@Article{info:doi/10.2196/66812,
author="Morena, Nina
and Htite, Dimya Elly
and Ahisar, Yitzchok
and Hayman, Victoria
and Rentschler, A. Carrie
and Meguerditchian, N. Ari",
title="Breast Cancer Vlogs on YouTube: Descriptive and Content Analyses",
journal="JMIR Infodemiology",
year="2025",
month="Mar",
day="31",
volume="5",
pages="e66812",
keywords="breast cancer vlog",
keywords="YouTube",
keywords="social media",
keywords="experience",
keywords="video",
keywords="content analysis",
keywords="breast",
keywords="cancer",
keywords="women",
keywords="oncology",
keywords="descriptive analysis",
abstract="Background: Many women with breast cancer document their experiences in YouTube vlogs, which may serve as peer-to-peer and community support. Objective: This study aimed to determine (1) the forms of content about breast cancer that tend to be discussed in vlogs, (2) the reasons why women choose to vlog their breast cancer experiences, and (3) the potential for breast cancer vlogs to serve as an alternative or complement to peer-to-peer support as well as a site of digital community overall. Methods: YouTube was searched in incognito mode in November 2023 using the search terms ``breast cancer vlog.'' A maximum of 10 videos/creator were included based on viewership and date created. Video characteristics collected included title; length; number of views, likes, comments; and playlist inclusion. Videos were assessed for sponsorship; presence of explanation and discussion on breast cancer; type of content; and themes. Creator characteristics included age, location, and engagement approaches. Descriptive and content analyses were performed to analyze video content and potential areas where peer-to-peer support may be provided. Results: Ninety vlogs by 13 creators were included, all from personal accounts. The mean (SD) video length, number of views, and number of comments were 21.4 (9.1) minutes, 266,780 (534,465), and 1485 (3422), respectively. Of the 90 videos, 35 (39\%) included hashtags, and 11 (12\%) included paid sponsorships. The most common filming location was the home (87/90; 97\%), followed by the hospital (28/90; 31\%) and car (19/90; 21\%). Home vlogs were most often set in the living room (43/90; 44\%), bedroom (32/90; 33\%), or kitchen (20/90; 21\%). Thirty-four of 60 videos (57\%) included treatment visuals and physical findings. Creators addressed motivation for vlogging in 44/90 videos (49\%); the two most common reasons were wanting to build a community and helping others. In 42/90 videos (47\%), creators explicitly expressed emotion. Most common themes were treatment (77/90; 86\%), mental health (73/90; 81\%), adverse effects (65/90; 72\%), appearance (57/90; 63\%), and family relationships (33/90; 37\%). Patient-directed advice was offered in 52/90 videos (58\%), mostly on treatment-related issues. In 51/90 videos (57\%), creators provided explicit treatment definitions. Chemotherapy was discussed in 63/90 videos (70\%); surgery in 52/90 (58\%), primarily mastectomy; radiation in 27/90 (30\%); and general adverse effects in 64/90 (71\%). Twenty-two of 90 videos (24\%) were about a new diagnosis. When mentioned (40/90; 44\%), the most common creator location was the United States. When mentioned (27/90; 30\%), the most common age was 20?29 years. Conclusions: The dedication to building community support by vlog creators, and the personal nature of their storytelling, may make vlogs a potential resource for peer-to-peer support. ",
doi="10.2196/66812",
url="https://infodemiology.jmir.org/2025/1/e66812"
}


@Article{info:doi/10.2196/56116,
author="Zhao, Xiyu
and Yang, Victor
and Menta, Arjun
and Blum, Jacob
and Ranasinghe, Padmini",
title="Exploring the Use of Social Media for Medical Problem Solving by Analyzing the Subreddit r/medical\_advice: Quantitative Analysis",
journal="JMIR Infodemiology",
year="2025",
month="Mar",
day="20",
volume="5",
pages="e56116",
keywords="online health information",
keywords="medical advice",
keywords="Reddit",
keywords="r/medical\_advice",
keywords="health information--seeking behavior",
keywords="user-generated content",
keywords="subreddits",
keywords="patient education",
keywords="virtual environments",
keywords="information quality",
keywords="social media",
keywords="medical problem",
keywords="quantitative analyses",
keywords="cross-sectional study",
keywords="user interactions",
keywords="online health",
keywords="decision-making",
keywords="social news",
keywords="health information",
abstract="Background: The advent of the internet has transformed the landscape of health information acquisition and sharing. Reddit has become a hub for such activities, such as the subreddit r/medical\_advice, affecting patients' knowledge and decision-making. While the popularity of these platforms is recognized, research into the interactions and content within these communities remains sparse. Understanding the dynamics of these platforms is crucial for improving online health information quality. Objective: This study aims to quantitatively analyze the subreddit r/medical\_advice to characterize the medical questions posed and the demographics of individuals providing answers. Insights into the subreddit's user engagement, information-seeking behavior, and the quality of shared information will contribute to the existing body of literature on health information seeking in the digital era. Methods: A cross-sectional study was conducted, examining all posts and top comments from r/medical\_advice since its creation on October 1, 2011. Data were collected on March 2, 2023, from pushhift.io, and the analysis included post and author flairs, scores, and engagement metrics. Statistical analyses were performed using RStudio and GraphPad Prism 9.0. Results: From October 2011 to March 2023, a total of 201,680 posts and 721,882 comments were analyzed. After excluding autogenerated posts and comments, 194,678 posts and 528,383 comments remained for analysis. A total of 41\% (77,529/194,678) of posts had no user flairs, while only 0.1\% (108/194,678) of posts were made by verified medical professionals. The average engagement per post was a score of 2 (SD 7.03) and 3.32 (SD 4.89) comments. In period 2, urgent questions and those with level-10 pain reported higher engagement, with significant differences in scores and comments based on flair type (P<.001). Period 3 saw the highest engagement in posts related to pregnancy and the lowest in posts about bones, joints, or ligaments. Media inclusion significantly increased engagement, with video posts receiving the highest interaction (P<.001). Conclusions: The study reveals a significant engagement with r/medical\_advice, with user interactions influenced by the type of query and the inclusion of visual media. High engagement with posts about pregnancy and urgent medical queries reflects a focused public interest and the subreddit's role as a preliminary health information resource. The predominance of nonverified medical professionals providing information highlights a shift toward community-based knowledge exchange, though it raises questions about the reliability of the information. Future research should explore cross-platform behaviors and the impact of misinformation on public health. Effective moderation and the involvement of verified medical professionals are recommended to enhance the subreddit's role as a reliable health information resource. ",
doi="10.2196/56116",
url="https://infodemiology.jmir.org/2025/1/e56116"
}


@Article{info:doi/10.2196/66524,
author="Okuhara, Tsuyoshi
and Terada, Marina
and Okada, Hiroko
and Yokota, Rie
and Kiuchi, Takahiro",
title="Experiences of Public Health Professionals Regarding Crisis Communication During the COVID-19 Pandemic: Systematic Review of Qualitative Studies",
journal="JMIR Infodemiology",
year="2025",
month="Mar",
day="14",
volume="5",
pages="e66524",
keywords="COVID-19",
keywords="health communication",
keywords="infodemic",
keywords="misinformation",
keywords="social media",
keywords="SARS-CoV-2",
keywords="pandemic",
keywords="infectious",
keywords="digital age",
keywords="systematic review",
keywords="internet",
keywords="public health",
keywords="government",
keywords="health professional",
keywords="crisis communication",
keywords="qualitative",
keywords="disinformation",
keywords="eHealth",
keywords="digital health",
keywords="medical informatics",
abstract="Background: The COVID-19 pandemic emerged in the digital age and has been called the first ``data-driven pandemic'' in human history. The global response demonstrated that many countries had failed to effectively prepare for such an event. Learning through experience in a crisis is one way to improve the crisis management process. As the world has returned to normal after the pandemic, questions about crisis management have been raised in several countries and require careful consideration. Objective: This review aimed to collect and organize public health professionals' experiences in crisis communication to the public during the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, and Communication Abstracts in February 2024 to locate English-language articles that qualitatively investigated the difficulties and needs experienced by health professionals in their communication activities during the COVID-19 pandemic. Results: This review included 17 studies. Our analysis identified 7 themes and 20 subthemes. The 7 themes were difficulties in pandemic communication, difficulties caused by the ``infodemic,'' difficulties in partnerships within or outside of public health, difficulties in community engagement, difficulties in effective communication, burnout among communicators, and the need to train communication specialists and establish a permanent organization specializing in communication. Conclusions: This review identified the gaps between existing crisis communication guidelines and real-world crisis communication in the digital environment and clarified the difficulties and needs that arose from these gaps. Crisis communication strategies and guidelines should be updated with reference to the themes revealed in this review to effectively respond to subsequent public health crises. Trial Registration: PROSPERO CRD42024528975; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=528975 International Registered Report Identifier (IRRID): RR2-10.2196/58040 ",
doi="10.2196/66524",
url="https://infodemiology.jmir.org/2025/1/e66524"
}


@Article{info:doi/10.2196/55309,
author="Chan, J. Garrett
and Fung, Mark
and Warrington, Jill
and Nowak, A. Sarah",
title="Understanding Health-Related Discussions on Reddit: Development of a Topic Assignment Method and Exploratory Analysis",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="29",
volume="9",
pages="e55309",
keywords="digital health",
keywords="internet",
keywords="open data",
keywords="social networking",
keywords="social media",
abstract="Background: Social media has become a widely used way for people to share opinions about health care and medical topics. Social media data can be leveraged to understand patient concerns and provide insight into why patients may turn to the internet instead of the health care system for health advice. Objective: This study aimed to develop a method to investigate Reddit posts discussing health-related conditions. Our goal was to characterize these topics and identify trends in these social media--based medical discussions. Methods: Using an initial query, we collected 1 year of Reddit posts containing the phrases ``get tested'' and ``get checked.'' These posts were manually reviewed, and subreddits containing irrelevant posts were excluded from analysis. This selection of posts was manually read by the investigators to categorize posts into topics. A script was developed to automatically assign topics to additional posts based on keywords. Topic and keyword selections were refined based on manual review for more accurate topic assignment. Topic assignment was then performed on the entire 1-year Reddit dataset containing 347,130 posts. Related topics were grouped into broader medical disciplines. Analysis of the topic assignments was then conducted to assess condition and medical topic frequencies in medical condition--focused subreddits and general subreddits. Results: We created an automated algorithm to assign medical topics to Reddit posts. By iterating through multiple rounds of topic assignment, we improved the accuracy of the algorithm. Ultimately, this algorithm created 82 topics sorted into 17 broader medical disciplines. Of all topics, sexually transmitted infections (STIs), eye disorders, anxiety, and pregnancy had the highest post frequency overall. STIs comprised 7.44\% (5876/78,980) of posts, and anxiety comprised 5.43\% (4289/78,980) of posts. A total of 34\% (28/82) of the topics comprised 80\% (63,184/78,980) of all posts. Of the medical disciplines, those with the most posts were?psychiatry and mental health;?genitourinary and reproductive health; infectious diseases;?and endocrinology, nutrition, and metabolism. Psychiatry and mental health comprised 26.6\% (21,009/78,980) of posts, and genitourinary and reproductive health comprised 13.6\% (10,741/78,980) of posts. Overall, most posts were also classified under these 4 medical disciplines. During analysis, subreddits were also classified as general if they did not focus on a specific health issue and topic-specific if they discussed a specific medical issue. Topics that appeared most frequently in the top 5 in general subreddits included addiction and drug anxiety, attention-deficit/hyperactivity disorder, abuse, and STIs. In topic-specific subreddits, most posts were found to discuss the topic of that subreddit. Conclusions: Certain health topics and medical disciplines are predominant on Reddit. These include topics such as STIs, eye disorders, anxiety, and pregnancy. Most posts were classified under the medical disciplines of psychiatry and mental health, as well as genitourinary and reproductive health. ",
doi="10.2196/55309",
url="https://formative.jmir.org/2025/1/e55309",
url="http://www.ncbi.nlm.nih.gov/pubmed/39879094"
}


@Article{info:doi/10.2196/68792,
author="Oyama, Rie
and Okuhara, Tsuyoshi
and Furukawa, Emi
and Okada, Hiroko
and Kiuchi, Takahiro",
title="Quality Assessment of Medical Institutions' Websites Regarding Prescription Drug Misuse of Glucagon-Like Peptide-1 Receptor Agonists by Off-Label Use for Weight Loss: Website Evaluation Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="1",
volume="9",
pages="e68792",
keywords="prescription drug misuse",
keywords="GLP-1 receptor agonists",
keywords="off-label use",
keywords="weight loss",
keywords="information quality",
keywords="DISCERN",
keywords="web-based information",
keywords="information provision",
keywords="misinformation",
keywords="advertising guidelines",
keywords="exaggerated advertisements",
abstract="Background: Misuse of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has emerged globally as individuals increasingly use these drugs for weight loss because of unrealistic and attractive body images advertised and shared on the internet. Objective: This study assesses the quality of information and compliance with Japan's medical advertising guidelines on the websites of medical institutions that prescribe GLP-1RAs off-label for weight loss. Methods: Websites were identified by searching Google and Yahoo! by using keywords related to GLP-1RAs and weight loss in August 2024. The quality of information on these websites was assessed using the DISCERN instrument. To comply with Japan's medical advertising guidelines, we evaluated whether the 5 mandatory items for advertisements of self-paid medical treatments involving the off-label use of drugs were stated and whether there were any exaggerated claims. The content of the exaggerated advertisements was categorized into themes. Results: Of the 87 websites included, only 1 website stated all 5 mandatory items. Websites listing ``ineligible for the relief system for sufferers from adverse drug reactions'' had the lowest percentage at 9\% (8/87), while 83\% (72/87) of the websites listed exaggerated advertisements. Approximately 69\% (60/87) of the websites suggested that no exercise or dietary therapy was required, 24\% (21/87) suggested that using GLP-1RAs is a natural and healthy method, and 31\% (27/87) of the websites provided the author's personal opinions on the risks of using GLP-1RAs. The mean total DISCERN score for all 87 websites was 32.6 (SD 5.5), indicating low quality. Only 1 website achieved a good rating, and 9 websites were rated as fair. The majority of the websites were rated as poor (72 websites) or very poor (5 websites). Conclusions: We found that the quality of information provided by the websites of medical institutions prescribing GLP-1RAs off-label for weight loss was very low and that many websites violated Japan's medical advertising guidelines. The prevalence of exaggerated advertisements, which may lead consumers to believe that they can lose weight without dietary or exercise therapy, suggests the risk of GLP-1RA misuse among consumers. Public institutions and health care providers should monitor and regulate advertisements that violate guidelines and provide accurate information regarding GLP-1RAs, obesity, and weight loss. ",
doi="10.2196/68792",
url="https://formative.jmir.org/2025/1/e68792"
}


@Article{info:doi/10.2196/64577,
author="Lemieux, Mackenzie
and Zhou, Cyrus
and Cary, Caroline
and Kelly, Jeannie",
title="Changes in Reproductive Health Information-Seeking Behaviors After the Dobbs Decision: Systematic Search of the Wikimedia Database",
journal="JMIR Infodemiology",
year="2024",
month="Dec",
day="16",
volume="4",
pages="e64577",
keywords="abortion",
keywords="Dobbs",
keywords="internet",
keywords="viewer trends",
keywords="Wikipedia",
keywords="women's health",
keywords="contraception",
keywords="contraceptive",
keywords="trend",
keywords="information seeking",
keywords="page view",
keywords="reproductive",
keywords="reproduction",
abstract="Background: After the US Supreme Court overturned Roe v. Wade, confusion followed regarding the legality of abortion in different states across the country. Recent studies found increased Google searches for abortion-related terms in restricted states after the Dobbsv. Jackson Women's Health Organization decision was leaked. As patients and providers use Wikipedia (Wikimedia Foundation) as a predominant medical information source, we hypothesized that changes in reproductive health information-seeking behavior could be better understood by examining Wikipedia article traffic. Objective: This study aimed to examine trends in Wikipedia usage for abortion and contraception information before and after the Dobbs decision. Methods: Page views of abortion- and contraception-related Wikipedia pages were scraped. Temporal changes in page views before and after the Dobbs decision were then analyzed to explore changes in baseline views, differences in views for abortion-related information in states with restrictive abortion laws versus nonrestrictive states, and viewer trends on contraception-related pages. Results: Wikipedia articles related to abortion topics had significantly increased page views following the leaked and final Dobbs decision. There was a 103-fold increase in the page views for the Wikipedia article Roe v. Wade following the Dobbs decision leak (mean 372,654, SD 135,478 vs mean 3614, SD 248; P<.001) and a 67-fold increase in page views following the release of the final Dobbs decision (mean 8942, SD 402 vs mean 595,871, SD 178,649; P<.001). Articles about abortion in the most restrictive states had a greater increase in page views (mean 40.6, SD 12.7; 18/51, 35\% states) than articles about abortion in states with some restrictions or protections (mean 26.8, SD 7.3; 24/51, 47\% states; P<.001) and in the most protective states (mean 20.6, SD 5.7; 8/51, 16\% states; P<.001). Finally, views to pages about common contraceptive methods significantly increased after the Dobbs decision. ``Vasectomy'' page views increased by 183\% (P<.001), ``IUD'' (intrauterine device) page views increased by 80\% (P<.001), ``Combined oral contraceptive pill'' page views increased by 24\% (P<.001), ``Emergency Contraception'' page views increased by 224\% (P<.001), and ``Tubal ligation'' page views increased by 92\% (P<.001). Conclusions: People sought information on Wikipedia about abortion and contraception at increased rates after the Dobbs decision. Increased traffic to abortion-related Wikipedia articles correlated to the restrictiveness of state abortion policies. Increased interest in contraception-related pages reflects the increased demand for contraceptives observed after the Dobbs decision. Our work positions Wikipedia as an important source of reproductive health information and demands increased attention to maintain and improve Wikipedia as a reliable source of health information after the Dobbs decision. ",
doi="10.2196/64577",
url="https://infodemiology.jmir.org/2024/1/e64577"
}


@Article{info:doi/10.2196/55182,
author="Mess, Veronica Elisabeth
and Kramer, Frank
and Krumme, Julia
and Kanelakis, Nico
and Teynor, Alexandra",
title="Use of Creative Frameworks in Health Care to Solve Data and Information Problems: Scoping Review",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="13",
volume="11",
pages="e55182",
keywords="creative frameworks",
keywords="data and information problems",
keywords="data collection",
keywords="data processing",
keywords="data provision",
keywords="health care",
keywords="information visualization",
keywords="interdisciplinary teams",
keywords="user-centered design",
keywords="user-centered data design",
keywords="user-centric development",
abstract="Background: Digitization is vital for data management, especially in health care. However, problems still hinder health care stakeholders in their daily work while collecting, processing, and providing health data or information. Data are missing, incorrect, cannot be collected, or information is inadequately presented. These problems can be seen as data or information problems. A proven way to elicit requirements for (software) systems is by using creative frameworks (eg, user-centered design, design thinking, lean UX [user experience], or service design) or creative methods (eg, mind mapping, storyboarding, 6 thinking hats, or interaction room). However, to what extent they are used to solve data or information-related problems in health care is unclear. Objective: The primary objective of this scoping review is to investigate the use of creative frameworks in addressing data and information problems in health care. Methods: Following JBI guidelines and the PRISMA-ScR framework, this paper analyzes selected papers, answering whether creative frameworks addressed health care data or information problems. Focusing on data problems (elicitation or collection, processing) and information problems (provision or visualization), the review examined German and English papers published between 2018 and 2022 using keywords related to ``data,'' ``design,'' and ``user-centered.'' The database SCOPUS was used. Results: Of the 898 query results, only 23 papers described a data or information problem and a creative method to solve it. These were included in the follow-up analysis and divided into different problem categories: data collection (n=7), data processing (n=1), information visualization (n=11), and mixed problems meaning data and information problem present (n=4). The analysis showed that most identified problems fall into the information visualization category. This could indicate that creative frameworks are particularly suitable for solving information or visualization problems and less for other, more abstract areas such as data problems. The results also showed that most researchers applied a creative framework after they knew what specific (data or information) problem they had (n=21). Only a minority chose a creative framework to identify a problem and realize it was a data or information problem (n=2). In response to these findings, the paper discusses the need for a new approach that addresses health care data and information challenges by promoting collaboration, iterative feedback, and user-centered development. Conclusions: Although the potential of creative frameworks is undisputed, applying these in solving data and information problems is a minority. To harness this potential, a suitable method needs to be developed to support health care system stakeholders. This method could be the User-Centered Data Approach. ",
doi="10.2196/55182",
url="https://humanfactors.jmir.org/2024/1/e55182"
}


@Article{info:doi/10.2196/39895,
author="Stone, Haley
and Heslop, David
and Lim, Samsung
and Sarmiento, Ines
and Kunasekaran, Mohana
and MacIntyre, Raina C.",
title="Open-Source Intelligence for Detection of Radiological Events and Syndromes Following the Invasion of Ukraine in 2022: Observational Study",
journal="JMIR Infodemiology",
year="2023",
month="Jun",
day="28",
volume="3",
pages="e39895",
keywords="artificial intelligence",
keywords="contamination",
keywords="data source",
keywords="early warning",
keywords="emergency response",
keywords="environmental health",
keywords="open source",
keywords="open-source intelligence",
keywords="OSINT",
keywords="power plant",
keywords="public health",
keywords="radiation",
keywords="radiobiological events",
keywords="radiological",
keywords="sensor",
keywords="Ukraine",
abstract="Background: On February 25, 2022, Russian forces took control of the Chernobyl power plant after continuous fighting within the Chernobyl exclusion zone. Continual events occurred in the month of March, which raised the risk of potential contamination of previously uncontaminated areas and the potential for impacts on human and environmental health. The disruption of war has caused interruptions to normal preventive activities, and radiation monitoring sensors have been nonfunctional. Open-source intelligence can be informative when formal reporting and data are unavailable. Objective: This paper aimed to demonstrate the value of open-source intelligence in Ukraine to identify signals of potential radiological events of health significance during the Ukrainian conflict. Methods: Data were collected from search terminology for radiobiological events and acute radiation syndrome detection between February 1 and March 20, 2022, using 2 open-source intelligence (OSINT) systems, EPIWATCH and Epitweetr. Results: Both EPIWATCH and Epitweetr identified signals of potential radiobiological events throughout Ukraine, particularly on March 4 in Kyiv, Bucha, and Chernobyl. Conclusions: Open-source data can provide valuable intelligence and early warning about potential radiation hazards in conditions of war, where formal reporting and mitigation may be lacking, to enable timely emergency and public health responses. ",
doi="10.2196/39895",
url="https://infodemiology.jmir.org/2023/1/e39895",
url="http://www.ncbi.nlm.nih.gov/pubmed/37379069"
}


@Article{info:doi/10.2196/40802,
author="Squires, A. Natalie
and Soyemi, Elizabeth
and Yee, M. Lynn
and Birch, M. Eleanor
and Badreldin, Nevert",
title="Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis",
journal="JMIR Infodemiology",
year="2023",
month="Jun",
day="23",
volume="3",
pages="e40802",
keywords="health information",
keywords="internet",
keywords="YouTube",
keywords="cesarean section",
keywords="cesarean",
keywords="C-section",
keywords="postpartum",
keywords="social media",
keywords="web-based video",
keywords="maternal",
keywords="postnatal",
keywords="pain",
keywords="systematic search",
keywords="patient education",
keywords="information quality",
keywords="accuracy",
keywords="credibility",
keywords="health education",
keywords="educational video",
keywords="education resource",
keywords="health video",
abstract="Background: YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain. Objective: The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management. Methods: A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management--related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video's relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ?5 and a DISCERN score of ?39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted. Results: Of 73 unique videos, video sources included medical videos (n=36, 49\%), followed by personal video blogs (vlogs; n=32, 44\%), advertisements (n=3, 4\%), and media (n=2, 3\%). The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos (n=22, 30\%) most frequently addressed overall content regarding pain duration (22/22, 100\%), pain types (20/22, 91\%), return-to-activity instructions (19/22, 86\%), and nonpharmacologic methods for pain control (19/22, 86\%). There were differences in the overall content score (P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score. Conclusions: Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource. ",
doi="10.2196/40802",
url="https://infodemiology.jmir.org/2023/1/e40802",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351938"
}


@Article{info:doi/10.2196/38865,
author="Howes, Jared
and Denier, Yvonne
and Gastmans, Chris",
title="Electronic Tracking Devices for People With Dementia: Content Analysis of Company Websites",
journal="JMIR Aging",
year="2022",
month="Nov",
day="11",
volume="5",
number="4",
pages="e38865",
keywords="dementia",
keywords="wandering",
keywords="electronic tracking devices",
keywords="bioethics",
keywords="locators",
keywords="monitors",
keywords="surveillance devices",
keywords="management",
keywords="technology",
keywords="care tool",
keywords="caregiver",
keywords="device",
keywords="vulnerable",
keywords="elderly",
abstract="Background: Electronic tracking devices, also known as locators, monitors, or surveillance devices, are increasingly being used to manage dementia-related wandering and, subsequently, raising various ethical questions. Despite the known importance technology design has on the ethics of technologies, little research has focused on the companies responsible for the design and development of electronic tracking devices. This paper is the first to perform a qualitative analysis of the ethically related content of the websites of companies that design and develop electronic tracking devices. Objective: The aim of this study was to understand how companies that design, develop, and market electronic tracking devices for dementia care frame, through textual marketing content, the vulnerabilities and needs of persons with dementia and caregivers, the way in which electronic tracking devices respond to these vulnerabilities and needs, and the ethical issues and values at stake. Methods: Electronic tracking device company websites were identified via a Google search, 2 device recommendation lists (Alzheimer's Los Angeles and the Canadian Agency for Drugs and Technologies in Health), and the 2 recent reviews of wander management technology by Neubauer et al and Ray et al. To be included, websites must be official representations of companies (not market or third-party websites) developing and selling electronic tracking devices for use in dementia care. The search was conducted on December 22, 2020, returning 199 websites excluding duplicates. Data synthesis and analysis were conducted on the textual content of the included websites using a modified form of the Qualitative Analysis Guide of Leuven. Results: In total, 29 websites met the inclusion criteria. Most (15/29, 52\%) companies were in the United States. The target audience of the websites was largely caregivers. A range of intertwined vulnerabilities facing persons with dementia and their caregivers were identified, and the companies addressed these via care tools that centered on certain values such as providing information while preserving privacy. Life after device implementation was characterized as a world aspired to that sees increased safety for persons with dementia and peace of mind for caregivers. Conclusions: The way electronic tracking device content is currently conveyed excludes persons with dementia as a target audience. In presenting their products as a response to vulnerabilities, particular values are linked to design elements. A limitation of the results is the opaque nature of website content origins. How or when values arise in the process of design, development, and marketing is unknown. Therefore, further research should explore the process companies use to identify vulnerabilities, how values are decided upon and integrated into the design of products, and the perceptions of developers regarding the ethics of electronic tracking devices. ",
doi="10.2196/38865",
url="https://aging.jmir.org/2022/4/e38865",
url="http://www.ncbi.nlm.nih.gov/pubmed/36367765"
}


@Article{info:doi/10.2196/35702,
author="Liu, Yongtai
and Yin, Zhijun
and Wan, Zhiyu
and Yan, Chao
and Xia, Weiyi
and Ni, Congning
and Clayton, Wright Ellen
and Vorobeychik, Yevgeniy
and Kantarcioglu, Murat
and Malin, A. Bradley",
title="Implicit Incentives Among Reddit Users to Prioritize Attention Over Privacy and Reveal Their Faces When Discussing Direct-to-Consumer Genetic Test Results: Topic and Attention Analysis",
journal="JMIR Infodemiology",
year="2022",
month="Aug",
day="3",
volume="2",
number="2",
pages="e35702",
keywords="direct-to-consumer genetic testing",
keywords="topic modeling",
keywords="social media",
abstract="Background: As direct-to-consumer genetic testing services have grown in popularity, the public has increasingly relied upon online forums to discuss and share their test results. Initially, users did so anonymously, but more recently, they have included face images when discussing their results. Various studies have shown that sharing images on social media tends to elicit more replies. However, users who do this forgo their privacy. When these images truthfully represent a user, they have the potential to disclose that user's identity. Objective: This study investigates the face image sharing behavior of direct-to-consumer genetic testing users in an online environment to determine if there exists an association between face image sharing and the attention received from other users. Methods: This study focused on r/23andme, a subreddit dedicated to discussing direct-to-consumer genetic testing results and their implications. We applied natural language processing to infer the themes associated with posts that included a face image. We applied a regression analysis to characterize the association between the attention that a post received, in terms of the number of comments, the karma score (defined as the number of upvotes minus the number of downvotes), and whether the post contained a face image. Results: We collected over 15,000 posts from the r/23andme subreddit, published between 2012 and 2020. Face image posting began in late 2019 and grew rapidly, with over 800 individuals revealing their faces by early 2020. The topics in posts including a face were primarily about sharing, discussing ancestry composition, or sharing family reunion photos with relatives discovered via direct-to-consumer genetic testing. On average, posts including a face image received 60\% (5/8) more comments and had karma scores 2.4 times higher than other posts. Conclusions: Direct-to-consumer genetic testing consumers in the r/23andme subreddit are increasingly posting face images and testing reports on social platforms. The association between face image posting and a greater level of attention suggests that people are forgoing their privacy in exchange for attention from others. To mitigate this risk, platform organizers and moderators could inform users about the risk of posting face images in a direct, explicit manner to make it clear that their privacy may be compromised if personal images are shared. ",
doi="10.2196/35702",
url="https://infodemiology.jmir.org/2022/2/e35702",
url="http://www.ncbi.nlm.nih.gov/pubmed/37113452"
}


@Article{info:doi/10.2196/24086,
author="Wang, Xiaohui
and Shi, Jingyuan
and Lee, Min Kwan",
title="The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="13",
volume="24",
number="1",
pages="e24086",
keywords="smartphone",
keywords="health information seeking",
keywords="Asia",
keywords="user profile",
keywords="digital divide",
abstract="Background: Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare. Objective: The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia. Methods: With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information. Results: Respondents who were women ($\beta$=.13, P<.001), parents ($\beta$=.16, P<.001), employed ($\beta$=.08, P=.002), of higher social status ($\beta$=.08, P<.001), and/or from countries with low health expenditures ($\beta$=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness ($\beta$=.10, P<.001) and frequency of smartphone use ($\beta$=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal ($\beta$=--.04, P<.001). Conclusions: Among smartphone users in Asia, health information seeking varies according to individuals' socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries. ",
doi="10.2196/24086",
url="https://www.jmir.org/2022/1/e24086",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023845"
}


@Article{info:doi/10.2196/22122,
author="Mart{\'i}nez Silvagnoli, Leia
and Shepherd, Caroline
and Pritchett, James
and Gardner, Jason",
title="Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e22122",
keywords="biomedical research",
keywords="health literacy",
keywords="multiple sclerosis",
keywords="plain language summary",
keywords="psoriasis",
keywords="rheumatoid arthritis",
abstract="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.) ",
doi="10.2196/22122",
url="https://www.jmir.org/2022/1/e22122",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014966"
}


@Article{info:doi/10.2196/27178,
author="Jiang, Fei
and Liu, Yongmei
and Hu, Junhua
and Chen, Xiaohong",
title="Understanding Health Empowerment From the Perspective of Information Processing: Questionnaire Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e27178",
keywords="online health information",
keywords="perceived argument quality",
keywords="perceived source credibility",
keywords="health literacy",
keywords="health empowerment",
keywords="information seeking",
abstract="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. ",
doi="10.2196/27178",
url="https://www.jmir.org/2022/1/e27178",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014957"
}


@Article{info:doi/10.2196/23210,
author="Taylor, A. Kimberly
and Humphrey Jr, F. William",
title="Impact of Medical Blog Reading and Information Presentation on Readers' Preventative Health Intentions: Mixed Methods, Multistudy Investigation",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="22",
volume="23",
number="12",
pages="e23210",
keywords="health blogs",
keywords="patient blogs",
keywords="preventative care",
keywords="cancer",
keywords="caregivers",
keywords="perceived risk",
abstract="Background: Medical blogs have become valuable information sources for patients and caregivers. Most research has focused on patients' creation of blogs as therapy. But we know less about how these blogs affect their readers and what format of information influences readers to take preventative health actions. Objective: This study aimed to identify how reading patient medical blogs influences readers' perceived health risk and their intentions to engage in preventative health actions. Further, we aimed to examine the format of the medical blog and the reader's response. Methods: We surveyed 99 university participants and a general-population, online panel of 167 participants. Both studies randomly assigned participants to conditions and measured blog evaluation, intentions for preventative health action, and evaluation of health risk and beliefs, and allowed open-ended comments. The second study used a different sample and added a control condition. A third study used a convenience sample of blog readers to evaluate the link between reading medical blogs and taking preventative health action. Results: Across 3 studies, participants indicated a desire to take future preventative health action after reading patient blogs. Studies 1 and 2 used experimental scenario-based designs, while Study 3 employed a qualitative design with real blog readers. The 2 experimental studies showed that the type of blog impacted intentions to engage in future preventative health actions (Study 1: F2,96=6.08, P=.003; Study 2: F3,166=2.59, P=.06), with a statistical blog being most effective in both studies and a personal narrative blog showing similar effectiveness in Study 2, contrary to some prior research. The readers' perceptions of their own health risk did not impact the relationship between the blog type and health intentions. In contrast, in one study, participants' judgments about the barriers they might face to accessing care improved the fit of the model (F2,95=13.57, P<.001). In Study 3's sample of medical blog readers, 53\% (24/45) reported taking preventative health action after reading a health blog, including performing a self-check, asking a doctor about their health risk, or requesting a screening test. Additionally, these readers expressed that they read the blogs to follow the author (patient) and to learn general health information. All studies demonstrated the blogs were somewhat sad and emotional but also informative and well-written. They noted that the blogs made them appreciate life more and motivated them to consider taking some action regarding their health.? Conclusions: Reading patient blogs influences intentions to take future health actions. However, blog formats show different efficacy, and the readers' disease risk perceptions do not. Physicians, medical practitioners, and health organizations may find it useful to curate or promote selected medical blogs to influence patient behavior. ",
doi="10.2196/23210",
url="https://www.jmir.org/2021/12/e23210",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941543"
}


@Article{info:doi/10.2196/31834,
author="Drescher, S. Larissa
and Roosen, Jutta
and Aue, Katja
and Dressel, Kerstin
and Sch{\"a}r, Wiebke
and G{\"o}tz, Anne",
title="The Spread of COVID-19 Crisis Communication by German Public Authorities and Experts on Twitter: Quantitative Content Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="22",
volume="7",
number="12",
pages="e31834",
keywords="COVID-19",
keywords="crisis communication",
keywords="content analysis",
keywords="Twitter",
keywords="experts",
keywords="authorities",
keywords="Germany",
keywords="negative binomial regression",
keywords="social media",
keywords="communication",
keywords="crisis",
keywords="information",
keywords="development",
abstract="Background: The COVID-19 pandemic led to the necessity of immediate crisis communication by public health authorities. In Germany, as in many other countries, people choose social media, including Twitter, to obtain real-time information and understanding of the pandemic and its consequences. Next to authorities, experts such as virologists and science communicators were very prominent at the beginning of German Twitter COVID-19 crisis communication. Objective: The aim of this study was to detect similarities and differences between public authorities and individual experts in COVID-19 crisis communication on Twitter during the first year of the pandemic. Methods: Descriptive analysis and quantitative content analysis were carried out on 8251 original tweets posted from January 1, 2020, to January 15, 2021. COVID-19--related tweets of 21 authorities and 18 experts were categorized into structural, content, and style components. Negative binomial regressions were performed to evaluate tweet spread measured by the retweet and like counts of COVID-19--related tweets. Results: Descriptive statistics revealed that authorities and experts increasingly tweeted about COVID-19 over the period under study. Two experts and one authority were responsible for 70.26\% (544,418/774,865) of all retweets, thus representing COVID-19 influencers. Altogether, COVID-19 tweets by experts reached a 7-fold higher rate of retweeting (t8,249=26.94, P<.001) and 13.9 times the like rate (t8,249=31.27, P<.001) compared with those of authorities. Tweets by authorities were much more designed than those by experts, with more structural and content components; for example, 91.99\% (4997/5432) of tweets by authorities used hashtags in contrast to only 19.01\% (536/2819) of experts' COVID-19 tweets. Multivariate analysis revealed that such structural elements reduce the spread of the tweets, and the incidence rate of retweets for authorities' tweets using hashtags was approximately 0.64 that of tweets without hashtags (Z=--6.92, P<.001). For experts, the effect of hashtags on retweets was insignificant (Z=1.56, P=.12). Conclusions: Twitter data are a powerful information source and suitable for crisis communication in Germany. COVID-19 tweet activity mirrors the development of COVID-19 cases in Germany. Twitter users retweet and like communications regarding COVID-19 by experts more than those delivered by authorities. Tweets have higher coverage for both authorities and experts when they are plain and for authorities when they directly address people. For authorities, it appears that it was difficult to win recognition during COVID-19. For all stakeholders studied, the association between number of followers and number of retweets was highly significantly positive (authorities Z=28.74, P<.001; experts Z=25.99, P<.001). Updated standards might be required for successful crisis communication by authorities. ",
doi="10.2196/31834",
url="https://publichealth.jmir.org/2021/12/e31834",
url="http://www.ncbi.nlm.nih.gov/pubmed/34710054"
}


@Article{info:doi/10.2196/26644,
author="Ming, Wai-kit
and Huang, Fengqiu
and Chen, Qiuyi
and Liang, Beiting
and Jiao, Aoao
and Liu, Taoran
and Wu, Huailiang
and Akinwunmi, Babatunde
and Li, Jia
and Liu, Guan
and Zhang, P. Casper J.
and Huang, Jian
and Liu, Qian",
title="Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="21",
volume="7",
number="12",
pages="e26644",
keywords="COVID-19",
keywords="Google Trends",
keywords="search peaks",
keywords="news coverage",
keywords="public concerns",
abstract="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. ",
doi="10.2196/26644",
url="https://publichealth.jmir.org/2021/12/e26644",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591781"
}


@Article{info:doi/10.2196/32161,
author="B{\'e}rub{\'e}, Caterina
and Kovacs, Ferenc Zsolt
and Fleisch, Elgar
and Kowatsch, Tobias",
title="Reliability of Commercial Voice Assistants' Responses to Health-Related Questions in Noncommunicable Disease Management: Factorial Experiment Assessing Response Rate and Source of Information",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e32161",
keywords="voice assistants",
keywords="conversational agents",
keywords="health literacy",
keywords="noncommunicable diseases",
keywords="mobile phone",
keywords="smart speaker",
keywords="smart display",
keywords="evaluation",
keywords="protocol",
keywords="assistant",
keywords="agent",
keywords="literacy",
keywords="audio",
keywords="health information",
keywords="management",
keywords="factorial",
keywords="information source",
abstract="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{\texttimes}3{\texttimes}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. ",
doi="10.2196/32161",
url="https://www.jmir.org/2021/12/e32161",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932003"
}


@Article{info:doi/10.2196/28318,
author="Song, Shijie
and Xue, Xiang
and Zhao, Chris Yuxiang
and Li, Jinhao
and Zhu, Qinghua
and Zhao, Mingming",
title="Short-Video Apps as a Health Information Source for Chronic Obstructive Pulmonary Disease: Information Quality Assessment of TikTok Videos",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e28318",
keywords="COPD",
keywords="information quality",
keywords="social media",
keywords="short-video apps",
keywords="TikTok",
abstract="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. ",
doi="10.2196/28318",
url="https://www.jmir.org/2021/12/e28318",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931996"
}


@Article{info:doi/10.2196/19183,
author="Lei, Yuqi
and Xu, Songhua
and Zhou, Linyun",
title="User Behaviors and User-Generated Content in Chinese Online Health Communities: Comparative Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="15",
volume="23",
number="12",
pages="e19183",
keywords="online health community",
keywords="user behaviors",
keywords="user-generated content",
keywords="social network analysis",
keywords="weighted knowledge network",
abstract="Background: Online health communities (OHCs) have increasingly gained traction with patients, caregivers, and supporters globally. Chinese OHCs are no exception. However, user-generated content (UGC) and the associated user behaviors in Chinese OHCs are largely underexplored and rarely analyzed systematically, forfeiting valuable opportunities for optimizing treatment design and care delivery with insights gained from OHCs. Objective: This study aimed to reveal both the shared and distinct characteristics of 2 popular OHCs in China by systematically and comprehensively analyzing their UGC and the associated user behaviors. Methods: We concentrated on studying the lung cancer forum (LCF) and breast cancer forum (BCF) on Mijian, and the diabetes consultation forum (DCF) on Sweet Home, because of the importance of the 3 diseases among Chinese patients and their prevalence on Chinese OHCs in general. Our analysis explored the key user activities, small-world effect, and scale-free characteristics of each social network. We examined the UGC of these forums comprehensively and adopted the weighted knowledge network technique to discover salient topics and latent relations among these topics on each forum. Finally, we discussed the public health implications of our analysis findings. Results: Our analysis showed that the number of reads per thread on each forum followed gamma distribution (HL=0, HB=0, and HD=0); the number of replies on each forum followed exponential distribution (adjusted RL2=0.946, adjusted RB2=0.958, and adjusted RD2=0.971); and the number of threads a user is involved with (adjusted RL2=0.978, adjusted RB2=0.964, and adjusted RD2=0.970), the number of followers of a user (adjusted RL2=0.989, adjusted RB2=0.962, and adjusted RD2=0.990), and a user's degrees (adjusted RL2=0.997, adjusted RB2=0.994, and adjusted RD2=0.968) all followed power-law distribution. The study further revealed that users are generally more active during weekdays, as commonly witnessed in all 3 forums. In particular, the LCF and DCF exhibited high temporal similarity ($\rho$=0.927; P<.001) in terms of the relative thread posting frequencies during each hour of the day. Besides, the study showed that all 3 forums exhibited the small-world effect (mean $\sigma$L=517.15, mean $\sigma$B=275.23, and mean $\sigma$D=525.18) and scale-free characteristics, while the global clustering coefficients were lower than those of counterpart international OHCs. The study also discovered several hot topics commonly shared among the 3 disease forums, such as disease treatment, disease examination, and diagnosis. In particular, the study found that after the outbreak of COVID-19, users on the LCF and BCF were much more likely to bring up COVID-19--related issues while discussing their medical issues. Conclusions: UGC and related online user behaviors in Chinese OHCs can be leveraged as important sources of information to gain insights regarding individual and population health conditions. Effective and timely mining and utilization of such content can continuously provide valuable firsthand clues for enhancing the situational awareness of health providers and policymakers. ",
doi="10.2196/19183",
url="https://www.jmir.org/2021/12/e19183",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914615"
}


@Article{info:doi/10.2196/31774,
author="Bohnhoff, James
and Davis, Alexander
and Bruine de Bruin, W{\"a}ndi
and Krishnamurti, Tamar",
title="COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey",
journal="JMIR Infodemiology",
year="2021",
month="Dec",
day="7",
volume="1",
number="1",
pages="e31774",
keywords="COVID-19",
keywords="health behavior",
keywords="health behaviour",
keywords="pregnancy",
keywords="obstetrics",
keywords="perinatal",
keywords="preventive",
keywords="preventative",
keywords="mHealth",
keywords="risk",
keywords="information source",
keywords="medical literacy",
keywords="media literacy",
keywords="information literacy",
keywords="protection",
keywords="protective",
keywords="harm",
keywords="women",
keywords="engagement",
keywords="online health information",
keywords="behavior",
keywords="information-seeking",
keywords="critical appraisal",
keywords="communication",
abstract="Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals' choice of specific protective health behaviors during pregnancy may be affected by information sources. Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system. Methods: Pregnant patients completed an app-based questionnaire about their sources of COVID-19 information and engagement in protective health behaviors. The voluntary questionnaire was made available to patients using a pregnancy app as part of their routine prenatal care between April 21 and November 27, 2020. Results: In total, 637 pregnant responders routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79\%) was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective actions was relatively common, although 14\% self-reported potentially harmful behaviors to avoid COVID-19 infection. The CDC and other sources were positively associated with engaging in protective behaviors while others (eg, US president Donald Trump) were negatively associated with protective behaviors. Participation in protective behaviors was not associated with refraining from potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased (P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the pandemic. Conclusions: Pregnant patients were highly engaged in COVID-19--related information-seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed health organizations about which actions may be harmful, in addition to which actions offer protection, may offer needed support to the pregnant population. ",
doi="10.2196/31774",
url="https://infodemiology.jmir.org/2021/1/e31774",
url="http://www.ncbi.nlm.nih.gov/pubmed/34926994"
}


@Article{info:doi/10.2196/28239,
author="Amundsen, Myklebust Ole
and Hoffart, Asle
and Johnson, Urnes Sverre
and Ebrahimi, V. Omid",
title="Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="3",
volume="5",
number="12",
pages="e28239",
keywords="information sources",
keywords="COVID-19",
keywords="avoidance",
keywords="psychopathology",
abstract="Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19--related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19--related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19--related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19--related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19--related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment. Trial Registration: ClinicalTrials.gov NCT04442360; https://clinicaltrials.gov/ct2/show/NCT04442360 ",
doi="10.2196/28239",
url="https://formative.jmir.org/2021/12/e28239",
url="http://www.ncbi.nlm.nih.gov/pubmed/34678750"
}


@Article{info:doi/10.2196/30855,
author="Xiong, Zihui
and Zhang, Liang
and Li, Zhong
and Xu, Wanchun
and Zhang, Yan
and Ye, Ting",
title="Frequency of Online Health Information Seeking and Types of Information Sought Among the General Chinese Population: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e30855",
keywords="online health information seeking",
keywords="sociodemographic factors",
keywords="information types",
keywords="Chinese population",
keywords="information seeking behavior",
keywords="demography",
keywords="China",
keywords="online health information",
abstract="Background: The internet is one of the most popular health information resources, and the Chinese constitute one-fifth of the online users worldwide. As internet penetration continues to rise, more details on the Chinese population seeking online health information need to be known based on the current literature. Objective: This study aims to explore the sociodemographic differences in online health information seeking (OHIS), including the frequency of OHIS and the types of online health information sought among the general Chinese population in mainland China. Methods: A cross-sectional study for assessing the residents' health care needs with self-administered questionnaires was implemented in 4 counties and districts in China from July 2018 to August 2018. Pearson's chi-square test was used to identify the sociodemographic differences between infrequent and frequent online health information seekers. We also performed binary logistic regression for the 4 types of online health information as the dependent variables and the sociodemographic factors as the independent variables. Results: Compared with infrequent online health information seekers, frequent seekers were more likely to be female (infrequent: 1654/3318; 49.85\%; frequent: 1015/1831, 55.43\%), older (over 60 years old; infrequent: 454/3318, 13.68\%; frequent: 282/1831, 15.40\%), married (infrequent: 2649/3318, 79.84\%; frequent: 1537/1831, 83.94\%), and better educated (bachelor's or above; infrequent: 834/3318, 25.14\%; frequent: 566/1831, 30.91\%). They were also more likely to earn a higher income (over RMB {\textyen}50k [RMB {\textyen}1=US \$0.15641]; infrequent: 1139/3318, 34.33\%; frequent: 710/1831, 34.78\%), have commercial health insurance (infrequent: 628/3318, 18.93\%; frequent: 470/1831, 25.67\%), and have reported illness in the past 12 months (infrequent: 659/3318, 19.86\%; frequent: 415/1831, 22.67\%). Among the 4 health information types, health science popularization was the most searched for information by Chinese online health information seekers (3654/5149, 70.79\%), followed by healthy behaviors (3567/5149, 69.28\%), traditional Chinese medicine (1931/5149, 37.50\%), and medical concerns (1703/5149, 33.07\%). The binary logistic regression models showed that males were less likely to seek information on healthy behaviors (adjusted odds ratio [AOR] 0.69, 95\% CI 0.61-0.78) and traditional Chinese medicine (AOR 0.64, 95\% CI 0.57-0.73), and respondents who had at least 1 chronic disease were more likely to seek information on medical concerns (AOR 1.27, 95\% CI 1.07-1.51) and traditional Chinese medicine (AOR 1.26, 95\% CI 1.06-1.49). Conclusions: Sociodemographic factors were associated with the frequency of OHIS and types of information sought among the general Chinese population. The results remind providers of online health information to consider the needs of specific population groups when tailoring and presenting health information to the target population. ",
doi="10.2196/30855",
url="https://www.jmir.org/2021/12/e30855",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860676"
}


@Article{info:doi/10.2196/26065,
author="Nabo?ny, Aleksandra
and Balcerzak, Bart?omiej
and Wierzbicki, Adam
and Morzy, Miko?aj
and Chlabicz, Ma?gorzata",
title="Active Annotation in Evaluating the Credibility of Web-Based Medical Information: Guidelines for Creating Training Data Sets for Machine Learning",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="26",
volume="9",
number="11",
pages="e26065",
keywords="active annotation",
keywords="credibility",
keywords="web-based medical information",
keywords="fake news",
abstract="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. ",
doi="10.2196/26065",
url="https://medinform.jmir.org/2021/11/e26065",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842547"
}


@Article{info:doi/10.2196/29600,
author="Gao, Yankun
and Xie, Zidian
and Sun, Li
and Xu, Chenliang
and Li, Dongmei",
title="Characteristics of and User Engagement With Antivaping Posts on Instagram: Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="25",
volume="7",
number="11",
pages="e29600",
keywords="anti-vaping",
keywords="Instagram",
keywords="user engagement",
keywords="e-cigarettes",
keywords="vaping",
keywords="social media",
keywords="content analysis",
keywords="public health",
keywords="lung health",
abstract="Background: Although government agencies acknowledge that messages about the adverse health effects of e-cigarette use should be promoted on social media, effectively delivering those health messages is challenging. Instagram is one of the most popular social media platforms among US youth and young adults, and it has been used to educate the public about the potential harm of vaping through antivaping posts. Objective: We aim to analyze the characteristics of and user engagement with antivaping posts on Instagram to inform future message development and information delivery. Methods: A total of 11,322 Instagram posts were collected from November 18, 2019, to January 2, 2020, by using antivaping hashtags including \#novape, \#novaping, \#stopvaping, \#dontvape, \#antivaping, \#quitvaping, \#antivape, \#stopjuuling, \#dontvapeonthepizza, and \#escapethevape. Among those posts, 1025 posts were randomly selected and 500 antivaping posts were further identified by hand coding. The image type, image content, and account type of antivaping posts were hand coded, the text information in the caption was explored by topic modeling, and the user engagement of each category was compared. Results: Analyses found that antivaping images of the educational/warning type were the most common (253/500; 50.6\%). The average likes of the educational/warning type (15 likes/post) were significantly lower than the catchphrase image type (these emphasized a slogan such as ``athletesdontvape'' in the image; 32.5 likes/post; P<.001). The majority of the antivaping posts contained the image content element text (n=332, 66.4\%), followed by the image content element people/person (n=110, 22\%). The images containing people/person elements (32.8 likes/post) had more likes than the images containing other elements (13.8-21.1 likes/post). The captions of the antivaping Instagram posts covered topics including ``lung health,'' ``teen vaping,'' ``stop vaping,'' and ``vaping death cases.'' Among the 500 antivaping Instagram posts, while most posts were from the antivaping community (n=177, 35.4\%) and personal account types (n=182, 36.4\%), the antivaping community account type had the highest average number of posts (1.69 posts/account). However, there was no difference in the number of likes among different account types. Conclusions: Multiple features of antivaping Instagram posts may be related to user engagement and perception. This study identified the critical elements associated with high user engagement, which could be used to design antivaping posts to deliver health-related information more efficiently. ",
doi="10.2196/29600",
url="https://publichealth.jmir.org/2021/11/e29600",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842553"
}


@Article{info:doi/10.2196/16006,
author="Seckin, Gul
and Hughes, Susan",
title="Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey",
journal="JMIR Aging",
year="2021",
month="Nov",
day="24",
volume="4",
number="4",
pages="e16006",
keywords="internet",
keywords="information",
keywords="health",
keywords="communication",
keywords="strain",
keywords="education",
keywords="eHealth literacy",
abstract="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 ($\beta$=--.17; P=.02), gender ($\beta$=--.22; P=.01), and medical satisfaction ($\beta$=--.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender ($\beta$=.13; P=.05) and satisfaction with medical encounters ($\beta$=.34; P<.001) but negatively predicted by education ($\beta$=--.18; P=.03) and eHealth literacy ($\beta$=--.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 ($\beta$=--.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress ($\beta$=--.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 ($\beta$=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem ($\beta$=--.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. ",
doi="10.2196/16006",
url="https://aging.jmir.org/2021/4/e16006",
url="http://www.ncbi.nlm.nih.gov/pubmed/34822340"
}


@Article{info:doi/10.2196/25287,
author="Assaf, Elias
and Bond, M. Robert
and Cranmer, J. Skyler
and Kaizar, E. Eloise
and Ratliff Santoro, Lauren
and Shikano, Susumu
and Sivakoff, J. David",
title="Understanding the Relationship Between Official and Social Information About Infectious Disease: Experimental Analysis",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="23",
volume="23",
number="11",
pages="e25287",
keywords="disease",
keywords="social information",
keywords="official information",
keywords="network experiments",
abstract="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. ",
doi="10.2196/25287",
url="https://www.jmir.org/2021/11/e25287",
url="http://www.ncbi.nlm.nih.gov/pubmed/34817389"
}


@Article{info:doi/10.2196/27835,
author="Schenkel, K. Sandra
and Jungmann, M. Stefanie
and Gropalis, Maria
and Witth{\"o}ft, Michael",
title="Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="18",
volume="23",
number="11",
pages="e27835",
keywords="cyberchondria",
keywords="health anxiety",
keywords="online health information seeking",
keywords="anxiety",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Cyberchondria describes the detrimental effects of health-related internet use. Current conceptualizations agree that cyberchondria is associated with anxiety-related pathologies and may best be conceptualized as a safety behavior; however, little is known about its exact underlying mechanisms. Objective: This systematic review and meta-analysis aims to give an overview of the conceptualizations of cyberchondria and its relation to anxiety-related pathologies, quantify the strength of association to health anxiety by using meta-analyses, highlight gaps in the literature, and outline a hypothetical integrative cognitive-behavioral model of cyberchondria based on the available empirical evidence. Methods: A systematic literature search was conducted using PubMed, Web of Science, and PsycINFO electronic databases. A total of 25 studies were included for qualitative synthesis and 7 studies, comprising 3069 individuals, were included for quantitative synthesis. The meta-analysis revealed a strong association of cyberchondria (r=0.63) and its subfacets (r=0.24-0.66) with health anxiety. Results: The results indicate that cyberchondria is a distinct construct related to health anxiety, obsessive-compulsive symptoms, intolerance of uncertainty, and anxiety sensitivity. Further studies should distinguish between state and trait markers of anxiety-related pathologies and use experimental and naturalistic longitudinal designs to differentiate among risk factors, triggers, and consequences related to cyberchondria. Conclusions: Health-related internet use in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. Here, we present a corresponding integrative cognitive-behavioral model. ",
doi="10.2196/27835",
url="https://www.jmir.org/2021/11/e27835",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792473"
}


@Article{info:doi/10.2196/20964,
author="Mallmann, A. Christoph
and Domr{\"o}se, M. Christian
and Schr{\"o}der, Lars
and Engelhardt, David
and Bach, Frederik
and Rueckel, Helena
and Abramian, Alina
and Kaiser, Christina
and Mustea, Alexander
and Faridi, Andree
and Malter, Wolfram
and Mallmann, Peter
and Rudlowski, Christian
and Zivanovic, Oliver
and Mallmann, R. Michael",
title="Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="18",
volume="7",
number="4",
pages="e20964",
keywords="digitalization",
keywords="eHealth",
keywords="breast cancer",
keywords="internet",
abstract="Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1\%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4\%), and were willing to use new eHealth solutions (379/426, 89\%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3\% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100\% [39/39] of the <59-year-old group used the internet in 2020, 92\% of the 60 to 69-year-old group [11/12] and only 47\% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8\% [59/114] of patients with primary school education used the internet, but 82.4\% [126/153] with middle school education and 90.3\% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7\% [111/164] of patients living alone used the internet, whereas 84.7\% [287/339] of patients living in a house with ?2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00012364 ",
doi="10.2196/20964",
url="https://cancer.jmir.org/2021/4/e20964",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792468"
}


@Article{info:doi/10.2196/32127,
author="An, Lawrence
and Russell, M. Daniel
and Mihalcea, Rada
and Bacon, Elizabeth
and Huffman, Scott
and Resnicow, Ken",
title="Online Search Behavior Related to COVID-19 Vaccines: Infodemiology Study",
journal="JMIR Infodemiology",
year="2021",
month="Nov",
day="12",
volume="1",
number="1",
pages="e32127",
keywords="online health information",
keywords="behavior",
keywords="search",
keywords="COVID-19",
keywords="vaccine",
keywords="infodemiology",
keywords="internet",
keywords="trend",
keywords="public health",
keywords="awareness",
keywords="concern",
keywords="interest",
keywords="public",
keywords="misinformation",
keywords="safety",
keywords="side effect",
keywords="availability",
abstract="Background: Vaccination against COVID-19 is an important public health strategy to address the ongoing pandemic. Examination of online search behavior related to COVID-19 vaccines can provide insights into the public's awareness, concerns, and interest regarding COVID-19 vaccination. Objective: The aim of this study is to describe online search behavior related to COVID-19 vaccines during the start of public vaccination efforts in the United States. Methods: We examined Google Trends data from January 1, 2021, through March 16, 2021, to determine the relative search volume for vaccine-related searches on the internet. We also examined search query log data for COVID-19 vaccine-related searches and identified 5 categories of searches: (1) general or other information, (2) vaccine availability, (3) vaccine manufacturer, (4) vaccine side-effects and safety, and (5) vaccine myths and conspiracy beliefs. In this paper, we report on the proportion and trends for these different categories of vaccine-related searches. Results: In the first quarter of 2021, the proportion of all web-based search queries related to COVID-19 vaccines increased from approximately 10\% to nearly 50\% of all COVID-19--related queries (P<.001). A majority of COVID-19 vaccine queries addressed vaccine availability, and there was a particularly notable increase in the proportion of queries that included the name of a specific pharmacy (from 6\% to 27\%; P=.01). Queries related to vaccine safety and side-effects (<5\% of total queries) or specific vaccine-related myths (<1\% of total queries) were uncommon, and the relative frequency of both types of searches decreased during the study period. Conclusions: This study demonstrates an increase in online search behavior related to COVID-19 vaccination in early 2021 along with an increase in the proportion of searches related to vaccine availability at pharmacies. These findings are consistent with an increase in public interest and intention to get vaccinated during the initial phase of public COVID-19 vaccination efforts. ",
doi="10.2196/32127",
url="https://infodemiology.jmir.org/2021/1/e32127",
url="http://www.ncbi.nlm.nih.gov/pubmed/34841200"
}


@Article{info:doi/10.2196/31944,
author="Choi, Bogeum
and Kim, Heejun
and Huh-Yoo, Jina",
title="Seeking Mental Health Support Among College Students in Video-Based Social Media: Content and Statistical Analysis of YouTube Videos",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="11",
volume="5",
number="11",
pages="e31944",
keywords="mental health",
keywords="college student",
keywords="social media",
keywords="YouTube",
keywords="help-seeking",
keywords="experiential knowledge",
keywords="video types",
keywords="content analysis",
keywords="time distribution analysis",
keywords="depression",
keywords="anxiety",
keywords="student",
keywords="knowledge",
keywords="stigma",
keywords="strategy",
keywords="engagement",
abstract="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. ",
doi="10.2196/31944",
url="https://formative.jmir.org/2021/11/e31944",
url="http://www.ncbi.nlm.nih.gov/pubmed/34762060"
}


@Article{info:doi/10.2196/30125,
author="Mulgund, Pavankumar
and Sharman, Raj
and Purao, Sandeep
and Thimmanayakanapalya, Suresh Sagarika
and Winkelstein, Peter",
title="Mapping Information Needs of Patients With Sexually Transmitted Infections Using Web-Based Data Sources: Grounded Theory Investigation",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="10",
volume="23",
number="11",
pages="e30125",
keywords="information needs",
keywords="sexually transmitted diseases",
keywords="patient journey maps",
keywords="health information seeking",
keywords="stigmatizing disorders",
keywords="online forum",
keywords="sexually transmitted infection",
keywords="American Sexual Health Association",
keywords="grounded theory",
keywords="stigma",
abstract="Background: According to the World health organization (WHO), more than 1 million sexually transmitted infections (STIs) are acquired each day across the world. The incidence rates of STIs in the United States are at a record high for the fourth consecutive year. Owing to the stigma associated with the incidence of STI, there is a general reluctance to seek information in person. Instead, web-based information sources remain the primary avenues of information-seeking. However, these sources are designed without a comprehensive understanding of the information needs of individuals who have contracted STIs. Objective: This study aimed to investigate the information needs of individuals who have or suspect they have contracted an STI. A better understanding of their information needs can drive the design of more effective digital interventions. Methods: This is a qualitative and analytical study of 549 transcripts (consisting of queries posted over the last 10 years) from web-based forums of the American Sexual Health Association (ASHA), which allows patients, volunteers, and health care providers connect anonymously. The analysis follows a grounded theory (GT) approach with multiple coding stages to uncover categories and themes. Results: Three categories of information needs emerged. The first two, clinical and logistical, are similar to other contexts. However, our analysis shows that there is a significant need for the last category---psychosocial information. Approximately 59\% of instances are linked to concerns such as confusion, discretion, remorse, and others. These needs vary across the stages of a patient's journey from symptom manifestation to treatment maintenance. Conclusions: Responding to the needs of individuals who have or suspect they have contracted an STI requires compassionate and personalized responses (beyond factual clinical and logistical information). Web-based forums provide anonymity but do not adequately incorporate mechanisms, practices, or incentives to respond to diverse psychosocial concerns. Innovative approaches to add such support can make the digital interventions more effective for this group of individuals. ",
doi="10.2196/30125",
url="https://www.jmir.org/2021/11/e30125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34757326"
}


@Article{info:doi/10.2196/26424,
author="Kim, Jihae Agnes
and Yang, Jisun
and Jang, Yihyun
and Baek, Sang Joon",
title="Acceptance of an Informational Antituberculosis Chatbot Among Korean Adults: Mixed Methods Research",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="9",
volume="9",
number="11",
pages="e26424",
keywords="tuberculosis",
keywords="chatbot",
keywords="technology acceptance model",
keywords="mobile phone",
abstract="Background: Tuberculosis (TB) is a highly infectious disease. Negative perceptions and insufficient knowledge have made its eradication difficult. Recently, mobile health care interventions, such as an anti-TB chatbot developed by the research team, have emerged in support of TB eradication programs. However, before the anti-TB chatbot is deployed, it is important to understand the factors that predict its acceptance by the population. Objective: This study aims to explore the acceptance of an anti-TB chatbot that provides information about the disease and its treatment to people vulnerable to TB in South Korea. Thus, we are investigating the factors that predict technology acceptance through qualitative research based on the interviews of patients with TB and homeless facility personnel. We are then verifying the extended Technology Acceptance Model (TAM) and predicting the factors associated with the acceptance of the chatbot. Methods: In study 1, we conducted interviews with potential chatbot users to extract the factors that predict user acceptance and constructed a conceptual framework based on the TAM. In total, 16 interviews with patients with TB and one focus group interview with 10 experts on TB were conducted. In study 2, we conducted surveys of potential chatbot users to validate the extended TAM. Survey participants were recruited among late-stage patients in TB facilities and members of web-based communities sharing TB information. A total of 123 responses were collected. Results: The results indicate that perceived ease of use and social influence were significantly predictive of perceived usefulness (P=.04 and P<.001, respectively). Perceived usefulness was predictive of the attitude toward the chatbot (P<.001), whereas perceived ease of use (P=.88) was not. Behavioral intention was positively predicted by attitude toward the chatbot and facilitating conditions (P<.001 and P=.03, respectively). The research model explained 55.4\% of the variance in the use of anti-TB chatbots. The moderating effect of TB history was found in the relationship between attitude toward the chatbot and behavioral intention (P=.01) and between facilitating conditions and behavioral intention (P=.02). Conclusions: This study can be used to inform future design of anti-TB chatbots and highlight the importance of services and the environment that empower people to use the technology. ",
doi="10.2196/26424",
url="https://mhealth.jmir.org/2021/11/e26424",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751667"
}


@Article{info:doi/10.2196/30704,
author="Bickmore, W. Timothy
and {\'O}lafsson, Stef{\'a}n
and O'Leary, K. Teresa",
title="Mitigating Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: Exploratory Mixed Methods Experiment",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="9",
volume="23",
number="11",
pages="e30704",
keywords="conversational assistant",
keywords="conversational interface",
keywords="dialogue system",
keywords="medical error",
keywords="patient safety",
keywords="risk mitigation",
keywords="warnings",
keywords="disclaimers",
keywords="grounding",
keywords="explainability",
keywords="mobile phone",
abstract="Background: Prior studies have demonstrated the safety risks when patients and consumers use conversational assistants such as Apple's Siri and Amazon's Alexa for obtaining medical information. Objective: The aim of this study is to evaluate two approaches to reducing the likelihood that patients or consumers will act on the potentially harmful medical information they receive from conversational assistants. Methods: Participants were given medical problems to pose to conversational assistants that had been previously demonstrated to result in potentially harmful recommendations. Each conversational assistant's response was randomly varied to include either a correct or incorrect paraphrase of the query or a disclaimer message---or not---telling the participants that they should not act on the advice without first talking to a physician. The participants were then asked what actions they would take based on their interaction, along with the likelihood of taking the action. The reported actions were recorded and analyzed, and the participants were interviewed at the end of each interaction. Results: A total of 32 participants completed the study, each interacting with 4 conversational assistants. The participants were on average aged 42.44 (SD 14.08) years, 53\% (17/32) were women, and 66\% (21/32) were college educated. Those participants who heard a correct paraphrase of their query were significantly more likely to state that they would follow the medical advice provided by the conversational assistant ($\chi$21=3.1; P=.04). Those participants who heard a disclaimer message were significantly more likely to say that they would contact a physician or health professional before acting on the medical advice received ($\chi$21=43.5; P=.001). Conclusions: Designers of conversational systems should consider incorporating both disclaimers and feedback on query understanding in response to user queries for medical advice. Unconstrained natural language input should not be used in systems designed specifically to provide medical advice. ",
doi="10.2196/30704",
url="https://www.jmir.org/2021/11/e30704",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751661"
}


@Article{info:doi/10.2196/28635,
author="Huemer, Matthias
and Jahn-Kuch, Daniela
and Hofmann, Guenter
and Andritsch, Elisabeth
and Farkas, Clemens
and Schaupp, Walter
and Masel, Katharina Eva
and Jost, J. Philipp
and Pichler, Martin",
title="Trends and Patterns in the Public Awareness of Palliative Care, Euthanasia, and End-of-Life Decisions in 3 Central European Countries Using Big Data Analysis From Google: Retrospective Analysis",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="20",
volume="23",
number="9",
pages="e28635",
keywords="Google Trends",
keywords="end-of-life decisions",
keywords="assisted suicide",
keywords="euthanasia",
keywords="palliative care",
keywords="health care policy",
abstract="Background: End-of-life decisions, specifically the provision of euthanasia and assisted suicide services, challenge traditional medical and ethical principles. Austria and Germany have decided to liberalize their laws restricting assisted suicide, thus reigniting the debate about a meaningful framework in which the practice should be embedded. Evidence of the relevance of assisted suicide and euthanasia for the general population in Germany and Austria is limited. Objective: The aim of this study is to examine whether the public awareness documented by search activities in the most frequently used search engine, Google, on the topics of palliative care, euthanasia, and advance health care directives changed with the implementation of palliative care services and new governmental regulations concerning end-of-life decisions. Methods: We searched for policies, laws, and regulations promulgated or amended in Austria, Germany, and Switzerland between 2004 and 2020 and extracted data on the search volume for each search term topic from Google Trends as a surrogate of public awareness and interest. Annual averages were analyzed using the Joinpoint Regression Program. Results: Important policy changes yielded significant changes in search trends for the investigated topics. The enactment of laws regulating advance health care directives coincided with a significant drop in the volume of searches for the topic of euthanasia in all 3 countries (Austria: ?24.48\%, P=.02; Germany: ?14.95\%, P<.001; Switzerland: ?11.75\%, P=.049). Interest in palliative care increased with the availability of care services and the implementation of laws and policies to promote palliative care (Austria: 22.69\%, P=.01; Germany: 14.39, P<.001; Switzerland: 17.59\%, P<.001). The search trends for advance health care directives showed mixed results. While interest remained steady in Austria within the study period, it increased by 3.66\% (P<.001) in Switzerland and decreased by 2.85\% (P<.001) in Germany. Conclusions: Our results demonstrate that legal measures securing patients' autonomy at the end of life may lower the search activities for topics related to euthanasia and assisted suicide. Palliative care may be a meaningful way to raise awareness of the different options for end-of-life care and to guide patients in their decision-making process regarding the same. ",
doi="10.2196/28635",
url="https://www.jmir.org/2021/9/e28635",
url="http://www.ncbi.nlm.nih.gov/pubmed/34542419"
}


@Article{info:doi/10.2196/29387,
author="Sajjadi, B. Nicholas
and Feldman, Kaylea
and Shepard, Samuel
and Reddy, K. Arjun
and Torgerson, Trevor
and Hartwell, Micah
and Vassar, Matt",
title="Public Interest and Behavior Change in the United States Regarding Colorectal Cancer Following the Death of Chadwick Boseman: Infodemiology Investigation of Internet Search Trends Nationally and in At-Risk Areas",
journal="JMIR Infodemiology",
year="2021",
month="Aug",
day="26",
volume="1",
number="1",
pages="e29387",
keywords="Google Trends",
keywords="colerectal cancer",
keywords="search analytics",
keywords="public health",
keywords="data analytics",
keywords="Chadwick Boseman",
keywords="Twitter",
keywords="infodemiology",
abstract="Background: Colorectal cancer (CRC) has the third highest cancer mortality rate in the United States. Enhanced screening has reduced mortality rates; however, certain populations remain at high risk, notably African Americans. Raising awareness among at-risk populations may lead to improved CRC outcomes. The influence of celebrity death and illness is an important driver of public awareness. As such, the death of actor Chadwick Boseman from CRC may have influenced CRC awareness. Objective: We sought to assess the influence of Chadwick Boseman's death on public interest in CRC in the United States, evidenced by internet searches, website traffic, and donations to prominent cancer organizations. Methods: We used an auto-regressive integrated moving average model to forecast Google searching trends for the topic ``Colorectal cancer'' in the United States. We performed bivariate and multivariable regressions on state-wise CRC incidence rateand percent Black population. We obtained data from the American Cancer Society (ACS) and the Colon Cancer Foundation (CCF) for information regarding changes in website traffic and donations. Results: The expected national relative search volume (RSV) for colorectal cancer was 2.71 (95\% CI 1.76-3.66), reflecting a 3590\% (95\% CI 2632\%-5582\%) increase compared to the expected values. With multivariable regression, the statewise RSV increased for each percent Black population by 1.09 (SE 0.18, P<.001), with 42\% of the variance explained (P<.001). The American Cancer Society reported a 58,000\% increase in CRC-related website traffic the weekend following Chadwick Boseman's death compared to the weekend before. The Colon Cancer Foundation reported a 331\% increase in donations and a 144\% increase in revenue in the month following Boseman's death compared to the month prior. Conclusions: Our results suggest that Chadwick Boseman's death was associated with substantial increases in awareness of CRC. Increased awareness of CRC may support earlier detection and better prognoses. ",
doi="10.2196/29387",
url="https://infodemiology.jmir.org/2021/1/e29387",
url="http://www.ncbi.nlm.nih.gov/pubmed/37114199"
}


@Article{info:doi/10.2196/29929,
author="Rovetta, Alessandro",
title="The Impact of COVID-19 on Conspiracy Hypotheses and Risk Perception in Italy: Infodemiological Survey Study Using Google Trends",
journal="JMIR Infodemiology",
year="2021",
month="Aug",
day="6",
volume="1",
number="1",
pages="e29929",
keywords="COVID-19",
keywords="fake news",
keywords="Google Trends",
keywords="infodemiology",
keywords="Italy",
keywords="risk perception",
abstract="Background: COVID-19 has caused the worst international crisis since World War II. Italy was one of the countries most affected by both the pandemic and the related infodemic. The success of anti--COVID-19 strategies and future public health policies in Italy cannot separate itself from the containment of fake news and the divulgation of correct information. Objective: The aim of this paper was to analyze the impact of COVID-19 on web interest in conspiracy hypotheses and risk perception of Italian web users. Methods: Google Trends was used to monitor users' web interest in specific topics, such as conspiracy hypotheses, vaccine side effects, and pollution and climate change. The keywords adopted to represent these topics were mined from Bufale.net---an Italian website specializing in detecting online hoaxes---and Google Trends suggestions (ie, related topics and related queries). Relative search volumes (RSVs) of the time-lapse periods of 2016-2020 (pre--COVID-19) and 2020-2021 (post--COVID-19) were compared through percentage difference (?\%) and the Welch t test (t). When data series were not stationary, other ad hoc criteria were used. The trend slopes were assessed through Sen slope (SS). The significance thresholds have been indicatively set at P=.05 and t=1.9. Results: The COVID-19 pandemic drastically increased Italian netizens' interest in conspiracies (?\% ? [60, 288], t ? [6, 12]). Web interest in conspiracy-related queries across Italian regions increased and became more homogeneous compared to the pre--COVID-19 period (average RSV=80{\textpm}2.8, tmin=1.8, ?min\%=+12.4, min?SD\%=--25.8). In addition, a growing trend in web interest in the infodemic YouTube channel ByoBlu has been highlighted. Web interest in hoaxes has increased more than interest in antihoax services (t1=11.3 vs t2=4.5; $\Delta$1\%=+157.6  vs  $\Delta$2\%=+84.7). Equivalently, web interest in vaccine side effects exceeded interest in pollution and climate change (SSvaccines=0.22, P<.001 vs SSpollution=0.05, P<.001; ?\%=+296.4). To date, a significant amount of fake news related to COVID-19 vaccines, unproven remedies, and origin has continued to circulate. In particular, the creation of SARS-CoV-2 in a Chinese laboratory constituted about 0.04\% of the entire web interest in the pandemic. Conclusions: COVID-19 has given a significant boost to web interest in conspiracy hypotheses and has made it more uniform across regions in Italy. The pandemic accelerated an already-growing trend in users' interest toward some fake news sources, including the 500,000-subscriber YouTube channel ByoBlu, which was removed from the platform by YouTube for disinformation in March 2021. The risk perception related to COVID-19 vaccines has been so distorted that vaccine side effect--related queries outweighed those relating to pollution and climate change, which are much more urgent issues. Moreover, a large amount of fake news has circulated about COVID-19 vaccines, remedies, and origin. Based on these findings, it is recommended that the Italian authorities implement more effective infoveillance systems, and that communication by the mass media be less sensationalistic and more consistent with the available scientific evidence. In this context, Google Trends can be used to monitor users' response to specific infodemiological countermeasures. Further research is needed to understand the psychological mechanisms that regulate risk perception. ",
doi="10.2196/29929",
url="https://infodemiology.jmir.org/2021/1/e29929",
url="http://www.ncbi.nlm.nih.gov/pubmed/34447925"
}


@Article{info:doi/10.2196/28740,
author="Sajjadi, B. Nicholas
and Shepard, Samuel
and Ottwell, Ryan
and Murray, Kelly
and Chronister, Justin
and Hartwell, Micah
and Vassar, Matt",
title="Examining the Public's Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study",
journal="JMIR Infodemiology",
year="2021",
month="Aug",
day="4",
volume="1",
number="1",
pages="e28740",
keywords="content",
keywords="COVID-19",
keywords="frequently asked questions",
keywords="internet",
keywords="machine learning",
keywords="natural language processing",
keywords="quality",
keywords="question",
keywords="SARS-CoV-2",
keywords="search analytics",
keywords="search engine",
keywords="transparency",
keywords="vaccine hesitancy",
keywords="vaccine",
keywords="web-based health information",
abstract="Background: The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19--related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective: Using Google's RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods: We searched COVID-19 vaccine terms on Google and used the ``People also ask'' box to obtain FAQs generated by Google's machine learning algorithms. FAQs are assigned an ``answer'' source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association's (JAMA's) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results: Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine--related FAQs were seeking factual information (22/28, 78.6\%), specifically about safety and efficacy (9/22, 40.9\%). The most common source type was media outlets (12/28, 42.9\%), followed by government sources (11/28, 39.3\%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6\%). JAMA benchmark criteria performance did not significantly differ among source types ($\chi$24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions: The most frequently asked COVID-19 vaccine--related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine--related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts. ",
doi="10.2196/28740",
url="https://infodemiology.jmir.org/2021/1/e28740",
url="http://www.ncbi.nlm.nih.gov/pubmed/34458683"
}