Wen-Ying Sylvia Chou

Social Media Use in the United States: Implications for Health Communication

Background Given the rapid changes in the communication landscape brought about by participative Internet use and social media, it is important to develop a better understanding of these technologies and their impact on health communication. The first step in this effort is to identify the characteristics of current social media users. Up-to-date reporting of current social media use will help monitor the growth of social media and inform health promotion/communication efforts aiming to effectively utilize social media. Objective The purpose of the study is to identify the sociodemographic and health-related factors associated with current adult social media users in the United States. Methods Data came from the 2007 iteration of the Health Information National Trends Study (HINTS, N = 7674). HINTS is a nationally representative cross-sectional survey on health-related communication trends and practices. Survey respondents who reported having accessed the Internet (N = 5078) were asked whether, over the past year, they had (1) participated in an online support group, (2) written in a blog, (3) visited a social networking site. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of each type of social media use. Results Approximately 69% of US adults reported having access to the Internet in 2007. Among Internet users, 5% participated in an online support group, 7% reported blogging, and 23% used a social networking site. Multivariate analysis found that younger age was the only significant predictor of blogging and social networking site participation; a statistically significant linear relationship was observed, with younger categories reporting more frequent use. Younger age, poorer subjective health, and a personal cancer experience predicted support group participation. In general, social media are penetrating the US population independent of education, race/ethnicity, or health care access. Conclusions Recent growth of social media is not uniformly distributed across age groups; therefore, health communication programs utilizing social media must first consider the age of the targeted population to help ensure that messages reach the intended audience. While racial/ethnic and health status–related disparities exist in Internet access, among those with Internet access, these characteristics do not affect social media use. This finding suggests that the new technologies, represented by social media, may be changing the communication pattern throughout the United States.

Predictors of eHealth Usage: Insights on The Digital Divide From the Health Information National Trends Survey 2012

Background Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease. Objective The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex. Methods We drew data from National Cancer Institute’s 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information–seeking, and user-generated content/sharing). Results Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information–seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95% CI 0.42-0.98; some college: OR 0.67, 95% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and user-generated content/sharing domains, whereas age was primarily influential for health information–seeking. Conclusions This study illustrates that lower SES, older, and male online US adults were less likely to engage in a number of eHealth activities compared to their counterparts. Future studies should assess issues of health literacy and eHealth literacy and their influence on eHealth engagement across social groups. Clinical care and public health communication efforts attempting to leverage Web 2.0 and 3.0 platforms should acknowledge differential eHealth usage to better address communication inequalities and persistent disparities in health.

Web 2.0 for health promotion: reviewing the current evidence.

As Web 2.0 and social media make the communication landscape increasingly participatory, empirical evidence is needed regarding their impact on and utility for health promotion. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 4 medical and social science databases for literature (2004-present) on the intersection of Web 2.0 and health. A total of 514 unique publications matched our criteria. We classified references as commentaries and reviews (n = 267), descriptive studies (n = 213), and pilot intervention studies (n = 34). The scarcity of empirical evidence points to the need for more interventions with participatory and user-generated features. Innovative study designs and measurement methods are needed to understand the communication landscape and to critically assess intervention effectiveness. To address health disparities, interventions must consider accessibility for vulnerable populations.

Health-related Internet use among cancer survivors: data from the Health Information National Trends Survey, 2003–2008

IntroductionIncreasing prevalence of Internet and new technologies are changing the communication pattern for patients and caregivers across the cancer care continuum. To date, little is known on how cancer survivors in the USA utilize the Internet for health-related purposes. This knowledge is crucial in developing effective communication programs to achieve quality and equitable cancer care.MethodsData from 2003, 2005, and 2008 iterations of the NCI-sponsored Health Information National Trends Survey(HINTS) were analyzed to: (1) compare health-related Internet use (hereafter HRIU) between individuals with and without a cancer diagnosis, (2) report trends, prevalence, and user profiles of HRIU, including support group participation, emailing provider, buying medicine online, and cancer information seeking on the Internet. Descriptive analyses and weighted multivariate logistic regression analyses were performed.ResultsWhile Internet penetration is growing over the years across the USA, cancer survivors access the Internet at a lower rate than general population (49.4% to 56.4% vs. 63.1% to 66.3%). Once on the Internet, they are more likely to use it for health-related purposes. Disparities in Internet access persists, as higher likelihood of Internet access is associated with younger age, higher education, non-Hispanic White race/ethnicity, metropolitan residence, and better self-rated health. On the other hand, among Internet-accessing survivors, socio-demographic, and health factors do not play a significant role in determining the pattern of HRIU.ConclusionsThe study identifies an increasing trend in HRIU among survivors, though the digital divide remains in Internet access. The findings also point to opportunities for narrowing the divide and using Internet to better serve survivors’ needs, as individuals from wide-ranging backgrounds and experiences are equally engaging in health-related activities on the Internet.Implications for survivorsTo increase equity and effectiveness in communication and cancer care, Internet access, functions, and technology literacy are important factors to be considered.

What Do People Like to “Share” About Obesity? A Content Analysis of Frequent Retweets About Obesity on Twitter

Twitter has been recognized as a useful channel for the sharing and dissemination of health information, owing in part to its “retweet” function. This study reports findings from a content analysis of frequently retweeted obesity-related tweets to identify the prevalent beliefs and attitudes about obesity on Twitter, as well as key message features that prompt retweeting behavior conducive to maximizing the reach of health messages on Twitter. The findings show that tweets that are emotionally evocative, humorous, and concern individual-level causes for obesity were more frequently retweeted than their counterparts. Specifically, tweets that evoke amusement were retweeted most frequently, followed by tweets evoking contentment, surprise, and anger. In regard to humor, derogatory jokes were more frequently retweeted than nonderogatory ones, and in terms of specific types of humor, weight-related puns, repartee, and parody were shared frequently. Consistent with extant literature about obesity, the findings demonstrated the predominance of the individual-level (e.g., problematic diet, lack of exercise) over social-level causes for obesity (e.g., availability of cheap and unhealthy food). Implications for designing social-media-based health campaign messages are discussed.

Meeting the healthy people 2020 goals: using the Health Information National Trends Survey to monitor progress on health communication objectives.

The Healthy People initiative outlines a comprehensive set of goals aimed at improving the nations health and reducing health disparities. Health communication has been included as an explicit goal since the launch of Healthy People 2010. The Health Information National Trends Survey (HINTS) was established as a means of exploring how the changing information environment was affecting the publics health, and is therefore an ideal tool for monitoring key health communication objectives included in the Healthy People agenda. In this article, the authors apply an integrative data analysis strategy to more than 10 years of HINTS data to demonstrate how public health surveillance can be used to evaluate broad national health goals, like those set forth under the Healthy People initiative. The authors analyzed just one item from the HINTS survey regarding Internet access in order to illustrate what public health surveillance tools, like HINTS, can reveal about important indicators that are of interest to all those who work to improve the health of the public. Results show that reported Internet penetration has exceeded the Healthy People 2020 target of 75.4%. HINTS data also allowed modeling of the effects of various sociodemographic factors, which revealed persistent differences on the basis of age and education, with the oldest age groups and those with less than a college education falling short of the Healthy People 2020 target as of 2013. Furthermore, although differences by race/ethnicity were observed, the analyses suggest that race in itself accounts for very little of the variance in Internet access.

Pediatric Palliative Care and eHealth Opportunities for Patient-Centered Care

BACKGROUND Pediatric palliative care currently faces many challenges including unnecessary pain from insufficiently personalized treatment, doctor-patient communication breakdowns, and a paucity of usable patient-centric information. Recent advances in informatics for consumer health through eHealth initiatives have the potential to bridge known communication gaps, but overall these technologies remain under-utilized in practice. PURPOSE This paper seeks to identify effective uses of existing and developing health information technology (HIT) to improve communications and care within the clinical setting. METHODS A needs analysis was conducted by surveying seven pediatric oncology patients and their extended support network at the Lombardi Pediatric Clinic at Georgetown University Medical Center in May and June of 2010. Needs were mapped onto an existing inventory of emerging HIT technologies to assess what existing informatics solutions could effectively bridge these gaps. RESULTS Through the patient interviews, a number of communication challenges and needs in pediatric palliative cancer care were identified from the interconnected group perspective surrounding each patient. These gaps mapped well, in most cases, to existing or emerging cyberinfrastructure. However, adoption and adaptation of appropriate technologies could improve, including for patient-provider communication, behavioral support, pain assessment, and education, all through integration within existing work flows. CONCLUSIONS This study provides a blueprint for more optimal use of HIT technologies, effectively utilizing HIT standards-based technology solutions to improve communication. This research aims to further stimulate the development and adoption of interoperable, standardized technologies and delivery of context-sensitive information to substantially improve the quality of care patients receive within pediatric palliative care clinics and other settings.

Cancer Prevention and Control in the Changing Communication Landscape

The changing communication landscape, characterized by social media, wikis, mobile technologies, and a host of other emerging, multidirectional communication channels, has dramatically altered the way we conceptualize and carry out health communication efforts related to cancer prevention and control. In this evolving environment, traditional health promotion models are increasingly challenged, while new and innovative communication approaches are developed, implemented, and evaluated. The rapid dissemination of cancer information through online media channels has influenced health journalism, and in clinical care, health information technologies are altering the ways in which providers and patients interact with one another and with health information. Researchers and practitioners have begun to examine the impact of the changing communication environment on cancer-related knowledge, attitudes, and behaviors across the cancer control continuum. Empirical evidence has begun to emerge, though many questions remain unanswered: How is the participative online environment affecting public health and clinical care? How is user-generated content shaping cancer-related health journalism and media campaigns? How can emerging technologies be leveraged to improve cancer control efforts? What are the outcomes of social media–based interventions for various populations? What is the impact of these new technologies and information channels on communication inequality and cancer disparities? To highlight emerging evidence for these and other questions, the National Cancer Institute’s (NCI) Health Communication and Informatics Research Branch (HCIRB), a part of the Behavioral Research Program within the Division of Cancer Control and Population Sciences, released an open call inviting investigators from a range of disciplines to contribute empirical work, commentaries, or systematic reviews to this issue of JNCI:Monographs. The call was met with an enthusiastic response represented by the submission of more than 100 abstracts followed by more than 60 competitive manuscripts, and a rigorous, multitiered peer review process that resulted in the final 16 innovative, thought-provoking papers that comprise this monograph. HCIRB last sponsored a cancer communication–related issue of JNCI in 1999, titled, “Cancer Risk Communication: What We Know and What We Need to Learn.” That issue followed a workshop on the same topic and consisted mostly of invited articles by workshop attendees. This most recent installment is meant to have a broader scope, with the goal of laying the foundation for the next generation of cancer communication research. Contributions address the influence of the changing communication landscape in three distinct domains: 1) clinical care and patient support, 2) health journalism and mass media, and 3) cancer prevention and control interventions. The selected papers highlight the use of innovative communication strategies and technologies in cancer prevention and control. Specifically, a key theme in this issue is social media, characterized by information sharing, interoperability, and participation. Social and participative communication technologies enable users to interact and collaborate in a dialogue as creators of user-generated content, in contrast to traditional communication endeavors (eg, websites or text messaging systems) where users are limited to consuming content passively. The issue begins with a grant portfolio analysis by Ramirez et al. (1) that examines trends in NCI funding for cancer communication research over more than a decade. The analysis includes funded grant proposals resultant of NCI’s “Extraordinary Opportunity in Cancer Communication,” as initially identified in NCI’s fiscal year 2001 budget (2) and further delineated in future budgets, prioritizing communication science as one critical mission of the institute. The “extraordinary opportunity” designation was the launching pad for initiatives such as the Health Information National Trends Survey (HINTS), the Centers of Excellence in Cancer Communication Research (CECCR) P50 and P20 grant program, as well as investments in extramural research aimed at bridging the digital divide. All of these initiatives, we believe, helped orient the research community to the opportunities enabled by the new communication environment and helped precipitate submission of the high-quality grants enumerated in the Ramirez et al. review. Other highlights of the monograph include papers led by Kim (3) and Portier (4) that feature methodological considerations for cancer communication research in the social media landscape. Papers led by Gollust (5), Post (6), Peterson (7), and Namkoong (8) examine how the emerging communication environment is shaping clinical care and patient support. Contributions by Kim (9) and Noar (10) demonstrate innovative methods for health journalism and mass media research and speak to the implications of the changing mass media environment on cancer prevention and control efforts, and Smith et al. (11) outline directions for research in this understudied area. In the domain of cancer prevention and control interventions, papers authored by Viswanath (12), Post (13), and An (14) offer evidence for using Web 2.0 intervention strategies to reach target populations, and a literature review by Thompson (15) summarizes how social media interventions are being used to target minority populations. Finally, as a closing piece, cancer communication science leaders at NCI, the Centers for Disease Control and Prevention, and the American Cancer Society outline a “blueprint” for coordinating efforts across the national cancer program by leveraging the new capabilities afforded by advances in communication science (16). As the communication environment continues to evolve and as cancer information and user-generated content become increasingly ubiquitous, investigators will continue to face design and measurement challenges for studies that attempt to isolate the effects of communication on intended cancer control outcomes. We are gratified by the enthusiastic response this issue generated in the scientific community, and it is our hope that the papers in this monograph will provide insight into cutting-edge methods and study designs for investigating the use of multidirectional communication in cancer prevention and control.

Pediatric Palliative Care in the Age of eHealth: Opportunities for Advances in HIT to Improve Patient-Centered Communication

BACKGROUND Pediatric palliative care currently faces many challenges including unnecessary pain from insufficiently personalized treatment, doctor-patient communication breakdowns, and a paucity of usable patient-centric information. Recent advances in informatics for consumer health through eHealth initiatives have the potential to bridge known communication gaps, but overall these technologies remain under-utilized in practice. PURPOSE This paper seeks to identify effective uses of existing and developing health information technology (HIT) to improve communications and care within the clinical setting. METHODS A needs analysis was conducted by surveying seven pediatric oncology patients and their extended support network at the Lombardi Pediatric Clinic at Georgetown University Medical Center in May and June of 2010. Needs were mapped onto an existing inventory of emerging HIT technologies to assess what existing informatics solutions could effectively bridge these gaps. RESULTS Through the patient interviews, a number of communication challenges and needs in pediatric palliative cancer care were identified from the interconnected group perspective surrounding each patient. These gaps mapped well, in most cases, to existing or emerging cyberinfrastructure. However, adoption and adaptation of appropriate technologies could improve, including for patient-provider communication, behavioral support, pain assessment, and education, all through integration within existing work flows. CONCLUSIONS This study provides a blueprint for more optimal use of HIT technologies, effectively utilizing HIT standards-based technology solutions to improve communication. This research aims to further stimulate the development and adoption of interoperable, standardized technologies and delivery of context-sensitive information to substantially improve the quality of care patients receive within pediatric palliative care clinics and other settings.

Communication of cancer-related genetic and genomic information: A landscape analysis of reviews

Cancer-related genetic and genomic testing (CGT) is changing cancer care by personalizing care options, leading to an era of precision medicine. Advances in and increased use of CGT add complexity to clinical communication. This landscape analysis assessed published reviews of communication issues related to CGT and discusses implications for practice and behavioral research. A comprehensive electronic literature search was conducted of peer-reviewed literature reviews on studies related to CGT communication published between January 2010 and January 2017, resulting in a final sample of 24 reviews. Reviews were categorized, with overlaps, into four domains across the genetic testing communication continuum. Reviews on CGT-related knowledge, attitudes, and perceptions (n = 8) found that despite substantial public interest, their knowledge and awareness remains low. Providers also reported insufficient knowledge and overall caution, particularly regarding direct-to-consumer (DTC) genetic testing. Reviews of decision-making about CGT and test uptake (n = 8) identified individual, interpersonal, and systems-level barriers to uptake. Reviews of patient-provider CGT communication (n = 8) revealed limited communication and little empirical research on outcomes of communication or efforts at improving clinical and family communication. There were mixed findings in reviews (n = 15) on the psychological and behavioral impact of CGT, and DTC testing particularly had little effect on behaviors. Taken together, there is very little extant research in CGT in minority and underserved communities. In order for scientific advances in CGT to translate into equitable, patient-centered care, behavioral research, including health literacy and communication, plays critical roles.