are able to identify corresponding information in a given sample of app descriptions; and whether, and how, this facilitates their informed usage decisions. Methods: All members of the German Society for Internal Medicine were invited by email to participate in an anonymous online survey over a 6-week period. Participants were randomly assigned one app description focusing on cardiology or pulmonology. In the survey, participants were asked three times about whether the assigned description sufficed for a usage decision: they were asked (1) after giving an appraisal of the relevance of nine predefined app quality principles, (2) after determining whether the descriptions covered the quality principles, and (3) after they assessed the availability of detailed quality information by means of 25 additional key questions. Tests for significance of changes in their decisions between assessments 1 and 2, and between assessments 2 and 3, were conducted with the McNemar-Bowker test of symmetry. The effect size represents the discordant proportion ratio sum as a quotient of the test statistics of the Bowker test and the number of observation units. The significance level was set to alpha=.05 with a power of 1-beta=.95. Results: A total of 441 of 724 participants (60.9%) who started the survey fully completed the questionnaires and were included in the evaluation. The participants predominantly rated the specified nine quality principles as important for their decision (approximately 80%-99% of ratings). However, apart from the practicality criterion, information provided in the app descriptions was lacking for both groups (approximately 51%-92%). Reassessment of the apps led to more critical assessments among both groups. After having familiarized themselves with the nine quality principles, approximately one-third of the participants (group A: 63/220, 28.6%; group B: 62/221, 28.1%) came to more critical usage decisions in a statistically significant manner (McNemar-Bowker test, groups A and B: P<.001). After a subsequent reassessment with 25 key questions, critical appraisals further increased, although not in a statistically significant manner (McNemar-Bowker, group A: P=.13; group B: P=.05). Conclusions: Sensitizing physicians to the topic of quality principles via questions about attitudes toward established quality principles, and letting them apply these principles to app descriptions, lead to more critical appraisals of the sufficiency of the information they provided. Even working with only nine generic criteria was sufficient to bring about the majority of decision changes. This may lay the foundation for aiding physicians in their app-related decision processes, without unduly taking up their valuable time. %M 31738179 %R 10.2196/16442 %U http://mhealth.jmir.org/2019/11/e16442/ %U https://doi.org/10.2196/16442 %U http://www.ncbi.nlm.nih.gov/pubmed/31738179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e12278 %T Patients’ Use of the Internet to Find Reliable Medical Information About Minor Ailments: Vignette-Based Experimental Study %A Kwakernaak,Joyce %A Eekhof,Just A H %A De Waal,Margot W M %A Barenbrug,Elisabeth A M %A Chavannes,Niels H %+ Department Public Health & Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300RC, Netherlands, 31 715268414, j.a.h.eekhof@lumc.nl %K internet %K information seeking behaviour %K consumer health information %K diagnosis %K humans %K adult %D 2019 %7 11.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the exact process of how patients search for medical information on the internet and what they retrieve. There is especially a paucity of literature on browsing for information on minor ailments, a term used for harmless diseases that are very common in the general population and thus have a significant impact on health care. Objective: This vignette-based experimental study aimed to explore what kind of Web-based search strategies are applied and how search strategies, demographic characteristics, and the quality of the visited websites relate to finding the right diagnosis. Additional goals were to describe how searching on the Web influences one’s perception of the severity of the potential diagnosis and whether or not the participants would discuss the information they found on the internet with their doctors. Methods: Out of 1372 survey participants, 355 were randomly sampled, and 155 of them were recruited and assigned to one of four clinical scenarios. Each search term they used was classified as one of three search strategies: (1) hypothesis testing, (2) narrowing within the general hypothesis area, and (3) symptom exploration. The quality of the websites used was determined by using the DISCERN instrument. To compare the diagnostic accuracy of the participants before and after the internet search, a McNemar test was used. Chi-square tests were used to describe which factors are related to the chosen search strategy. A multivariate binary logistic regression model was constructed to predict which factors are related to finding a sound diagnosis after searching the internet for health information. Results: Most participants (65.8%, 102/155) used the symptom exploration strategy. However, this depends on the assigned scenario (P<.001) and the self-estimated severity score of the symptoms before the internet search (P=.001). A significant relation was found between choosing an accurate diagnosis and age (odds ratio [OR] 0.94, 95% CI 0.90 to 0.98) and the clinical scenario, as well as the use of high-quality websites (OR 7.49, 95% CI 1.85 to 30.26). Browsing the internet did not lead to a statistically significant change in participants’ beliefs about the severity of the condition (McNemar test, P=.85). Most participants (65%) shared their retrieved information with their physician and most of them (75%) received a positive response. Conclusions: Our findings suggest that most patients use a symptom-based approach; however, if patients expect the potential diagnosis to be severe, they tend to use a hypothesis verification strategy more often and are therefore prone to certain forms of bias. In addition, self-diagnosing accuracy is related to younger age, the symptom scenario, and the use of high-quality websites. We should find ways to guide patients toward search strategies and websites that may more likely lead to accurate decision making. %M 31710304 %R 10.2196/12278 %U http://www.jmir.org/2019/11/e12278/ %U https://doi.org/10.2196/12278 %U http://www.ncbi.nlm.nih.gov/pubmed/31710304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14007 %T Automatically Appraising the Credibility of Vaccine-Related Web Pages Shared on Social Media: A Twitter Surveillance Study %A Shah,Zubair %A Surian,Didi %A Dyda,Amalie %A Coiera,Enrico %A Mandl,Kenneth D %A Dunn,Adam G %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia, 61 9850 2400, adam.dunn@mq.edu.au %K health misinformation %K credibility appraisal %K machine learning %K social media %D 2019 %7 4.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Tools used to appraise the credibility of health information are time-consuming to apply and require context-specific expertise, limiting their use for quickly identifying and mitigating the spread of misinformation as it emerges. Objective: The aim of this study was to estimate the proportion of vaccine-related Twitter posts linked to Web pages of low credibility and measure the potential reach of those posts. Methods: Sampling from 143,003 unique vaccine-related Web pages shared on Twitter between January 2017 and March 2018, we used a 7-point checklist adapted from validated tools and guidelines to manually appraise the credibility of 474 Web pages. These were used to train several classifiers (random forests, support vector machines, and recurrent neural networks) using the text from a Web page to predict whether the information satisfies each of the 7 criteria. Estimating the credibility of all other Web pages, we used the follower network to estimate potential exposures relative to a credibility score defined by the 7-point checklist. Results: The best-performing classifiers were able to distinguish between low, medium, and high credibility with an accuracy of 78% and labeled low-credibility Web pages with a precision of over 96%. Across the set of unique Web pages, 11.86% (16,961 of 143,003) were estimated as low credibility and they generated 9.34% (1.64 billion of 17.6 billion) of potential exposures. The 100 most popular links to low credibility Web pages were each potentially seen by an estimated 2 million to 80 million Twitter users globally. Conclusions: The results indicate that although a small minority of low-credibility Web pages reach a large audience, low-credibility Web pages tend to reach fewer users than other Web pages overall and are more commonly shared within certain subpopulations. An automatic credibility appraisal tool may be useful for finding communities of users at higher risk of exposure to low-credibility vaccine communications. %M 31682571 %R 10.2196/14007 %U https://www.jmir.org/2019/11/e14007 %U https://doi.org/10.2196/14007 %U http://www.ncbi.nlm.nih.gov/pubmed/31682571 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e12225 %T How Do Publicly Available Allergy-Specific Web-Based Training Programs Conform to the Established Criteria for the Reporting, Methods, and Content of Evidence-Based (Digital) Health Information and Education: Thematic Content Evaluation %A Lander,Jonas %A Drixler,Karin %A Dierks,Marie-Luise %A Bitzer,Eva Maria %+ Freiburg University of Education, Department of Public Health and Health Education, Kartäuserstraße 47, Freiburg, 79117, Germany, 49 761 682 142, evamaria.bitzer@ph-freiburg.de %K allergy %K asthma %K health communication %K health education %K health information systems %K evidence-based practice %D 2019 %7 24.10.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Allergic diseases, such as allergic asthma, rhinitis, and atopic eczema, are widespread, and they are a considerable burden on the health care system. For patients and health care professionals, Web-based training programs may be helpful to foster self-management and provide allergy-specific information, given, for instance, their good accessibility. Objective: This study aimed to assess an exploratory sample of publicly available allergy-specific Web-based training programs—that is, interactive, feedback-oriented Web-based training platforms promoting health behavior change and improvement of personal skills—with regard to (1) general characteristics, aims, and target groups and (2) the extent to which these tools meet established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Methods: Web-based training programs were identified via an initial Google search and a search of English and German language websites of medical and public health services, such as the European Centre for Allergy Research Foundation (German), Asthma UK, and Anaphylaxis Canada. We developed a checklist from (1) established guidelines for Web-based health information (eg, the Journal of the American Medical Association benchmarks, DISCERN criteria, and Health On the Net code) and (2) a database search of related studies. The checklist contained 44 items covering 11 domains in 3 areas: (1) content (completeness, transparency, and evidence), (2) structure (data safety and qualification of trainers and authors), and (3) impact (effectiveness, user perspective, and integration into health care). We rated the Web-based training programs as completely, partly, or not satisfying each checklist item and calculated overall and domain-specific scores for each Web-based training program using SPSS 23.0 (SPSS Inc). Results: The 15 identified Web-based training programs covered an average of 37% of the items (score 33 out of 88). A total of 7 Web-based training programs covered more than 40% (35/88; maximum: 49%; 43/88). A total of 5 covered 30% (26/88) to 40% (35/88) of all rated items and the rest covered fewer (n=3; lowest score 24%; 21/88). Items relating to intervention (58%; 10/18), content (49%; 9/18), and data safety (60%; 1/2) were more often considered, as opposed to user safety (10%; 0.4/4), qualification of staff (10%; 0.8/8), effectiveness (16%; 0.4/2), and user perspective (45%; 5/12). In addition, in 13 of 15 Web-based training programs, a minimum of 3 domains were not covered at all. Regarding evidence-based content, 46% of all Web-based training programs (7/15) scored on use of scientific research, 53% on regular information update (8/15), and 33% on provision of references (5/15). None of 15 provided details on the quality of references or the strength of evidence. Conclusions: English and German language allergy-specific Web-based training programs, addressing lay audiences and health care professionals, conform only partly to established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Particularly, well-conducted studies on their effectiveness are missing. %M 31651401 %R 10.2196/12225 %U http://www.i-jmr.org/2019/4/e12225/ %U https://doi.org/10.2196/12225 %U http://www.ncbi.nlm.nih.gov/pubmed/31651401 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e12855 %T Readability and Quality of Online Information on Osteoarthritis: An Objective Analysis With Historic Comparison %A Murray,Kieran Edward %A Murray,Timothy Eanna %A O'Rourke,Anna Caroline %A Low,Candice %A Veale,Douglas James %+ St. Vincent’s University Hospital, University College Dublin, Merrion Road, Elm Park, Dublin, Ireland, 353 1 221 4000, kemurray@hotmail.com %K osteoarthritis %K arthritis %K patient %K readability %K internet %D 2019 %7 16.09.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Osteoarthritis (OA) is the most common cause of disability in people older than 65 years. Readability of online OA information has never been assessed. A 2003 study found the quality of online OA information to be poor. Objective: The aim of this study was to review the readability and quality of current online information regarding OA. Methods: The term osteoarthritis was searched across the three most popular English language search engines. The first 25 pages from each search engine were analyzed. Duplicate pages, websites featuring paid advertisements, inaccessible pages (behind a pay wall, not available for geographical reasons), and nontext pages were excluded. Readability was measured using Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Website quality was scored using the Journal of the American Medical Association (JAMA) benchmark criteria and the DISCERN criteria. Presence or absence of the Health On the Net Foundation Code of Conduct (HONcode) certification, age of content, content producer, and author characteristics were noted. Results: A total of 37 unique websites were found suitable for analysis. Readability varied by assessment tool from 8th to 12th grade level. This compares with the recommended 7th to 8th grade level. Of the 37, 1 (2.7%) website met all 4 JAMA criteria. Mean DISCERN quality of information for OA websites was “fair,” compared with the “poor” grading of a 2003 study. HONcode-endorsed websites (43%, 16/37) were of a statistically significant higher quality. Conclusions: Readability of online health information for OA was either equal to or more difficult than the recommended level. %M 31538953 %R 10.2196/12855 %U https://www.i-jmr.org/2019/3/e12855 %U https://doi.org/10.2196/12855 %U http://www.ncbi.nlm.nih.gov/pubmed/31538953 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e13619 %T Influence of Enthusiastic Language on the Credibility of Health Information and the Trustworthiness of Science Communicators: Insights From a Between-Subject Web-Based Experiment %A König,Lars %A Jucks,Regina %+ Department of Psychology, University of Münster, Fliednerstraße 21, Münster, 48149, Germany, 49 2518323685, lars.koenig@uni-muenster.de %K health communication %K information seeking behavior %K trust %K language %K occupations %K deep learning %K FMRI %K source credibility %K persuasiveness %D 2019 %7 12.8.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: To decide whether online health information is reliable, information seekers apply 2 stretegies: first, information seekers can make credibility judgments by using their prior knowledge to evaluate the validity of the encountered health claim. Second, instead of evaluating the health claim itself, information seekers can make trustworthiness judgments by evaluating the character of the information source. In recent years, information givers from various professions have begun to use enthusiastic language to disseminate their information and persuade their audiences. Objective: To systematically explore this phenomenon, the goal of this study was to answer the following research questions: (1) does an enthusiastic language style, in comparison with a neutral language style, increase the trustworthiness of a person arguing in an online health forum and the credibility of his or her information? (2) does working for a university, in comparison with working for a lobbying organization, increase the trustworthiness of a person arguing in an online health forum and the credibility of his or her information? (3) does working for a university in combination with using an enthusiastic language style result in especially high trustworthiness and credibility ratings? Methods: In a 2x2 between-subject online experiment, 270 participants read a post from an online health forum and subsequently rated the trustworthiness of the forum post author and the credibility of his information. A total of 2 aspects of the forum post varied, namely the professional affiliation of the forum post author (whether the person introduced himself as a scientist or a lobbyist) and his language style (whether he used a neutral language style or an enthusiastic language style). Results: When the forum post author used an enthusiastic language style, he was perceived as more manipulative (P<.001), less knowledgeable (P<.001), and his information was perceived as less credible (P<.001). Overall, scientists were perceived as less manipulative (P=.04) than lobbyists. Furthermore, language style and professional affiliation interacted: When the forum post author was a lobbyist, language style did not affect integrity (P=.96) and benevolence (P=.79) ratings. However, when the forum post author was a scientist, enthusiastic language led to lower integrity (P=.002) and benevolence (P<.001) ratings than neutral language. Conclusions: The current findings illustrate that health information seekers do not just react to online health information itself. In addition, they are also sensitive to the ways in which health information is presented (“Which langue style is used to communicate health information?”) and who presents it (“Who does the health information source work for?”). %M 31411138 %R 10.2196/13619 %U http://www.i-jmr.org/2019/3/e13619/ %U https://doi.org/10.2196/13619 %U http://www.ncbi.nlm.nih.gov/pubmed/31411138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e11340 %T Users’ Experiences With Web-Based Health Care Information: Qualitative Study About Diabetes and Dementia Information Presented on a Governmental Website %A Wiegers,Therese Agnes %A Hendriks,Michelle %A Malanda,Uriëll %A de Boer,Dolf %+ Nivel, Otterstraat 118-124, 3513CR, Utrecht,, Netherlands, 33 30 2729 658, D.deBoer@nivel.nl %K patients %K qualitative research %K choice behavior %D 2019 %7 08.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Information on health and health care is abundant on the internet. To make informed choices, patients need reliable and easy-to-understand information about quality and availability of care providers and treatment options. However, the reliability of such Web-based information is difficult to assess. Objective: This study aimed to test Web-based information about diabetes and dementia and specifically a new presentation format of care routes to see if people are able to understand and use the information. Methods: Overall, 38 cognitive interviews were held; 20 people viewed the information about diabetes and 18 viewed the dementia information. Participants were asked what they would want to know about either diabetes or dementia, what choices they would want to make concerning their preferred care provider and treatment, and what information they would like to find to make these choices. They were then asked to view the relevant pages and comment on them. The interview was focused on general information about the condition, the care route, and the quality information for choosing a hospital. The interviews were transcribed verbatim and then systematically coded and ordered into themes. Results: The themes that were developed for both Web pages during the analysis were information needs, findability, usability, comprehension and readability, recognizability, care route, quality information, and usefulness. Information needs were found to be very diverse and dependent on the personal situation and condition of the participant. Several participants were unable to find specific items because they were not where they expected them to be. Most participants were positive about the layout, font, and color scheme of the test pages. However, options of clicking through to another website and indications where information can be expanded and collapsed could be made clearer. Participants generally found the information easy to understand but felt a need for a more detailed explanation of the medical terms. Recognition of the information played an important role: participants assessed whether the information they found matched their experiences. The term care route meant little to most of the participants, but the layout of the care route itself was found to be clear. Not many respondents spontaneously went to the quality information, and a number of participants had difficulty understanding it. Overall, the participants thought the information on the website was useful and helpful. Conclusions: The cognitive interviews gave numerous insights into how Web-based information is processed and understood. The care route offers a clear overview of the various stages as the condition progresses, but the name care route is not clear to everyone. We gained insight into differences between subgroups of people in terms of information needs, comprehension, and use of the information because the diversity within the group of participants was lower than expected. %M 31287066 %R 10.2196/11340 %U https://www.jmir.org/2019/7/e11340/ %U https://doi.org/10.2196/11340 %U http://www.ncbi.nlm.nih.gov/pubmed/31287066 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13987 %T Using the Extended Parallel Process Model to Examine the Nature and Impact of Breast Cancer Prevention Information on Mobile-Based Social Media: Content Analysis %A Chen,Liang %A Yang,Xiaodong %A Fu,Lunrui %A Liu,Xiaoming %A Yuan,Congyi %+ School of Journalism and Communication, Shandong University, No.57 Shanda South Road, Jinan, 250100, China, 86 531 88361159, XYANG012@e.ntu.edu.sg %K breast cancer %K prevention information %K mobile social media %K EPPM %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. Objective: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals’ engagement with the information, such as readings and likes. Methods: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. Results: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. Conclusions: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes. %M 31237239 %R 10.2196/13987 %U http://mhealth.jmir.org/2019/6/e13987/ %U https://doi.org/10.2196/13987 %U http://www.ncbi.nlm.nih.gov/pubmed/31237239 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12709 %T Promotion of Vape Tricks on YouTube: Content Analysis %A Kong,Grace %A LaVallee,Heather %A Rams,Alissa %A Ramamurthi,Divya %A Krishnan-Sarin,Suchitra %+ Yale School of Medicine, 34 Park St, New Haven, CT, 06519, United States, 1 2039747601, grace.kong@yale.edu %K e-cigarettes %K social media %K marketing %D 2019 %7 18.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The ability to perform vape tricks (ie, blowing large vapor clouds or shapes like rings) using e-cigarettes appeals to youth. Vape tricks are promoted on social media, but the promotion of vape tricks on social media is not well understood. Objective: The aim of this study was to examine how vape tricks were promoted on YouTube to youth. Methods: Videos on vape tricks that could be accessed by underage youth were identified. The videos were coded for number of views, likes, dislikes, and content (ie, description of vape tricks, e-cigarette devices used for this purpose, video sponsors [private or industry], brand marketing, and contextual characteristics [eg, model characteristics, music, and profanity]). Results: An analysis of 59 sample videos on vape tricks identified 25 distinct vape tricks. These videos had more likes than dislikes (11 to 1 ratio) and a 32,017 median view count. 48% (28/59) of the videos were posted by industry accounts (27% [16/59] provaping organizations, 15% [9/59] online shops, and 3% [2/59] vape shops) and 53% by private accounts (55% [17/31] private users, 26% [8/31] vape enthusiasts, and 19% [6/31] YouTube influencers); 53% (31/59) of the videos promoted a brand of e-cigarette devices, e-liquids, or online/vape shops, and 99% of the devices used for vape tricks were advanced generation devices. The models in the videos were 80.2% (160/198) male, 51.5% white (102/198), and 61.6% (122/198) aged 18 to 24 years; 85% (50/59) of the videos had electronic dance music and hip hop, and 32% (19/59) had profanity. Conclusions: Vape trick videos on YouTube, about half of which were industry sponsored, were accessible to youth. Restrictions of e-cigarette marketing on social media, such as YouTube, are needed. %M 31215510 %R 10.2196/12709 %U http://www.jmir.org/2019/6/e12709/ %U https://doi.org/10.2196/12709 %U http://www.ncbi.nlm.nih.gov/pubmed/31215510 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12524 %T Online Information About Periviable Birth: Quality Assessment %A Haragan,Adriane F %A Zuwiala,Carly A %A Himes,Katherine P %+ Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15228, United States, 1 412 973 2249, himekp@upmc.edu %K periviable birth %K patient education %K patient counseling %K Internet resources %D 2019 %7 7.6.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Over 20,000 parents in the United States face the challenge of participating in decisions about whether to use life support for their infants born on the cusp of viability every year. Clinicians must help families grasp complex medical information about their baby’s immediate prognosis as well as the risk for significant long-term morbidity. Patients faced with this decision want supplemental information and frequently seek medical information on the Internet. Empirical evidence about the quality of websites is lacking. Objective: We sought to evaluate the quality of online information available about periviable birth and treatment options for infants born at the cusp of viability. Methods: We read a counseling script to 20 pregnant participants that included information typically provided by perinatal and neonatal providers when periviable birth is imminent. The women were then asked to list terms they would use to search the Internet if they wanted additional information. Using these search terms, two reviewers evaluated the content of websites obtained via a Google search. We used two metrics to assess the quality of websites. The first was the DISCERN instrument, a validated questionnaire designed to assess the quality of patient-targeted health information for treatment choices. The second metric was the Essential Content Tool (ECT), a tool designed to address key components of counseling around periviable birth as outlined by professional organizations. DISCERN scores were classified as low quality if scores were 2, fair quality if scores were 3, and high quality if scores were 4 or higher. Scores of 6 or higher on the ECT were considered high quality. Interreviewer agreement was assessed by calculated kappa statistic. Results: A total of 97 websites were reviewed. Over half (57/97, 59%) were for-profit sites, news stories, or personal blogs; 28% (27/97) were government or medical sites; and 13% (13/97) were nonprofit or advocacy sites. The majority of sites scored poorly in DISCERN questions designed to assess the reliability of information presented as well as data regarding treatment choices. Only 7% (7/97) of the websites were high quality as defined by the DISCERN tool. The majority of sites did not address the essential content defined by the ECT. Importantly, only 18% of websites (17/97) indicated that there are often a number of reasonable approaches to newborn care when faced with periviable birth. Agreement was strong, with kappa ranging from .72 to .91. Conclusions: Most information about periviable birth found on the Internet using common search strategies is of low quality. News stories highlighting positive outcomes are disproportionately represented. Few websites discuss comfort care or how treatment decisions impact quality of life. %M 31518325 %R 10.2196/12524 %U http://pediatrics.jmir.org/2019/1/e12524/ %U https://doi.org/10.2196/12524 %U http://www.ncbi.nlm.nih.gov/pubmed/31518325 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13373 %T Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel %A Abed Elhadi Shahbari,Nour %A Gesser-Edelsburg,Anat %A Mesch,Gustavo S %+ School of Public Health, University of Haifa, 199 Aba Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 504847217, nabede01@campus.haifa.ac.il %K web-based health informational materials %K HPV vaccine %K Israel %K cultural sensitivity %K transparency %K sexuality %K quantitative analysis %K qualitative content analysis %K Hebrew and Arabic %D 2019 %7 17.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine’s safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture. %M 31102371 %R 10.2196/13373 %U http://www.jmir.org/2019/5/e13373/ %U https://doi.org/10.2196/13373 %U http://www.ncbi.nlm.nih.gov/pubmed/31102371 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13357 %T Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review %A Ferreira,Giovanni %A Traeger,Adrian C %A Machado,Gustavo %A O'Keeffe,Mary %A Maher,Christopher G %+ Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Level 10 North, King George V Building, Sydney, 2050, Australia, 61 0286279961, giovanni.ferreira@sydney.edu.au %K medical informatics %K low back pain %K patient portals %K systematic review %K consumer health information %D 2019 %7 07.05.2019 %9 Review %J J Med Internet Res %G English %X Background: Low back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations are an important source of health information for many people. However, the content of these websites regarding treatment recommendations for LBP has not been fully evaluated. Objective: This study aimed to determine the credibility, accuracy, and comprehensiveness of treatment recommendations for LBP in noncommercial, freely accessible websites. Methods: We conducted a systematic review of websites from government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations. We conducted searches on Google. Treatment recommendations were coded based on the 2016 National Institute for Health and Care Excellence (NICE) guidelines and the 2017 American College of Physicians guideline on LBP. Primary outcomes were credibility of the website (4-item Journal of the American Medical Association benchmark), accuracy (proportion of website treatment recommendations that were appropriate), and comprehensiveness of website treatment recommendations (proportion of guideline treatment recommendations that were appropriately covered by a website). Results: We included 79 websites from 6 English-speaking countries. In terms of credibility, 31% (25/79) of the websites clearly disclosed that they had been updated after the publication of the NICE guidelines. Only 43.28% (487/1125) website treatment recommendations were judged as accurate. Comprehensiveness of treatment recommendations correctly covered by websites was very low across all types of LBP. For acute LBP, an average of 28% (4/14) guideline recommendations were correctly covered by websites. Websites for radicular LBP were the least comprehensive, correctly covering an average of 16% (2.3/14) recommendations. Conclusions: Noncommercial freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness across all types of LBP. %M 31066689 %R 10.2196/13357 %U https://www.jmir.org/2019/5/e13357/ %U https://doi.org/10.2196/13357 %U http://www.ncbi.nlm.nih.gov/pubmed/31066689 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11620 %T Evaluation of Mobile Apps Targeted to Parents of Infants in the Neonatal Intensive Care Unit: Systematic App Review %A Richardson,Brianna %A Dol,Justine %A Rutledge,Kallen %A Monaghan,Joelle %A Orovec,Adele %A Howie,Katie %A Boates,Talia %A Smit,Michael %A Campbell-Yeo,Marsha %+ School of Nursing, Dalhousie University, PO Box 15000, Forrest Bldg, 5869 University Avenue, Halifax, NS, B3H4R2, Canada, 1 9024944283, marsha.campbell-yeo@dal.ca %K parenting %K intensive care units, neonatal %K review %K mobile health %K mHealth %K mobile apps %K eHealth %K education, nonprofessional %K infant, premature %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents of preterm infants increasingly use their mobile phone to search for health information. In a recent review, websites targeted toward parents with infants in the neonatal intensive care unit (NICU) were found to have poor to moderate quality educational material; however, there is a dearth of literature regarding mobile apps for NICU parents. Objective: This study aimed to identify and evaluate apps targeting parents of infants in the NICU for quality of information, usability, and credibility. Methods: We systematically searched the Apple App Store and Google Play using 49 key terms (eg, “preterm infant”) from July 26 to August 18, 2017. English apps targeting NICU parents that cost less than $20 were included. Apps for health care professionals, e-books/magazines, or nonrelevant results were excluded. In total, 3 tools were used for evaluation: Mobile Application Rating Scale (MARS) to measure quality; Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) to measure the app’s content usability; and Trust it or Trash It to measure credibility. Results: The initial search yielded 6579 apps, with 49 apps eligible after title and description screening. In total, 27 apps met the eligibility criteria with 9 apps available in both app stores; of those, the app with the most recent update date was chosen to be included in the analysis. Thus, 18 unique apps were included for final analysis. Using MARS, 7 apps (7/18, 39%) received a good score on overall quality (ie, 4.0 out of 5.0), with none receiving an excellent score. In addition, 8 apps (8/18, 44%) received a PEMAT-AV score between 51% and 75% on the understandability subscale, and 8 apps (8/18, 44%) scored between 76% and 100% on the actionability subscale. Trust It or Trash It deemed 13 apps (13/18, 72%) as trash for reasons including no identification of sources or lack of current information, with only 5 (5/18, 28%) deemed trustworthy. Reviewer’s expert evaluation found 16 apps contained content that matched information provided by multiple sources; however, most apps did not meet other objective measurement items to support credibility. When comparing the MARS overall quality and subjective quality scores with trustworthiness of apps, there was no statistically significant difference. A statistically significant difference was found between the 2 MARS quality scores, indicating that, on average, apps were ranked significantly lower on subjective quality compared with overall quality measures. Conclusions: This evaluation revealed that of the available apps targeting NICU parents, less than half should be considered as acceptable educational material. Over two-thirds of the apps were found to have issues regarding credibility and just over a quarter were considered good quality. The apps currently available for NICU parents are lacking and of concern in terms of quality and credibility. %M 30985282 %R 10.2196/11620 %U http://mhealth.jmir.org/2019/4/e11620/ %U https://doi.org/10.2196/11620 %U http://www.ncbi.nlm.nih.gov/pubmed/30985282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e10810 %T Searching for Information on the Risks of Combined Hormonal Contraceptives on the Internet: A Qualitative Study Across Six European Countries %A Gomes Alves,Paula %A Petersen,Irene %A Stevenson,Fiona %+ eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 02080168011 ext 68011, p.alves@ucl.ac.uk %K oral combined hormonal contraceptives %K venous thromboembolism %K risks %K information sources %K internet %K health information %K qualitative research %K content analysis %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Searching for health information online is increasingly common and is an obvious source of information about oral combined hormonal contraceptives (CHCs) and their risks. However, little is known about how publicly available websites address the risks of CHCs, particularly venous thromboembolism (VTE). Objective: The aim was to explore the information available to women about VTE and other risks of CHCs on websites available through commonly used search engines. Methods: A qualitative study was conducted to explore whether and how websites about CHCs in Denmark, Germany, Netherlands, Slovakia, Spain, and the United Kingdom make reference to VTE and other CHC risks. A systematic search procedure was adopted across the six countries, based on relevant keywords. The search was carried out using the Google search engine by fluent/native speakers of each language. A content analysis approach was conducted to extract information from the selected websites. Results: A total of 357 websites were reviewed. Nearly all (343/357, 96.1%) the websites mentioned VTE as a risk of CHCs, with approximately half referring to other side effects as well. One-fifth (92/357, 25.8%) of the websites provided suggestions about the best contraceptive method to use, and only a minority (23/357, 6.4%) recommended women discuss CHCs with their health professionals. Sites were generally run by the media (110/357 30.8%) or medical services from nongovernmental organizations (140/357, 39.2%). Only a minority of websites referred to organizations such as the European Medicines Agency (11/357, 3.1%). Conclusions: Despite the large number of websites containing information about oral CHCs and their risks, particularly VTE, only a limited number referred to information from accredited health agency sources. We argue this is a missed opportunity for accredited health agencies to share high-quality information to assist women using CHCs to make informed decisions about contraception. %M 30882358 %R 10.2196/10810 %U http://www.jmir.org/2019/3/e10810/ %U https://doi.org/10.2196/10810 %U http://www.ncbi.nlm.nih.gov/pubmed/30882358 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12450 %T Improving the Quality of Consumer Health Information on Wikipedia: Case Series %A Weiner,Shira Schecter %A Horbacewicz,Jill %A Rasberry,Lane %A Bensinger-Brody,Yocheved %+ Doctor of Physical Therapy Program, School of Health Science, Touro College, 320 W 31st Street, Physical Therapy Department, New York, NY,, United States, 1 212 463 0400 ext 55256, shira.weiner4@touro.edu %K consumer health information %K health literacy %K Wikipedia %K public health %K physical therapy education %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Wikipedia is one of the most consulted health resources in the world. Since the public is using health information from Wikipedia to make health care decisions, improving the quality of that health information is in the public interest. The open editable content design of Wikipedia and quality control processes in place provide an opportunity to add high-value, evidence-based information and take an active role in improving the health care information infrastructure. Objective: The aim of this project was to enhance Wikipedia health pages using high-quality, current research findings and track the persistence of those edits and number of page views after the changes to assess the reach of this initiative. Methods: We conducted Wikipedia Editathons with 3 different cohorts of Physical Therapy (PT) students to add high-quality health information to existing Wikipedia pages. Students synthesized best evidence information and updated and/or corrected existing Wikipedia entries on specific health pages. To evaluate the impact of these contributions, we examined two factors: (1) response to our contributions from the Wikipedia editing community, including number and type of subsequent edits as well as persistence of the student contributions and (2) number of page views by the public from the time of the page edits. Results: A total of 98 PT students in 3 different cohorts engaged in Editathons, editing 24 health pages. Of the 24 edits, 22 persisted at the end of the observation period (from time of entry to May 31, 2018) and received nearly 8 million page views. Each health page had an average of 354,724 page views. Conclusions: The Wikipedia Editathon is an effective way to continuously enhance the quality of health information available on Wikipedia. It is also an excellent way of bridging health technology with best-evidence medical facts and disseminating accurate, useful information to the public. %M 30882357 %R 10.2196/12450 %U https://www.jmir.org/2019/3/e12450/ %U https://doi.org/10.2196/12450 %U http://www.ncbi.nlm.nih.gov/pubmed/30882357 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e9838 %T Popular Nutrition-Related Mobile Apps: An Agreement Assessment Against a UK Reference Method %A Fallaize,Rosalind %A Zenun Franco,Rodrigo %A Pasang,Jennifer %A Hwang,Faustina %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 1183786418, j.a.lovegrove@reading.ac.uk %K weighed food records %K smartphone application %K dietary assessment %K diet apps %K nutrition apps %K diet records %K mobile applications %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nutrition-related apps are commonly used to provide information about the user’s dietary intake, but limited research has been performed to assess how well their outputs agree with those from standard methods. Objective: The objective of our study was to evaluate the level of agreement of popular nutrition-related apps for the assessment of energy and available macronutrients and micronutrients against a UK reference method. Methods: We compared dietary analysis of 24-hour weighed food records (n=20) between 5 nutrition-related apps (Samsung Health, MyFitnessPal, FatSecret, Noom Coach, and Lose It!) and Dietplan6 (reference method), using app versions available in the United Kingdom. We compared estimates of energy, macronutrients (carbohydrate, protein, fat, saturated fat, and fiber), and micronutrients (sodium, calcium, iron, vitamin A, and vitamin C) using paired t tests and Wilcoxon signed-rank tests, correlation coefficients, and Bland-Altman plots. We obtained 24-hour weighed food records from 20 participants (15 female, 5 male participants; mean age 36.3 years; mean body mass index 22.9 kg/m2) from previous controlled studies conducted at the Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading, UK. Participants had recorded their food consumption over a 24-hour period using standard protocols. Results: The difference in estimation of energy and saturated fat intake between Dietplan6 and the diet apps was not significant. Estimates of protein and sodium intake were significantly lower using Lose It! and FatSecret than using Dietplan6. Lose It! also gave significantly lower estimates for other reported outputs (carbohydrate, fat, fiber, and sodium) than did Dietplan6. Samsung Health and MyFitnessPal significantly underestimated calcium, iron, and vitamin C compared with Dietplan6, although there was no significant difference for vitamin A. We observed no other significant differences between Dietplan6 and the apps. Correlation coefficients ranged from r=–.12 for iron (Samsung Health vs Dietplan6) to r=.91 for protein (FatSecret vs Dietplan6). Noom Coach was limited to energy output, but it had a high correlation with Dietplan6 (r=.91). Samsung Health had the greatest variation of correlation, with energy at r=.79. Bland-Altman analysis revealed potential proportional bias for vitamin A. Conclusions: The findings suggest that the apps provide estimates of energy and saturated fat intake comparable with estimates by Dietplan6. With the exception of Lose It!, the apps also provided comparable estimates of carbohydrate, total fat, and fiber. FatSecret and Lose It! tended to underestimate protein and sodium. Estimates of micronutrient intake (calcium, iron, vitamin A, and vitamin C) by 2 apps (Samsung Health and MyFitnessPal) were inconsistent and less reliable. Lose It! was the app least comparable with Dietplan6. As the use and availability of apps grows, this study helps clinicians and researchers to make better-informed decisions about using these apps in research and practice. %M 30785409 %R 10.2196/mhealth.9838 %U http://mhealth.jmir.org/2019/2/e9838/ %U https://doi.org/10.2196/mhealth.9838 %U http://www.ncbi.nlm.nih.gov/pubmed/30785409 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 1 %P e11938 %T Evaluating Information Quality of Revised Patient Education Information on Colonoscopy: It Is New But Is It Improved? %A Bernstein,Matthew Tyler %A Kong,James %A Sriranjan,Vaelan %A Reisdorf,Sofia %A Restall,Gayle %A Walker,John Roger %A Singh,Harminder %+ Department of Clinical Health Psychology, University of Manitoba, M4-Street Boniface Hospital, 409 Tache Ave, Winnipeg, MB, R2H2A6, Canada, 1 2042936286, umbernsm@myumanitoba.ca %K colonoscopy %K evaluation methodology %K information science %K information dissemination %K information literacy %D 2019 %7 20.02.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Previous research indicates that patients and their families have many questions about colonoscopy that are not fully answered by existing resources. We developed revised forms on colonoscopy bowel preparation and on the procedure itself. Objective: As the goal of the revised materials is to have improved information relative to currently available information, we were interested in how revised information compared with what is currently available in terms of information quality and patient preference. Methods: Participants were asked to review one at a time the Revised and Current versions of Colonoscopy bowel preparation instructions (study 1) and About Colonoscopy (study 2). The order of administration of the Revised and Current versions was randomly counterbalanced to assess order effects. Respondents rated each form along the following dimensions: amount, clarity, trustworthiness, readability and understandability, how new or familiar the information was, and reassurance. Participants were asked which form they preferred and 4 questions about why they preferred it. Open-ended questions asked participants to describe likes and dislikes of the forms and suggestions for improvement. Results: The study 1 and study 2 samples were similar. Overall, in study 1, 62.4% preferred the Revised form, 28.1% preferred the Current form, and 6.7% were not sure. Overall, in study 2, 50.5% preferred the Revised form, 31.1% preferred the Current form, and 18.4% were not sure. Almost 75% of those in study 1 who received the Revised form first, preferred it, compared with less than half of those who received it first in study 2. In study 1, 75% of those without previous colonoscopy experience preferred the Revised form, compared with more than half of those who had previously undergone a colonoscopy. The study 1 logistic regression analysis demonstrated that participants were more likely to prefer the Revised form if they had viewed it first and had no previous experience with colonoscopy. In study 2, none of the variables assessed were associated with a preference for the Revised form. In comparing the 2 forms head-to-head, participants who preferred the Revised form in study 1 rated it as clearer compared with those who preferred the Current form. Finally, many participants who preferred the Revised form indicated in the open-ended questions that they liked it because it had more information than the Current form and that it had good visual information. Conclusions: This study is one of the first to evaluate 2 different patient education resources in a head-to-head comparison using the same participants in a within-subjects design. This approach was useful in comparing revised educational information with current resources. Moving forward, this knowledge translation approach of a head-to-head comparison of 2 different information sources could be taken to develop and refine information sources on other health issues. %M 30785412 %R 10.2196/11938 %U http://www.i-jmr.org/2019/1/e11938/ %U https://doi.org/10.2196/11938 %U http://www.ncbi.nlm.nih.gov/pubmed/30785412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11129 %T Evaluating the Quality of Health Information in a Changing Digital Ecosystem %A Keselman,Alla %A Arnott Smith,Catherine %A Murcko,Anita C %A Kaufman,David R %+ Division of Specialized Information Services, National Library of Medicine, National Institutes of Health, 6707 Democracy Boulevard, Bethesda, MD, MSC 5467, United States, 1 301 827 5671, allagkeselman@gmail.com %K eHealth %K eHealth literacy %K type 2 diabetes mellitus %K consumer health information %K health literacy %K information evaluation %K information quality %K information literacy %D 2019 %7 08.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Critical evaluation of online health information has always been central to consumer health informatics. However, with the emergence of new Web media platforms and the ubiquity of social media, the issue has taken on a new dimension and urgency. At the same time, many established existing information quality evaluation guidelines address information characteristics other than the content (eg, authority and currency), target information creators rather than users as their main audience, or do not address information presented via novel Web technologies. Objective: The aim of this formative study was to (1) develop a methodological approach for analyzing health-related Web pages and (2) apply it to a set of relevant Web pages. Methods: This qualitative study analyzed 25 type 2 diabetes pages, which were derived from the results of a Google search with the keywords “diabetes,” “reversal,” and “natural.” The coding scheme, developed via a combination of theory- and data-driven approaches, includes 5 categories from existing guidelines (resource type, information authority, validity of background information sources, objectivity, and currency) and 7 novel categories (treatment or reversal method, promises and certainty, criticisms of establishment, emotional appeal, vocabulary, rhetoric and presentation, and use of science in argumentation). The coding involves both categorical judgment and in-depth narrative characterization. On establishing satisfactory level of agreement on the narrative coding, the team coded the complete dataset of 25 pages. Results: The results set included “traditional” static pages, videos, and digitized versions of printed newspapers or magazine articles. Treatments proposed by the pages included a mixture of conventional evidence-based treatments (eg, healthy balanced diet exercise) and unconventional treatments (eg, dietary supplements, optimizing gut flora). Most pages either promised or strongly implied high likelihood of complete recovery. Pages varied greatly with respect to the authors’ stated background and credentials as well as the information sources they referenced or mentioned. The majority included criticisms of the traditional health care establishment. Many sold commercial products ranging from dietary supplements to books. The pages frequently used colloquial language. A significant number included emotional personal anecdotes, made positive mentions of the word cure, and included references to nature as a positive healing force. Most pages presented some biological explanations of their proposed treatments. Some of the explanations involved the level of complexity well beyond the level of an educated layperson. Conclusions: Both traditional and data-driven categories of codes used in this work yielded insights about the resources and highlighted challenges faced by their users. This exploratory study underscores the challenges of consumer health information seeking and the importance of developing support tools that would help users seek, evaluate, and analyze information in the changing digital ecosystem. %M 30735144 %R 10.2196/11129 %U https://www.jmir.org/2019/2/e11129/ %U https://doi.org/10.2196/11129 %U http://www.ncbi.nlm.nih.gov/pubmed/30735144 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10986 %T Consumer Health Search on the Web: Study of Web Page Understandability and Its Integration in Ranking Algorithms %A Palotti,Joao %A Zuccon,Guido %A Hanbury,Allan %+ Institute for Information Systems Engineering, Technische Universität Wien, Favoritenstraße 9-11/194 04, Vienna, 1040, Austria, 43 158801188310, allan.hanbury@tuwien.ac.at %K readability %K literacy %K comprehension %K patients %K machine learning %D 2019 %7 30.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Understandability plays a key role in ensuring that people accessing health information are capable of gaining insights that can assist them with their health concerns and choices. The access to unclear or misleading information has been shown to negatively impact the health decisions of the general public. Objective: The aim of this study was to investigate methods to estimate the understandability of health Web pages and use these to improve the retrieval of information for people seeking health advice on the Web. Methods: Our investigation considered methods to automatically estimate the understandability of health information in Web pages, and it provided a thorough evaluation of these methods using human assessments as well as an analysis of preprocessing factors affecting understandability estimations and associated pitfalls. Furthermore, lessons learned for estimating Web page understandability were applied to the construction of retrieval methods, with specific attention to retrieving information understandable by the general public. Results: We found that machine learning techniques were more suitable to estimate health Web page understandability than traditional readability formulae, which are often used as guidelines and benchmark by health information providers on the Web (larger difference found for Pearson correlation of .602 using gradient boosting regressor compared with .438 using Simple Measure of Gobbledygook Index with the Conference and Labs of the Evaluation Forum eHealth 2015 collection). Conclusions: The findings reported in this paper are important for specialized search services tailored to support the general public in seeking health advice on the Web, as they document and empirically validate state-of-the-art techniques and settings for this domain application. %M 30698536 %R 10.2196/10986 %U http://www.jmir.org/2019/1/e10986/ %U https://doi.org/10.2196/10986 %U http://www.ncbi.nlm.nih.gov/pubmed/30698536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11429 %T The Most Influential Medical Journals According to Wikipedia: Quantitative Analysis %A Jemielniak,Dariusz %A Masukume,Gwinyai %A Wilamowski,Maciej %+ Department of Management in Networked and Digital Societies, Kozminski University, Jagiellonska 59, Warszawa, 03301, Poland, 48 604901352, darekj@kozminski.edu.pl %K citizen science %K medical journals %K open knowledge %K Wikipedia %K knowledge translation %K journalology %K medical publishing %K scholarly publishing %D 2019 %7 18.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Wikipedia, the multilingual encyclopedia, was founded in 2001 and is the world’s largest and most visited online general reference website. It is widely used by health care professionals and students. The inclusion of journal articles in Wikipedia is of scholarly interest, but the time taken for a journal article to be included in Wikipedia, from the moment of its publication to its incorporation into Wikipedia, is unclear. Objective: We aimed to determine the ranking of the most cited journals by their representation in the English-language medical pages of Wikipedia. In addition, we evaluated the number of days between publication of journal articles and their citation in Wikipedia medical pages, treating this measure as a proxy for the information-diffusion rate. Methods: We retrieved the dates when articles were included in Wikipedia and the date of journal publication from Crossref by using an application programming interface. Results: From 11,325 Wikipedia medical articles, we identified citations to 137,889 journal articles from over 15,000 journals. There was a large spike in the number of journal articles published in or after 2002 that were cited by Wikipedia. The higher the importance of a Wikipedia article, the higher was the mean number of journal citations it contained (top article, 48.13 [SD 33.67]; lowest article, 6.44 [SD 9.33]). However, the importance of the Wikipedia article did not affect the speed of reference addition. The Cochrane Database of Systematic Reviews was the most cited journal by Wikipedia, followed by The New England Journal of Medicine and The Lancet. The multidisciplinary journals Nature, Science, and the Proceedings of the National Academy of Sciences were among the top 10 journals with the highest Wikipedia medical article citations. For the top biomedical journal papers cited in Wikipedia's medical pages in 2016-2017, it took about 90 days (3 months) for the citation to be used in Wikipedia. Conclusions: We found evidence of “recentism,” which refers to preferential citation of recently published journal articles in Wikipedia. Traditional high-impact medical and multidisciplinary journals were extensively cited by Wikipedia, suggesting that Wikipedia medical articles have robust underpinnings. In keeping with the Wikipedia policy of citing reviews/secondary sources in preference to primary sources, the Cochrane Database of Systematic Reviews was the most referenced journal. %M 30664451 %R 10.2196/11429 %U http://www.jmir.org/2019/1/e11429/ %U https://doi.org/10.2196/11429 %U http://www.ncbi.nlm.nih.gov/pubmed/30664451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11935 %T The Absence of Evidence is Evidence of Non-Sense: Cross-Sectional Study on the Quality of Psoriasis-Related Videos on YouTube and Their Reception by Health Seekers %A Mueller,Simon M %A Jungo,Pierre %A Cajacob,Lucian %A Schwegler,Simon %A Itin,Peter %A Brandt,Oliver %+ Department of Dermatology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland, 41 61 328 69 64, simon.mueller@usb.ch %K psoriasis %K YouTube videos %K layperson %K poor quality %K misleading information %K dangerous content %D 2019 %7 16.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately 80% of internet users access health information online and patients with chronic illnesses especially rely on internet-based resources. YouTube ranks second among the most accessed websites worldwide and hosts an increasing number of videos with medical information. However, their quality is sometimes unscientific, misleading, or even harmful. Objective: As little is known about YouTube as a source of information on psoriasis, we aimed to investigate the quality of psoriasis-related videos and, if necessary, point out strategies for their improvement. Methods: The quality of the 100 most viewed psoriasis-related videos was assessed using the DISCERN instrument and the Global Quality Scale (GQS) by categorizing the videos into useful, misleading, and dangerous and by evaluating the reception of the videos by users. Results: Evaluation of the videos exhibited a total of 117,221,391 views and a total duration of 10:28 hour. The majority of clips contained anecdotal personal experiences with complementary and alternative psoriasis treatments, topical treatments, and nutrition and diets being the most frequently addressed topics. While advertisements accounted for 26.0% (26/100) of the videos, evidence-based health information amounted to only 20.0% (20/100); 32.0% (32/100) of the videos were classified as useful, 52.0% (52/100) as misleading, and 11.0% (11/100) as even dangerous. The quality of the videos evaluated by DISCERN and GQS was generally low (1.87 and 1.95, respectively, on a 1 to 5 scale with 5 being the maximum). Moreover, we found that viewers rated poor-quality videos better than higher quality videos. Conclusions: Our in-depth study demonstrates that nearly two-thirds of the psoriasis-related videos we analyzed disseminate misleading or even dangerous content. Subjective anecdotal and unscientific content is disproportionately overrepresented and poor-quality videos are predominantly rated positively by users, while higher quality video clips receive less positive ratings. Strategies by professional dermatological organizations are urgently needed to improve the quality of information on psoriasis on YouTube and other social media. %M 30664460 %R 10.2196/11935 %U http://www.jmir.org/2019/1/e11935/ %U https://doi.org/10.2196/11935 %U http://www.ncbi.nlm.nih.gov/pubmed/30664460 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 1 %P e10050 %T Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations %A Beckett,Jeffrey M %A Bird,Marie-Louise %A Pittaway,Jane K %A Ahuja,Kiran DK %+ School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, 7250, Australia, 61 3 6324 5478, Kiran.Ahuja@utas.edu.au %K multiple sclerosis %K diet %K evidence-based medicine %K internet %D 2019 %7 09.01.2019 %9 Review %J Interact J Med Res %G English %X Background: There is currently no scientific evidence supporting the use of specific diets in the management of multiple sclerosis (MS); the strongest dietary associations are observed with vitamin D and omega-3 fatty acid supplementation. Despite this, there are many websites that provide advice or suggestions about using various dietary approaches to control symptoms or disease progression. Objective: The objective of this study was to assess the dietary advice for the symptomatic management of MS available on the internet. Methods: This study was a systematic review of webpages that provided dietary advice for the management of MS. Webpages were selected from an internet search conducted in November 2016 using Google, Yahoo, and Bing search engines and the search term “MS diet.” The first two pages of results from each search engine were included for the initial assessment. Duplicates were removed. Data extracted from websites included specific advice relating to diet and its rationale and the citation of supporting scientific literature. Authorship and credential information were reviewed to assess webpage quality. Results: We included 32 webpages in the final assessment. The webpages made a wide variety of specific recommendations regarding dietary patterns and individual foods to help manage MS. The most common dietary pattern advised on these webpages was the low-fat, high-fiber balanced diet, followed by the low-saturated fat diet, near-vegetarian Swank diet, and the Paleo diet. The main categories of individual foods or nutrients suggested for addition to the diet were: supplements (especially omega-3 and vitamin D), fruits, vegetables, and lean protein. In contrast, the most commonly recommended for removal were saturated fats, dairy, gluten-containing grains, and refined sugar. These recommendations were often accompanied by rationale relating to how the particular food or nutrient may affect the development, prevalence and symptoms of MS; however, very little of this information is supported by the current scientific evidence between diet and MS. Only 9 webpages provided full authorship including credential information. Conclusions: There is a wide variety of Web-based dietary advice, which in some cases is contradictory. In most cases, this advice is the result of peoples’ individual experiences and has not been scientifically tested. How people living with MS use this information is not known. These findings highlight the important role health professionals can play in assisting people living with MS in their health information-seeking behaviors. %M 30626570 %R 10.2196/10050 %U https://www.i-jmr.org/2019/1/e10050/ %U https://doi.org/10.2196/10050 %U http://www.ncbi.nlm.nih.gov/pubmed/30626570 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e10282 %T Investigating the Role of Communication for Information Seekers’ Trust-Related Evaluations of Health Videos on the Web: Content Analysis, Survey Data, and Experiment %A Zimmermann,Maria %A Jucks,Regina %+ Department of Psychology and Sport Science, Institute for Psychology in Education, Fliedner Straße 21, Münster,, Germany, 49 251 8339482, maria.zimmermann@uni-muenster.de %K trust %K health communication %K social media %K information-seeking behavior %K language %D 2018 %7 21.12.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: According to the language expectancy theory and the communication accommodation theory, health information seekers’ trust evaluations of Web-based videos are determined by interplays between content and seekers’ expectations on vloggers’ appropriate language use in specific contexts of Web-based communication. Objectives: Two investigations focused on differences both between vloggers’ language styles and between users’ general trust in specific Web-based platforms to investigate how the context of Web-based communication can be characterized (research question, RQ1). Thereafter, we investigated whether information uncertainty, vloggers’ language style, and context of Web-based communication affect seekers’ trust evaluations of videos (RQ2). Methods: With a content analysis of 36 health videos from YouTube and Vimeo, we examined the extent of trust-related linguistic characteristics (ie, first-person and second-person pronouns). Additionally, we surveyed participants (n=151) on their trust in YouTube and Moodle (academic Web-based platform; RQ1). In an experiment, further participants (n=124) watched a video about nutrition myths and were asked to evaluate the information credibility, vloggers’ trustworthiness, and accommodation of language by vloggers (RQ2). Following a 3 × 2 × 2 mixed design, vloggers’ explanations contained unambiguous (confirming or disconfirming) or ambiguous (neither confirming nor disconfirming) evidence on the myths (within factor). Furthermore, vloggers used YouTube-typical language (many first-person pronouns) or formal language (no first-person pronouns), and videos were presented on YouTube or Moodle (between factors). Results: The content analysis revealed that videos on YouTube contained more first-person pronouns than on Vimeo (F1,35=4.64; P=.04; ηp2=0.12), but no more second-person pronouns (F1,35=1.23; P=.23). Furthermore, when asked about their trust in YouTube or Moodle, participants trusted YouTube more than Moodle (t150≤−9.63; all P ≤.001). In the experiment, participants evaluated information to be more credible when information contained unambiguous rather than ambiguous evidence (F2,116=9.109; P<.001; ηp2=0.14). Unexpectedly, information credibility did not depend on vloggers’ language style or the video platform (F1,117≤2.40; P ≥.06). Likewise, video’s platform did not affect participants’ evaluations of vloggers’trustworthiness (F1,117<0.18; P>.34). However, participants judged vloggers who used a YouTube-typical language as being more benevolent, and their language use as being more appropriate in both video platforms (F1,117≥3.41; P ≤.03; ηp2≥0.028). Moreover, participants rated the YouTube-typical (vs formal) language as more appropriate for Moodle, but they did not rate one or the other language style as more appropriate for YouTube (F1,117=5.40; P=.01; ηp2=0.04). Conclusions: This study shows that among specific Web-based contexts, users’ typical language use can differ, as can their trust-related evaluations. In addition, health information seekers seem to be affected by providers’ language styles in ways that depend on the Web-based communication context. Accordingly, further investigations that would identify concrete interplays between language style and communication context might help providers to understand whether additional information would help or hurt seekers’ ability to accurately evaluate information. %M 30578181 %R 10.2196/10282 %U http://www.i-jmr.org/2018/2/e10282/ %U https://doi.org/10.2196/10282 %U http://www.ncbi.nlm.nih.gov/pubmed/30578181 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10031 %T Reliability of Cancer Treatment Information on the Internet: Observational Study %A Ogasawara,Ryo %A Katsumata,Noriyuki %A Toyooka,Tatsushi %A Akaishi,Yuko %A Yokoyama,Takaaki %A Kadokura,Gemmu %+ Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugi-machi, Nakahara-ku, Kawasaki City, 211-8533, Japan, 81 44 733 5181 ext 3040, nkatsuma@nms.ac.jp %K internet %K cancer treatment %K clinical practice guideline %K mobile phone %D 2018 %7 17.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Finding the correct medical information in a flood of information from the internet is a significant issue for patients with cancer. Objective: We investigated the reliability of the information on cancer treatment methods available on the internet based on an evaluation by medical oncologists, medical students, and cancer survivors. Methods: Using Google and Yahoo as the search engines, we carried out the information search using 2 keywords, “cancer treatment” and “cancer cure,” and the top 20 information sites were identified. A similar search was conducted on 5 types of cancer. The reliability of the information presented was rated on a 3-level scale (A, B, or C). Level A referred to reliable sites (providing information complying with the clinical practice guidelines for various types of cancer), Level B included sites not falling under either Level A or Level C, and Level C comprised dangerous or harmful sites (providing information on treatment not approved by the regulatory authority in Japan and bombastic advertisements without any relevant clinical evidence). The evaluation was conducted by medical oncologists, medical students, and cancer survivors. The consistency of the information reliability level rating between the medical students or cancer survivors with that of the medical oncologists was assessed by using the kappa value. Results: A total of 247 sites were evaluated for reliability. The ratings provided by the medical students’ group were as follows: Level A, 12.1% (30/247); Level B, 56.3% (139/247); and Level C, 31.6% (78/247). The ratings provided by the cancer survivors’ group were as follows: Level A, 16.8% (41/244); Level B, 44.7% (109/244); and Level C, 38.5% (94/244). The ratings provided by the oncologists’ group were as follows: Level A, 10.1% (25/247); Level B, 51.4% (127/247); and Level C, 38.5% (95/247). The intergroup rating consistency between the medical students’ group and oncologists’ group was 87.4% (216/247, kappa=0.77) and that between the cancer survivors’ group and oncologists’ group was 76.2% (186/244, kappa=0.61). Conclusions: Of the investigated sites providing information on cancer treatment on the internet, the percentage of sites that seemed to provide harmful information was much higher than that of sites providing reliable information. The reliability level rating was highly consistent between the medical students’ group and the medical oncologists’ group and also between the cancer survivors’ group and the medical oncologists’ group. %M 30559090 %R 10.2196/10031 %U http://cancer.jmir.org/2018/2/e10031/ %U https://doi.org/10.2196/10031 %U http://www.ncbi.nlm.nih.gov/pubmed/30559090 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10676 %T Exploring the Most Visible German Websites on Melanoma Immunotherapy: A Web-Based Analysis %A Brütting,Julia %A Steeb,Theresa %A Reinhardt,Lydia %A Berking,Carola %A Meier,Friedegund %+ Department of Dermatology, Dresden University Hospital and Medical Faculty Carl Gustav Carus, Technical University of Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 176 207 896 27, julia.bruetting@uniklinikum-dresden.de %K melanoma %K immunotherapy %K internet %K patient education %K quality %K readability %K websites %K reliability %K information %D 2018 %7 13.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients diagnosed with melanoma frequently search the internet for treatment information, including novel and complex immunotherapy. However, health literacy is limited among half of the German population, and no assessment of websites on melanoma treatment has been performed so far. Objective: The aim of this study was to identify and assess the most visible websites in German language on melanoma immunotherapy. Methods: In accordance with the common Web-based information-seeking behavior of patients with cancer, the first 20 hits on Google, Yahoo, and Bing were searched for combinations of German synonyms for “melanoma” and “immunotherapy” in July 2017. Websites that met our predefined eligibility criteria were considered for assessment. Three reviewers independently assessed their quality by using the established DISCERN tool and by checking the presence of quality certification. Usability and reliability were evaluated by the LIDA tool and understandability by the Patient Education Materials Assessment Tool (PEMAT). The Flesch Reading Ease Score (FRES) was calculated to estimate the readability. The ALEXA and SISTRIX tools were used to investigate the websites’ popularity and visibility. The interrater agreement was determined by calculating Cronbach alpha. Subgroup differences were identified by t test, U test, or one-way analysis of variance. Results: Of 480 hits, 45 single websites from 30 domains were assessed. Only 2 website domains displayed a German quality certification. The average assessment scores, mean (SD), were as follows: DISCERN, 48 (7.6); LIDA (usability), 40 (2.0); LIDA (reliability), 10 (1.6); PEMAT, 69% (16%); and FRES, 17 (14), indicating mediocre quality, good usability, and understandability but low reliability and an even very low readability of the included individual websites. SISTRIX scores ranged from 0 to 6872 and ALEXA scores ranged from 17 to 192,675, indicating heterogeneity of the visibility and popularity of German website domains providing information on melanoma immunotherapy. Conclusions: Optimization of the most accessible German websites on melanoma immunotherapy is desirable. Especially, simplification of the readability of information and further adaption to reliability criteria are required to support the education of patients with melanoma and laypersons, and to enhance transparency. %M 30545808 %R 10.2196/10676 %U https://cancer.jmir.org/2018/2/e10676/ %U https://doi.org/10.2196/10676 %U http://www.ncbi.nlm.nih.gov/pubmed/30545808 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 2 %P e11358 %T Quality of Medical Advice Provided Between Members of a Web-Based Message Board for Patients With Implantable Defibrillators: Mixed-Methods Study %A Knoepke,Christopher E %A Slack,D Hogan %A Ingle,M Pilar %A Matlock,Daniel D %A Marzec,Lucas N %+ Division of Cardiology, School of Medicine, University of Colorado, Room 210-17, 13199 East Montview Boulevard, Denver, CO, 80045, United States, 1 7196605540, christopher.knoepke@ucdenver.edu %K education of patients %K information sharing %K implantable cardioverter-defibrillator, data accuracy %D 2018 %7 04.12.2018 %9 Short Paper %J JMIR Cardio %G English %X Background: Patients use Web-based medical information to understand medical conditions and treatments. A number of efforts have been made to understand the quality of professionally created content; however, none have described the quality of advice being provided between anonymous members of Web-based message boards. Objective: The objective of this study was to characterize the quality of medical information provided between members of an anonymous internet message board addressing treatment with an implantable cardioverter-defibrillator (ICD). Methods: We quantitatively analyzed 2 years of discussions using a mixed inductive-deductive framework, first, for instances in which members provided medical advice and, then, for the quality of the advice. Results: We identified 82 instances of medical advice within 127 discussions. Advice covered 6 topical areas: (1) Device information, (2) Programming, (3) Cardiovascular disease, (4) Lead management, (5) Activity restriction, and (6) Management of other conditions. Across all advice, 50% (41/82) was deemed generally appropriate, 24% (20/82) inappropriate for most patients, 6% (5/82) controversial, and 20% (16/82) without sufficient context. Proportions of quality categories varied between topical areas. We have included representative examples. Conclusions: The quality of advice shared between anonymous members of a message board regarding ICDs varied considerably according to topical area and the specificity of advice. This report provides a model to describe the quality of the available Web-based patient-generated material. %M 31758775 %R 10.2196/11358 %U http://cardio.jmir.org/2018/2/e11358/ %U https://doi.org/10.2196/11358 %U http://www.ncbi.nlm.nih.gov/pubmed/31758775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e11515 %T Nature and Diffusion of Gynecologic Cancer–Related Misinformation on Social Media: Analysis of Tweets %A Chen,Liang %A Wang,Xiaohui %A Peng,Tai-Quan %+ Department of Communication, Michigan State University, 404 Wilson Road, Room 473, East Lansing, MI, 48824, United States, 1 5173550221, pengtaiq@msu.edu %K social media %K breast cancer %K cervical cancer %K misinformation %K diffusion %K China %D 2018 %7 16.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the last two decades, the incidence and mortality rates of gynecologic cancers have increased at a constant rate in China. Gynecologic cancers have become one of the most serious threats to women’s health in China. With the widespread use of social media, an increasing number of individuals have employed social media to produce, seek, and share cancer-related information. However, health information on social media is not always accurate. Health, and especially cancer-related, misinformation has been widely spread on social media, which can affect individuals’ attitudinal and behavioral responses to cancer. Objective: The aim of this study was to examine the nature and diffusion of gynecologic cancer–related misinformation on Weibo, the Chinese equivalent of Twitter. Methods: A total of 2691 tweets related to 2 gynecologic cancers—breast cancer and cervical cancer—posted on Weibo from June 2015 to June 2016 were extracted using the Python Web Crawler. Two medical school graduate students with expertise in gynecologic diseases were recruited to code the tweets to differentiate between true information and misinformation as well as to identify the types of falsehoods. The diffusion characteristics of gynecologic cancer–related misinformation were compared with those of the true information. Results: While most of the gynecologic cancer–related tweets provided medically accurate information, approximately 30% of them were found to contain misinformation. Furthermore, it was found that tweets about cancer treatment contained a higher percentage of misinformation than prevention-related tweets. Nevertheless, the prevention-related misinformation diffused significantly more broadly and deeply than true information on social media. Conclusions: The findings of this study suggest the need for controlling and reducing the cancer-related misinformation on social media with the efforts from both service providers and medical professionals. More specifically, it is important to correct falsehoods related to the prevention of gynecologic cancers on social media and increase individuals’ capacity to assess the veracity of Web-based information to curb the spread and thus minimize the consequences of cancer-related misinformation. %M 30327289 %R 10.2196/11515 %U http://www.jmir.org/2018/10/e11515/ %U https://doi.org/10.2196/11515 %U http://www.ncbi.nlm.nih.gov/pubmed/30327289 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e11384 %T Quality of HIV Websites With Information About Pre-Exposure Prophylaxis or Treatment as Prevention for Men Who Have Sex With Men: Systematic Evaluation %A Silverman,Taylor %A Asante,Nicole %A van den Berg,Jacob J %+ Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, United States, 1 401 863 7566, jacob_vandenberg@brown.edu %K pre-exposure prophylaxis %K treatment as prevention %K sexual and gender minorities %K telemedicine %K African Americans %K Hispanic Americans %K HIV %D 2018 %7 16.10.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Knowledge and uptake of high-efficacy HIV prevention strategies such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) remain low among men who have sex with men (MSM) who are at the highest risk for HIV infection in the United States. Electronic health (eHealth) interventions are promising tools for disseminating information about these critical yet underutilized strategies and addressing key barriers to uptake among target populations. However, existing HIV prevention websites are understudied and unevaluated. Objective: This study aimed to systematically review and evaluate existing HIV websites that include information about PrEP or TasP for MSM. Methods: From March 2018 to May 2018, 2 trained research assistants (RAs) entered relevant key words and phrases into 3 commonly used search engines and applied exclusion criteria to all returned results to identify 31 websites included in this review. RAs independently scored each website for authority, usability, interactivity, and PrEP/TasP-related content based on a standardized rating scale and then averaged the results. Results: No website received a perfect score in any of the 4 categories, and the average website score was 62% (37/60). Less than a quarter of the websites (23%, 7/31) received a score of more than 75% (7.5/10) for content. Approximately two-thirds of the websites (65%, 20/31) received a score of 50% (5/10) or lower for interactivity. The average score in usability was 68% (6.8/10) and in authority was 69% (6.9/10). Other deficiencies observed included difficulty locating relevant content and lack of information targeting audiences with the highest likelihood of HIV infection. Conclusions: Existing HIV prevention websites with information about PrEP or TasP for MSM fail to provide adequate content as well as present that content to users in an interactive and audience-conscious way. Future eHealth interventions should attempt to rectify these deficiencies to successfully engage and educate MSM at high risk for HIV regarding prevention strategies. %M 30327291 %R 10.2196/11384 %U http://publichealth.jmir.org/2018/4/e11384/ %U https://doi.org/10.2196/11384 %U http://www.ncbi.nlm.nih.gov/pubmed/30327291 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e14 %T Characterizing Websites That Provide Information About Complementary and Integrative Health: Systematic Search and Evaluation of Five Domains %A Chen,Annie T %A Taylor-Swanson,Lisa %A Buie,Ronald W %A Park,Albert %A Conway,Mike %+ Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, 850 Republican Street, Box 358047, C238, UW Medicine South Lake Union, Seattle, WA, 98109, United States, 1 2062219218, atchen@uw.edu %K complementary and integrative health %K online information quality %K website quality %K website content %K acupuncture %K massage %K homeopathy %K reiki %K yoga %D 2018 %7 10.10.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: In recent years, there has been an increase in the utilization of complementary and integrative health (CIH) care, and an increase in information-seeking behavior focused on CIH. Thus, understanding the quality of CIH information that is available on the internet is imperative. Although there have been a limited number of studies evaluating the quality of websites providing information about specific CIH-related topics, a broad evaluation of CIH websites has not been conducted. Objective: This study was designed to fill that gap. We set out to assess website quality in 5 CIH domains: (1) acupuncture, (2) homeopathy, (3) massage, (4) reiki, and (5) yoga. This study aimed to 1) characterize the websites by type and quality; 2) evaluate website characteristics which may affect readers’ perceptions, specifically message content, structural features, and presentation style, and 3) investigate the extent to which harms, benefits and purposes of use are stated on websites. Methods: This study employed a systematic search strategy to identify websites in each of the target domains to be evaluated. The websites were then classified by type, and a set of checklists focusing on quality, message content, structural features, and presentation style was used to evaluate the websites. Lastly, we performed content analysis to identify harms, benefits, and perceived purposes of use. Results: There were similarities across domains regarding their overall quality and their message content. Across all domains, a high proportion of websites received strong scores in terms of ownership, currency, interactivity and navigability. Scores were more variable concerning authorship, balanced presentation of information and the use of sources of information. However, there were differences regarding their structural features and presentation style. Acupuncture and reiki sites tended to include more external links, and yoga, fewer. There was variation across domains in the extent to which the websites contained domain-specific terminology. Websites tended to provide an extensive list of potential benefits, while reporting of harms was scarce. Conclusions: This is the first study to perform a multidimensional assessment of websites in multiple CIH domains. This review showed that while there are similarities among websites of different CIH domains, there are also differences. The diverse distribution of website types suggests that, regardless of CIH domain, the public encounters information through many different types of media, and it would be useful to consider how the presentation of this content may differ depending on the medium. The characteristics for which variability exist are areas that warrant greater attention from researchers, policy makers, clinicians and patients. There is also a need to better understand how individuals may interact with CIH websites, and to develop tools to assist people to interpret the CIH-related information that they encounter. %M 30305254 %R 10.2196/ijmr.9803 %U http://www.i-jmr.org/2018/2/e14/ %U https://doi.org/10.2196/ijmr.9803 %U http://www.ncbi.nlm.nih.gov/pubmed/30305254 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e15 %T Health Information Discrepancies Between Internet Media and Scientific Papers Reporting on Omega-3 Supplement Research: Comparative Analysis %A Nault,Daryl %A Beccia,Ariel %A Ito,Haruka %A Kashdan,Sarah %A Senders,Angela %+ Helfgott Research Institute, School of Research and Graduate Studies, National University of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201, United States, 1 971 704 1172, dnault@muih.edu %K consumer health information %K health literacy %K health communication %K health promotion %K evidence-based practice %K dietary supplements %K omega-3 fatty acids %K journalism %D 2018 %7 01.10.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Dietary supplements are the most used complementary and alternative health modality in the United States, and omega-3 supplements continue to be the most popularly used nonvitamin or nonmineral supplements by adults. Users of dietary supplements report that they obtain health guidance from internet media resources, but there is question as to whether or not these resources provide the necessary evidence to guide health decisions. Current evidence suggests that there is a mistranslation occurring somewhere between researchers and the media. Objective: The aim of this study was to conduct a comparative cross-sectional analysis to identify areas of discordance created when science is translated from the laboratory to Web-based news media. Methods: A Google news search provided our convenience sample of 40 omega-3 supplement–based media reports stratified by the years 2009 to 2012. Media reports (n=17) were compared with the corresponding scientific papers for content. Report and scientific paper content were extracted using commonly accepted reporting guideline domains, and domains were then compared for detecting underlying omissions or mistranslations in reporting. Mean scores for all of the scientific papers and media reports were assessed for each domain. Results: Scientific papers (n=14) generally maintained a mean close to complete for each reporting domain. The only domain where there was not a significant difference between media and scientific reporting match was within the objectives domain (χ21= 0.8, P=.36). Media reports (n=17) more frequently reported potential caveats and warnings for consumers with a mean domain for caveat reporting of 0.88, with possible scores falling between 0 and 1. Conclusions: There are inherent differences in the intended audience, structure, and goals in scientific and media communications. These differences should be explored further, and consumers should be made aware of them. Additional considerations for balanced reporting and reader accessibility are also necessary to take into account and are explored further in this analysis. %M 30274960 %R 10.2196/ijmr.8981 %U http://www.i-jmr.org/2018/2/e15/ %U https://doi.org/10.2196/ijmr.8981 %U http://www.ncbi.nlm.nih.gov/pubmed/30274960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e11510 %T Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant %A Bickmore,Timothy W %A Trinh,Ha %A Olafsson,Stefan %A O'Leary,Teresa K %A Asadi,Reza %A Rickles,Nathaniel M %A Cruz,Ricardo %+ College of Computer and Information Science, Northeastern University, 910-177, 360 Huntington Avenue, Boston, MA, 02115, United States, 1 6173735477, bickmore@ccs.neu.edu %K conversational assistant %K conversational interface %K dialogue system %K medical error %K patient safety %D 2018 %7 04.09.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Conversational assistants, such as Siri, Alexa, and Google Assistant, are ubiquitous and are beginning to be used as portals for medical services. However, the potential safety issues of using conversational assistants for medical information by patients and consumers are not understood. Objective: To determine the prevalence and nature of the harm that could result from patients or consumers using conversational assistants for medical information. Methods: Participants were given medical problems to pose to Siri, Alexa, or Google Assistant, and asked to determine an action to take based on information from the system. Assignment of tasks and systems were randomized across participants, and participants queried the conversational assistants in their own words, making as many attempts as needed until they either reported an action to take or gave up. Participant-reported actions for each medical task were rated for patient harm using an Agency for Healthcare Research and Quality harm scale. Results: Fifty-four subjects completed the study with a mean age of 42 years (SD 18). Twenty-nine (54%) were female, 31 (57%) Caucasian, and 26 (50%) were college educated. Only 8 (15%) reported using a conversational assistant regularly, while 22 (41%) had never used one, and 24 (44%) had tried one “a few times.“ Forty-four (82%) used computers regularly. Subjects were only able to complete 168 (43%) of their 394 tasks. Of these, 49 (29%) reported actions that could have resulted in some degree of patient harm, including 27 (16%) that could have resulted in death. Conclusions: Reliance on conversational assistants for actionable medical information represents a safety risk for patients and consumers. Patients should be cautioned to not use these technologies for answers to medical questions they intend to act on without further consultation from a health care provider. %M 30181110 %R 10.2196/11510 %U http://www.jmir.org/2018/9/e11510/ %U https://doi.org/10.2196/11510 %U http://www.ncbi.nlm.nih.gov/pubmed/30181110 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e10440 %T Trustworthiness, Readability, and Suitability of Web-Based Information for Stroke Prevention and Self-Management for Korean Americans: Critical Evaluation %A Lee,Mikyoung A %A Shin,Cha-Nam %A An,Kyungeh %+ College of Nursing, Texas Woman's University, PO Box 425498, Denton, TX, 76204-5498, United States, 1 940 898 2424, mikyoungLee@twu.edu %K stroke %K website evaluation %K trustworthiness %K readability %K suitability %D 2018 %7 20.07.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Websites are common sources of health information to stroke survivors and caregivers for continual management of stroke and its long-term sequelae. The presence of risk factors and mortality rates related to stroke are high in Korean Americans. A vast majority of this group are active Web users and rely on the Web-based information due to lack of insurance and, thus, limited access to long-term stroke care. Thus, it is critical to evaluate existing stroke websites for their trustworthiness, readability, and suitability. Objective: The objective of our study was to provide a systematic evaluation of stroke-related websites regarding (1) trustworthiness, (2) readability, and (3) suitability for stroke prevention and self-management for Korean Americans. Methods: We selected a total of 156 websites using search terms “stroke,” “CVA,” “중풍 (jungpung),” and “뇌졸증 (noejoljung)” on Google and Yahoo. After eliminating duplicates and irrelevant websites (n=116), we evaluated a total of 42 websites (15 in English and 27 in Korean) using the National Library of Medicine’s health website’s evaluation tool for trustworthiness; Simple Measure of Gobbledygook for readability; and Suitability Assessment of Materials for suitability. All three instruments used the 3-point Likert scale: superior (=2), adequate (=1), or not suitable (=0). Results: Of the 42 websites evaluated, we rated 62% (26/42) websites as “adequate” or above for trustworthiness. The information on 48% (20/42) websites had not been updated for more than a year, which indicates poor currency; 33% (14/42) websites failed to provide the publisher and contact information, which yields poor authority; 50% (21/42) websites did not cite sources of health information, which indicates lack of accuracy. Only 2 websites met the recommended readability (5th grade or lower reading level). The suitability was also suboptimal; only 1 website was rated as “superior”; 60% (25/42) websites were “adequate,” and 38% (16/42) were “not suitable.” Most websites were limited in graphical directions, interactive motivations for desired healthy behaviors, and multiple language translations. Conclusions: The existing stroke-related websites in either English or Korean are trustworthy and suitable, yet precise citation of evidence-based information will improve trustworthiness. The contents requiring high reading level may set a barrier to the utilization of Web-based health information for Korean Americans with a lower level of education. In addition, supplementing graphical examples, interaction features, and culturally relevant information in multiple languages are the areas for improvement in suitability. The improved features can reduce the reading burden of stroke patients or caregivers and build their confidence when applying the information for stroke management in daily living. These strategies are especially crucial to Korean Americans, who inevitably seek Web-based information to fill the gap between their demand and access to health care for a long-term self-management after a stroke. %M 30030210 %R 10.2196/10440 %U http://www.i-jmr.org/2018/2/e10440/ %U https://doi.org/10.2196/10440 %U http://www.ncbi.nlm.nih.gov/pubmed/30030210 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e12 %T Health Information on Firefighter Websites: Structured Analysis %A Hu,Mostin A %A MacDermid,Joy C %A Killip,Shannon %A Lomotan,Margaret %A , %+ School of Physical Therapy, Western University, Elborn College, Room 1440, 1201 Western Road, London, ON, N6G 1H1, Canada, 1 519 661 2111 ext 88912, jmacderm@uwo.ca %K firefighters %K physical health %K mental health %K websites %D 2018 %7 16.07.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Owing to the fact that firefighters have unique health risks, access to firefighter-specific internet-based health information is a potential mechanism for achieving better health and work outcomes. Objective: The objective of our study was to identify the amount and nature of health information resources available on Canadian firefighter-specific websites and the extent to which resources are consistent across websites as a surrogate indicator of diffusion of information. Methods: A search of health resources on firefighter websites (union and employer) for all Canadian provinces, major cities and a subset of smaller cities, and the International Association of Fire Fighters (IAFF) website was conducted on Google (July 2017). Content was identified and classified based on the type of resource, health focus, and location. The quantity and nature of the resources were summarized using descriptive statistics. Results: Among all (N=313) websites reviewed, 41 websites had health information with a cumulative total of 128 resources that addressed firefighter mental (59/128, 46.1%), physical (43/128, 33.6%), and work health (26/128, 20.3%). The highest density of information was found on international and national websites (13 resources per website) and the least on local websites (1 resource per 7 websites). Three provinces (Ontario, Québec, and British Columbia) hosted 81% (65/80) of the provincial, territorial and local resources. General mental health (20/59, 34%), posttraumatic stress disorder (14/59, 24%), and suicide (14/59, 24%) were the most prevalent topics within the mental health resources, whereas half (21/43, 49%) of all physical health resources were on cancer. No resources from Northern Canada were found. Musculoskeletal health was not mentioned in any of the resources identified. There was minimal cross-linking of resources across sites (only 4 resources were duplicated across sites), and there was no clear indication of how the content was vetted or evaluated for quality. Conclusions: There was wide variation in the amount and type of information available on different firefighter websites with limited diffusion of information across jurisdictions. Quality evaluation and coordination of resources should be considered to enhance firefighters’ access to quality health information to meet their specific needs. Mental health and cancer information aligned with high rates of these health problems in firefighters, whereas the lack of information on musculoskeletal health was discordant with their high rate of work injury claims for these problems. %M 30012543 %R 10.2196/ijmr.9369 %U http://www.i-jmr.org/2018/2/e12/ %U https://doi.org/10.2196/ijmr.9369 %U http://www.ncbi.nlm.nih.gov/pubmed/30012543 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10016 %T An Assessment Framework for e-Mental Health Apps in Canada: Results of a Modified Delphi Process %A Zelmer,Jennifer %A van Hoof,Krystle %A Notarianni,MaryAnn %A van Mierlo,Trevor %A Schellenberg,Megan %A Tannenbaum,Cara %+ Canadian Institutes of Health Research, Institute of Gender and Health, 4565 chemin Queen Mary, Montreal, QC, H3W 1W5, Canada, 1 5143129019, krystle.van.hoof@criugm.qc.ca %K mental health %K mobile phone apps %K consensus %K Delphi process %K evaluation framework %K telemedicine %D 2018 %7 09.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of e-mental health apps is increasing rapidly. Studies have shown that the use of some apps is beneficial, whereas others are ineffective or do not meet users’ privacy expectations. Individuals and organizations that curate, recommend, host, use, or pay for apps have an interest in categorizing apps according to the consensus criteria of usability and effectiveness. Others have previously published recommendations for assessing health-related apps; however, the extent to which these recommendations can be generalized across different population groups (eg, culture, gender, and language) remains unclear. This study describes an attempt by Canadian stakeholders to develop an e-mental health assessment framework that responds to the unique needs of people living in Canada in an evidence-based manner. Objective: The objective of our study was to achieve consensus from a broad group of Canadian stakeholders on guiding principles and criteria for a framework to assess e-mental health apps in Canada. Methods: We developed an initial set of guiding principles and criteria from a rapid review and environmental scan of pre-existing app assessment frameworks. The initial list was refined through a two-round modified Delphi process. Participants (N=25) included app developers and users, health care providers, mental health advocates, people with lived experience of a mental health problem or mental illness, policy makers, and researchers. Consensus on each guideline or criterion was defined a priori as at least 70% agreement. The first round of voting was conducted electronically. Prior to Round 2 voting, in-person presentations from experts and a persona empathy mapping process were used to explore the perspectives of diverse stakeholders. Results: Of all respondents, 68% (17/25) in Round 1 and 100% (13/13) in Round 2 agreed that a framework for evaluating health apps is needed to help Canadian consumers identify high-quality apps. Consensus was reached on 9 guiding principles: evidence based, gender responsive, culturally appropriate, user centered, risk based, internationally aligned, enabling innovation, transparent and fair, and based on ethical norms. In addition, 15 informative and evaluative criteria were defined to assess the effectiveness, functionality, clinical applicability, interoperability, usability, transparency regarding security and privacy, security or privacy standards, supported platforms, targeted users, developers’ transparency, funding transparency, price, user desirability, user inclusion, and meaningful inclusion of a diverse range of communities. Conclusions: Canadian mental health stakeholders reached the consensus on a framework of 9 guiding principles and 15 criteria important in assessing e-mental health apps. What differentiates the Canadian framework from other scales is explicit attention to user inclusion at all stages of the development, gender responsiveness, and cultural appropriateness. Furthermore, an empathy mapping process markedly influenced the development of the framework. This framework may be used to inform future mental health policies and programs. %M 29986846 %R 10.2196/10016 %U http://mhealth.jmir.org/2018/7/e10016/ %U https://doi.org/10.2196/10016 %U http://www.ncbi.nlm.nih.gov/pubmed/29986846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e229 %T Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes %A Albarracin,Dolores %A Romer,Daniel %A Jones,Christopher %A Hall Jamieson,Kathleen %A Jamieson,Patrick %+ University of Illinois at Urbana Champaign, 603 E Daniel Street, Champaign, IL, 61822, United States, 1 2178402383, dalbarra@illinois.edu %K health communication %K tobacco %D 2018 %7 29.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent content analyses of YouTube postings reveal a proliferation of user generated videos with misleading statements about the health consequences of various types of nontraditional tobacco use (eg, electronic cigarettes; e-cigarettes). Objective: This research was aimed at obtaining evidence about the potential effects of YouTube postings about tobacco products on viewers' attitudes toward these products. Methods: A sample of young adults recruited online (N=350) viewed one of four highly viewed YouTube videos containing misleading health statements about chewing tobacco, e-cigarettes, hookahs, and pipe smoking, as well as a control YouTube video unrelated to tobacco products. Results: The videos about e-cigarettes and hookahs led to more positive attitudes toward the featured products than did control videos. However, these effects did not fully translate into attitudes toward combustive cigarette smoking, although the pipe video led to more positive attitudes toward combustive smoking than did the chewing and the hookah videos, and the e-cigarette video led to more positive attitudes toward combustive cigarette smoking than did the chewing video. Conclusions: This research revealed young people’s reactions to misleading claims about tobacco products featured in popular YouTube videos. Policy implications are discussed. %M 29959113 %R 10.2196/jmir.9959 %U http://www.jmir.org/2018/6/e229/ %U https://doi.org/10.2196/jmir.9959 %U http://www.ncbi.nlm.nih.gov/pubmed/29959113 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e10199 %T “It’s Totally Okay to Be Sad, but Never Lose Hope”: Content Analysis of Infertility-Related Videos on YouTube in Relation to Viewer Preferences %A Kelly-Hedrick,Margot %A Grunberg,Paul H %A Brochu,Felicia %A Zelkowitz,Phyllis %+ Jewish General Hospital, Department of Psychiatry, 4333 Cote Ste. Catherine, Montreal, QC, H3T 1E4, Canada, 1 514 340 8222 ext 25258, phyllis.zelkowitz@mcgill.ca %K infertility %K internet %K YouTube %K social media %K online health information %D 2018 %7 23.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Infertility patients frequently use the internet to find fertility-related information and support from people in similar circumstances. YouTube is increasingly used as a source of health-related information and may influence health decision making. There have been no studies examining the content of infertility-related videos on YouTube. Objective: The purpose of this study was to (1) describe the content of highly viewed videos on YouTube related to infertility and (2) identify video characteristics that relate to viewer preference. Methods: Using the search term “infertility,” the 80 top-viewed YouTube videos and their viewing statistics (eg, views, likes, and comments) were collected. Videos that were non-English, unrelated to infertility, or had age restrictions were excluded. Content analysis was used to examine videos, employing a coding rubric that measured the presence or absence of video codes related to purpose, tone, and demographic and fertility characteristics (eg, sex, parity, stage of fertility treatment). Results: A total of 59 videos, with a median of 156,103 views, met the inclusion criteria and were categorized into 35 personal videos (35/59, 59%) and 24 informational-educational videos (24/59, 41%). Personal videos did not differ significantly from informational-educational videos on number of views, dislikes, subscriptions driven, or shares. However, personal videos had significantly more likes (P<.001) and comments (P<.001) than informational-educational videos. The purposes of the videos were treatment outcomes (33/59, 56%), sharing information (30/59, 51%), emotional aspects of infertility (20/59, 34%), and advice to others (6/59, 10%). The tones of the videos were positive (26/59, 44%), neutral (25/59, 42%), and mixed (8/59, 14%); there were no videos with negative tone. No videos contained only male posters. Videos with a positive tone did not differ from neutral videos in number of views, dislikes, subscriptions driven, or shares; however, positive videos had significantly more likes (P<.001) and comments (P<.001) than neutral videos. A majority (21/35, 60%) of posters of personal videos shared a pregnancy announcement. Conclusions: YouTube is a source of both technical and personal experience-based information about infertility. However, videos that include personal experiences may elicit greater viewer engagement. Positive videos and stories of treatment success may provide hope to viewers but could also create and perpetuate unrealistic expectations about the success rates of fertility treatment. %M 29792296 %R 10.2196/10199 %U http://www.jmir.org/2018/5/e10199/ %U https://doi.org/10.2196/10199 %U http://www.ncbi.nlm.nih.gov/pubmed/29792296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e171 %T Effects of Contributor Experience on the Quality of Health-Related Wikipedia Articles %A Holtz,Peter %A Fetahu,Besnik %A Kimmerle,Joachim %+ IWM Leibniz-Institut für Wissensmedien (Knowledge Media Research Center), Knowledge Construction Lab, Schleichstraße 6, Tübingen, 72076, Germany, 49 7071979303, p.holtz@iwm-tuebingen.de %K Wikipedia %K health-information online %K collaborative knowledge construction %K contributor characteristics %D 2018 %7 10.05.2018 %9 Short Paper %J J Med Internet Res %G English %X Background: Consulting the Internet for health-related information is a common and widespread phenomenon, and Wikipedia is arguably one of the most important resources for health-related information. Therefore, it is relevant to identify factors that have an impact on the quality of health-related Wikipedia articles. Objective: In our study we have hypothesized a positive effect of contributor experience on the quality of health-related Wikipedia articles. Methods: We mined the edit history of all (as of February 2017) 18,805 articles that were listed in the categories on the portal health & fitness in the English language version of Wikipedia. We identified tags within the articles’ edit histories, which indicated potential issues with regard to the respective article’s quality or neutrality. Of all of the sampled articles, 99 (99/18,805, 0.53%) articles had at some point received at least one such tag. In our analysis we only considered those articles with a minimum of 10 edits (10,265 articles in total; 96 tagged articles, 0.94%). Additionally, to test our hypothesis, we constructed contributor profiles, where a profile consisted of all the articles edited by a contributor and the corresponding number of edits contributed. We did not differentiate between rollbacks and edits with novel content. Results: Nonparametric Mann-Whitney U-tests indicated a higher number of previously edited articles for editors of the nontagged articles (mean rank tagged 2348.23, mean rank nontagged 5159.29; U=9.25, P<.001). However, we did not find a significant difference for the contributors’ total number of edits (mean rank tagged 4872.85, mean rank nontagged 5135.48; U=0.87, P=.39). Using logistic regression analysis with the respective article’s number of edits and number of editors as covariates, only the number of edited articles yielded a significant effect on the article’s status as tagged versus nontagged (dummy-coded; Nagelkerke R2 for the full model=.17; B [SE B]=-0.001 [0.00]; Wald c2 [1]=19.70; P<.001), whereas we again found no significant effect for the mere number of edits (Nagelkerke R2 for the full model=.15; B [SE B]=0.000 [0.01]; Wald c2 [1]=0.01; P=.94). Conclusions: Our findings indicate an effect of contributor experience on the quality of health-related Wikipedia articles. However, only the number of previously edited articles was a predictor of the articles’ quality but not the mere volume of edits. More research is needed to disentangle the different aspects of contributor experience. We have discussed the implications of our findings with respect to ensuring the quality of health-related information in collaborative knowledge-building platforms. %M 29748161 %R 10.2196/jmir.9683 %U http://www.jmir.org/2018/5/e171/ %U https://doi.org/10.2196/jmir.9683 %U http://www.ncbi.nlm.nih.gov/pubmed/29748161 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e9 %T Representation of Tinnitus in the US Newspaper Media and in Facebook Pages: Cross-Sectional Analysis of Secondary Data %A Manchaiah,Vinaya %A Ratinaud,Pierre %A Andersson,Gerhard %+ Department of Speech and Hearing Sciences, Lamar University, PO Box 10076, Beaumont, TX, 77710, United States, 1 4098808927, vinaya.manchaiah@lamar.edu %K tinnitus %K chronic condition %K health communication %K health information %K media %K news media %K social media %D 2018 %7 08.05.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: When people with health conditions begin to manage their health issues, one important issue that emerges is the question as to what exactly do they do with the information that they have obtained through various sources (eg, news media, social media, health professionals, friends, and family). The information they gather helps form their opinions and, to some degree, influences their attitudes toward managing their condition. Objective: This study aimed to understand how tinnitus is represented in the US newspaper media and in Facebook pages (ie, social media) using text pattern analysis. Methods: This was a cross-sectional study based upon secondary analyses of publicly available data. The 2 datasets (ie, text corpuses) analyzed in this study were generated from US newspaper media during 1980-2017 (downloaded from the database US Major Dailies by ProQuest) and Facebook pages during 2010-2016. The text corpuses were analyzed using the Iramuteq software using cluster analysis and chi-square tests. Results: The newspaper dataset had 432 articles. The cluster analysis resulted in 5 clusters, which were named as follows: (1) brain stimulation (26.2%), (2) symptoms (13.5%), (3) coping (19.8%), (4) social support (24.2%), and (5) treatment innovation (16.4%). A time series analysis of clusters indicated a change in the pattern of information presented in newspaper media during 1980-2017 (eg, more emphasis on cluster 5, focusing on treatment inventions). The Facebook dataset had 1569 texts. The cluster analysis resulted in 7 clusters, which were named as: (1) diagnosis (21.9%), (2) cause (4.1%), (3) research and development (13.6%), (4) social support (18.8%), (5) challenges (11.1%), (6) symptoms (21.4%), and (7) coping (9.2%). A time series analysis of clusters indicated no change in information presented in Facebook pages on tinnitus during 2011-2016. Conclusions: The study highlights the specific aspects about tinnitus that the US newspaper media and Facebook pages focus on, as well as how these aspects change over time. These findings can help health care providers better understand the presuppositions that tinnitus patients may have. More importantly, the findings can help public health experts and health communication experts in tailoring health information about tinnitus to promote self-management, as well as assisting in appropriate choices of treatment for those living with tinnitus. %M 29739734 %R 10.2196/ijmr.9065 %U http://www.i-jmr.org/2018/1/e9/ %U https://doi.org/10.2196/ijmr.9065 %U http://www.ncbi.nlm.nih.gov/pubmed/29739734 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 1 %P e3 %T A Tool That Assesses the Evidence, Transparency, and Usability of Online Health Information: Development and Reliability Assessment %A Dobbins,Maureen %A Watson,Susannah %A Read,Kristin %A Graham,Kelly %A Yousefi Nooraie,Reza %A Levinson,Anthony J %+ The National Collaborating Centre for Methods and Tools, School of Nursing, McMaster University, Suite 210A, 175 Longwood Road South, Hamilton, ON, L8P0A1, Canada, 1 905 525 9140 ext 20455, dobbinsm@mcmaster.ca %K knowledge translation %K Consumer Health Information %K consumer health standards %K internet standards %K Patient Education as Topic %K Patient Education as standards %K critical appraisal %K online health information %K reliability analysis %D 2018 %7 07.05.2018 %9 Original Paper %J JMIR Aging %G English %X Background: The internet is commonly used by older adults to obtain health information and this trend has markedly increased in the past decade. However, studies illustrate that much of the available online health information is not informed by good quality evidence, developed in a transparent way, or easy to use. Furthermore, studies highlight that the general public lacks the skills necessary to distinguish between online products that are credible and trustworthy and those that are not. A number of tools have been developed to assess the evidence, transparency, and usability of online health information; however, many have not been assessed for reliability or ease of use. Objective: The first objective of this study was to determine if a tool assessing the evidence, transparency, and usability of online health information exists that is easy and quick to use and has good reliability. No such tool was identified, so the second objective was to develop such a tool and assess it for reliability when used to assess online health information on topics of relevant to optimal aging. Methods: An electronic database search was conducted between 2002 and 2012 to identify published papers describing tools that assessed the evidence, transparency, and usability of online health information. Papers were retained if the tool described was assessed for reliability, assessed the quality of evidence used to create online health information, and was quick and easy to use. When no one tool met expectations, a new instrument was developed and tested for reliability. Reliability between two raters was assessed using the intraclass correlation coefficient (ICC) for each item at two time points. SPSS Statistics 22 software was used for statistical analyses and a one-way random effects model was used to report the results. The overall ICC was assessed for the instrument as a whole in July 2015. The threshold for retaining items was ICC>0.60 (ie, “good” reliability). Results: All tools identified that evaluated online health information were either too complex, took a long time to complete, had poor reliability, or had not undergone reliability assessment. A new instrument was developed and assessed for reliability in April 2014. Three items had an ICC<0.60 (ie, “good” reliability). One of these items was removed (“minimal scrolling”) and two were retained but reworded for clarity. Four new items were added that assessed the level of research evidence that informed the online health information and the tool was retested in July 2015. The total ICC score showed excellent agreement with both single measures (ICC=0.988; CI 0.982–0.992) and average measures (ICC=0.994; CI 0.991–0.996). Conclusions: The results of this study suggest that this new tool is reliable for assessing the evidence, transparency, and usability of online health information that is relevant to optimal aging. %M 31518240 %R 10.2196/aging.9216 %U http://aging.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/aging.9216 %U http://www.ncbi.nlm.nih.gov/pubmed/31518240 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e10 %T Food Addiction Support: Website Content Analysis %A McKenna,Rebecca A %A Rollo,Megan E %A Skinner,Janelle A %A Burrows,Tracy L %+ School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 249215514, tracy.burrows@newcastle.edu.au %K food addiction %K self-help groups %K social support %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking. Objective: This study aimed to evaluate the availability and content of support options, accessible online, for food addiction. Methods: A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation. Results: Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support. Conclusions: This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction. %M 31758778 %R 10.2196/cardio.8718 %U http://cardio.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/cardio.8718 %U http://www.ncbi.nlm.nih.gov/pubmed/31758778 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e7 %T Quality of Web Information About Palliative Care on Websites from the United States and Japan: Comparative Evaluation Study %A Tanabe,Kouichi %A Fujiwara,Kaho %A Ogura,Hana %A Yasuda,Hatsuna %A Goto,Nobuyuki %A Ohtsu,Fumiko %+ Drug Informatics, Faculty of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku-ku, Nagoya,, Japan, 81 52 833 1063, fohtsu@meijo-u.ac.jp %K internet %K website %K reliability %K quality %K usefulness %K palliative care %K consumer health information %K evaluation studies %D 2018 %7 03.04.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Patients and their families are able to obtain information about palliative care from websites easily nowadays. However, there are concerns on the accuracy of information on the Web and how up to date it is. Objective: The objective of this study was to elucidate problematic points of medical information about palliative care obtained from websites, and to compare the quality of the information between Japanese and US websites. Methods: We searched Google Japan and Google USA for websites relating to palliative care. We then evaluated the top 50 websites from each search using the DISCERN and LIDA instruments. Results: We found that Japanese websites were given a lower evaluation of reliability than US websites. In 3 LIDA instrument subcategories—engagability (P<.001), currency (P=.001), and content production procedure (P<.001)—US websites scored significantly higher and had large effect sizes. Conclusions: Our results suggest that Japanese websites have problems with the frequency with which they are updated, their update procedures and policies, and the scrutiny process the evidence must undergo. Additionally, there was a weak association between search ranking and reliability, and simultaneously we found that reliability could not be assessed by search ranking alone. %M 29615388 %R 10.2196/ijmr.9574 %U http://www.i-jmr.org/2018/1/e7/ %U https://doi.org/10.2196/ijmr.9574 %U http://www.ncbi.nlm.nih.gov/pubmed/29615388 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e6 %T Weight Stigma Goes Viral on the Internet: Systematic Assessment of YouTube Comments Attacking Overweight Men and Women %A Jeon,Yongwoog Andrew %A Hale,Brent %A Knackmuhs,Eric %A Mackert,Michael %+ Center for Health Communication, Moody College of Communication, The University of Texas at Austin, 300 W Dean Keeton (A0900), Austin, TX, 78712, United States, 1 8122233163, yongwoog@utexas.edu %K stigma %K cyberbullying %K gender %K sex differences %K verbal behavior %D 2018 %7 20.03.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Anonymous verbal attacks against overweight individuals on social media are common and widespread. These comments often use negative, misogynist, or derogatory words, which stigmatize the targeted individuals with obesity. These verbal attacks may cause depression in overweight individuals, which could subsequently promote unhealthy eating behavior (ie, binge eating) and further weight gain. To develop an intervention policy and strategies that tackle the anonymous, Web-based verbal attacks, a thorough understanding of the comments is necessary. Objective: This study aimed to examine how anonymous users verbally attack or defend overweight individuals in terms of 3 themes: (1) topic of verbal attack (ie, what aspects of overweight individuals are verbally attacked), (2) gender of commenters and targeted overweight individuals, and (3) intensity of derogation depending on the targeted gender (ie, the number of swear words used within comments). Methods: This study analyzed the content of YouTube comments that discuss overweight individuals or groups from 2 viral videos, titled “Fat Girl Tinder Date” and “Fat Guy Tinder Date.” The twin videos provide an avenue through which to analyze discussions of obesity as they organically occurred in a contemporary setting. We randomly sampled and analyzed 320 comments based on a coding instrument developed for this study. Results: First, there were twice as many comments verbally attacking overweight individuals (n=174) than comments defending them (n=89). Second, overweight women are attacked for their capacities (eg, laziness, maturity; 14/51, 28%), whereas overweight men are attacked for their heterosocial skills (eg, rudeness, annoyance; 24/29, 83%). Third, the majority of commenters who attacked overweight women are male (42/52, 81%). Fourth, attacking comments generated toward overweight women included more swear words (mean 0.44, SD 0.77) than those targeting men (mean 0.23, SD 0.48). Conclusions: Our data elucidate a worrying situation of frequent disinhibited aggressive messages against overweight individuals online. Importantly, the patterns of verbal aggression differ depending on the gender of the targeted overweight individuals. Thus, gender-tailored intervention strategies that specifically tackle Internet users’ verbal aggression against overweight individuals need to be developed. %M 29559426 %R 10.2196/ijmr.9182 %U http://www.i-jmr.org/2018/1/e6/ %U https://doi.org/10.2196/ijmr.9182 %U http://www.ncbi.nlm.nih.gov/pubmed/29559426 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e3 %T Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment %A Rosen,Brittany L %A Bishop,James M %A McDonald,Skye L %A Kahn,Jessica A %A Kreps,Gary L %+ School of Human Services, University of Cincinnati, PO Box 210068, Cincinnati, OH, 45221, United States, 1 513 556 3872, brittany.rosen@uc.edu %K papillomavirus vaccines %K internet %K program evaluation %K health personnel %D 2018 %7 16.02.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. Objective: The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. Methods: Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions’ content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. Results: A total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. Conclusions: This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians. %M 29453187 %R 10.2196/cancer.9114 %U http://cancer.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/cancer.9114 %U http://www.ncbi.nlm.nih.gov/pubmed/29453187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e29 %T Clinical Validity, Understandability, and Actionability of Online Cardiovascular Disease Risk Calculators: Systematic Review %A Bonner,Carissa %A Fajardo,Michael Anthony %A Hui,Samuel %A Stubbs,Renee %A Trevena,Lyndal %+ School of Public Health, The University of Sydney, Edward Ford Building (A27) Room 226A, Camperdown,, Australia, 61 2 9351 7125, carissa.bonner@sydney.edu.au %K cardiovascular disease %K risk assessment %K risk communication %K risk formats %D 2018 %7 01.02.2018 %9 Review %J J Med Internet Res %G English %X Background: Online health information is particularly important for cardiovascular disease (CVD) prevention, where lifestyle changes are recommended until risk becomes high enough to warrant pharmacological intervention. Online information is abundant, but the quality is often poor and many people do not have adequate health literacy to access, understand, and use it effectively. Objective: This project aimed to review and evaluate the suitability of online CVD risk calculators for use by low health literate consumers in terms of clinical validity, understandability, and actionability. Methods: This systematic review of public websites from August to November 2016 used evaluation of clinical validity based on a high-risk patient profile and assessment of understandability and actionability using Patient Education Material Evaluation Tool for Print Materials. Results: A total of 67 unique webpages and 73 unique CVD risk calculators were identified. The same high-risk patient profile produced widely variable CVD risk estimates, ranging from as little as 3% to as high as a 43% risk of a CVD event over the next 10 years. One-quarter (25%) of risk calculators did not specify what model these estimates were based on. The most common clinical model was Framingham (44%), and most calculators (77%) provided a 10-year CVD risk estimate. The calculators scored moderately on understandability (mean score 64%) and poorly on actionability (mean score 19%). The absolute percentage risk was stated in most (but not all) calculators (79%), and only 18% included graphical formats consistent with recommended risk communication guidelines. Conclusions: There is a plethora of online CVD risk calculators available, but they are not readily understandable and their actionability is poor. Entering the same clinical information produces widely varying results with little explanation. Developers need to address actionability as well as clinical validity and understandability to improve usefulness to consumers with low health literacy. %M 29391344 %R 10.2196/jmir.8538 %U http://www.jmir.org/2018/2/e29/ %U https://doi.org/10.2196/jmir.8538 %U http://www.ncbi.nlm.nih.gov/pubmed/29391344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e30 %T How Experts’ Use of Medical Technical Jargon in Different Types of Online Health Forums Affects Perceived Information Credibility: Randomized Experiment With Laypersons %A Zimmermann,Maria %A Jucks,Regina %+ Institute for Psychology in Education, Department of Psychology and Sport Science, University of Münster, Fliednerstraße 21, Münster, 48149, Germany, 49 251 8339482, maria.zimmermann@uni-muenster.de %K trust %K health communication %K social media %K information seeking behavior %K language %D 2018 %7 23.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health forums are widely used, but the quality of advice differs as much as the knowledge backgrounds of the audience members who receive the advice. It is important to understand how people judge the information given online. In line with the communication accommodation theory (CAT), online forums represent specific social contexts of communication which can present either accommodative or nonaccommodative language to an audience. Accordingly, use of accommodative or nonaccommodative language might affect people’s perceived trust in the communicator. Objective: The objective of this study was to investigate how experts who use accommodative (vs nonaccommodative) language are evaluated by passive users of an online forum. Methods: Participants (n=98) took part in an online experiment and read experts’ posts about 10 nutrition myths. Following a 2 x 2 mixed design, experts’ posts were written using either low or high amounts of medical technical jargon (MTJ) (within factor) and were directed at different audiences (mainly other medical experts [in a professional forum] vs a user group mainly comprising laypersons [in an advisory forum]) (between factor). Accommodation occurred where experts used high amounts of MTJ to address other medical experts in the professional forum; it also occurred when experts used low amounts of MTJ to address laypersons in the advisory forum. Conversely, nonaccommodation occurred when experts used high amounts of MTJ in the advisory forum and low amounts of MTJ in the professional forum. In each condition, participants evaluated the credibility of the information, the trustworthiness of the experts, and the accommodation by the experts. Results: Overall, participants judged the credibility of information to be higher when experts used MTJ that was accommodative to the designated audience, F1,95=3.10, P=.04, ηp2=.031. In addition, participants judged the experts in professional forums to be more trustworthy than experts in advisory forums (all F1,96≥3.54, P ≤.03, ηp2≥.036). Moreover, participants rated experts who used high amounts of MTJ to have higher competence (F1,96=37.54, P<.001, ηp2=.28], lower integrity (F1,96=10.77, P=.001, ηp2=.101), and lower benevolence (F1,96=9.75, P=.002, ηp2=.092), as well as to have lower perceived accommodation to the audience (all F1,96≥72.17, P<.001, ηp2≥.43) compared with experts who used low MTJ. Conclusions: To provide health information online that is perceived as credible, experts should consider using similar language as the language used by the addressed audience. As it is often impossible to determine the exact makeup of an online audience, further research might investigate whether having experts explicitly declare which audience they intend to address can help people to more reliably assess an expert’s trustworthiness. Furthermore, as people assess information differently depending on the context of online communication, it would be valuable for research to consider other aspects of the context beyond those of the audience. %M 29362212 %R 10.2196/jmir.8346 %U http://www.jmir.org/2018/1/e30/ %U https://doi.org/10.2196/jmir.8346 %U http://www.ncbi.nlm.nih.gov/pubmed/29362212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e415 %T Evaluating the Dental Caries-Related Information on Brazilian Websites: Qualitative Study %A Aguirre,Patricia Estefania Ayala %A Coelho,Melina Martins %A Rios,Daniela %A Machado,Maria Aparecida Andrade Moreira %A Cruvinel,Agnes Fátima Pereira %A Cruvinel,Thiago %+ Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Al. Dr. Octávio Pinheiro Brisolla, 9-75, Vila Universitária, Bauru, 17012-901, Brazil, 55 14 3245 5229, thiagocruvinel@fob.usp.br %K dental caries %K internet %K consumer health information %K health education %D 2017 %7 13.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Dental caries is the most common chronic oral disease, affecting 2.4 billion people worldwide who on average have 2.11 decayed, missing, or filled teeth. It impacts the quality of life of patients, socially and economically. However, the comprehension of dental caries may be difficult for most people, as it involves a multifactorial etiology with the interplay between the tooth surface, the dental biofilm, dietary fermentable carbohydrates, and genetic and behavioral factors. Therefore, the production of effective materials addressed to the education and counseling of patients for the prevention of dental caries requires a high level of specialization. In this regard, the dental caries-related contents produced by laypersons and their availability on the Internet may be low-quality information. Objective: The aim of this study was to assess the readability and the quality of dental caries-related information on Brazilian websites. Methods: A total of 75 websites were selected through Google, Bing, Yahoo!, and Baidu. The websites were organized in rankings according to their order of appearance in each one of the 4 search engines. Furthermore, 2 independent examiners evaluated the quality of websites using the DISCERN questionnaire and the Journal of American Medical Association (JAMA) benchmark criteria. The readability of the websites was assessed by the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). In addition, the information presented on the websites was categorized as etiology, prevention, and treatment of dental caries. The statistical analysis was performed using Spearman rank correlation coefficient, Mann-Whitney U test, hierarchical clustering analysis by Ward minimum variance method, Kruskal-Wallis test, and post hoc Dunn test. P<.05 was considered significant. Results: The Web contents were considered to be of poor quality by DISCERN (mean 33.48, standard deviation, SD 9.06) and JAMA (mean 1.12, SD 0.97) scores, presenting easy reading levels (FRE-BP: mean 62.93, SD 10.15). The rankings of the websites presented by Google (ρ=−.22, P=.08), Baidu (ρ=−.19, P=.53), Yahoo! (ρ=.22, P=.39), and Bing (ρ=−.36, P=.23) were not correlated with DISCERN scores. Moreover, the quality of websites with health- and nonhealth-related authors was similar (P=.27 for DISCERN and P=.47 for JAMA); however, the pages with a greater variety of dental caries information showed significantly higher quality scores than those with limited contents (P=.009). Conclusions: On the basis of this sample, dental caries-related contents available on Brazilian websites were considered simple, accessible, and of poor quality, independent of their authorship. These findings indicate the need for the development of specific policies focused on the stimulus for the production and publication of Web health information, encouraging dentists to guide their patients in searching for recommended oral health websites. %M 29237585 %R 10.2196/jmir.7681 %U http://www.jmir.org/2017/12/e415/ %U https://doi.org/10.2196/jmir.7681 %U http://www.ncbi.nlm.nih.gov/pubmed/29237585 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e163 %T A New Tool for Nutrition App Quality Evaluation (AQEL): Development, Validation, and Reliability Testing %A DiFilippo,Kristen Nicole %A Huang,Wenhao %A Chapman-Novakofski,Karen M %+ Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 238 Bevier Hall, 905 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 217 552 5777, kdifilip@illinois.edu %K evaluation %K mobile apps %K dietitians %K health education %K diet, food, and nutrition %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling. Objective: The goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps’ educational quality and technical functionality. Methods: Items for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app. Results: Development and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support. Conclusions: Our preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps’ qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed. %M 29079554 %R 10.2196/mhealth.7441 %U http://mhealth.jmir.org/2017/10/e163/ %U https://doi.org/10.2196/mhealth.7441 %U http://www.ncbi.nlm.nih.gov/pubmed/29079554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e349 %T Web-Based Information on the Treatment of Tobacco Dependence for Oral Health Professionals: Analysis of English-Written Websites %A Diniz-Freitas,Márcio %A Insua,Angel %A Keat,Ross %A Fricain,Jean Christophe %A Catros,Sylvain %A Monteiro,Luis %A Silva,Luis %A Lodi,Giovanni %A Pispero,Alberto %A Albuquerque,Rui %+ School of Medicine and Dentistry, University of Santiago de Compostela, Calle Entrrríos /n, Santiago de Compostela, 15782, Spain, 34 981563100 ext 12344, marcio.diniz@usc.es %K tobacco use cessation %K Internet %K general practice %K dentistry %K education, continuing %D 2017 %7 20.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals. Objective: The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals. Methods: Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability. Results: Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01). Conclusions: The mean quality of webpages with information for oral health care professionals about smoking cessation is low and displayed a high heterogeneity. These webpages are also difficult to read and often lack multimedia resources, which further limits their usefulness. %M 29054831 %R 10.2196/jmir.8174 %U http://www.jmir.org/2017/10/e349/ %U https://doi.org/10.2196/jmir.8174 %U http://www.ncbi.nlm.nih.gov/pubmed/29054831 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e19 %T Alzheimer’s Disease in Social Media: Content Analysis of YouTube Videos %A Tang,Weizhou %A Olscamp,Kate %A Choi,Seul Ki %A Friedman,Daniela B %+ Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Office 536, 915 Greene Street, Columbia, SC, 29208, United States, 1 803 777 5766, choi27@mailbox.sc.edu %K Alzheimer’s disease %K YouTube %K videos %K content analysis %D 2017 %7 19.10.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Approximately 5.5 million Americans are living with Alzheimer’s disease (AD) in 2017. YouTube is a popular platform for disseminating health information; however, little is known about messages specifically regarding AD that are being communicated through YouTube. Objective: This study aims to examine video characteristics, content, speaker characteristics, and mobilizing information (cues to action) of YouTube videos focused on AD. Methods: Videos uploaded to YouTube from 2013 to 2015 were searched with the term “Alzheimer’s disease” on April 30th, 2016. Two coders viewed the videos and coded video characteristics (the date when a video was posted, Uniform Resource Locator, video length, audience engagement, format, author), content, speaker characteristics (sex, race, age), and mobilizing information. Descriptive statistics were used to examine video characteristics, content, audience engagement (number of views), speaker appearances in the video, and mobilizing information. Associations between variables were examined using Chi-square and Fisher’s exact tests. Results: Among the 271 videos retrieved, 25.5% (69/271) were posted by nonprofit organizations or universities. Informal presentations comprised 25.8% (70/271) of all videos. Although AD symptoms (83/271, 30.6%), causes of AD (80/271, 29.5%), and treatment (76/271, 28.0%) were commonly addressed, quality of life of people with AD (34/271, 12.5%) had more views than those more commonly-covered content areas. Most videos featured white speakers (168/187, 89.8%) who were adults aged 20 years to their early 60s (164/187, 87.7%). Only 36.9% (100/271) of videos included mobilizing information. Videos about AD symptoms were significantly less likely to include mobilizing information compared to videos without AD symptoms (23/83, 27.7% vs 77/188, 41.0% respectively; P=.03). Conclusions: This study contributes new knowledge regarding AD messages delivered through YouTube. Findings of the current study highlight a potential gap between available information and viewers’ interests. YouTube videos on AD could be beneficial if the messages delivered meet users’ needs and provide mobilizing information for further resources. Study findings will be useful to government agencies, researchers, nonprofit organizations that promote information about AD, and those responsible for social media to provide useful and accurate health information for the public. %M 29051137 %R 10.2196/ijmr.8612 %U http://www.i-jmr.org/2017/2/e19/ %U https://doi.org/10.2196/ijmr.8612 %U http://www.ncbi.nlm.nih.gov/pubmed/29051137 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e25 %T Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults %A Tao,Donghua %A LeRouge,Cynthia %A Smith,K Jody %A De Leo,Gianluca %+ Medical Center Library, Saint Louis Univesity, 1402 S. Grand Blvd., St. Louis, MO, 63104, United States, 1 3149778812, donghua.tao@slu.edu %K consumer health information %K World Wide Web %K Internet %K information services %K quality control %K young adults %K evaluation studies as topic %K medical informatics %D 2017 %7 06.10.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Today’s health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care–related purposes. Objective: To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults’ use of health websites for health care–related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults’ use of health websites for health care–related purposes. Methods: The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants’ means of assessing information quality on health websites. Results: Five dimensions of information quality for health websites were identified: Completeness of information, Understandability of information, Relevance of information, Depth of information, and Accuracy of information. Completeness of information and Understandability of information were rated as the two most important quality dimensions by the study participants. Results indicated that these five information quality dimensions for health websites were supported by the following main driver themes: Content, Design, Links, Consumer resources, Search functionality, Supporting references, User focus, Content FAQ, Open access, Policy statements, and Site performance. Conclusions: This study contributes to the literature by developing a health website information quality conceptual framework with quality dimensions and associated drivers specified for a young educated adult population. The detailed quality drivers supporting the corresponding quality dimensions provide a rich picture of young educated adults’ perceptions on health website information quality. This framework can be used to guide the development of health websites, as well as the foundation for a means to evaluate health information from existing health websites with young educated adults as the target audience. %M 28986336 %R 10.2196/humanfactors.6455 %U http://humanfactors.jmir.org/2017/4/e25/ %U https://doi.org/10.2196/humanfactors.6455 %U http://www.ncbi.nlm.nih.gov/pubmed/28986336 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e18 %T Social Media and Multiple Sclerosis in the Posttruth Age %A Lavorgna,Luigi %A Lanzillo,Roberta %A Brescia Morra,Vincenzo %A Abbadessa,Gianmarco %A Tedeschi,Gioacchino %A Bonavita,Simona %+ 1st Clinic of Neurology, University of Campania, Piazza Miraglia 2, Naples, 80138, Italy, 39 0815665090, luigi.lavorgna@policliniconapoli.it %K social media %K multiple sclerosis %K social network %K digital health %K eHealth %K Web medicine %D 2017 %7 27.09.2017 %9 Viewpoint %J Interact J Med Res %G English %X Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is really important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease, but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. This is why a professional approach is imperative in this posttruth age, in order to maintain confidentiality, honesty, and trust in the medical profession. %M 28954717 %R 10.2196/ijmr.7879 %U http://www.i-jmr.org/2017/2/e18/ %U https://doi.org/10.2196/ijmr.7879 %U http://www.ncbi.nlm.nih.gov/pubmed/28954717 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e15 %T Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis %A Carlsson,Tommy %A Melander Marttala,Ulla %A Wadensten,Barbro %A Bergman,Gunnar %A Axelsson,Ove %A Mattsson,Elisabet %+ Department of Women's and Children's Health, Uppsala University, Husargatan 3, D11:1, Box 564, Uppsala, SE-75237, Sweden, 46 736143454, tommy.carlsson@kbh.uu.se %K congenital heart defects %K consumer health information %K information literacy %K Internet %K popular works %K pregnancy %K prenatal diagnosis %D 2017 %7 12.09.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: When a heart defect is prenatally diagnosed in the fetus, expectant parents experience a great need for information about various topics. After the diagnosis, the Web is used for supplemental information, and the scarcity of research calls attention to the need to explore patient information websites from the perspectives of the intended consumers. Objective: The overarching aim of this study was to explore the quality of Swedish patient information websites about congenital heart defects, from the perspectives of individuals with experience of a prenatal diagnosis of congenital heart defect in the fetus. Methods: This was a mixed-methods study of websites identified through systematic searches in the two most used Web-based search engines. Of the total 80 screened hits, 10 hits led to patient information websites about congenital heart defects. A quality assessment tool inspired by a previous study was used to evaluate each website’s appearance, details, relevance, suitability, information about treatment choices, and overall quality. Answers were given on a 5-point Likert scale, ranging from 1, representing the lowest score, to 5, representing the highest score. Each website was assessed individually by persons with experience of continued (n=4) and terminated (n=5) pregnancy following a prenatal diagnosis. Assessments were analyzed with Kendall’s coefficient of concordance W, Mann-Whitney U test, Friedman’s test, and a Wilcoxon-Nemenyi-McDonald-Thompson test. In addition, each assessor submitted written responses to open-ended questions in the quality assessment tool, and two joint focus group discussions were conducted with each group of assessors. The qualitative data were analyzed with inductive manifest content analysis. Results: Assessments represented a low score (median=2.0) for treatment choices and moderate scores (median=3.0) for appearance, details, relevance, suitability, and overall quality. No website had a median of the highest achievable score for any of the questions in the quality assessment tool. Medians of the lowest achievable score were found in questions about treatment choices (n=4 websites), details (n=2 websites), suitability (n=1 website), and overall quality (n=1 website). Websites had significantly different scores for appearance (P=.01), details (P<.001), relevance (P<.001), suitability (P<.001), treatment choices (P=.04), and overall quality (P<.001). The content analysis of the qualitative data generated six categories: (1) advertisements, (2) comprehensiveness, (3) design, (4) illustrations and pictures, (5) language, and (6) trustworthiness. Various issues with the included websites were highlighted, including the use of inappropriate advertisements, biased information, poor illustrations, complex language, and poor trustworthiness. Conclusions: From the perspectives of the intended consumers, patient information websites about congenital heart defects are, to a large extent, inadequate tools for supplemental information following a prenatal diagnosis. Health professionals should initiate discussions with patients about their intentions to use the Web, inform them about the varied quality in the Web-based landscape, and offer recommendations for appropriate Web-based sources. %M 28899846 %R 10.2196/ijmr.7844 %U http://www.i-jmr.org/2017/2/e15/ %U https://doi.org/10.2196/ijmr.7844 %U http://www.ncbi.nlm.nih.gov/pubmed/28899846 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e16 %T Perceptions of Health-Related Information on Facebook: Cross-Sectional Study Among Vietnamese Youths %A Zhang,Melvyn WB %A Tran,Bach Xuan %A Le,Huong Thi %A Nguyen,Hinh Duc %A Nguyen,Cuong Tat %A Tran,Tho Dinh %A Latkin,Carl A %A Ho,Roger CM %+ Institute for Global Health Innovations, Duy Tan University, 182 Nguyen Van Linh, Thanh Khe district, Da Nang,, Vietnam, 84 982 228662, cuong.ighi@gmail.com %K health information %K social media %K Facebook %K beliefs %D 2017 %7 07.09.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: While health information websites may have previously been the core source of information about health-related conditions on the Internet, social networking sites are increasingly replacing those websites as a source of health-related information. The increasingly popularity of social networking sites among the general population has consequential impact on health policies as well as health-related interventions. To date, there remains a paucity of research conducted in developing countries like Vietnam looking at the influence of social networking sites. Objective: Our goal is to establish the baseline use of Facebook among Vietnamese youths and establish their perception of the reliability and usefulness of health-related information that they previously encountered while using the social networking site. Methods: An online cross-sectional study was conducted from August 2015 to October 2015. Respondent-driven sampling (RDS) technique was used in the recruitment of participants. Sociodemographic, health status, behaviors, Facebook use and belief of information on Facebook, and interpersonal influence of social network sites were collected via an online structured questionnaire. Results: Among 1080 participants, 72.87% (787/1080) reported being interested in health information on Facebook, and 50.74% (548/1080) and 17.50% (189/1080) perceived the information to be reliable and useful, respectively. A total of 10.93% (118/1080) of the participants also reported that they would follow the health advice they obtained from Facebook. Of significance, 7.13% (77/1080) of the participants also reported peer influences on their behavior. Factors that mediate Vietnamese perceptions of the information online include gender, level of perceived stress, age, educational level, and interpersonal influences from Facebook. Conclusions: Our study is perhaps one of the first conducted in Vietnam that looks at the relationship between health information on Facebook and factors that might influence young Vietnamese perceptions of the information and the consequential use of that information. %M 28882813 %R 10.2196/ijmr.8072 %U http://www.i-jmr.org/2017/2/e16/ %U https://doi.org/10.2196/ijmr.8072 %U http://www.ncbi.nlm.nih.gov/pubmed/28882813 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e7 %T Dupuytren Disease: Is There Enough Comprehensive Patient Information on the Internet? %A Zuk,Grzegorz %A Reinisch,Katharina B %A Raptis,Dimitri A %A Fertsch,Sonia %A Guggenheim,Merlin %A Palma,Adrian F %+ Hospital of Wetzikon, Department of Surgery, Spitalstrasse 66, Wetzikon, 8620, Switzerland, 41 449341111, mail@adrianpalma.com %K congenital hand deformity %K Internet %K patient education %D 2017 %7 22.06.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Dupuytren disease is a chronic nonmalign fibroproliferative disorder that causes finger contractures via proliferation of new tissue under the glabrous skin of the hand, resulting in multiple functional limitations for the patient. As many surgical therapy options exist, patients suffering from this condition actively search for information in their environment before consulting a health professional. Objective: As little is known about the quality of Web-based patient information, the aim of this study was to conduct its systematic evaluation using a validated tool. Methods: A total of 118 websites were included, and qualitative and quantitative assessment was performed using the modified Ensuring Quality Information for Patients (EQIP) tool. This standardized and reproducible tool consists of 36 items to assess available information in three categories: contents, identification, and structure data. Scientific data with restricted access, duplicates, and irrelevant websites were not included. Results: Only 32 websites addressed more than 19 items, and the scores did not significantly differ among the website developers. The median number of items from the EQIP tool was 16, with the top websites addressing 28 out of 36 items. The quality of the newly developed websites did not increase with passing time. Conclusions: This study revealed several shortcomings in the quality of Web-based information available for patients suffering from Dupuytren disease. In the world of continuously growing and instantly available Web-based information, it is the health providers’ negligence of the last two decades that there are very few good quality, informative, and educative websites that could be recommended to patients. %M 28642214 %R 10.2196/ijmr.7822 %U http://www.i-jmr.org/2017/1/e7/ %U https://doi.org/10.2196/ijmr.7822 %U http://www.ncbi.nlm.nih.gov/pubmed/28642214 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e218 %T Trust and Credibility in Web-Based Health Information: A Review and Agenda for Future Research %A Sbaffi,Laura %A Rowley,Jennifer %+ Information School, Department of Social Sciences, University of Sheffield, 211 Portobello, Sheffield, S1 4DP, United Kingdom, 44 114 2222 ext 686, L.Sbaffi@sheffield.ac.uk %K literature review %K trust %K health information %K information retrieval %K web %D 2017 %7 19.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet sources are becoming increasingly important in seeking health information, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of Web-based health information (WHI) from different organizations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and more specifically, how they assess their credibility and trustworthiness. Objective: The aim of this study was to review empirical studies on trust and credibility in the use of WHI. The article seeks to present a profile of the research conducted on trust and credibility in WHI seeking, to identify the factors that impact judgments of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aimed to identify the gaps in current knowledge and to propose an agenda for future research. Methods: A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms WHI, trust, credibility, and their variants in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of the exclusion criteria, 73 were analyzed fully. Results: Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science, and computer science and originating mostly from the United States and the United Kingdom. Documents in the final dataset fell into 3 categories: (1) those using trust or credibility as a dependent variable, (2) those using trust or credibility as an independent variable, and (3) studies of the demographic factors that influence the role of trust or credibility in WHI seeking. There is a consensus that website design, clear layout, interactive features, and the authority of the owner have a positive effect on trust or credibility, whereas advertising has a negative effect. With regard to content features, authority of the author, ease of use, and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender, and perceived health status. Conclusions: There is considerable scope for further research. This includes increased clarity of the interaction between the variables associated with health information seeking, increased consistency on the measurement of trust and credibility, a greater focus on specific WHI sources, and enhanced understanding of the impact of demographic variables on trust and credibility judgments. %M 28630033 %R 10.2196/jmir.7579 %U http://www.jmir.org/2017/6/e218/ %U https://doi.org/10.2196/jmir.7579 %U http://www.ncbi.nlm.nih.gov/pubmed/28630033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e205 %T “Click for Closer Care”: A Content Analysis of Community Pharmacy Websites in Four Countries %A Zwier,Sandra %+ Amsterdam School of Communication Research ASCoR, Department of Communication Science, University of Amsterdam, Post box 15796, Amsterdam, 1001 NG, Netherlands, 31 20 5255094, s.m.zwier@uva.nl %K community pharmacy services %K pharmaceutical services %K online pharmacies %K marketing of health services %K commerce %K pharmacy ethics %D 2017 %7 14.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Combinations of professional and commercial communication are typically very controversial, particularly in health care communication on the Internet. Websites of licensed community pharmacies on the other hand tend to raise remarkably little controversy, although they typically contain controversial combinations of clinical and commercial services previously unprecedented in professional health care communication. Objective: The aim of this study was to fill the void of knowledge about the combination of clinical and commercial services presented on the websites of licensed community pharmacies. Methods: A content analysis of clinical and commercial services presented in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia was conducted. Results: The top five specific services mentioned on the community pharmacy websites were cosmetic products (126/200, 63.0%), medication refill request options (124/200, 62.0%), over-the-counter medicine (115/200, 57.5%), complementary and alternative medicine (107/200, 53.5%), and home medical aids (98/200, 49.0%). On average, 72.5% (145/200) of the community pharmacy websites across the 4 countries included a combination of clinical and commercial services. A combination of clinical and commercial services was more often present on chain pharmacy websites (120/147, 82.8%) than single pharmacy websites (25/53, 47%; P<.001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites, respectively (P<.02). Furthermore, more than half of the pharmacies’ homepages contained a combination of clinical and commercial images (107/200, 53.5%), and almost half of the homepage menus contained a combination of clinical and commercial items (99/200, 49.5%). The latter were, again, more common on chain pharmacy than single pharmacy websites (P<.001), with significant differences between countries (P<.001). Conclusions: A considerable share of websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia combine clinical services with commercial services. Previous research into the presence of a combination of commercial and professional services suggests that such a combination may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients’ health. %M 28615153 %R 10.2196/jmir.6899 %U http://www.jmir.org/2017/6/e205/ %U https://doi.org/10.2196/jmir.6899 %U http://www.ncbi.nlm.nih.gov/pubmed/28615153 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e5 %T Thoracic Surgery Information on the Internet: A Multilingual Quality Assessment %A Davaris,Myles %A Barnett,Stephen %A Abouassaly,Robert %A Lawrentschuk,Nathan %+ Austin Hospital, Department of Surgery, University of Melbourne, Suite 5, 210 Burgundy Street, Heidelberg, Melbourne,, Australia, 61 394553363, lawrentschuk@gmail.com %K thoracic %K Internet %K multilingualism %K language %K websites %D 2017 %7 12.05.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery. Objective: The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment. Methods: Health On the Net (HON) principles may be applied to websites using an automated toolbar function. We used the English, French, Spanish, and German Google search engines to identify 12,000 websites using keywords related to thoracic conditions and procedures. The first 150 websites returned by each keyword in each language were examined. We compared website quality to assess for tertile (is the quality better in first, second, or third 50 websites returned) and language differences. A further analysis of the English site types was undertaken performing a comparative analysis of website provider types. Results: Overall, there are a considerable number of websites devoted to thoracic surgery: “lung cancer” returned over 150 million websites. About 7.85% (940/11,967) of websites are HON-accredited with differences by search term (P<.001) and tertiles (P<.001) of the first 150 websites, but not between languages. Oncological keywords regarding conditions and procedures were found to return a higher percentage of HON-accreditation. The percentage of HON-accredited sites was similar across all four languages (P=.77). In general, the first tertile contained a higher percentage of HON-accredited sites for every keyword. Conclusions: Clinicians should appreciate the lack of validation of the majority of thoracic websites, with discrepancies in quality and number of websites across conditions and procedures. These differences appear similar regardless of language. An opportunity exists for clinicians to participate in the development of informative, ethical, and reliable health websites on the Internet and direct patients to them. %M 28500021 %R 10.2196/ijmr.6732 %U http://www.i-jmr.org/2017/1/e5/ %U https://doi.org/10.2196/ijmr.6732 %U http://www.ncbi.nlm.nih.gov/pubmed/28500021 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e6 %T Quality of Social Media and Web-Based Information Regarding Inappropriate Nuclear Cardiac Stress Testing and the Choosing Wisely Campaign: A Cross-Sectional Study %A Winchester,David E %A Baxter,Diana %A Markham,Merry J %A Beyth,Rebecca J %+ Division of Cardiovascular Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, PO Box 100288, Gainesville, FL, 32610-0288, United States, 1 352 273 9076, dwinches@ufl.edu %K myocardial perfusion imaging %K health services research %K Internet %K unnecessary procedures %D 2017 %7 04.05.2017 %9 Short Paper %J Interact J Med Res %G English %X Background: The World Wide Web and social media provide the public with access to medical information unlike any other time in human history. However, the quality of content related to cardiac stress testing is not well understood. Objective: The aim of our study was to evaluate the quality of content on the Internet relating to the use of cardiac nuclear stress testing and the Choosing Wisely campaign. Methods: We searched the World Wide Web, Google Video (including YouTube), and Twitter for information relating to these two topics. Searches were performed using English language terms from a computer in the United States not logged into any personal user accounts. Search results were reviewed for discussion of specific topics including radiation risk, accuracy of testing, alternative testing options, and discouragement of inappropriate test use. Results: We evaluated a total of 348 items of content from our searches. Relevant search results for Choosing Wisely were fewer than for other search terms (45 vs 303). We did not find any content which encouraged inappropriate testing (ie, screening in low risk individuals or testing prior to low risk operations). Content related to Choosing Wisely was more likely to discourage inappropriate testing than search results for other terms (29/45, 64% vs 12/303, 4.0%, odds ratio 43.95, 95% CI 17.6-112.2, P<.001). Conclusions: The Internet content on nuclear stress tests consistently discouraged inappropriate testing. The Choosing Wisely content was more likely to discourage inappropriate testing, less relevant content was available. Generating authoritative content on the Internet relating to judicious use of medical interventions may be an important role for the Choosing Wisely campaign. %M 28473305 %R 10.2196/ijmr.7210 %U http://www.i-jmr.org/2017/1/e6/ %U https://doi.org/10.2196/ijmr.7210 %U http://www.ncbi.nlm.nih.gov/pubmed/28473305 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e3 %T Using eHealth Technologies: Interests, Preferences, and Concerns of Older Adults %A Ware,Patrick %A Bartlett,Susan J %A Paré,Guy %A Symeonidis,Iphigenia %A Tannenbaum,Cara %A Bartlett,Gillian %A Poissant,Lise %A Ahmed,Sara %+ School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400 ext 00531, sara.ahmed@mcgill.ca %K Internet %K telemedicine %K self care %K chronic disease %D 2017 %7 23.03.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The Internet and eHealth technologies represent new opportunities for managing health. Age, sex, socioeconomic status, and current technology use are some of the known factors that influence individuals’ uptake of eHealth; however, relatively little is known about facilitators and barriers to eHealth uptake specific to older adults, particularly as they relate to their experiences in accessing health care. Objective: The aim of our study was to explore the interests, preferences, and concerns of older adults in using the Internet and eHealth technologies for managing their health in relation to their experiences with the current health care system. Methods: Two focus groups (n=15) were conducted with adults aged 50+ years. Pragmatic thematic analysis using an inductive approach was conducted to identify the interests, preferences, and concerns of using the Internet and eHealth technologies. Results: Five themes emerged that include (1) Difficulty in identifying credible and relevant sources of information on the Web; (2) Ownership, access, and responsibility for medical information; (3) Peer communication and support; (4) Opportunities to enhance health care interactions; and (5) Privacy concerns. These findings support the potential value older adults perceive in eHealth technologies, particularly in their ability to provide access to personal health information and facilitate communication between providers and peers living with similar conditions. However, in order to foster acceptance, these technologies will need to provide personal and general health information that is secure, readily accessible, and easily understood. Conclusions: Older adults have diverse needs and preferences that, in part, are driven by their experiences and frustrations with the health care system. Results can help inform the design and implementation of technologies to address gaps in care and access to health information for older adults with chronic conditions who may benefit the most from this approach. %M 28336506 %R 10.2196/ijmr.4447 %U http://www.i-jmr.org/2017/1/e3/ %U https://doi.org/10.2196/ijmr.4447 %U http://www.ncbi.nlm.nih.gov/pubmed/28336506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e23 %T Rare Diseases on the Internet: An Assessment of the Quality of Online Information %A Pauer,Frédéric %A Litzkendorf,Svenja %A Göbel,Jens %A Storf,Holger %A Zeidler,Jan %A Graf von der Schulenburg,Johann-Matthias %+ Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str 1, Hannover, 30159, Germany, 49 511 762 ext 14244, frp@cherh.de %K health literacy %K rare disesases %K quality indicators %K health information exchange %D 2017 %7 18.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The importance of the Internet as a medium for publishing and sharing health and medical information has increased considerably during the last decade. Nonetheless, comprehensive knowledge and information are scarce and difficult to find, especially for rare diseases. Additionally, the quality of health or medical information about rare diseases is frequently difficult to assess for the patients and their family members. Objective: The aim of this study is to assess the quality of information on the Internet about rare diseases. Additionally, the study aims to evaluate if the quality of information on rare diseases varies between different information supplier categories. Methods: A total of 13 quality criteria for websites providing medical information about rare diseases were transferred to a self-disclosure questionnaire. Identified providers of information on the Internet about rare diseases were invited to fill out the questionnaire. The questionnaire contained questions about the information provider in general (eg, supplier category, information category, language, use of quality certificates, and target group) and about quality aspects that reflect the 13 quality criteria. Differences in subgroup analyses were performed using t tests. Results: We identified 693 websites containing information about rare diseases. A total of 123 questionnaires (17.7%) were completely filled out by the information suppliers. For the remaining identified suppliers (570/693, 82.3%), the questionnaires were filled out by the authors based on the information available on their website. In many cases, the quality of websites was proportionally low. Furthermore, subgroup analysis showed no statistically significant differences between the quality of information provided by support group/patient organization compared to medical institution (P=.19). The quality of information by individuals (patient/relative) was significantly lower compared to information provided by support group/patient organization (P=.001), medical institution (P=.009), and other associations and sponsoring bodies (P=.001) as well. Conclusions: Overall, the quality of information on the Internet about rare diseases is low. Quality certificates are rarely used and important quality criteria are often not fulfilled completely. Additionally, some information categories are underrepresented (eg, information about psychosocial counseling, social-legal advice, and family planning). Nevertheless, due to the high amount of information provided by support groups, this study shows that these are extremely valuable sources of information for patients suffering from a rare disease and their relatives. %M 28100442 %R 10.2196/jmir.7056 %U http://www.jmir.org/2017/1/e23/ %U https://doi.org/10.2196/jmir.7056 %U http://www.ncbi.nlm.nih.gov/pubmed/28100442 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e8 %T Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues %A Carlsson,Tommy %A Axelsson,Ove %+ Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, Ing 95-96 nbv, Uppsala, SE-75185, Sweden, 46 736143454, tommy.carlsson@kbh.uu.se %K consumer health information %K induced abortion %K information literacy %K Internet %K popular works %K second pregnancy trimester %D 2017 %7 10.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites. Objective: Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations. Methods: We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues. Results: The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42). Conclusions: The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites. %M 28073735 %R 10.2196/jmir.6380 %U http://www.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/jmir.6380 %U http://www.ncbi.nlm.nih.gov/pubmed/28073735 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e1 %T Evaluating YouTube as a Source of Patient Education on the Role of the Hospitalist: A Cross-Sectional Study %A Hudali,Tamer %A Papireddy,Muralidhar %A Bhattarai,Mukul %A Deckard,Alan %A Hingle,Susan %+ Department of Internal Medicine, Southern Illinois University School of Medicine, PO Box 19636, Springfield, IL, 62794-9636, United States, 1 217 545 1385, mpapireddy@gmail.com %K YouTube %K hospitalist %K patient education %D 2017 %7 10.01.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Hospital medicine is a relatively new specialty field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTube is one of the most frequently used websites, offering access to a gamut of videos from self-produced to professionally made. Objective: The aim of our study was to determine the adequacy of YouTube as an effective means to define and depict the role of hospitalists. Methods: YouTube was searched on November 17, 2014, using the following search words: “hospitalist,” “hospitalist definition,” “what is the role of a hospitalist,” “define hospitalist,” and “who is a hospitalist.” Videos found only in the first 10 pages of each search were included. Non-English, noneducational, and nonrelevant videos were excluded. A novel 7-point scoring tool was created by the authors based on the definition of a hospitalist adopted by the Society of Hospital Medicine. Three independent reviewers evaluated, scored, and classified the videos into high, intermediate, and low quality based on the average score. Results: A total of 102 videos out of 855 were identified as relevant and included in the analysis. Videos uploaded by academic institutions had the highest mean score. Only 6 videos were classified as high quality, 53 as intermediate quality, and 42 as low quality, with 82.4% (84/102) of the videos scoring an average of 4 or less. Conclusions: Most videos found in the search of a hospitalist definition are inadequate. Leading medical organizations and academic institutions should consider producing and uploading quality videos to YouTube to help patients and their families better understand the roles and definition of the hospitalist. %M 28073738 %R 10.2196/ijmr.6393 %U http://www.i-jmr.org/2017/1/e1/ %U https://doi.org/10.2196/ijmr.6393 %U http://www.ncbi.nlm.nih.gov/pubmed/28073738 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e1 %T The Readability of Electronic Cigarette Health Information and Advice: A Quantitative Analysis of Web-Based Information %A Park,Albert %A Zhu,Shu-Hong %A Conway,Mike %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, United States, 1 206 743 7843, alpark1216@gmail.com %K electronic cigarettes %K tobacco use cessation products %K health services %K consumer health information %K health education %D 2017 %7 06.01.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The popularity and use of electronic cigarettes (e-cigarettes) has increased across all demographic groups in recent years. However, little is currently known about the readability of health information and advice aimed at the general public regarding the use of e-cigarettes. Objective: The objective of our study was to examine the readability of publicly available health information as well as advice on e-cigarettes. We compared information and advice available from US government agencies, nongovernment organizations, English speaking government agencies outside the United States, and for-profit entities. Methods: A systematic search for health information and advice on e-cigarettes was conducted using search engines. We manually verified search results and converted to plain text for analysis. We then assessed readability of the collected documents using 4 readability metrics followed by pairwise comparisons of groups with adjustment for multiple comparisons. Results: A total of 54 documents were collected for this study. All 4 readability metrics indicate that all information and advice on e-cigarette use is written at a level higher than that recommended for the general public by National Institutes of Health (NIH) communication guidelines. However, health information and advice written by for-profit entities, many of which were promoting e-cigarettes, were significantly easier to read. Conclusions: A substantial proportion of potential and current e-cigarette users are likely to have difficulty in fully comprehending Web-based health information regarding e-cigarettes, potentially hindering effective health-seeking behaviors. To comply with NIH communication guidelines, government entities and nongovernment organizations would benefit from improving the readability of e-cigarettes information and advice. %M 28062390 %R 10.2196/publichealth.6687 %U http://publichealth.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/publichealth.6687 %U http://www.ncbi.nlm.nih.gov/pubmed/28062390 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 1 %N 2 %P e6 %T Widely Viewed English Language YouTube Videos Relating to Diabetic Retinopathy: A Cross-Sectional Study %A Basch,Corey Hannah %A Fung,Isaac Chun-Hai %A Berdnik,Alyssa %A Basch,Charles E %+ Department of Public Health, William Paterson University, 366 University Hall, Wayne, NJ, United States, 1 973 720 2603, baschc@wpunj.edu %K diabetic retinopathy %K social media %K YouTube %D 2016 %7 14.12.2016 %9 Original Paper %J JMIR Diabetes %G English %X Background: An emergent source of information on health issues is the Internet. One such platform with 1 billion users is YouTube, the global video-sharing service. Objective: The purpose of this study was to describe the content and characteristics of the most widely viewed YouTube videos related to diabetic retinopathy. Methods: Videos were sorted according to number of views using the key words “diabetic retinopathy.” For each video, general descriptive information was collected. This information included date and source of upload (news, professional, or consumer), length, and total number of views as of July 18, 2016. Content categories were largely informed by a National Eye Institute fact sheet. Each video was viewed to determine which, if any, of the given content categories were present. Results: Of the 98 most widely viewed videos related to diabetic retinopathy, 42 were generated by consumers, 40 were generated by professionals, and 16 were generated from news-based sources. The largest number of views were generated from professionals (624,770/994,494, 63.82%). Compared with professional videos, consumer videos were viewed less frequently (W=622, P=.04). The main purpose of the majority of videos was to provide information (59/98, 60%), and most of the videos showed or mentioned retinopathy in general (75/98, 77%). Smaller numbers offered information about specific types of retinopathy, namely proliferative (26/98, 27%) and nonproliferative (17/98, 17%). Compared with consumer-generated videos, professional videos were 5.57 times more likely to mention that diabetic retinopathy can go unnoticed (95% CI 1.59-26.15). More than 80% (80/98) of the most widely viewed videos did not address the asymptomatic nature of the disease, only about one-third (33/98) mentioned prevention, and only 58 of the 98 videos (59%) mentioned screening. Conclusion: Future research is needed to identify aspects of YouTube videos that attract viewer attention and best practices for using this medium to increase diabetic retinopathy screening among people with diabetes. %M 30291055 %R 10.2196/diabetes.6450 %U http://diabetes.jmir.org/2016/2/e6/ %U https://doi.org/10.2196/diabetes.6450 %U http://www.ncbi.nlm.nih.gov/pubmed/30291055 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 4 %P e25 %T Online Health Information Regarding Male Infertility: An Evaluation of Readability, Suitability, and Quality %A Robins,Stephanie %A Barr,Helena J %A Idelson,Rachel %A Lambert,Sylvie %A Zelkowitz,Phyllis %+ Jewish General Hospital, Department of Psychiatry, 4333 Cote Ste Catherine, Montreal, QC, H3T1E4, Canada, 1 514 340 8222 ext 5258, phyllis.zelkowitz@mcgill.ca %K male infertility %K fertility preservation %K Internet %K online health information %K men’s health %D 2016 %7 21.10.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Many men lack knowledge about male infertility, and this may have consequences for their reproductive and general health. Men may prefer to seek health information online, but these sources of information vary in quality. Objective: The objective of this study is to determine if online sources of information regarding male infertility are readable, suitable, and of appropriate quality for Internet users in the general population. Methods: This study used a cross-sectional design to evaluate online sources resulting from search engine queries. The following categories of websites were considered: (1) Canadian fertility clinics, (2) North American organizations related to fertility, and (3) the first 20 results of Google searches using the terms “male infertility” and “male fertility preservation” set to the search locations worldwide, English Canada, and French Canada. Websites that met inclusion criteria (N=85) were assessed using readability indices, the Suitability Assessment of Materials (SAM), and the DISCERN tool. The associations between website affiliation (government, university/medical, non-profit organization, commercial/corporate, private practice) and Google placement to readability, suitability, and quality were also examined. Results: None of the sampled websites met recommended levels of readability. Across all websites, the mean SAM score for suitability was 45.37% (SD 11.21), or “adequate”, while the DISCERN mean score for quality was 43.19 (SD 10.46) or “fair”. Websites that placed higher in Google obtained a higher overall score for quality with an r (58) value of -.328 and a P value of .012, but this position was not related to readability or suitability. In addition, 20% of fertility clinic websites did not include fertility information for men. Conclusions: There is a lack of high quality online sources of information on male fertility. Many websites target their information to women, or fail to meet established readability criteria for the general population. Since men may prefer to seek health information online, it is important that health care professionals develop high quality sources of information on male fertility for the general population. %M 27769954 %R 10.2196/ijmr.6440 %U http://www.i-jmr.org/2016/4/e25/ %U https://doi.org/10.2196/ijmr.6440 %U http://www.ncbi.nlm.nih.gov/pubmed/27769954 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 3 %P e24 %T Adopting Quality Criteria for Websites Providing Medical Information About Rare Diseases %A Pauer,Frédéric %A Göbel,Jens %A Storf,Holger %A Litzkendorf,Svenja %A Babac,Ana %A Frank,Martin %A Lührs,Verena %A Schauer,Franziska %A Schmidtke,Jörg %A Biehl,Lisa %A Wagner,Thomas OF %A Ückert,Frank %A Graf von der Schulenburg,Johann-Matthias %A Hartz,Tobias %+ Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str 1, Hannover, 30159, Germany, 49 511 762 14244, frp@cherh.de %K rare diseases %K self-help groups %K Internet %K health information exchange %K quality indicators %D 2016 %7 25.08.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: The European Union considers diseases to be rare when they affect less than 5 in 10,000 people. It is estimated that there are between 5000 and 8000 different rare diseases. Consistent with this diversity, the quality of information available on the Web varies considerably. Thus, quality criteria for websites about rare diseases are needed. Objective: The objective of this study was to generate a catalog of quality criteria suitable for rare diseases. Methods: First, relevant certificates and quality recommendations for health information websites were identified through a comprehensive Web search. Second, all considered quality criteria of each certification program and catalog were examined, extracted into an overview table, and analyzed by thematic content. Finally, an interdisciplinary expert group verified the relevant quality criteria. Results: We identified 9 quality certificates and criteria catalogs for health information websites with 304 single criteria items. Through this, we aggregated 163 various quality criteria, each assigned to one of the following categories: thematic, technical, service, content, and legal. Finally, a consensus about 13 quality criteria for websites offering medical information on rare diseases was determined. Of these categories, 4 (data protection concept, imprint, creation and updating date, and possibility to contact the website provider) were identified as being the most important for publishing medical information about rare diseases. Conclusions: The large number of different quality criteria appearing within a relatively small number of criteria catalogs shows that the opinion of what is important in the quality of health information differs. In addition, to define useful quality criteria for websites about rare diseases, which are an essential source of information for many patients, a trade-off is necessary between the high standard of quality criteria for health information websites in general and the limited provision of information about some rare diseases. Finally, transparently presented quality assessments can help people to find reliable information and to assess its quality. %M 27562540 %R 10.2196/ijmr.5822 %U http://www.i-jmr.org/2016/3/e24/ %U https://doi.org/10.2196/ijmr.5822 %U http://www.ncbi.nlm.nih.gov/pubmed/27562540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e228 %T An Evaluation and Ranking of Children’s Hospital Websites in the United States %A Huerta,Timothy R %A Walker,Daniel M %A Ford,Eric W %+ The Ohio State University, College of Medicine, Department of Family Medicine, 2231 North High St., Rm 265, Columbus, OH, 43201, United States, 1 6143666636, timothy.huerta@osumc.edu %K pediatric hospital %K Internet %K social media %K patient participation %K patient education %D 2016 %7 22.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective: The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods: All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results: Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions: Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals. %M 27549074 %R 10.2196/jmir.5799 %U http://www.jmir.org/2016/8/e228/ %U https://doi.org/10.2196/jmir.5799 %U http://www.ncbi.nlm.nih.gov/pubmed/27549074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e211 %T Making Quality Health Websites a National Public Health Priority: Toward Quality Standards %A Devine,Theresa %A Broderick,Jordan %A Harris,Linda M %A Wu,Huijuan %A Hilfiker,Sandra Williams %+ CommunicateHealth, Inc., 26 Market St., Northampton, MA, 01060, United States, 1 413 582 0425, huijuan@communicatehealth.com %K online health information %K health literacy %K reliability %K usability %K measurement %D 2016 %7 02.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. Objective: The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. Methods: The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. Results: This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out of 100 (58.0%) websites met 3 or more out of 6 reliability criteria. For objective HC/HIT-8.2, a total of 42 out of 100 (42.0%) websites followed 10 or more out of 19 established usability principles. On the basis of these baseline data points, ODPHP set targets for the year 2020 that meet the minimal statistical significance—increasing objective HC/HIT-8.1 data point to 70.5% and objective HC/HIT-8.2 data point to 55.7%. Conclusions: This research is a critical first step in evaluating the quality of Web-based health information. The criteria proposed by ODPHP provide methods to assess website quality for professionals designing, developing, and managing health-related websites. The criteria, baseline data, and targets are valuable tools for driving quality improvement. %M 27485512 %R 10.2196/jmir.5999 %U http://www.jmir.org/2016/8/e211/ %U https://doi.org/10.2196/jmir.5999 %U http://www.ncbi.nlm.nih.gov/pubmed/27485512 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 3 %P e21 %T Evaluation of Web-Based Consumer Medication Information: Content and Usability of 4 Australian Websites %A Raban,Magdalena Z %A Tariq,Amina %A Richardson,Lauren %A Byrne,Mary %A Robinson,Maureen %A Li,Ling %A Westbrook,Johanna I %A Baysari,Melissa T %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, 2109, Australia, 61 298502433, magda.raban@mq.edu.au %K consumer health information %K health communication %K prescription drugs %K nonprescription drugs %K drug information service %K Internet %K usability testing %D 2016 %7 21.07.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Medication is the most common intervention in health care, and written medication information can affect consumers’ medication-related behavior. Research has shown that a large proportion of Australians search for medication information on the Internet. Objective: To evaluate the medication information content, based on consumer medication information needs, and usability of 4 Australian health websites: Better Health Channel, myDr, healthdirect, and NPS MedicineWise . Methods: To assess website content, the most common consumer medication information needs were identified using (1) medication queries to the healthdirect helpline (a telephone helpline available across most of Australia) and (2) the most frequently used medications in Australia. The most frequently used medications were extracted from Australian government statistics on use of subsidized medicines in the community and the National Census of Medicines Use. Each website was assessed to determine whether it covered or partially covered information and advice about these medications. To assess website usability, 16 consumers participated in user testing wherein they were required to locate 2 pieces of medication information on each website. Brief semistructured interviews were also conducted with participants to gauge their opinions of the websites. Results: Information on prescription medication was more comprehensively covered on all websites (3 of 4 websites covered 100% of information) than nonprescription medication (websites covered 0%-67% of information). Most websites relied on consumer medicines information leaflets to convey prescription medication information to consumers. Information about prescription medication classes was less comprehensive, with no website providing all information examined about antibiotics and antidepressants. Participants (n=16) were able to locate medication information on websites in most cases (accuracy ranged from 84% to 91%). However, a number of usability issues relating to website navigation and information display were identified. For example, websites not allowing combinations of search terms to be entered in search boxes and continuous blocks of text without subheadings. Conclusions: Of the 4 Australian health information websites tested, none provided consumers with comprehensive medication information on both prescription and nonprescription medications in a user-friendly way. Using data on consumer information needs and user testing to guide medication information content and website design is a useful approach to inform consumer website development. %M 27443680 %R 10.2196/ijmr.5651 %U http://www.i-jmr.org/2016/3/e21/ %U https://doi.org/10.2196/ijmr.5651 %U http://www.ncbi.nlm.nih.gov/pubmed/27443680 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e19 %T Quality of Web-based Information for the 10 Most Common Fractures %A Memon,Muzammil %A Ginsberg,Lydia %A Simunovic,Nicole %A Ristevski,Bill %A Bhandari,Mohit %A Kleinlugtenbelt,Ydo Vincent %+ McMaster University, Medical Student, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada, 1 516 708 3981, muzammil.memon@medportal.ca %K fractures %K quality %K readability %K patient %K online %K information %K HONcode %K DISCERN %K Google %D 2016 %7 17.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: In today's technologically advanced world, 75% of patients have used Google to search for health information. As a result, health care professionals fear that patients may be misinformed. Currently, there is a paucity of data on the quality and readability of Web-based health information on fractures. Objectives: In this study, we assessed the quality and readability of Web-based health information related to the 10 most common fractures. Methods: Using the Google search engine, we assessed websites from the first results page for the 10 most common fractures using lay search terms. Website quality was measured using the DISCERN instrument, which scores websites as very poor (15-22.5), poor (22.5-37.5), fair (37.5-52.5), good (52.5-67.5), or excellent (67.5-75). The presence of Health on the Net code (HONcode) certification was assessed for all websites. Website readability was measured using the Flesch Reading Ease Score (0-100), where 60-69 is ideal for the general public, and the Flesch-Kincaid Grade Level (FKGL; −3.4 to ∞), where the mean FKGL of the US adult population is 8. Results: Overall, website quality was “fair” for all fractures, with a mean (standard deviation) DISCERN score of 50.3 (5.8). The DISCERN score correlated positively with a higher website position on the search results page (r2=0.1, P=.002) and with HONcode certification (P=.007). The mean (standard deviation) Flesch Reading Ease Score and FKGL for all fractures were 62.2 (9.1) and 6.7 (1.6), respectively. Conclusion: The quality of Web-based health information on fracture care is fair, and its readability is appropriate for the general public. To obtain higher quality information, patients should select HONcode-certified websites. Furthermore, patients should select websites that are positioned higher on the results page because the Google ranking algorithms appear to rank the websites by quality. %M 27317159 %R 10.2196/ijmr.5767 %U http://www.i-jmr.org/2016/2/e19/ %U https://doi.org/10.2196/ijmr.5767 %U http://www.ncbi.nlm.nih.gov/pubmed/27317159 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 6 %P e89 %T “Less Than A Wife”: A Study of Polycystic Ovary Syndrome Content in Teen and Women’s Digital Magazines %A Sanchez,Ninive %A Jones,Hillary %+ School of Social Work, University of Missouri, 712 Clark Hall, Columbia, MO, 65211, United States, 1 573 882 0920, sanchezni@missouri.edu %K polycystic ovary syndrome %K digital magazines %K women's health %K edutainment %D 2016 %7 02.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Polycystic ovary syndrome (PCOS) is a major public health problem that affects women’s physical and mental health. According to the US National Institutes of Health Office of Disease Prevention, there is a need to improve public awareness of the syndrome among health care providers and the public. Women’s magazines are a type of “edutainment” that publish health content in addition to beauty, fashion, and entertainment content. These media have the potential to expose primarily female readers to content on PCOS and influence readers’ beliefs and attitudes about women with PCOS. Objective: The objective of this study was to explore how digital (online) teen and women’s magazines portray women with PCOS. Methods: We used data from the Alliance for Audited Media to identify popular digital teen and women’s magazines with circulation rates ≥1,000,001. We also included magazines with circulation rates 100,001–1,000,000 directed toward racial and ethnic minority readers. A search of magazine websites over a 1-month period in 2015 yielded 21 magazines (eg, Glamour, Cosmopolitan en Español, Essence, and O, The Oprah Magazine) and 170 articles containing “PCOS” and “polycystic ovary syndrome.” Textual analysis using a grounded theory approach was used to identify themes. Results: Articles depicted PCOS symptoms as a hindrance to women’s social roles as wives and mothers and largely placed personal responsibility on women to improve their health. To a lesser extent, women were depicted as using their personal experience with PCOS to advocate for women’s health. Experiences of Latina and African American women and adolescents with PCOS were absent from women’s magazine articles. Conclusions: The findings can inform health education programs that teach women to be critical consumers of PCOS-related content in digital women’s magazines. Future research on PCOS content in digital teen and women’s magazines can help researchers, patients, and consumer groups engage with the media to increase public awareness of PCOS. %M 27255809 %R 10.2196/jmir.5417 %U http://www.jmir.org/2016/6/e89/ %U https://doi.org/10.2196/jmir.5417 %U http://www.ncbi.nlm.nih.gov/pubmed/27255809 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 2 %P e15 %T Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan %A Kashihara,Hidenori %A Nakayama,Takeo %A Hatta,Taichi %A Takahashi,Naomi %A Fujita,Misao %+ Center for iPS Cell Research and Application (CiRA), Kyôto University, 53 Kawahara-cho, Shôgoin, Sakyô-ku, Kyôto, 606-8507, Japan, 81 75 366 7194, oakfield007@gmail.com %K stem cell %K health information %K regulations %K regenerative medicine %K misrepresentation %K medical tourism %K direct-to-consumer %K online marketing %K web survey %K descriptive analysis %D 2016 %7 24.05.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics’ websites. Meanwhile, the Health Science Council at the Ministry of Health, Labour, and Welfare (MHLW) in Japan has pointed out noncompliance of some local clinics with the provisions concerning medical advertising in the Medical Care Act in the past. However, locally little is known about the current status of those clinics including the quality of their webpage information disseminated. Objective: To evaluate the quality of website information of private-practice clinics offering cell therapies in Japan. Methods: Twenty-four websites with 77 treatments from the Google search were identified for evaluation. The following three exploratory analyses were performed: first in order to ascertain web-based portrayal of private-practice clinics offering cell therapies, a descriptive analysis was conducted using a coding frame; second we evaluated the quality of the target website information from the viewpoint of the level of consideration taken for patients and their family members, using 10 quality criteria (“the Minimum Standard”) from the e-Health Code of Ethics 2.0; third we counted and coded expressions that matched set categories for “name-dropping” and “personalized medicine” in the information posted on these websites. Results: Analysis on the treatments (N=77) revealed 126 indications (multiple response): the top three indications were “cancer,” “skin-rejuvenation/antiaging/anti–skin aging,” and “breast augmentation/buttock augmentation.” As for the portrayal of treatment risks and benefits, 78% (60/77) of treatments were mentioned with “benefits,” whereas 77% (59/77) of treatments were mentioned with “risks.” As for the source(s) cited for the discussions of treatment risks and benefits, no treatment quoted an expert’s opinion for the risks, whereas 7% (6/77) treatments quoted external sources for the benefits. As for the results with e-Health Code of Ethics 2.0, not a single clinic fulfilled all the 10 criteria; 63% (15/24) of the clinics was found exercising “name-dropping,” and 21% (5/24) of the clinics mentioned expressions related to “personalized medicine” on their websites. Conclusions: Our website content analyses confirmed the following: (1) the clinics mentioned the risks or benefits of the treatments with hardly any scientific citations, (2) the way the website information was disseminated was inappropriate for patients and their families, and (3) many websites seemed to be using marketing techniques in order to draw patients’ interests or attentions. It is important that more similar studies are undertaken globally to enable an orchestrated regulatory approach toward private-practice clinics. %M 27222494 %R 10.2196/ijmr.5479 %U http://www.i-jmr.org/2016/2/e15/ %U https://doi.org/10.2196/ijmr.5479 %U http://www.ncbi.nlm.nih.gov/pubmed/27222494 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e81 %T Crowdsourcing and the Accuracy of Online Information Regarding Weight Gain in Pregnancy: A Descriptive Study %A Chang,Tammy %A Verma,Bianca A %A Shull,Trevor %A Moniz,Michelle H %A Kohatsu,Lauren %A Plegue,Melissa A %A Collins-Thompson,Kevyn %+ Department of Family Medicine, University of Michigan, 2800 Plymouth Rd, Building 14- Room G107, Ann Arbor, MI, , United States, 1 734 647 3305, tachang@med.umich.edu %K Internet %K crowdsourcing %K weight gain %K pregnancy %D 2016 %7 07.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Excess weight gain affects nearly half of all pregnancies in the United States and is a strong risk factor for adverse maternal and fetal outcomes, including long-term obesity. The Internet is a prominent source of information during pregnancy; however, the accuracy of this online information is unknown. Objective: To identify, characterize, and assess the accuracy of frequently accessed webpages containing information about weight gain during pregnancy. Methods: A descriptive study was used to identify and search frequently used phrases related to weight gain during pregnancy on the Google search engine. The first 10 webpages of each query were characterized by type and then assessed for accuracy and completeness, as compared to Institute of Medicine guidelines, using crowdsourcing. Results: A total of 114 queries were searched, yielding 305 unique webpages. Of these webpages, 181 (59.3%) included information regarding weight gain during pregnancy. Out of 181 webpages, 62 (34.3%) contained no specific recommendations, 48 (26.5%) contained accurate but incomplete recommendations, 41 (22.7%) contained complete and accurate recommendations, and 22 (12.2%) were inaccurate. Webpages were most commonly from for-profit websites (112/181, 61.9%), followed by government (19/181, 10.5%), medical organizations or associations (13/181, 7.2%), and news sites (12/181, 6.6%). The largest proportion of for-profit sites contained no specific recommendations (44/112, 39.3%). Among pages that provided inaccurate information (22/181, 12.2%), 68% (15/22) were from for-profit sites. Conclusions: For-profit websites dominate the online space with regard to weight gain during pregnancy and largely contain incomplete, inaccurate, or no specific recommendations. This represents a significant information gap regarding an important risk factor for obesity among mothers and infants. Our findings suggest that greater clinical and public health efforts to disseminate accurate information regarding healthy weight gain during pregnancy may help prevent significant morbidity and may support healthier pregnancies among at-risk women and children. %M 27056465 %R 10.2196/jmir.5138 %U http://www.jmir.org/2016/4/e81/ %U https://doi.org/10.2196/jmir.5138 %U http://www.ncbi.nlm.nih.gov/pubmed/27056465 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e67 %T 100 Million Views of Electronic Cigarette YouTube Videos and Counting: Quantification, Content Evaluation, and Engagement Levels of Videos %A Huang,Jidong %A Kornfield,Rachel %A Emery,Sherry L %+ Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 312 355 0195, jhuang12@uic.edu %K electronic cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco products %K YouTube %K social media %D 2016 %7 18.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The video-sharing website, YouTube, has become an important avenue for product marketing, including tobacco products. It may also serve as an important medium for promoting electronic cigarettes, which have rapidly increased in popularity and are heavily marketed online. While a few studies have examined a limited subset of tobacco-related videos on YouTube, none has explored e-cigarette videos’ overall presence on the platform. Objective: To quantify e-cigarette-related videos on YouTube, assess their content, and characterize levels of engagement with those videos. Understanding promotion and discussion of e-cigarettes on YouTube may help clarify the platform’s impact on consumer attitudes and behaviors and inform regulations. Methods: Using an automated crawling procedure and keyword rules, e-cigarette-related videos posted on YouTube and their associated metadata were collected between July 1, 2012, and June 30, 2013. Metadata were analyzed to describe posting and viewing time trends, number of views, comments, and ratings. Metadata were content coded for mentions of health, safety, smoking cessation, promotional offers, Web addresses, product types, top-selling brands, or names of celebrity endorsers. Results: As of June 30, 2013, approximately 28,000 videos related to e-cigarettes were captured. Videos were posted by approximately 10,000 unique YouTube accounts, viewed more than 100 million times, rated over 380,000 times, and commented on more than 280,000 times. More than 2200 new videos were being uploaded every month by June 2013. The top 1% of most-viewed videos accounted for 44% of total views. Text fields for the majority of videos mentioned websites (70.11%); many referenced health (13.63%), safety (10.12%), smoking cessation (9.22%), or top e-cigarette brands (33.39%). The number of e-cigarette-related YouTube videos was projected to exceed 65,000 by the end of 2014, with approximately 190 million views. Conclusions: YouTube is a major information-sharing platform for electronic cigarettes. YouTube appears to be used unevenly for promotional purposes by e-cigarette brands, and our analyses indicated a high level of user engagement with a small subset of content. There is evidence that YouTube videos promote e-cigarettes as cigarette smoking cessation tools. Presence and reach of e-cigarette videos on YouTube warrants attention from public health professionals and policymakers. %M 26993213 %R 10.2196/jmir.4265 %U http://www.jmir.org/2016/3/e67/ %U https://doi.org/10.2196/jmir.4265 %U http://www.ncbi.nlm.nih.gov/pubmed/26993213 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e4 %T Health Advice from Internet Discussion Forums: How Bad Is Dangerous? %A Cole,Jennifer %A Watkins,Chris %A Kleine,Dorothea %+ H2B2, Department of Computer Science, Royal Holloway, University of London, 112 McCrea Building, Egham, Surrey, TW20 0EX, United Kingdom, 44 7885 655695, Jennifer.Cole.2013@live.rhul.ac.uk %K eHealth %K communication %K Internet %K social media %K health literacy %K health care information systems %K information seeking %K information science %K Medicine 2.0 %K Web-based and mobile health interventions %D 2016 %7 06.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Concerns over online health information–seeking behavior point to the potential harm incorrect, incomplete, or biased information may cause. However, systematic reviews of health information have found few examples of documented harm that can be directly attributed to poor quality information found online. Objective: The aim of this study was to improve our understanding of the quality and quality characteristics of information found in online discussion forum websites so that their likely value as a peer-to-peer health information–sharing platform could be assessed. Methods: A total of 25 health discussion threads were selected across 3 websites (Reddit, Mumsnet, and Patient) covering 3 health conditions (human immunodeficiency virus [HIV], diabetes, and chickenpox). Assessors were asked to rate information found in the discussion threads according to 5 criteria: accuracy, completeness, how sensible the replies were, how they thought the questioner would act, and how useful they thought the questioner would find the replies. Results: In all, 78 fully completed assessments were returned by 17 individuals (8 were qualified medical doctors, 9 were not). When the ratings awarded in the assessments were analyzed, 25 of the assessments placed the discussion threads in the highest possible score band rating them between 5 and 10 overall, 38 rated them between 11 and 15, 12 rated them between 16 and 20, and 3 placed the discussion thread they assessed in the lowest rating band (21-25). This suggests that health threads on Internet discussion forum websites are more likely than not (by a factor of 4:1) to contain information of high or reasonably high quality. Extremely poor information is rare; the lowest available assessment rating was awarded only 11 times out of a possible 353, whereas the highest was awarded 54 times. Only 3 of 78 fully completed assessments rated a discussion thread in the lowest possible overall band of 21 to 25, whereas 25 of 78 rated it in the highest of 5 to 10. Quality assessments differed depending on the health condition (chickenpox appeared 17 times in the 20 lowest-rated threads, HIV twice, and diabetes once). Although assessors tended to agree on which discussion threads contained good quality information, what constituted poor quality information appeared to be more subjective. Conclusions: Most of the information assessed in this study was considered by qualified medical doctors and nonmedically qualified respondents to be of reasonably good quality. Although a small amount of information was assessed as poor, not all respondents agreed that the original questioner would have been led to act inappropriately based on the information presented. This suggests that discussion forum websites may be a useful platform through which people can ask health-related questions and receive answers of acceptable quality. %M 26740148 %R 10.2196/jmir.5051 %U http://www.jmir.org/2016/1/e4/ %U https://doi.org/10.2196/jmir.5051 %U http://www.ncbi.nlm.nih.gov/pubmed/26740148 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e256 %T Pro-Anorexia and Anti-Pro-Anorexia Videos on YouTube: Sentiment Analysis of User Responses %A Oksanen,Atte %A Garcia,David %A Sirola,Anu %A Näsi,Matti %A Kaakinen,Markus %A Keipi,Teo %A Räsänen,Pekka %+ School of Social Sciences and Humanities, University of Tampere, Tampere, 33014, Finland, 358 50 318 7279, atte.oksanen@uta.fi %K eating disorders %K anorexia %K social media %K emotions %D 2015 %7 12.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Pro-anorexia communities exist online and encourage harmful weight loss and weight control practices, often through emotional content that enforces social ties within these communities. User-generated responses to videos that directly oppose pro-anorexia communities have not yet been researched in depth. Objective: The aim was to study emotional reactions to pro-anorexia and anti-pro-anorexia online content on YouTube using sentiment analysis. Methods: Using the 50 most popular YouTube pro-anorexia and anti-pro-anorexia user channels as a starting point, we gathered data on users, their videos, and their commentators. A total of 395 anorexia videos and 12,161 comments were analyzed using positive and negative sentiments and ratings submitted by the viewers of the videos. The emotional information was automatically extracted with an automatic sentiment detection tool whose reliability was tested with human coders. Ordinary least squares regression models were used to estimate the strength of sentiments. The models controlled for the number of video views and comments, number of months the video had been on YouTube, duration of the video, uploader’s activity as a video commentator, and uploader’s physical location by country. Results: The 395 videos had more than 6 million views and comments by almost 8000 users. Anti-pro-anorexia video comments expressed more positive sentiments on a scale of 1 to 5 (adjusted prediction [AP] 2.15, 95% CI 2.11-2.19) than did those of pro-anorexia videos (AP 2.02, 95% CI 1.98-2.06). Anti-pro-anorexia videos also received more likes (AP 181.02, 95% CI 155.19-206.85) than pro-anorexia videos (AP 31.22, 95% CI 31.22-37.81). Negative sentiments and video dislikes were equally distributed in responses to both pro-anorexia and anti-pro-anorexia videos. Conclusions: Despite pro-anorexia content being widespread on YouTube, videos promoting help for anorexia and opposing the pro-anorexia community were more popular, gaining more positive feedback and comments than pro-anorexia videos. Thus, the anti-pro-anorexia content provided a user-generated counterforce against pro-anorexia content on YouTube. Professionals working with young people should be aware of the social media dynamics and versatility of user-generated eating disorder content online. %M 26563678 %R 10.2196/jmir.5007 %U http://www.jmir.org/2015/11/e256/ %U https://doi.org/10.2196/jmir.5007 %U http://www.ncbi.nlm.nih.gov/pubmed/26563678 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 4 %P e19 %T Third Molars on the Internet: A Guide for Assessing Information Quality and Readability %A Hanna,Kamal %A Brennan,David %A Sambrook,Paul %A Armfield,Jason %+ PhD Candidate, Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry, The University of Adelaide, ARCPOH, 122 Frome Street, Adelaide, South Australia, 5005, Australia, 61 883135626, kamal.hanna@adelaide.edu.au %K DISCERN %K health information online %K Health on the Net Code %K readability %K Scientific Information Quality Scale %K website affiliation %K website content analysis %K wisdom teeth %D 2015 %7 06.10.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Directing patients suffering from third molars (TMs) problems to high-quality online information is not only medically important, but also could enable better engagement in shared decision making. Objectives: This study aimed to develop a scale that measures the scientific information quality (SIQ) for online information concerning wisdom tooth problems and to conduct a quality evaluation for online TMs resources. In addition, the study evaluated whether a specific piece of readability software (Readability Studio Professional 2012) might be reliable in measuring information comprehension, and explored predictors for the SIQ Scale. Methods: A cross-sectional sample of websites was retrieved using certain keywords and phrases such as “impacted wisdom tooth problems” using 3 popular search engines. The retrieved websites (n=150) were filtered. The retained 50 websites were evaluated to assess their characteristics, usability, accessibility, trust, readability, SIQ, and their credibility using DISCERN and Health on the Net Code (HoNCode). Results: Websites’ mean scale scores varied significantly across website affiliation groups such as governmental, commercial, and treatment provider bodies. The SIQ Scale had a good internal consistency (alpha=.85) and was significantly correlated with DISCERN (r=.82, P<.01) and HoNCode (r=.38, P<.01). Less than 25% of websites had SIQ scores above 75%. The mean readability grade (10.3, SD 1.9) was above the recommended level, and was significantly correlated with the Scientific Information Comprehension Scale (r=.45. P<.01), which provides evidence for convergent validity. Website affiliation and DISCERN were significantly associated with SIQ (P<.01) and explained 76% of the SIQ variance. Conclusion: The developed SIQ Scale was found to demonstrate reliability and initial validity. Website affiliation, DISCERN, and HoNCode were significant predictors for the quality of scientific information. The Readability Studio software estimates were associated with scientific information comprehensiveness measures. %M 26443470 %R 10.2196/ijmr.4712 %U http://www.i-jmr.org/2015/4/e19/ %U https://doi.org/10.2196/ijmr.4712 %U http://www.ncbi.nlm.nih.gov/pubmed/26443470 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e18 %T Infant Feeding Websites and Apps: A Systematic Assessment of Quality and Content %A Taki,Sarah %A Campbell,Karen J %A Russell,Catherine G %A Elliott,Rosalind %A Laws,Rachel %A Denney-Wilson,Elizabeth %+ Faculty of Health, University of Technology Sydney, Building 10, 235 Jones Street, Sydney, , Australia, 61 2 9514 2000, sarah.b.taki@student.uts.edu.au %K applications %K Internet %K infant feeding %K health information %K quality %K suitability %K readability %D 2015 %7 29.09.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Internet websites and smartphone apps have become a popular resource to guide parents in their children’s feeding and nutrition. Given the diverse range of websites and apps on infant feeding, the quality of information in these resources should be assessed to identify whether consumers have access to credible and reliable information. Objective: This systematic analysis provides perspectives on the information available about infant feeding on websites and smartphone apps. Methods: A systematic analysis was conducted to assess the quality, comprehensibility, suitability, and readability of websites and apps on infant feeding using a developed tool. Google and Bing were used to search for websites from Australia, while the App Store for iOS and Google Play for Android were used to search for apps. Specified key words including baby feeding, breast feeding, formula feeding and introducing solids were used to assess websites and apps addressing feeding advice. Criteria for assessing the accuracy of the content were developed using the Australian Infant Feeding Guidelines. Results: A total of 600 websites and 2884 apps were screened, and 44 websites and 46 apps met the selection criteria and were analyzed. Most of the websites (26/44) and apps (43/46) were noncommercial, some websites (10/44) and 1 app were commercial and there were 8 government websites; 2 apps had university endorsement. The majority of the websites and apps were rated poor quality. There were two websites that had 100% coverage of information compared to those rated as fair or poor that had low coverage. Two-thirds of the websites (65%) and almost half of the apps (47%) had a readability level above the 8th grade level. Conclusions: The findings of this unique analysis highlight the potential for website and app developers to merge user requirements with evidence-based content to ensure that information on infant feeding is of high quality. There are currently no apps available to consumers that address a variety of infant feeding topics. To keep up with the rapid turnover of the evolving technology, health professionals need to consider developing an app that will provide consumers with a credible and reliable source of information about infant feeding, using quality assessment tools and evidence-based content. %M 26420339 %R 10.2196/ijmr.4323 %U http://www.i-jmr.org/2015/3/e18/ %U https://doi.org/10.2196/ijmr.4323 %U http://www.ncbi.nlm.nih.gov/pubmed/26420339 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e77 %T Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps %A Modave,François %A Bian,Jiang %A Leavitt,Trevor %A Bromwell,Jennifer %A Harris III,Charles %A Vincent,Heather %+ University of Florida, Department of Health Outcomes and Policy, CTRB 2243 PO Box 100177, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 352 294 5984, modavefp@ufl.edu %K apps %K fitness %K mHealth %K mobile coaching %K obesity %K quality %K weight loss %D 2015 %7 24.07.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Objective: Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. Methods: A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Results: Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean 1.4525, SD 1.2101, maximum 4.1094), and no app scored above 50% on the flexibility component (mean 0.1118, SD 0.2679, maximum 0.9816). Finally, only 1 app had an overall score (64.3%) above 50% (mean 2.3158, SD 1.911, maximum 9.0072). Conclusions: There are over 100,000 health-related apps. When looking at popular free apps related to physical activity, we observe that very few of them are evidence based, and respect the guidelines for aerobic activity, strength/resistance training, and flexibility, set forth by the ACSM. Users should exercise caution when adopting a new app for physical activity purposes. This study also clearly identifies a gap in evidence-based apps that can be used safely and effectively to start a physical routine program, develop fitness, and lose weight. App developers have an exciting opportunity to improve mobile coaching app quality by addressing these gaps. %M 26209109 %R 10.2196/mhealth.4669 %U http://mhealth.jmir.org/2015/3/e77/ %U https://doi.org/10.2196/mhealth.4669 %U http://www.ncbi.nlm.nih.gov/pubmed/26209109 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e14 %T Readability of Information Related to the Parenting of a Child With a Cleft %A De Felippe,Nanci %A Kar,Farnaz %+ School of Dentistry, Division of Orthodontics, University of Minnesota, Rm 6-320A, Moos Tower, 515 Delaware St SE, Minneapolis, MN, 55455, United States, 1 612 625 3652, farah049@umn.edu %K cleft lip %K cleft palate %K parenting %K readability %K literacy %D 2015 %7 08.07.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Many parents look to various sources for information about parenting when their child has a cleft lip and/or palate. More than 8 million Americans perform health-related searches every day on the World Wide Web. Furthermore, a significant number of them report feeling “overwhelmed” by the language and content of the information. Objective: The purpose of this study is to determine the readability of information related to parenting a child with cleft lip and/or palate. It was hypothesized that the readability of such materials would be at a level higher than 6th grade. Methods: In February of 2012, a Web-based search was conducted using the search engine Google for the terms “parenting cleft lip and palate.” Results: A total of 15 websites, 7 books, and 8 booklets/factsheets (N=30) entered the readability analysis. Flesch-Kincaid Grade Level, Fog Scale Level, and Simple Measure of Gobbledygook (SMOG) index scores were calculated. The reading level of the websites and books ranged from 8th to 9th and 9th to10th grade, respectively. The average reading level of the booklets/factsheets was 10th grade. Overall, the mean readability of the media resources analyzed was considered “hard to read.” No statistically significant mean difference was found for the readability level across websites, books, and booklets/factsheets (Kruskal-Wallis test, significance level .05). Conclusions: When considering websites, books, booklets, and factsheets analyzed, the average readability level was between 8th and 10th grade. With the US national reading level average at 8th grade and the general recommendation that health-related information be written at a 6th grade level, many parents may find the text they are reading too difficult to comprehend. Therefore, many families might be missing out on the opportunity to learn parenting practices that foster optimal psychosocial development of their children. %M 26155814 %R 10.2196/ijmr.4210 %U http://www.i-jmr.org/2015/3/e14/ %U https://doi.org/10.2196/ijmr.4210 %U http://www.ncbi.nlm.nih.gov/pubmed/26155814 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e133 %T Vaccination Persuasion Online: A Qualitative Study of Two Provaccine and Two Vaccine-Skeptical Websites %A Grant,Lenny %A Hausman,Bernice L %A Cashion,Margaret %A Lucchesi,Nicholas %A Patel,Kelsey %A Roberts,Jonathan %+ Vaccination Research Group, Department of English, Virginia Tech, 323 Shanks Hall (MC0112), 181 Turner St. NW, Blacksburg, VA, 24061, United States, 1 540 231 6501, lenny@vt.edu %K vaccination %K communication %K Internet %K social networking %K Web 2.0 %K qualitative research %D 2015 %7 29.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Most academic studies of vaccine resistance online use quantitative methods to describe misinformation on vaccine-skeptical websites. Findings from these studies are useful for categorizing the generic features of these websites, but they do not provide insights into why these websites successfully persuade their viewers. To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites. Objective: The purpose of this research was to examine the persuasive features of provaccine and vaccine-skeptical websites. The qualitative analysis was conducted to generate hypotheses concerning what features of these websites are persuasive to people seeking information about vaccination and vaccine-related practices. Methods: This study employed a fully qualitative case study methodology that used the anthropological method of thick description to detail and carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website focused on general vaccine safety, and 1 vaccine-skeptical website focused on a specific vaccine. The data gathered were organized into 5 domains: website ownership, visual and textual content, user experience, hyperlinking, and social interactivity. Results: The study found that the 2 provaccine websites analyzed functioned as encyclopedias of vaccine information. Both of the websites had relatively small digital ecologies because they only linked to government websites or websites that endorsed vaccination and evidence-based medicine. Neither of these websites offered visitors interactive features or made extensive use of the affordances of Web 2.0. The study also found that the 2 vaccine-skeptical websites had larger digital ecologies because they linked to a variety of vaccine-related websites, including government websites. They leveraged the affordances of Web 2.0 with their interactive features and digital media. Conclusions: By employing a rhetorical framework, this study found that the provaccine websites analyzed concentrate on the accurate transmission of evidence-based scientific research about vaccines and government-endorsed vaccination-related practices, whereas the vaccine-skeptical websites focus on creating communities of people affected by vaccines and vaccine-related practices. From this personal framework, these websites then challenge the information presented in scientific literature and government documents. At the same time, the vaccine-skeptical websites in this study are repositories of vaccine information and vaccination-related resources. Future studies on vaccination and the Internet should take into consideration the rhetorical features of provaccine and vaccine-skeptical websites and further investigate the influence of Web 2.0 community-building features on people seeking information about vaccine-related practices. %M 26024907 %R 10.2196/jmir.4153 %U http://www.jmir.org/2015/5/e133/ %U https://doi.org/10.2196/jmir.4153 %U http://www.ncbi.nlm.nih.gov/pubmed/26024907 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e8 %T Medical Information on the Internet: A Tool for Measuring Consumer Perception of Quality Aspects %A Dubowicz,Arthur %A Schulz,Peter J %+ Institute of Communication and Health, University of Lugano, Via G. Buffi 13, Lugano, 6904, Switzerland, 41 58 666 48 21, arthur.dubowicz@usi.ch %K online health information %K scale development %K quality assessment %K sleeping disorders %K Internet intervention %D 2015 %7 30.03.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Most of adult Internet users have searched for health information on the Internet. The Internet has become one of the most important sources for health information and treatment advice. In most cases, the information found is not verified with a medical doctor, but judged by the “online-diagnosers” independently. Facing this situation, public health authorities raise concern over the quality of medical information laypersons can find on the Internet. Objective: The objective of the study was aimed at developing a measure to evaluate the credibility of websites that offer medical advice and information. The measure was tested in a quasi-experimental study on two sleeping-disorder websites of different quality. Methods: There were 45 survey items for rating the credibility of websites that were tested in a quasi-experimental study with a random assignment of 454 participants to either a high- or a low-quality website exposure. Using principal component analysis, the original items were reduced to 13 and sorted into the factors: trustworthiness, textual deficits of the content, interferences (external links on the Web site), and advertisements. The first two factors focus more on the provided content itself, while the other two describe the embedding of the content into the website. The 45 survey items had been designed previously using exploratory observations and literature research. Results: The final scale showed adequate power and reliability for all factors. The loadings of the principal component analysis ranged satisfactorily (.644 to .854). Significant differences at P<.001 were found between the low- and high-quality groups. Advertisements on the website were rated as disturbing in both experimental conditions, meaning that they do not differentiate between good and bad information. Conclusions: The scale reliably distinguished high- and low-quality of medical advice given on websites. %M 25835333 %R 10.2196/ijmr.3144 %U http://www.i-jmr.org/2015/1/e8/ %U https://doi.org/10.2196/ijmr.3144 %U http://www.ncbi.nlm.nih.gov/pubmed/25835333 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e7 %T Patients' Perspectives of Accessibility and Digital Delivery of Factual Content Provided by Official Medical and Surgical Specialty Society Websites: A Qualitative Assessment %A Ow,Darren %A Wetherell,David %A Papa,Nathan %A Bolton,Damien %A Lawrentschuk,Nathan %+ Austin Hospital, Department of Surgery, University of Melbourne, Urology Office, Level 8 Harold Stokes Building, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, 3084, Australia, 61 412813240, okhdarren@gmail.com %K Internet %K online health information %K patient education %K social media %K Web science %D 2015 %7 27.03.2015 %9 Short Paper %J Interact J Med Res %G English %X Background: Health care websites provide a valuable resource of health information to online consumers, especially patients. Official surgical and medical society websites should be a reliable first point of contact. Objective: The primary aim of this study was to quantitatively assess medical and surgical society websites for content and highlight the essential features required for a high-quality, user-friendly society website. Methods: Twenty specialty association websites from each of the regions, Australia, UK, Canada, Europe, and the USA were selected for a total of 100 websites. Medical and surgical specialities were consistent across each region. Each website was systematically and critically analysed for content and usability. Results: The average points scored per website was 3.2 out of 10. Of the total (N=100) websites, 12 scored at least 7 out of 10 points and 2 scored 9 out of 10. As well, 35% (35.0/100) of the websites had an information tab for patients on their respective homepages while 38% (38.0/100) had download access to patient information. A minority of the websites included different forms of multimedia such as pictures and diagrams (24.0/100, 24%) and videos (18.0/100, 18%). Conclusions: We found that most society websites did not meet an adequate standard for delivery of information. Half of the websites were not patient accessible, with the primary focus being for health professionals. As well, most required logins for information access. Specialty health care societies should create patient-friendly websites that would be beneficial to all online consumers. %M 25830824 %R 10.2196/ijmr.3963 %U http://www.i-jmr.org/2015/1/e7/ %U https://doi.org/10.2196/ijmr.3963 %U http://www.ncbi.nlm.nih.gov/pubmed/25830824 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e2 %T Availability of Information About Lifestyle for Cancer Survivors in England: A Review of Statutory and Charitable Sector Organizations and Cancer Centers %A Williams,Kate %A Fisher,Abigail %A Beeken,Rebecca J %A Wardle,Jane %+ Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 1720, j.wardle@ucl.ac.uk %K cancer %K survivorship %K guideline %K health behavior %K lifestyle %K diet %K physical activity %K body weight %K smoking %K alcohol drinking %D 2015 %7 09.03.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Health behavior change following a cancer diagnosis has the potential to improve long-term outcomes. However, many patients do not receive professional advice about lifestyle and are therefore increasingly using the Internet to seek further information. The statutory and charitable sectors and cancer centers all play an important role in the provision of information and have been found to be favored by cancer survivors searching for information. However, to date there has been no systematic evaluation of the lifestyle information available online for cancer survivors. Objective: The purpose of this review was to identify the lifestyle information provided for cancer survivors by statutory and charitable sector organizations and cancer centers in the United Kingdom. We aimed to identify information on tobacco, physical activity, diet, weight, and alcohol designed for people who have been diagnosed with breast, prostate, or colorectal cancer. Methods: The National Health Service (NHS) website was the focus of the search for information provided by the statutory sector. Cancer centers were identified from the Organization of European Cancer Institutes and an Internet search, and charitable sector organizations were identified by searching the Charity Commission database. The three largest generic, breast, prostate, and colorectal cancer charitable organizations were included. A systematic search of the organizations was conducted to identify lifestyle information for cancer survivors. Results: Ten organizations had some lifestyle information for cancer survivors on their websites. The Christie NHS Foundation Trust, Macmillan Cancer Support, and Prostate Cancer UK had the most comprehensive guides, covering physical activity, diet, weight management, smoking, and alcohol. The NHS website did not provide any information but had a link to Cancer Research UK’s information about diet. Eight organizations suggested talking to a health professional before making any changes. Conclusions: The majority of organizations included in this review would benefit from updating their websites to include adequate information and advice about lifestyle for cancer survivors, or they risk cancer survivors turning to less reliable sources of information. Health professionals should be appropriately trained to deal with questions about lifestyle and to advise cancer survivors about lifestyle changes following their diagnosis. %M 28410175 %R 10.2196/cancer.3521 %U http://cancer.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/cancer.3521 %U http://www.ncbi.nlm.nih.gov/pubmed/28410175 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T YouTube Videos Related to Skin Cancer: A Missed Opportunity for Cancer Prevention and Control %A Basch,Corey H %A Basch,Charles E %A Hillyer,Grace Clarke %A Reeves,Rachel %+ William Paterson University, 143 H Wing, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K skin cancer %K social media %K YouTube %D 2015 %7 02.03.2015 %9 Short Paper %J JMIR Cancer %G English %X Background: Early detection and treatment influence the mortality risk of skin cancer. Objective: The objective of this study was to analyze the content of the most viewed professional and consumer videos uploaded to YouTube related to skin cancer. Methods: A total of 140 professional and consumer videos uploaded between 2007 and 2014 were identified and coded. Coding involved identifying and sorting followed by gathering descriptive information, including length of the video, number of views, and year uploaded. A dichotomous coding scheme (ie, yes or no) was used in coding specific aspects of video content, including provision of information, type of skin cancer, age group, family history, risk reduction, risk factors, fear, and home remedies for skin cancer treatment. Results: The majority of videos provided information related to screening. Many consumer videos conveyed information related to the use of a black salve as a home remedy for skin cancer, despite the fact that there is no evidence that it is an effective treatment. Conclusions: Research is needed to identify characteristics of videos that are most likely to be viewed to inform the development of credible communications. %M 28410167 %R 10.2196/cancer.4204 %U http://cancer.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/cancer.4204 %U http://www.ncbi.nlm.nih.gov/pubmed/28410167 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e4 %T Content and Quality of Information Websites About Congenital Heart Defects Following a Prenatal Diagnosis %A Carlsson,Tommy %A Bergman,Gunnar %A Karlsson,Anna-Malin %A Mattsson,Elisabet %+ Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, Uppsala, S-75122, Sweden, 46 736143454, tommy.carlsson@pubcare.uu.se %K consumer health information %K heart defects, congenital %K Internet %K prenatal diagnosis %D 2015 %7 21.01.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Pregnant women and their partners use the Internet to search for information following a prenatal diagnosis of congenital heart defect. Objective: Our aim was to explore central subjects of content and to assess the accessibility, reliability, usability, and quality of written information on publicly available information websites about congenital heart defects following a prenatal diagnosis. Methods: Following searches on Bing and Google, we included websites containing patient information in English. Hits ranged from 340,000-67,500,000 and the first 50 hits from each search were screened for inclusion (N=600). Of these hits, 39.3% (236/600) were irrelevant. A total of 67 websites were included, of which 37% (25/67) were affiliated with independent information websites, 25% (17/67) with charity/private organizations, 25% (17/67) with hospitals/clinics, and 13% (8/67) had other affiliations. The majority of the websites (76%, 51/67) could not be attributed to an author. A manifest content analysis was performed to explore central subjects of content. The DISCERN instrument was used to assess the quality of information, and the LIDA tool was used to assess accessibility, usability, and reliability of the included websites. Results: The content on the majority of the websites included care and treatment of children with congenital heart defects (88%, 59/67), causes of congenital heart defects (88%, 59/67), symptoms of congenital heart defects (85%, 57/67), prevalence of congenital heart defects (81%, 54/67), potential complications of congenital heart defects (75%, 50/67), prenatal diagnostics/screening methods (72%, 48/67), and specific congenital heart defects (72%, 48/67), whereas less than 10% included information about termination of pregnancy (6%, 4/67), care during pregnancy (5%, 3/67), and information specifically directed to partners (1%, 1/67). The mean of the total DISCERN score was 27.9 (SD 9.7, range 16-53). According to the instrument, a majority of the websites were categorized as very poor regarding information about effects of no treatment (88%, 59/67), support for shared decision making (85%, 57/67), achievement of its aims (84%, 56/67), explicit aims (82%, 55/67), risks of each treatment (82%, 55/67), how treatment choices affect overall quality of life (76%, 51/67), and areas of uncertainty (76%, 51/67). The mean of the total LIDA score was 92.3 (SD 13.1, range 61-127). According to the tool, a majority of the websites were categorized as good with regard to registration (97%, 65/67) and browser test (75%, 50/67), whereas a majority were categorized as poor with regard to currency (87%, 58/67), content production (84%, 56/67), and engagability (75%, 50/67). Conclusions: Difficulties in finding relevant information sources using Web search engines and quality deficits on websites are an incentive for health professionals to take an active part in providing adequate and reliable information online about congenital heart defects. %M 25608457 %R 10.2196/ijmr.3819 %U http://www.i-jmr.org/2015/1/e4/ %U https://doi.org/10.2196/ijmr.3819 %U http://www.ncbi.nlm.nih.gov/pubmed/25608457 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e3 %T Information Seeking in Social Media: A Review of YouTube for Sedentary Behavior Content %A Knight,Emily %A Intzandt,Brittany %A MacDougall,Alicia %A Saunders,Travis J %+ University of Western Ontario, Health and Rehabilitation Sciences, 1201 Western Road, London, ON, N6G 1H1, Canada, 1 519 685 4292, eknigh2@uwo.ca %K sedentary lifestyle %K translational medical research %K social media %D 2015 %7 20.01.2015 %9 Review %J Interact J Med Res %G English %X Background: The global prevalence of sedentary lifestyles is of grave concern for public health around the world. Moreover, the health risk of sedentary behaviors is of growing interest for researchers, clinicians, and the general public as evidence demonstrates that prolonged amounts of sedentary time increases risk for lifestyle-related diseases. There is a growing trend in the literature that reports how social media can facilitate knowledge sharing and collaboration. Social sites like YouTube facilitate the sharing of media content between users. Objective: The purpose of this project was to identify sedentary behavior content on YouTube and describe features of this content that may impact the effectiveness of YouTube for knowledge translation. Methods: YouTube was searched on a single day by 3 independent reviewers for evidence-based sedentary behavior content. Subjective data (eg, video purpose, source, and activity type portrayed) and objective data (eg, number of views, comments, shares, and length of the video) were collected from video. Results: In total, 106 videos met inclusion criteria. Videos were uploaded from 13 countries around the globe (ie, Australia, Barbados, Belgium, Canada, Colombia, Kenya, New Zealand, Russia, South Africa, Spain, Ukraine, United Kingdom, United States). The median video length was 3:00 minutes: interquartile range (IQR) 1:44-5:40. On average, videos had been on YouTube for 15.0 months (IQR 6.0-27.5) and had been viewed 239.0 times (IQR 44.5-917.5). Videos had remarkably low numbers of shares (median 0) and comments (median 1). Only 37.7% (40/106) of videos portrayed content on sedentary behaviors, while the remaining 66 videos portrayed physical activity or a mix of behaviors. Academic/health organizations (39.6%, 42/106) and individuals (38.7%, 41/106) were the most prevalent source of videos, and most videos (67.0%, 71/106) aimed to educate viewers about the topic. Conclusions: This study explored sedentary behavior content available on YouTube. Findings demonstrate that there is confusion between physical activity and sedentary behaviors, that content is being uploaded to the site from around the globe, that content is primarily from health organizations and individuals with the purpose of educating fellow users, but that low views, comments, and shares suggest that sedentary behavior content is relatively underutilized on YouTube. Future research may wish to leverage social platforms, such as YouTube, to facilitate implementation and sharing of evidence-based sedentary behavior content. %M 25604433 %R 10.2196/ijmr.3835 %U http://www.i-jmr.org/2015/1/e3/ %U https://doi.org/10.2196/ijmr.3835 %U http://www.ncbi.nlm.nih.gov/pubmed/25604433 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e10 %T Growing Concerns With the Flow of Misinformation From Electronic Books %A Takahashi,Kenzo %A Kanda,Hideyuki %A Mizushima,Shunsaku %+ Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2610, kt_intl_@ja2.so-net.ne.jp %K misinformation %K e-book %K ethical guideline %K anti-vaccinists %K atopy business %K wellness maintenance %D 2013 %7 24.05.2013 %9 Viewpoint %J Interact J Med Res %G English %X In 2012, several kinds of electronic books (e-books) became available in Japan. Since several major book retailers launched e-book businesses, it is expected that e-books will become a popular source of information in the country. However, we are concerned that e-books may also be a source of misinformation. In examining 24 available materials published by anti-vaccinists, "atopy businesses", and "wellness maintenance" authors, each was found to contain inaccuracies or misinformation. Thus far, such information is only available in printed books. If these books are scanned and circulated, or published in e-book format, this misinformation may circulate rapidly as e-book devices are becoming popular, and, consequently, harm people’s health. We think that it is important for the government to formulate ethical guidelines for the publishing e-books with due consideration to freedom of expression. %M 23709125 %R 10.2196/ijmr.2541 %U http://www.i-jmr.org/2013/1/e10/ %U https://doi.org/10.2196/ijmr.2541 %U http://www.ncbi.nlm.nih.gov/pubmed/23709125 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T Identifying Measures Used for Assessing Quality of YouTube Videos with Patient Health Information: A Review of Current Literature %A Gabarron,Elia %A Fernandez-Luque,Luis %A Armayones,Manuel %A Lau,Annie YS %+ NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 35, Tromsø, 9038, Norway, 47 07766, elia.gabarron@telemed.no %K YouTube %K patient education %K Internet %K health education %K quality of information %D 2013 %7 28.02.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: Recent publications on YouTube have advocated its potential for patient education. However, a reliable description of what could be considered quality information for patient education on YouTube is missing. Objective: To identify topics associated with the concept of quality information for patient education on YouTube in the scientific literature. Methods: A literature review was performed in MEDLINE, ISI Web of Knowledge, Scopus, and PsychINFO. Abstract selection was first conducted by two independent reviewers; discrepancies were discussed in a second abstract review with two additional independent reviewers. Full text of selected papers were analyzed looking for concepts, definitions, and topics used by its authors that focused on the quality of information on YouTube for patient education. Results: In total, 456 abstracts were extracted and 13 papers meeting eligibility criteria were analyzed. Concepts identified related to quality of information for patient education are categorized as expert-driven, popularity-driven, or heuristic-driven measures. These include (in descending order): (1) quality of content in 10/13 (77%), (2) view count in 9/13 (69%), (3) health professional opinion in 8/13 (62%), (4) adequate length or duration in 6/13 (46%), (5) public ratings in 5/13 (39%), (6) adequate title, tags, and description in 5/13 (39%), (7) good description or a comprehensive narrative in 4/13 (31%), (8) evidence-based practices included in video in 4/13 (31%), (9) suitability as a teaching tool in 4/13 (31%), (10) technical quality in 4/13 (31%), (11) credentials provided in video in 4/13 (31%), (12) enough amount of content to identify its objective in 3/13 (23%), and (13) viewership share in 2/13 (15%). Conclusions: Our review confirms that the current topics linked to quality of information for patient education on YouTube are unclear and not standardized. Although expert-driven, popularity-driven, or heuristic-driven measures are used as proxies to estimate the quality of video information, caution should be applied when using YouTube for health promotion and patient educational material. %M 23612432 %R 10.2196/ijmr.2465 %U http://www.i-jmr.org/2013/1/e6/ %U https://doi.org/10.2196/ijmr.2465 %U http://www.ncbi.nlm.nih.gov/pubmed/23612432 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T Can Consumers Trust Web-Based Information About Celiac Disease? Accuracy, Comprehensiveness, Transparency, and Readability of Information on the Internet %A McNally,Shawna L %A Donohue,Michael C %A Newton,Kimberly P %A Ogletree,Sandra P %A Conner,Kristen K %A Ingegneri,Sarah E %A Kagnoff,Martin F %+ Wm. K. Warren Medical Research Center for Celiac Disease, Department of Medicine, University of California, San Diego, MC 0623, Room 412 Medical Teaching Facililty, 9500 Gilman Drive, La Jolla, CA, 92093-0623, United States, 1 858 534 4622, mkagnoff@ucsd.edu %K Celiac disease %K health information %K website accuracy %K website comprehensiveness %K website transparency %K website quality %D 2012 %7 04.04.2012 %9 Original Paper %J Interact J Med Res %G English %X Background: Celiac disease is an autoimmune disease that affects approximately 1% of the US population. Disease is characterized by damage to the small intestinal lining and malabsorption of nutrients. Celiac disease is activated in genetically susceptible individuals by dietary exposure to gluten in wheat and gluten-like proteins in rye and barley. Symptoms are diverse and include gastrointestinal and extraintestinal manifestations. Treatment requires strict adherence to a gluten-free diet. The Internet is a major source of health information about celiac disease. Nonetheless, information about celiac disease that is available on various websites often is questioned by patients and other health care professionals regarding its reliability and content. Objectives: To determine the accuracy, comprehensiveness, transparency, and readability of information on 100 of the most widely accessed websites that provide information on celiac disease. Methods: Using the search term celiac disease, we analyzed 100 of the top English-language websites published by academic, commercial, nonprofit, and other professional (nonacademic) sources for accuracy, comprehensiveness, transparency, and reading grade level. Each site was assessed independently by 3 reviewers. Website accuracy and comprehensiveness were probed independently using a set of objective core information about celiac disease. We used 19 general criteria to assess website transparency. Website readability was determined by the Flesch-Kincaid reading grade level. Results for each parameter were analyzed independently. In addition, we weighted and combined parameters to generate an overall score, termed website quality. Results: We included 98 websites in the final analysis. Of these, 47 (48%) provided specific information about celiac disease that was less than 95% accurate (ie, the predetermined cut-off considered a minimum acceptable level of accuracy). Independent of whether the information posted was accurate, 51 of 98 (52%) websites contained less than 50% of the core celiac disease information that was considered important for inclusion on websites that provide general information about celiac disease. Academic websites were significantly less transparent (P = .005) than commercial websites in attributing authorship, timeliness of information, sources of information, and other important disclosures. The type of website publisher did not predict website accuracy, comprehensiveness, or overall website quality. Only 4 of 98 (4%) websites achieved an overall quality score of 80 or above, which a priori was set as the minimum score for a website to be judged trustworthy and reliable. Conclusions: The information on many websites addressing celiac disease was not sufficiently accurate, comprehensive, and transparent, or presented at an appropriate reading grade level, to be considered sufficiently trustworthy and reliable for patients, health care providers, celiac disease support groups, and the general public. This has the potential to adversely affect decision making about important aspects of celiac disease, including its appropriate and proper diagnosis, treatment, and management. %M 23611901 %R 10.2196/ijmr.2010 %U http://www.i-jmr.org/2012/1/e1/ %U https://doi.org/10.2196/ijmr.2010 %U http://www.ncbi.nlm.nih.gov/pubmed/23611901