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Instagram and WhatsApp are two social media and networking services introduced in 2010. They are currently subsidiaries of Facebook, Inc., California, USA. Using evidence from the published literature and case reports indexed in PubMed and other sources, we present an overview of the various applications of Instagram and WhatsApp in health and healthcare. We also briefly describe the main issues surrounding the uses of these two apps in health and medicine. Open Access:
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future internet
Instagram and WhatsApp in Health and Healthcare:
An Overview
Maged N. Kamel Boulos 1, *, Dean M. Giustini 2and Steve Wheeler 3
1The Alexander Graham Bell Centre for Digital Health, University of the Highlands and Islands,
Elgin IV30 1JJ, UK
2Diamond Health Care Centre, The UBC Biomedical Branch Library, University of British Columbia,
Vancouver, BC V5Z 1M9, Canada;
3Plymouth Institute of Education, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
*Correspondence:; Tel.: +44-07552-211634
Academic Editor: Dino Giuli
Received: 2 May 2016; Accepted: 15 July 2016; Published: 26 July 2016
Instagram and WhatsApp are two social media and networking services introduced in
2010. They are currently subsidiaries of Facebook, Inc., California, USA. Using evidence from the
published literature and case reports indexed in PubMed and other sources, we present an overview
of the various applications of Instagram and WhatsApp in health and healthcare. We also briefly
describe the main issues surrounding the uses of these two apps in health and medicine.
social media; Instagram; WhatsApp; mHealth; teleconsultation; health; healthcare; medicine
1. Introduction
The rise of smartphones, tablets and mobile apps is an important development in health and
healthcare, particularly social apps that provide learning and collaboration opportunities to busy health
professionals and peer-to-peer support and health education for the general public [
]. Effective
use of smartphones is part of how doctors and patients communicate in the 21st century. The latest
social media trends point to social networking services and mobile tools, such as Instagram [
and WhatsApp [
], as a viable medium for sharing and discussing clinical cases and medical and
health knowledge.
In 2006 and 2007, the first and third authors published two highly accessed and cited reviews
of social media applications in health and healthcare [
]. Since then, a growing number of social
media and networking services have been introduced and have grown popular in the health and
healthcare arena, joining the more established and older services in the social media toolbox, such as
Facebook, Twitter and LinkedIn. This paper focuses on two social media and networking services that
were launched in 2010, namely Instagram, a photo- and video-sharing service, and WhatsApp, an
instant messaging client. Both services are currently (as of April 2016) subsidiaries of Facebook, Inc.,
California, USA. The article examines the available research evidence and reports into their uses in
health and healthcare and the main issues that are involved in such applications.
Photo-sharing and messaging apps are part of the mobile revolution. They change how text,
audio and visual information are shared and communicated within social networks. In medicine,
Instagram and WhatsApp are finding a niche among health professionals that use hospital-specific and
dedicated accounts and groups on these platforms to communicate and encourage social and mobile
forms of learning.
Instagram and WhatsApp are free and easy-to-use apps that facilitate all sorts of clinical and
non-clinical exchanges, and can also support mobile learning. WhatsApp user base reached one billion
Future Internet 2016,8, 37; doi:10.3390/fi8030037
Future Internet 2016,8, 37 2 of 14
in February 2016 [
], while Instagram’s monthly active user base is expected to reach 520 million by the
end of 2016 [
]. Facebook (the parent company) is currently exploring business models to monetize the
two services [
], learning from the successful and innovative revenue generation models implemented
by WeChat [
], WhatsApp’s direct Chinese competitor (e.g., ordering a taxi or paying for goods and
services directly from the platform).
Instagram is available as an app for the Android and iOS platforms [
], but can also be
accessed from any Web browser on desktop PCs and notebooks, thanks to its Web-based user
timelines functionality, e.g., the Instagram timeline of the US CDC (Centers for Disease Control
and Prevention [10] and Figure 1).
Figure 1.
The US CDC (Centers for Disease Control and Prevention) timeline on Instagram, as captured
on 15 April 2016 [10].
Future Internet 2016,8, 37 3 of 14
Instagram users can easily share photos and videos with text captions and hashtags on their
timelines. Timeline visitors and followers can ‘like’ or comment on timeline posts. Instagram Direct
lets users send private messages to single contacts or groups.
With WhatsApp, users can send text messages, and share video and voice messages and images
over the Internet to their personal and professional learning networks. WhatsApp’s Group Chat
feature lets users chat and share content with up to 256 people at once. WhatsApp’s Broadcast Lists
are saved lists of message recipients that a user can repeatedly send broadcast messages to without
having to select them each time. Available for the Android, iOS and Windows Phone platforms [
the app is tied to the user’s cellular mobile number, but can also be accessed from any Web browser
on desktop PCs and notebooks (Figure 2), once an account has been created via the app on the user’s
smartphone. The service has recently implemented end-to-end encryption to protect user privacy [
making it even better suited to clinical applications.
Figure 2.
WhatsApp’s Web-based interface running in Microsoft Edge Web browser on a Windows 10
desktop PC.
Sources of Evidence
This review is based on articles collected via PubMed by searching for entries using the keywords
‘WhatsApp OR Instagram’. More than 70 PubMed-indexed records were found as of mid-April 2016,
in addition to some other hand-picked papers about the two apps that the authors located through
sources such as CINAHL, Embase and Med-e-Tel 2016 conference proceedings. Of these, a total of
about 50 papers that had WhatsApp or Instagram as a major or the main focus were considered in this
review. We excluded papers that only mentioned WhatsApp or Instagram in passing, and were not
sufficiently focused on either of these services.
Future Internet 2016,8, 37 4 of 14
2. Instagram
Instagram’s uses are mainly educational/informational and motivational/supportive. The app
has great potential to serve as a social networking platform in visually rich disciplines, such as clinical
dermatology [
], clinical infectious diseases [
] and radiology [
], owing to its strong, albeit not
unique, photo- and video-sharing affordances. However, negative uses capitalizing on these same
visual affordances have also been documented in the literature, such as the promotion of tobacco and
alcohol use [
], of pro-anorexia messages [
] and of unhealthy foods that are high in calories but
low in nutrients [
]. According to Moreno et al. [
], non-suicidal self-injury or self-harm content is
also popular on Instagram and may influence adolescents, with ‘Content Advisory’ warnings failing
to protect unwitting users.
Yi-Frazier et al. [
] experimented with the use of Instagram in disease-related discussions and
photo-sharing for peer-to-peer support among adolescents with type 1 diabetes. Another study
by Al-Eisa et al. [
] concluded that the use of Instagram with a home exercise programme as
a motivational modality could be attractive and effective to reinforce adherence and maintain an
appropriate level of physical activity. However, Tiggemann and Zaccardo [
] reported that Instagram
fitspiration images (promoting exercise and healthy food to inspire viewers towards a healthier
lifestyle) might have negative unintended consequences for body image among certain users, who
are more prone to develop increased negative mood and body dissatisfaction and decreased state
appearance self-esteem upon exposure to such images.
Photo-sharing platforms are also being used for information exchange about public health crises,
but the useful-signal-to-noise ratio can be low. Seventy-eight percent (78%) of images in an Instagram
sample about Ebola were primarily coded as ‘jokes’ or ‘unrelated’ in a study by Seltzer et al. [
Nevertheless, Instagram remains one of the tools used by the World Health organization (WHO),
the US Centers for Disease Control and Prevention (Figure 1, [
]) and other public health bodies to
disseminate visually-rich public health messages that both educate and interest the general public, and
for risk communication during public health crises and man-made or natural disasters.
Cool et al. [25]
report one such use by the WHO following Typhoon Haiyan in the Philippines.
Correia et al. [
] describe a quite novel use of Instagram to monitor Drug-Drug Interactions (DDI)
and Adverse Drug Reactions (ADR) among the general public through complex network analysis of
Instagram user timelines.
3. WhatsApp
A number of studies have examined the usefulness of WhatsApp in clinical decision-making
and patient care. Nardo et al. [
] tested WhatsApp to verify if it facilitates communication, enhances
learning, and improves patient care (and maintains privacy). They conducted focus groups of
surgeons over the periods from March 2013 to July 2015 and September 2014 to July 2015 through
a ‘WhatsApp Surgery Group’. Patients signed consent and information-release forms to let team
members communicate clinical data using WhatsApp. A total of 1053 images were used with an
average of 78 images for each patient (range 41–143). One hundred twenty-five hours of communication
were recorded, generating 354 communication events. An expert surgeon received the highest number
of questions (p, 0.001), while residents asked clinical questions (p, 0.001) and were fastest to respond
(p, 0.001). In their conclusion, they described WhatsApp as a low-cost and fast technology with the
potential of facilitating clinical communications, enhancing learning, and improving patient care whilst
preserving their privacy.
Another study by Cheung et al. [
] looked at whether group discussion and reminders via
WhatsApp or Facebook were effective in preventing smoking relapse for those who had stopped
smoking. They conducted a randomized controlled trial allocating recent quitters who had completed
eight-week treatment reporting abstinence for at least seven days to WhatsApp (n= 42) or Facebook
n= 40
) and a control (n= 54). Groups participated in two-month online group discussions on
WhatsApp or Facebook, which were moderated by trained smoking cessation experts and received
Future Internet 2016,8, 37 5 of 14
a self-help booklet on smoking cessation. The control group only received the booklet. The primary
outcome was two- and six-month relapse rates. WhatsApp was found to be effective in reducing
relapse, thanks to enhanced discussion and social support. Inactive discussion in Facebook might have
attributed to lower effectiveness.
Dorwal et al. [
] tested the use of WhatsApp in laboratory management by forming multiple
laboratory groups. Thirty-five members used the service for three months and responses were taken
on a scale of 1 to 10. Significant improvements in communication were seen in sharing photographic
evidence, information about accidents, critical alerts, academic activities and directives. An increase in
the load of adding information to the application and some disturbance in routine workflows were
documented, but the benefits outweighed the minor hassles associated with the use of WhatsApp.
Research by Johnston et al. [
] analyzed WhatsApp as a communication method among
emergency surgery teams in a London hospital. All emergency surgery team members (n= 40)
who participated in their study used WhatsApp for 19 weeks. Initiator and receiver of communications
were compared for response times and communication types. Safety events were reported. More
than 1100 communication hours covering the details of 636 patients were logged, resulting in 1495
communication events. The attending started the most instruction-giving communication, while
interns asked the largest number of questions (p< 0.001). The resident was faster to respond compared
to intern or attending (p< 0.001). Participants felt the app helped to “flatten hierarchy” amongst
students, residents and experienced consultants, enabling them all to actively contribute to discussions
without inhibition.
Kaliyadan et al. [
] evaluated the frequency of use, advantages and disadvantages of WhatsApp
in clinical discussion groups. An online survey was created and sent to a convenience sample made
up of members of three WhatsApp dermatology groups. The survey looked at individual activities,
satisfaction with app, and perceptions regarding platform. Sixty-one (61) dermatologists completed a
survey; 38 males and 23 females. Ages of participants ranged from 26 to 57 years. Years of experience
varied from 1st year residents to senior consultants with up to 34 years of clinical experience. Fifty
(out of 61) respondents were active in other Web-based forums, such as Facebook or other e-groups.
The majority of participants agreed that WhatsApp was better for case discourse.
Khanna et al. [
] assessed the impact of WhatsApp as an intradepartmental communication
tool regarding (i) awareness of patient-related information; (ii) efficiency of the handover process;
and (iii) duration of traditional morning handovers among orthopedic residents in a 300-bed tertiary
care teaching center. Wide usage, low costs, availability and double password protection (phone
lock and WhatsApp lock) made the group conversation feature an ideal tool for intradepartmental
patient-related communication. Residents reported swifter and more efficient handovers with
WhatsApp. The results indicated that WhatsApp can bring about an improvement in patient-related
awareness, communication and handovers among orthopedic residents.
Mars et al. [
] undertook a descriptive scoping review of the literature of WhatsApp in clinical
medicine. They searched PubMed, Science Direct and Google Scholar, among others. Their inclusion
criteria were papers that described the use of WhatsApp in a telemedicine context. Papers describing
the use of WhatsApp for teaching or social support in weight loss, exercise or similar programmes
were excluded. Abstracts were reviewed for relevance, duplicates removed, and the remaining full
text papers read. After initial abstract review 58 papers were retrieved and 32 met inclusion criteria.
They found that WhatsApp is used for group chats and doctor-to-doctor telemedicine. The literature
they reviewed showed a lack of understanding of how information is transmitted and stored when
using WhatsApp and of the problems this might create for patient confidentiality and data security.
They concluded that WhatsApp has a role to play, particularly in the developing world, as it is freely
available and widely-used outside of medicine, and that guidelines are needed to assist users in
adequately tackling the associated medicolegal and ethical concerns.
Petruzzi et al. [
] describe their use of WhatsApp to share clinical oral medicine information.
This involved WhatsApp being used by dentists, physicians, hygienists, and patients to submit images
Future Internet 2016,8, 37 6 of 14
and questions. For each submission, a clinical impression was registered and classified as traumatic,
infective, neoplastic, autoimmune or uncategorized. Three hundred and thirty-nine images were
received for 96 patients; 92 (95.8%) patients underwent clinicopathologic examination, and 45 (49%)
received a biopsy. Dentists (62%) and dental hygienists (26%) were the most frequent senders. The most
common type of question was related to diagnosis (56%). The telemedicine impression agreed with the
clinicopathologic assessment for 82% of cases. They concluded that multimedia messaging apps, such
as WhatsApp, can support communication about oral conditions among clinicians and patients. Their
experience showed that telemedicine consultation using WhatsApp can reduce geographic barriers
to initial clinical consultation and encourage the significant majority of patients to pursue expert
clinical examination.
Robinson et al. [
] report their findings of using WhatsApp to develop social presence among
first-year undergraduate radiography students. An analysis was done using a validated tool specifically
designed to identify categories of social presence, developed using the Community of Enquiry model.
Students undertook the analysis. Six hundred posts (10% of total year’s messages) were analyzed in
the first-year student journey. WhatsApp was able to provide students with a platform to demonstrate
characteristics relevant for the development of social presence. Furthermore, its immediacy seemed to
offer advantages over embedded social media platforms, such as conventional discussion boards.
Another study by Wani et al. [
] assessed WhatsApp as a communication method among staff
of plastic and reconstructive surgery at a tertiary care health facility. In 2012, Wani and colleagues
used smartphones and WhatsApp as a communication method in patient management and as a tool
for academic endorsements. There were 116 episodes regarding patient management, handled in a
timelier fashion by using WhatsApp. The opinion of residents was sought regarding this method of
communication. A majority of residents were satisfied with this mode of communication. Wani et al.
concluded that WhatsApp is an effective, low-cost, quick and easy-to-implement method for clinical
and academic endorsements. Along the same line, Martyn-Hemphill et al. [
] evaluated the use of
WhatsApp instant group messaging amongst urology team members to promote patient safety within
a busy acute and elective urology service, and found it to be “a cost and time efficient, user-friendly
adjunct to traditional modes of communication”.
Similarly, Astarcioglu et al. [
] concluded that WhatsApp “is cheap, quick, and easy to operate”
following their assessment of its efficacy as a communication method between the emergency physician
in a rural hospital without percutaneous coronary intervention (PCI) capability and the interventional
cardiologist at a tertiary PCI centre.
Thota and Divatia [
] report a life-saving use of WhatsApp in resource-limited situations that
involved sending clinical images. They were able to save the life of a critically ill patient by sending
clinical monitor images of transvenous pacing with ECG (electrocardiogram) changes to, and receiving
feedback from, an expert consultant who was 40 km away from the center where the patient was located.
Giordano et al. [
] evaluated the inter- and intra-observer agreement in the initial diagnosis and
classification by way of CT (computerized tomography) scans and plain radiographs of tibial plateau
fractures photographed and sent using WhatsApp. They found an excellent inter- and intra-observer
agreement in the imaging assessment of tibial plateau fractures on WhatsApp, and concluded that the
app is suited for obtaining the opinion of an experienced consultant when not on call. In the same
vein, Kelahmetoglu et al. [
] found that “sending and receiving images and videos on WhatsApp is
an easy, rapid way of evaluating maxillofacial CT scans in night-time teleconsultation”.
There are also studies that investigated the effectiveness of WhatsApp as a communication tool in
supporting patients. In a study presented at the Third World Congress on Integrated Care, Mexico City,
Mexico, 19–21 November, 2015, Saavedra Ramirez [
] reported on the use of WhatsApp as a means
of communication within a self-help group that involved hypertensive patients with type 2 diabetes
and expert medical staff. Social support received in this way promoted greater adherence of patients
to treatment and self-care guidelines. However, in another study by Muntaner-Mas et al. [
], in
which they evaluated the feasibility and preliminary effectiveness of a WhatsApp-based intervention
Future Internet 2016,8, 37 7 of 14
aimed at enhancing health-related physical fitness components and cardiovascular disease risk factors,
WhatsApp was found to be less effective than the face-to-face mode with which it was compared.
In the context of learning, social media have been used progressively in recent years to support all
areas of learning. WhatsApp exhibits some useful benefits in this respect and its increasing popularity
has spawned several research studies. Willemse [
] reviewed the experiences of undergraduate
nurses in using WhatsApp to improve primary healthcare education at a university in the Western
Cape, South Africa. Rambe and Bere [
] showed how WhatsApp can improve peer engagement
and increase learner participation. The use of WhatsApp in mobile social learning was found to have
a significant positive impact on learners’ attitudes and achievement levels [
]. The discourse of
spontaneous interaction [
] is assuming increasing importance as we begin to apprehend the power
and potential of mobile learning and information exchange.
4. Discussion
Instagram’s uses fall into two main categories, namely educational/informational and
motivational/supportive applications. Instagram’s public timelines feature enables health
organizations, such as the US CDC [
], to reach out and disseminate visually rich public health
messages to hundreds of millions of potential readers who are using the service. There are also
some documented negative uses of Instagram, e.g., by the tobacco industry [
]. According to
Lee et al. [
], Instagram users have five primary social and psychological motives: social interaction,
archiving, self-expression, escapism, and peeking, but these motives are not always without negative
consequences (see, for example, [
]). Lup et al. [
] found that more frequent Instagram use had
negative associations for people who follow more strangers, but positive associations for people who
follow fewer strangers, with social comparison and depressive symptoms among 18–29 year olds.
Sharing text, documents and images on WhatsApp may have a role in improving clinical
decision-making and patient care for clinicians, from consultation to bedside. The tool facilitates
and improves communication for healthcare teams, providing good ways for physicians to monitor
work performed by clinical staff. For example, Gulacti et al. [
] found WhatsApp to be a useful
communication tool between physicians, especially for emergency department consultants when they
are outside the hospital.
One can also think of a good use of WhatsApp involving members of the general public
subscribing to receive WhatsApp alerts that are relevant to their health needs, e.g., health information
and health-related motivational messages covering weight loss coaching and support, healthy lifestyle
tips, or smoking cessation, among other topics. WhatsBroadcast [
] can be used to deliver such alerts
to subscribers. Lay users can also benefit from hosting relevant virtual peer-to-peer support groups in
WhatsApp, e.g., for patients with chronic conditions, HIV-positive youth, etc.
Moreover, WhatsApp has been successfully used in health and medical education and learning.
All respondents (n= 61 dermatologists) in a survey by Kaliyadan et al. [
] agreed that WhatsApp
discussions enriched their clinical knowledge, not only with regard to particular clinical case
discussions, but generally by sharing learning resources about relevant references/journal articles
and upcoming conferences/meetings. WhatsApp group-chat dynamic also enables junior doctors to
contact, and learn from, senior doctors more easily where they may not previously have felt able to
phone them directly [53].
Both Instagram and WhatsApp enjoy ease of use, particularly of image uploading and
downloading, with generally fast loading times (see, for example, the results reported in [
A number of studies we covered in this review concluded that Instagram and WhatsApp, being
free to use, are suitable for low-resource settings (e.g., [
]). Different studies also concurred
that the high photo quality (transmission and display) offered by these services is more than
adequate for clinical diagnostic purposes in teleconsultations (e.g., [
]), although diagnostic
picture quality is also dependent on other factors such as the user’s camera specifications (including
Future Internet 2016,8, 37 8 of 14
camera lens specifications), lighting, and camera angle/position and distance from photographed
lesions, particularly in disciplines such as clinical dermatology.
Table 1presents some of the above discussed themes in relation to Instagram and WhatsApp uses
in health and healthcare.
Table 1. Instagram and WhatsApp in health and healthcare: select themes from this review.
Theme References
Alcohol and tobacco (negative uses of Instagram in marketing and promoting them) [1517]
Diet, exercise and fitness, including negative uses [18,19,22,23]
Public health concerns and alerts, including uses by organizations such as the US CDC [10,2426]
Nonsuicidal self-injury and mental health related [20,50]
Visual-social information-sharing [1214,21]
Tobacco treatment and control [28]
eLearning [46,47]
Enhanced communication and social interaction [29,30,32,3638,53]
Exercise and fitness [44]
Medicolegal aspects [33,34]
Nurses [45]
Teleconsultation and Surgical [27,30,35,37,39,4143]
Visual-social information-sharing [31,35,40]
4.1. Instagram, WhatsApp and Learning
Learning is essentially a social activity, where people scaffold and extend each other’s knowledge
gain [
], but in recent years, new theories have emerged to explain distributed forms of learning that
have been made possible through mobile technology and social media. Digital forms of scaffolding
emerge where learners access new knowledge using personal devices [
]. The power differentials
between experts and novices is also thought to be diminishing due to new and emerging forms of peer
learning and knowledge production. This ‘paragogical’ theory is based on the premise that online
networks are sufficiently developed to support user-generated content that can be shared freely and
widely [
] to inform communities of practice and interest [
] (‘paragogy’ in this context refers
to the conscious practice of peer learning, according to [
]). Another emerging theory relates to
the increasing mutability of knowledge in the digital age. Proposed by Siemens [
], ‘connectivism’
suggests that knowledge now resides in the network as well as in the minds of those who use it.
Learning is amplified and knowledge becomes more widely available as the network of people, tools
and connections strengthens. WhatsApp fulfils many of the requirements of this kind of learning,
and its rising popularity—particularly among younger generations—assures it continues to be widely
used, and scrutinized, in many forms of peer production and information dissemination. The same
could be said about Instagram and its uses in medical education, e.g., [59].
4.2. A Plethora of Options
Despite similar functionalities being offered on the main Facebook platform, e.g., photo- and
video-sharing with hashtags on timelines, and private multimedia chat and messaging with single
contacts or groups, there are still very many millions of users worldwide who prefer Instagram and/or
WhatsApp over Facebook (or use Instagram and/or WhatsApp in addition to Facebook), particularly
on smartphones. In a large sample of 2418 users, Montag et al. [
] recorded WhatsApp behaviour
over a four-week period. Their data showed that the use of WhatsApp accounted for almost 20% of all
smartphone behaviour compared with Facebook, which accounted for less than 10% of all recorded
behaviour in the same study. In another survey conducted in 2015 [
], only 2% of UK doctors and
4% of US doctors reported using WhatsApp to communicate with patients in the month preceding
Future Internet 2016,8, 37 9 of 14
the survey, compared to 87% in Brazil, 61% in Italy and 50% in China (in China, WeChat is used as
WhatsApp’s equivalent).
Going beyond Facebook, Inc.’s offerings, several other tools and services exist, such as Skype
(does not enforce account tying to user’s cellular mobile number, [
]), WeChat (tied to user’s cellular
]), Viber (tied to user’s cellular number, [
]), etc., but some of these alternative options
are seen as more complex to use, offering less immediacy and spontaneity. Immediacy has been
identified as one of the key affordances for successful learning and information dissemination in
digital environments [
]. On the other hand, some of the available alternative options feature
unique functionalities that might be useful in certain scenarios, e.g., Skype Translator applied to patient
care [
]. Furthermore, encryption levels vary across these different options, which might be a decisive
factor in preferring one service over the other, e.g., encrypting private messages only when they are in
transit between a user’s device and company servers, where they are stored and can be handed over if
required by law (as in the main Facebook platform, for example) vs. end-to-end encryption, with the
company not storing messages on its servers (as in WhatsApp, for example).
As with many other things in life in which there are many options and models to choose from
(e.g., cars, smartphones, computers, etc.), it is an advantage to see Facebook embracing alternatives
within its own portfolio of services and to have other options from different providers as well.
Competition produces better services, and the availability of a number of options to select from
enables end users to choose the service that best matches their individual and local needs, though this
can, at times, be a confusing task to some people. However, with trial and error and by learning from
the experiences of others (e.g., reports in the published literature as covered in this article), most users
and teams will be able to find the tool(s) and protocols that best work for them.
Indeed, the different social media platforms on offer today are not mutually exclusive, and can in
fact be synergistic. For example, the US CDC has established a presence on a good number of these
platforms (Instagram being just one of them, [
]) to ensure the widest possible dissemination of its
public health messages and to reach out to more people wherever they might be online. Different
platforms will often have different but also overlapping demographics, and this should be carefully
considered and leveraged by health and healthcare organizations when devising their social media
outreach strategies.
4.3. Patient Privacy, Confidentiality and Other Issues Surrounding the Health and Healthcare Uses of
Instagram and WhatsApp
Mars et al. [
] list the following downsides of WhatsApp, some of which might
have medicolegal ramifications: frequent interruptions; disparity on urgency; decreased verbal
communication; being online 24 h (could also be seen as an upside depending on context); cannot
easily print communication record; communications are not readily included in patient’s medical
record; and identifying patients can be difficult. Other limitations of WhatsApp are to do with Internet
connectivity issues, the lack of adequate follow-up in some case discussions, and the variable quality
of images [31].
There have also been concerns related to the risks of breaching patient confidentiality and data
protection requirements on Instagram and WhatsApp, e.g., [
]. These risks are common to all social
media services and not only Instagram and WhatsApp [
]. For clinical photos posted on public
Instagram timelines, it remains the poster’s (doctor’s) full responsibility to protect their patients’
privacy and confidentiality (and also observe any applicable content copyrights). The same rules and
ethical requirements (including patient consent) for publishing clinical photos in medical journals
still apply here. Most reputable health and healthcare organizations have well-established and clear
policies governing such clinician ethics and discipline issues as they apply to online environments,
including social media.
For images privately stored on smartphones, and exchanged among closed groups using
WhatsApp and similar apps, there are also risks of breaching patient confidentiality [
]; for
Future Internet 2016,8, 37 10 of 14
example, in cases of unauthorized access (e.g., if the smartphone is left unattended and unlocked);
smartphone theft; if the photos are forwarded to the wrong recipients; or if the photos are advertently
or inadvertently used beyond their original purpose to which the patient had consented. Measures to
address confidentiality of patient data stored on, and exchanged via, smartphones include bolstering
smartphone security (e.g., data encryption and remote data wiping in case the device is stolen). Again,
organizations often have, and should have, very clear policies, rules and provisions in place regarding
these very important information governance issues [69].
Drake et al. [
] point to the fact that when a message is sent from a device via an instant
messaging service, the data are relayed to commercial servers that often reside outside of the user’s
home country via the Internet, where from recipient devices can retrieve messages. This can be
problematic in countries such as the UK, where any transmission of sensitive, patient-level data to
third-party providers outside the European Economic Area (EEA) would constitute a breach of the
Data Protection Act of 1998. In 2014, the National Health Service (NHS) in England enumerated its
concerns about instant messaging and advised against using it in clinical exchanges due to problems
with data and third-party server security and territory, but this position is gradually changing with the
introduction of NHS-oriented apps, such as Babylon Pocket Doctor [
] and Push Doctor [
]. In the
US, the Health Insurance Portability and Accountability Act (HIPAA) protects confidential healthcare
information, with similar laws in Canada and Australia protecting patients. WhatsApp may partially
meet these standards given its newer end-to-end encryption policies and that it does not store chat
content/history on WhatsApp’s servers (unlike Facebook messaging, [
]), but these protections
remain not formally and explicitly tested in a clinical environment, and should not be accepted without
more robust evidence.
No discussion of social media in health and healthcare is complete without at least a mention
of user (patient) privacy issues on these networks. Bertsima et al. [
] offer a good treatment of this
important subject, including a comprehensive range of options for strengthening online privacy in
healthcare social networks.
4.4. Successive Updates and Versions
Pooling together older and newer studies about a given social media service (as in this article)
might carry some limitations. Older studies would have their results based on older versions of the
service, and might not fully apply to newer (better or worse) versions of the same service. For example,
WhatsApp used to have an annual subscription fee of US $0.99, but is now completely free. It also
does not support live video calls (it only supports voice calls) as of April 2016, but this is about to
change with the introduction of video calling in the next update of WhatsApp [
]. Additionally, in
the past, Instagram could only be accessed by logging to one’s account on a dedicated Instagram
smartphone app; Windows PC users could not access content on Instagram. However, this is has
changed today, with the introduction of Web-based Instagram public timelines (e.g., [
]) that can be
fully displayed on any PC or mobile browser, without using the dedicated app or having an Instagram
account. Furthermore, Instagram is now no longer limited to square (1:1) photos as it used to be in
the past.
The first author expects future versions of WhatsApp to introduce even more social and
health-related functionalities similar to those already in place in WeChat, WhatsApp’s immediate
rival [76,77].
5. Conclusions
Social media have changed, and will continue changing, health and medicine [
Smartphones are effective across a range of social learning and communicative contexts in health
and healthcare: in patient care, monitoring, rehabilitation, communication, diagnosis, teaching and
research [1,2]. Adding Instagram and WhatsApp to the clinical communication and teaching toolbox
facilitates timely responses among health teams, faster handovers for residents at hospitals, and a
Future Internet 2016,8, 37 11 of 14
wider dissemination of public health messages to more people. Apps, when deployed as user-friendly
adjuncts to traditional communication, can help to create virtual communities of enquiry and practice,
and bridge distances both temporal and psychological that may be characteristic of busy distributed
healthcare settings. However, more research into the safety and security of Instagram, WhatsApp and
similar apps should be conducted, particularly to address concerns about patient confidentiality and
safe, secure communications. New research techniques, such as Imagga [
], an automated image
recognition and tagging software tool, are also needed and are being introduced to help in investigating
the various and ever-growing health and healthcare uses of Instagram and related apps [80].
Author Contributions:
M.N.K.B. conceived and drafted the whole manuscript. D.M.G. contributed to the survey
and summary of the literature about WhatsApp (large parts of ’ Section 3. WhatsApp’). S.W. contributed specialist
text about social learning in the context of the reviewed apps (’Subsection 4.1. Instagram, WhatsApp and Learning’).
All authors read and approved the final manuscript.
Conflicts of Interest: The authors declare no conflict of interest.
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... Various reviews have documented the evolution, since 2013 [8], of WhatsApp use in clinical medicine for both one-on-one consultation and one-to-many chat groups, usually within clinical departments [9,10]. While initially mostly reported in developing countries, recent papers have identified its growing use and acceptance in the developed world [11][12][13][14]. ...
... It should be noted that the district hospitals do not have dermatopathology facilities with biopsies sent either to the anatomical pathology department of the medical school or local private practices. The most common diagnoses were eczema (27), lichen planus (19), tinea corporis (12), contact dermatitis (11), bullous impetigo (10) and papular urticaria (10), and for the 23 infants (under 12 months), bullous impetigo (5), eczema (4), and xanthogranuloma (3). In 76 cases (24%), the referring doctor provided a diagnosis, of which 32 (42%) were congruent with the dermatologist's final diagnosis. ...
Full-text available
Background: In KwaZulu-Natal (KZ-N), South Africa, recent reports have indicated that spontaneous use of smartphones has occurred, providing access to specialist dermatological care to remote areas. This informal use has raised a number of practical, legal, regulatory, and ethical concerns. Aim: To assess the nature and content of WhatsApp messages sent to dermatologists, to determine the referring doctors' reasons for, and satisfaction with, their interactions, as well as their knowledge of legal, regulatory, and ethical requirements. Methods: A retrospective study of WhatsApp messages between referring doctors and dermatologists, as well as a cross-sectional survey of doctors working at district hospitals in KZ-N who used IM for teledermatology. Results: Use of IM (primarily WhatsApp) for teledermatology was almost universal, but often not considered 'telemedicine'. Few referring doctors were aware of South Africa's ethical guidelines and their requirements, and few of those who did followed them, e.g., the stipulated and onerous consent process and existing privacy and security legislations. No secure methods for record keeping or data storage of WhatsApp content were used. A desire to formalize the service existed. Conclusions: Based upon these findings, it was proposed that a number of described steps be followed in order to formalize the use of IM for teledermatology.
... To utilize the hedonic social applications, many health professionals and medical institutions have tried to distribute health knowledge, initiate health campaigns and promote public health literacy on hedonic social applications, covering a wide range of topics such as disease prevention, diagnosis, treatment and medical advice on chronic disease management (Kamel Boulos et al., 2016). For example, government agencies and nonprofit health organizations actively used Twitter for smoking cessation campaigns (Chung, 2016). ...
... Moreover, social hedonic platforms provide interactive technology features which may advance consumers' health information adoption (Kamel Boulos et al., 2016). First, the hedonic social applications are primarily characterized as being visually rich, providing possibilities of presenting information in different modalities such as images, audio or videos. ...
Purpose-Hedonic social applications have been increasingly popular among health information consumers. However, it remains unclear what motivates consumers to adopt health information in hedonic applications when they have alternative choices of more formal health information sources. Building on the self-determination theory and the affordances lens, this study aims to investigate how different affordances on hedonic social applications affect consumers' basic psychological needs and further influence their intention to adopt health information on such applications. Design/methodology/approach-As TikTok demonstrated great potential in disseminating health information, we developed a model that we analyze using the PLS-SEM technique with data collected from a valid research sample of 384 respondents with health information seeking or encountering experience in TikTok. Findings-The results suggested that health information adoption in hedonic social applications is significantly predicted by the satisfaction of consumers' basic psychological needs, namely autonomy, relatedness and competence. Moreover, the satisfaction of basic psychological needs is positively affected by affordances provided by the hedonic social applications. The hedonic affordances positively influence autonomy satisfaction, while the connective affordances positively affect relatedness satisfaction, and the utilitarian affordances positively support competence satisfaction. Originality/value-The study indicates that hedonic social applications such as TikTok could be an important channel for consumers to access and adopt health information. The study contributes to the literature by proposing a theoretical model that explains consumers' health information adoption and yields practical implications for designers and service providers of hedonic social applications.
... As mentioned above, the results of the present study showed that WhatsApp, Telegram, and Instagram were the most used social networks to receive diabetes self-care services. The results of studies by Sap et al. 35 and Kamel Boulos et al. 36 showed that most patients use Instagram and WhatsApp to get health instructions. Petrovski et al. 14 also noted that social network platforms such as Facebook, Twitter, WhatsApp, Instagram, Skype, and Dropbox are very popular among young people and offer unique opportunities for online diabetes education, intervention and support. ...
... Petrovski et al. 14 also noted that social network platforms such as Facebook, Twitter, WhatsApp, Instagram, Skype, and Dropbox are very popular among young people and offer unique opportunities for online diabetes education, intervention and support. Some studies 35,36 have considered easy access to care information, the ability to understand information due to the use of audio and video capabilities and sharing experiences as the most important reasons for patients' tendency to use Instagram and WhatsApp. These results suggest that the power of social networks should not be underestimated due to various benefits such as access to up-to-date health information, information sharing, cost reduction, availability, ease of use and online interactions. ...
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Background Patient involvement with diabetes self-care is critical to reducing complications, morbidity, and mortality. Social media, as one of the most important forms of digital health, has always been available for diabetes self-care, although the role of these media in supporting patient self-care is unclear. Aims The aim of this study was to investigate the role of social networks in diabetes self-care. In this study, the most important social networks used to receive self-care services, diabetes self-care behaviors, diabetes self-care educations and benefits of using various services provided through social networks were identified. Methods The present study is a cross-sectional study that was conducted through an electronic researcher-made questionnaire in 2021. Two hundred and eighteen patients were selected to participate in the study from centers of diabetes of Fasa city, south of Iran. Sampling was performed by convenience sampling and in accordance with inclusion and exclusion criteria. Data were analyzed by descriptive statistics and analytical tests. Results In the data analysis section on Diabetes self-care behaviors, there was no significant relationship between gender (p = 0.292), age (p = 0.49), type of diabetes (p = 0.909) and duration of diabetes (p = 0.076) with the use of self-care services provided through social networks. There was a significant relationship between education level and the use of self-care services provided through social networks (p = 0.01). “Recognizing diabetes and its complications,” “observing personal hygiene,” and “the impact of physical activity on diabetes control” were the most important educations. “Increasing patient knowledge and understanding about diabetes and its complications,” “reducing the consumption of high-calorie foods and sugars,” and “observing personal and public health” were the most important social network's benefits, respectively. Conclusions Various self-care educations and services provided through social networks can increase the in-depth knowledge of diabetic patients about self-care techniques and their effective role in controlling and managing diabetes and performing more self-care processes.
... Also, WhatsApp is used for health education (Willemse, 2015;Kamel Boulos, Giustini & Wheeler, 2016;Pereira., Destro, Bernuci, Garcia, & Lucena, 2020;Sukriani & Arisani, 2020;Cheung et al., 2020;Yusriani & Acob, 2020), and this happens when users of similar interest join WhatsApp groups that engage in such education (Nobre, Ferreira & Almeida, 2020). As users get enlightened on the WhatsApp groups (Grover, Garg & Sood, 2020), they also seek information relevant to their needs (Adejo & Opeyemi, 2019;Ayandiji, Afolabi & Olaojo, 2021). ...
Full-text available
Previous studies on computer-mediated communication have investigated the use of WhatsApp groups for health education, health communication, and behavior change, but no empirical study had documented the experiences of Cesarean Section (CS) mothers on their use of WhatsApp groups for health education, information seeking and postpartum healing. This study identifies the post-CS goals of mothers who joined Csection Mum Community WhatsApp group, examines the extent to which the group‖s activities satisfied those goals, investigates why they felt safe disclosing their personal health information in the group and explores the role of interpersonal empathic communication on their postpartum healing. Using Online Focus Group Discussion (OFGD) to collect data from twenty-seven CS mothers, and guided by some propositions of uses and gratifications, social penetration theories, and empathic model, the findings revealed that the WhatsApp group satisfied the mothers‖ informational, educational, experiential learning and social support needs. Their affinity with the group‖s activities influenced their spontaneous self-disclosure in the group. It was also found that interpersonal empathic communication improved the postpartum depression healing process of the mothers. It, therefore, recommends that hospitals (that operate on patients) empower adult mental health nurses or clinical psychiatrists to engage CS mothers and their caregivers (family members, spouses, etc.) in psycho-education, especially empathic communication, before discharging the mothers.
... There are indeed indications that job characteristics such as skill variety are related to the use of alternative solutions. One industry that is particularly known for its use of workarounds and alternative systems such as Whatsapp, is healthcare [21,22]. It is believed that alternative solutions are created more in healthcare than in any other context because of the complexity of delivering patient care [23]. ...
Full-text available
IT users are increasingly experienced at adapting technologies to their needs; resulting in the widespread use of workarounds and shadow IT. To ascertain the impact of job characteristics on this behavior, a survey was conducted among 415 IT users. The collected data underwent Reliability Analysis and Exploratory Factor Analysis in SPSS software. Subsequently, Confirmatory Factor Analysis and Structural Equation Modeling were conducted with the SmartPLS software. The main results indicate that autonomy is strongly related to workaround behavior and shadow IT usage. Workaround behavior and shadow IT use have also been proven to be strongly related. However, the level of skill variety and task identity do not seem to significantly affect workaround behavior and shadow IT usage. Finally, this study’s findings demonstrate that both workaround behavior and shadow IT use are positively related to individual performance. Organizations are therefore encouraged to increase job autonomy in order to achieve enhanced individual performance by presenting workers with opportunities to adapt technologies in the form of workarounds and shadow IT. The use of such alternative solutions provides for faster and more dynamic communication and thus boosts collaboration among co-workers, external partners, and clients.
... TikTok learns quickly via artificial intelligence what users like (12), which results in more recommendations of hearing aids-related videos for users with hearing impairment. Many health professionals and medical institutions have tried to distribute health knowledge and promote public health literacy on short video applications, such as TikTok, which demonstrated a vast potential for disseminating health information (8,13). ...
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Hearing aids are effective at improving listening ability and health-related quality of life. Recently, we observed that there are many hearing aids-related videos published on TikTok. However, the quality of the information they offer remains unstudied. This study aimed to evaluate the information quality of hearing aids videos on TikTok. We collected a sample of 155 hearing aids-related videos in Chinese and extracted the basic information. First, we identified the source of each video. Two independent raters assessed the quality of the information in the videos, using the PEMAT-A/V tool and DISCERN instrument. Regarding content, the results showed that the video contents on TikTok mainly about features, functionalities, and suggestions of purchase or fitting of hearing aids, while the information about the disadvantages and complications of hearing aids was limited. The overall quality of the hearing aids-related videos was acceptable on average, although the quality varies greatly depending on the type of source. Patients should be cautious in obtaining information about hearing aids on TikTok.
Instagram is a leading social network for information sharing and communication. Rigorous studies are missing that leverage bibliometric techniques to comprehensively portray the field. To fill this knowledge gap, this study carries out a holistic bibliometric and network analysis of Instagram research, illustrating the dynamic evolution from 2013 to 2021. On the basis of 2,242 publications from the Web of Science database, which were authored by 6,206 researchers, this study identifies the most prominent scholars and articles in the literature. Furthermore, it analyzes diverse bibliometric networks, such as citation, co-citation, collaboration and keyword co-occurrence networks, and presents two intellectual structure maps (i.e., conceptual structure map, thematic map). The results indicate that the number of academic studies about Instagram has been growing significantly over time and that the dominant topics are the psychological motivation of Instagram use, the COVID-19 pandemic, Instagram marketing, social media platforms, and healthcare.
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This study seeks to answer the question of how Brazilian female senators addressed public health on their Instagram profiles in the first year of the new coronavirus pandemic. It conducted an exploratory study combined with a content analysis of 10 female senators’ profiles. The corpus gathered 4,814 posts, published between March 11th, 2020, and March 11th, 2021. 42,0% of the posts were about health, and most of them emphasized the sanitary crisis in the country. These politicians used the platform to publicize their political activities and reinforce their position of power in the context of the pandemic. Their parliamentary performance regarding public health was the main theme of the posts. The study highlights that their political party and ideological perspectives influenced their approach to the topic of public policy. It observed the presence of disinformation in parts of the content related to the pandemic, despite the presence of informative content with recommendations from the World Health Organization (WHO).
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The COVID-19 pandemic has had an extraordinary impact on people's life. The elderly, however, suffer unique obstacles and healthcare providers must recognize and address their unique requirements so that they can be effectively protected and supported during these trying times. The objectives of this research were to improve the desirable healthcare knowledge and behaviour among the elderly with diabetes mellitus using Line application in conjunction with Tele-counselling during the COVID-19 pandemic. The sample was elderly with diabetes mellitus in Chiang Mai Province. There were two groups, namely the intervention group (n=30) and the control group (n=30). The sample was selected based on simple random sampling. After using the Line application and Tele-counselling, the results showed that the intervention group had a higher mean score of healthcare knowledge and behaviour after using Line application and Tele-counseling than before. The intervention group had a higher mean score for healthcare knowledge and behaviour than the control group, with a statistical significance (p <0.001). Overall satisfaction was an average of 4.63 (SD=0.56), indicating that the users had a high level of satisfaction when participating in the program. In order to promote the healthcare knowledge and behaviour of the elderly with diabetes mellitus, related personnel should use the study findings by applying a Line application and new networking tools that can also reach the elderly.
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Background and aims: During the COVID-19 pandemic, college students can access health-related information on the Internet to improve preventative behaviors, but they often judge the merits of such information and create challenges in the community. The aim of this study was to investigate information-seeking behaviors in regard to COVID-19 among students at Kerman University of Medical Sciences (KUMS) with the help of mass and social media. Methods: The present study is a cross-sectional study, which was conducted using an online researcher-made questionnaire. An invitation to participate in the study was sent to 500 students at KUMS, of which 203 were selected according to the inclusion criteria and completed the questionnaire. Descriptive statistics were used to analyze the data. Results: COVID-19 news was mostly obtained through social media platforms such as WhatsApp, Telegram, Instagram, radio, and television, as well as online publications and news agencies. Social media platforms such as WhatsApp, Telegram, Instagram, and satellite networks such as BBC contained the most rumors about COVID-19. Some of the most common misconceptions regarding COVID-19 were as follows: "COVID-19 is the deadliest disease in the world," "COVID-19 is a biological attack," and "COVID-19 disappears as the air temperature rises." In addition, most of the virtual training provided through mass media focused on "refraining from visiting holy places and crowded locations such as markets," "observing personal hygiene and refraining from touching the eyes, nose, and mouth with infected hands," and "the role of quarantine in reducing the incidence of COVID-19." Conclusion: Our findings demonstrated that during the pandemic, students used social media platforms the most to obtain health-related information and these media have a significant impact on their willingness to engage in preventative behaviors and take the COVID-19 risk seriously.
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Much recent research aims to identify evidence for Drug-Drug Interactions (DDI) and Adverse Drug reactions (ADR) from the biomedical scientific literature. In addition to this "Bibliome", the universe of social media provides a very promising source of large-scale data that can help identify DDI and ADR in ways that have not been hitherto possible. Given the large number of users, analysis of social media data may be useful to identify under-reported, population-level pathology associated with DDI, thus further contributing to improvements in population health. Moreover, tapping into this data allows us to infer drug interactions with natural products--including cannabis--which constitute an array of DDI very poorly explored by biomedical research thus far. Our goal is to determine the potential of Instagram for public health monitoring and surveillance for DDI, ADR, and behavioral pathology at large. Using drug, symptom, and natural product dictionaries for identification of the various types of DDI and ADR evidence, we have collected ~7000 timelines. We report on 1) the development of a monitoring tool to easily observe user-level timelines associated with drug and symptom terms of interest, and 2) population-level behavior via the analysis of co-occurrence networks computed from user timelines at three different scales: monthly, weekly, and daily occurrences. Analysis of these networks further reveals 3) drug and symptom direct and indirect associations with greater support in user timelines, as well as 4) clusters of symptoms and drugs revealed by the collective behavior of the observed population. This demonstrates that Instagram contains much drug- and pathology specific data for public health monitoring of DDI and ADR, and that complex network analysis provides an important toolbox to extract health-related associations and their support from large-scale social media data.
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In an age where young people seem to have a natural affinity with smartphones, computer games and social media, teachers and lecturers face a big challenge or a golden opportunity. How can new technology promote learning, engage students and motivate them to sustain a lifelong career in learning? For educators everywhere, our challenge is to take devices that have the potential for great distraction and boldly appropriate them as tools that can inspire and engage. On the back of Steve s hugely popular blog, also named Learning with e s , he shows how the world of learning is changing, and how new technology and you and I can make a difference. The proliferation of digital technologies and cultures is having a profound impact on learning, prompting questions which need answers. How will technology change our conceptions of learning? How will new ways of learning impact upon our uses of technology? How will teachers and lecturers roles change; what will they need to know; and what will we see learners doing in the future? Grounded in his research and in pedagogical theory, Steve explores the practical ways in which technology is influencing how we learn, and looks toward emerging trends to examine what the future of learning may look like. Subjects covered include: Learning with technology Theories for the digital age Digital literacies Pedagogical theories and practices New and emerging technologies New learning architectures Changing education Global educators A 21st century curriculum. For teachers, lecturers, learning and development professionals and anybody who wants to be inspired by the new ways learning is being revolutionised through the use of new and emerging technologies.
Conference Paper
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Several projects have shown the feasibility to use emph{textual} social media data to track public health concerns, such as temporal influenza patterns or geographical obesity patterns. In this paper, we look at whether geo-tagged emph{images} from Instagram also provide a viable data source. Especially for "lifestyle" diseases, such as obesity, drinking or smoking, images of social gatherings could provide information that is not necessarily shared in, say, tweets. In this study, we explore whether (i) tags provided by the users and (ii) annotations obtained via automatic image tagging are indeed valuable for studying public health. We find that both user-provided and machine-generated tags provide information that can be used to infer a county's health statistics. Whereas for most statistics user-provided tags are better features, for predicting excessive drinking machine-generated tags such as "liquid' and "glass' yield better models. This hints at the potential of using machine-generated tags to study substance abuse.
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Journal of Medical Systems. SCI-expanded journal_The aim of this study was to evaluate WhatsApp messenger usage for communication between consulting and emergency physicians. A retrospective, observational study was conducted in the emergency department (ED) of a tertiary care university hospital between January 2014 and June 2014. A total of 614 consultations requested by using the WhatsApp application were evaluated, and 519 eligible consultations were included in the study. The WhatsApp messages that were transferred to consultant physicians consisted of 510 (98.3 %) photographic images, 517 (99.6 %) text messages, 59 (11.3 %) videos, and 10 (1.9 %) voice messages. Consultation was most frequently requested from the orthopedics clinic (n = 160, 30.8 %). The majority of requested consultations were terminated only by evaluation via WhatsApp messages. (n = 311, 59.9 %). Most of the consulting physicians were outside of the hospital or were mobile at the time of the consultation (n = 292, 56.3 %). The outside consultation request rate was significantly higher for night shifts than for day shifts (p =.004), and the majority of outside consultation request were concluded by only WhatsApp application (p <.001). WhatsApp is useful a communication tool between physicians, especially for ED consultants who are outside the hospital, because of the ability to transfer large amounts of clinical and radiological data during a short period of time.
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Objective. To investigate the efficacy of using “Instagram application” with a “home-exercise program” as a motivational stimulus in improving physical activity (PA) adherence levels among female college students. Methods. Fifty-eight female undergraduate students with the mean age 20.3 ± 0.96 years participated. Participants were divided into two groups: intervention and the control group; both the groups received an exercise program and the intervention group was additionally motivated by “Instagram.” Adherence to PA was measured by using an adherence sheet. The Exercise Motivation Inventory (EMI-2) was used to assess the motivational factors. Results. The most frequent motivational factors were extrinsic as assessed using the EMI-2. “Positive health” was the most frequent factor mentioned of the two types with 47% of the sample. The intervention group adhered with 17% more to the activity program compared to the control group. Moreover, 72% of the participants in the intervention and control groups found the activity program flexible enough to be performed at home; they agreed about its effectiveness on adherence (53%). Conclusions. The use of Instagram with the home exercise program as a motivational modality could be attractive and effective to reinforce adherence and maintain an appropriate PA level.
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The purpose of this chapter is to present a comprehensive approach to the problem of privacy protection in healthcare social networks, to summarize threats and suggest emerging technological solutions to protect users. For this purpose we start with a definition of the term “privacy” and how it evolved through time. We continue within the context of social networks and highlight the main privacy issues and threats for network members. In addition, we analyze the Common Criteria for IT security evaluation that apply to privacy, under the prism of Healthcare Social Networks (HSNs) and present tools and methods that may enhance privacy in such networks. Finally, we provide examples of popular HSNs, categorized according to the purpose they serve and discuss the privacy challenges for them.
Conference Paper
Much recent research aims to identify evidence for Drug-Drug Interactions (DDI) and Adverse Drug reactions (ADR) from the biomedical scientific literature. In addition to this "Bibliome", the universe of social media provides a very promising source of large-scale data that can help identify DDI and ADR in ways that have not been hitherto possible. Given the large number of users, analysis of social media data may be useful to identify under-reported, population-level pathology associated with DDI, thus further contributing to improvements in population health. Moreover, tapping into this data allows us to infer drug interactions with natural products—including cannabis—which constitute an array of DDI very poorly explored by biomedical research thus far. Our goal is to determine the potential of Instagram for public health monitoring and surveillance for DDI, ADR, and behavioral pathology at large. Most social media analysis focuses on Twitter and Facebook, but Instagram is an increasingly important platform, especially among teens, with unrestricted access of public posts, high availability of posts with geolocation coordinates, and images to supplement textual analysis. Using drug, symptom, and natural product dictionaries for identification of the various types of DDI and ADR evidence, we have collected close to 7000 user timelines spanning from October 2010 to June 2015.We report on 1) the development of a monitoring tool to easily observe user-level timelines associated with drug and symptom terms of interest, and 2) population-level behavior via the analysis of co-occurrence networks computed from user timelines at three different scales: monthly, weekly, and daily occurrences. Analysis of these networks further reveals 3) drug and symptom direct and indirect associations with greater support in user timelines, as well as 4) clusters of symptoms and drugs revealed by the collective behavior of the observed population. This demonstrates that Instagram contains much drug- and pathology specific data for public health monitoring of DDI and ADR, and that complex network analysis provides an important toolbox to extract health-related associations and their support from large-scale social media data. This demonstrates that Instagram contains much drug- and pathology specific data for public health monitoring of DDI and ADR, and that complex network analysis provides an important toolbox to extract health-related associations and their support from large-scale social media data.