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What are the ways in which social media is used in the context of complementary and alternative medicine in the health and medical scholarly literature? a scoping review

February 2023
BMC Complementary Medicine and Therapies 23(1)

DOI:10.1186/s12906-023-03856-6

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CC BY 4.0

Authors:

Jeremy Y. Ng

Ottawa Hospital Research Institute

Jeremy Steen

McMaster University

Background Despite the increased use of social media to share health-related information and the substantial impact that complementary and alternative medicine (CAM) can have on individuals’ health and wellbeing, currently, to our knowledge, there is no review that compiles research on how social media is used in the context of CAM. The objective of this study was to summarize what are the ways in which social media is used in the context of CAM. Methods A scoping review was conducted, following Arksey and O’Malley’s five-stage methodological framework. MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL databases were systematically searched from inception until October 3, 2020, in addition to the Canadian Agency for Drugs and Technology in Health (CADTH) website. Eligible studies had to have investigated how at least one social media platform is used in the context of a single or multiple types of CAM treatments. Results Searches retrieved 1714 items following deduplication, of which 1687 titles and abstracts were eliminated, leaving 94 full-text articles to be considered. Of those, 65 were not eligible, leaving a total of 29 articles eligible for review. Three themes emerged from our analysis: 1) social media is used to share user/practitioner beliefs, attitudes, and experiences about CAM, 2) social media acts as a vehicle for the spread of misinformation about CAM, and 3) there are unique challenges with social media research in the context of CAM. Conclusions In addition to social media being a useful tool to share user/practitioner beliefs, attitudes, and experiences about CAM, it has shown to be accessible, effective, and a viable option in delivering CAM therapies and information. Social media has also been shown to spread a large amount of misleading and false information in the context of CAM. Additionally, this review highlights the challenges with conducting social media research in the context of CAM, particularly in collecting a representative sample.

PRISMA Diagram. *List of Abbreviations: CAM = complementary and alternative medicine, CADTH = Canadian Agency for Drugs and Technologies in Health

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BMC Complementary Medicine and Therapies (2023) 23:32

https://doi.org/10.1186/s12906-023-03856-6

RESEARCH

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Open Access

BMC Complementary

Medicine and Therapies

What are theways inwhich social media

isused inthecontext ofcomplementary

andalternative medicine inthehealth

andmedical scholarly literature? ascoping

review

Jeremy Y. Ng* , Natasha Verhoeﬀ and Jeremy Steen

Abstract

Background Despite the increased use of social media to share health-related information and the substantial

impact that complementary and alternative medicine (CAM) can have on individuals’ health and wellbeing, currently,

to our knowledge, there is no review that compiles research on how social media is used in the context of CAM. The

objective of this study was to summarize what are the ways in which social media is used in the context of CAM.

Methods A scoping review was conducted, following Arksey and O’Malley’s ﬁve-stage methodological framework.

MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL databases were systematically searched from inception until Octo-

ber 3, 2020, in addition to the Canadian Agency for Drugs and Technology in Health (CADTH) website. Eligible studies

had to have investigated how at least one social media platform is used in the context of a single or multiple types of

CAM treatments.

Results Searches retrieved 1714 items following deduplication, of which 1687 titles and abstracts were eliminated,

leaving 94 full-text articles to be considered. Of those, 65 were not eligible, leaving a total of 29 articles eligible for

review. Three themes emerged from our analysis: 1) social media is used to share user/practitioner beliefs, attitudes,

and experiences about CAM, 2) social media acts as a vehicle for the spread of misinformation about CAM, and 3)

there are unique challenges with social media research in the context of CAM.

Conclusions In addition to social media being a useful tool to share user/practitioner beliefs, attitudes, and expe-

riences about CAM, it has shown to be accessible, eﬀective, and a viable option in delivering CAM therapies and

information. Social media has also been shown to spread a large amount of misleading and false information in the

context of CAM. Additionally, this review highlights the challenges with conducting social media research in the con-

text of CAM, particularly in collecting a representative sample.

Keywords Complementary and alternative medicine, Social media, Social networks, Scoping review

*Correspondence:

Jeremy Y. Ng

ngjy2@mcmaster.ca

Department of Health Research Methods, Evidence, and Impact, Faculty

of Health Sciences, McMaster University, Michael G. DeGroote Centre for

Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton,

ON L8S 4K1, Canada

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Ngetal. BMC Complementary Medicine and Therapies (2023) 23:32

Background

Over 3.6 billion people worldwide used social media in

2020 [1]. is number has been predicted to increase to

4.41 billion by 2025. e American population using at

least one social media platform such as Facebook, Snap-

chat, Instagram, Twitter or YouTube, has continuously

increased over the past 15years from just 5% of Ameri-

cans in 2005 to 72% of Americans in 2019 [2]. Similarly,

in 2017, 94% of Canadian internet users had at least one

social media account [3]. Social media is comprised of

a complex ecology of networking sites and falls in the

larger context of health communication [4, 5]. Social

media has changed the landscape of health informa-

tion by allowing for dialogic communication rather than

one-sided communication from health professionals and

experts, resulting in health communicators such as prac-

titioners, policy makers, and patients monitoring, listen-

ing to, and engaging with dialogue on social media [6–9].

It has been shown that 72% of internet users search for

health information online and social media is one source

of such health information [10, 11]. Social media is used

to discuss health information with regards to comple-

mentary and alternative medicine (CAM) [11, 12]. How

social media is used in the context of CAM would be val-

uable to better understand as surveys conducted by Pew

Research Center have found that 35% of internet users

have looked online for information about CAM speciﬁ-

cally [11, 12].

CAM is frequently used across the world and consists

of a variety of health care approaches that are not typi-

cally part of conventional medicine or completely inte-

grated into the country’s main health care system. CAM

includes, but is not limited to, manual therapies such as

chiropractic and osteopathy, natural products such as

herbal medicines and dietary supplements, and other

forms of therapies including naturopathy, homeopathy,

and traditional Chinese medicine [13–16]. e National

Center for Complementary and Integrative Health

(NCCIH) in the United States deﬁnes “complementary”

approaches as those that are used together with conven-

tional medicine and “alternative” approaches as those

that are used in place of conventional medicine [13, 14,

17]. Positive motivations for trying CAM which may

have contributed to its popularity include factors such

as its accessibility, holistic and non-invasive nature, and

perceived eﬀectiveness and safety, while negative moti-

vations include factors such as dissatisfaction with con-

ventional medicine, rejection of science and technology,

and desperation [18–21]. How CAM is portrayed in

social media is important considering the ever-grow-

ing popularity and usage of social media and its ability

to inﬂuence health behaviours and beliefs [22]. In the

context of CAM, social media can be used to enhance

patient’s access to health care related resources and

support [23, 24]. Media sharing platforms such as You-

Tube are usually free, easy to use, and accessible on both

mobile and desktop devices [25]. Also, unlike health

information in the medical literature, when health infor-

mation is shared on social media it is often written in

lay terms [24, 26]. By allowing individuals to engage,

interact with, and contribute health information, social

media creates an environment that encourages patient

conversation [27–29]. Sharing health information on

social media can motivate and inspire others, but italso

has the power to facilitate the spread of misinforma-

tion about health-related topics [30]. ere are various

scholars who study the processes and risks of misinfor-

mation and disinformation on social media and features

of social media that may contribute to the spread of

health-related misinformation [31–33]. Firstly, the low

cost of generating and disseminating information over

social media allows misinformation to spread globally

at a rapid pace. Additionally, virtually anyone can post

about CAM on social media regardless of academic or

professional training,knowledge or skills [34]. Further-

more, it can be diﬃcultto determine the credibility of

social media content as users are self-publishers and

often are not subject to scrutiny or accountability [30].

Moreover, since social media feeds are personalized to

individual beliefs, values, preferences and biases, there is

information silo and echo chamber eﬀects which result

in decreased exposure to diﬀering opinions, reinforce-

ment of conﬁrmation biases, and the ampliﬁcation of

misinformation [35, 36].

Currently, to our knowledge, there is no review that

compiles research on the ways in which social media is

used in the context of CAM. Due to the increased impact

of social media as a form of information sharing in North

America, and the signiﬁcant impact that CAM can have

on people’s health and lives, it is important that a scop-

ing review is performed to outline the research on this

topic and identify the gaps. e results from this scoping

review could help inform various stakeholders such as

clinicians, policy makers, patients, and researchers. us,

the aim of our scoping review is to provide a summary of

the research on the ways in whichsocial media is used in

the context of CAM.

Methods

Approach

As described above, to our knowledge, there is a lack of

review articles on the ways in which social media is used

in the context of CAM. us, a scoping review method-

ology was appropriate as it allows for systematic scop-

ing of a broad array of research and the identiﬁcation

of literature gaps [37]. e method for conducting this

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scoping review was based on Arksey and O’Malley’s ﬁve-

stage scoping review framework [38]. is method was

also supplemented by modiﬁcations proposed by Levac,

Colquhoun, & O’Brien and Daudt, van Mossel, & Scott

[39, 40]. We used this ﬁve-stage scoping review frame-

work to ensure that all scoping review prerequisiteswere

met including identifying and analyzing the current lit-

erature on the topic, summarizing it, and recognizing

knowledge gaps that could potentially be looked into by

future research[40].

Step 1: Identifying theresearch question

Our research question is as follows: what are the ways

in which social media is used in the context of CAM in

the health and medical scholarly literature? For the pur-

pose of this scoping review, we referred to the Cochrane

Complementary Medicine group’s operational deﬁnition

of CAM [41]. For social media, we referred to the deﬁ-

nition by Obar etal. 2015 as it is comprehensive, con-

taining four parts, and has been used by many others

in the academic community [42]. is deﬁnition states

that social media consists of the following four main

characteristics:

1. Social media services are (currently) applications

that are Web 2.0 Internet-based

2. e lifeblood of social media is user-generated

content

3. For a site or app designed and maintained by a

social media service, individuals and groups create

user-speciﬁc proﬁles

4. e development of social networks online by con-

necting a proﬁle with those of other individuals and/

or groups is facilitated by social media services

Step 2: Finding relevant studies

After identifying the research question, we found rel-

evant studies to include in our scoping review using

a comprehensive and systematic search strategy. We

searched the bibliographic databases MEDLINE,

EMBASE, PsycINFO, AMED, and CINAHL. Indexed

headings and keywords relating to social media and

CAM were used in each ofthe search strategies where

appropriate. Additionally, we searched the Canadian

Agency for Drugs and Technology in Health (CADTH)

for any grey literature related to our topic. Search terms

on CADTH included “complementary and alternative

medicine” and “social media”. e search of these various

databases and websites included literature from incep-

tion until October 3, 2020. A sample search strategy

used is shown in Table1.

Step 3: Selecting thestudies

We included research articles and protocols in this

scoping review. While review articles were not eligible,

we screened the reference lists of review articles that

appeared relevant to our research question to identify

eligible articles. Conference abstracts, commentar-

ies, editorials, letters to the editor, opinion pieces, and

articles that were not published in the English language

were ineligible. Additionally, articles that could not be

publicly accessed, found through our library system, or

ordered via interlibrary loan were excluded. In order to

be eligible, it had to be evident in the record’s title and/

or abstract that the study was about how any form(s)

of social media is used in the context of any form(s)

of CAM. Two authors (JYN and NJV) pilot-screened

a subset of titles and abstracts individually and then

met to verify their application of the inclusion crite-

ria. en, all full articles were screened independently

in duplicate by JYN and NJV. In the case of disagree-

ment about article eligibility, when discussion between

the two authors (JYN and NJV) was not suﬃcient to

resolve the disagreement, a third author (JS) partook in

the discussion and a majority vote took place to deter-

mine eligibility.

Step 4: Charting thedata

Arksey and O’Malley’s descriptive narrative method was

used to critically assess articles meeting the inclusion

criteria [38]. To chart the eligible articles, the following

information was extracted: ﬁrst author and year of pub-

lication, country of authors, study setting, article type,

objective, population and sample size, CAM discussed/

used, social media discussed/used, primary and second-

ary outcomes, how primary and secondary outcomes

were measured, main ﬁndings, challenges encountered,

and study conclusions. Two authors (JYN and NJV) par-

ticipated in a pilot data extraction exercise using a subset

of eligible articles. Any discrepancies between the pilot

data extraction of the two authors were discussed and

resolved by three authors (JYN, NJV and JS). en, data

from all eligible articles was independently extracted by

JYN and NJV; following this, all authors met todiscuss

and resolve anydiscrepancies. Only data relevant to the

research question was extracted and charted from the

eligible studies. Additionally, a descriptive map of the lit-

erature on our topic was created which highlighted key

themes that emerged from the analysis.

Step 5: Collating, summarizing, andreporting theresults

Tables were used to summarize charted data and an

inductive thematic analysis was performed on descrip-

tive data [43]. e descriptive data was reviewed by all

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Table 1 MEDLINE Search Strategy for Studies Investigating How Social Media is Used in the Context of CAM, Executed October 3,

2020

Database: OVID Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946

to Present

Search Strategy:

––––––––––––––––––––––––––––––––––––––––

1 (alternative medicine* or alternative therap*).mp. (24,388)

2 (complementary medicine* or complementary therap*).mp. (22,183)

3 exp Complementary Therapies/ (228,775)

4 (integrat* adj1 (medicine or therap*)).mp. (4385)

5 exp Integrative Medicine/ (1582)

6 naturopath*.mp. (1597)

7 exp Naturopathy/ (999)

8 acupunctur*.mp. (29,450)

9 exp Acupuncture Analgesia/ or exp Acupuncture Points/ or exp Acupuncture Therapy/ or exp electroacupuncture/ or exp Acupuncture/ (25,426)

10 (chiropract* or spinal manipulation*).mp. (8728)

11 exp Chiropractic/ or exp Manipulation, Chiropractic/ (4104)

12 (herb* adj1 (medic* or therap* or supplement*)).mp. (26,197)

13 exp Medicine, East Asian Traditional/ or exp Medicine, Chinese Traditional/ or exp Herbal Medicine/ or exp Plants, Medicinal/ or exp Phytotherapy/

(109,867)

14 tcm.mp. (11,027)

15 exp Drugs, Chinese Herbal/ (43,922)

16 traditional Chinese medicine.mp. (21,324)

17 exp Medicine, Ayurvedic/ (2231)

18 ayurved*.mp. (6714)

19 acupressure.mp. (1459)

20 exp Acupressure/ (758)

21 applied kinesiolog*.mp. (99)

22 exp Kinesiology, Applied/ (312)

23 herbalism.mp. (152)

24 exp Osteopathic Medicine/ or exp Manipulation, Osteopathic/ (4050)

25 osteopath*.mp. (7627)

26 exp Mind–Body Therapies/ (50,683)

27 mind–body*.mp. (5356)

28 exp Yoga/ (2857)

29 yoga.mp. (5708)

30 or/1–29 (373,277)

31 exp Social Media/ or exp Social Networking/ or exp Blogging/ (12,139)

32 (((e or electronic) adj3 newsletter*) or ((peer to peer adj5 network*) or p2p) or (digital adj5 platform*) or (forum* adj3 (internet or web* or chat*)) or

(rss adj3 (reader* or feed*)) or (social adj3 media*) or (social adj3 medium*) or (social adj3 network*) or (twitter or tweet*) or (viral adj5 market*) or ("web

2.0" or "web 2") or (website* or "web site*" or webpage* or "web page*") or altmetric or badoo or blackplanet or blog* or buddypress or buzznet or

care2 or classmates or clicktotweet or "content communit*" or couchsurﬁng or discord or facebook or faces or ﬁverr or ﬂickr or ﬂixster or fotki or fotolog

or foursquare or gaiaonline or geni or girlsaskguys or googl* or groupme or hashtagify or hashtags or "health 2.0." or hi5 or hkgolden or hootsuite or

i-phone* or instagram or keyhole or kik or kuaishou or "last.fm" or linkedin or lipstickalley or lithium or livejournal or "medicine 2.0." or meetup or micro-

blog* or myspace or myspace or naijapals or neopets or ning or okcupid or pinterest or podcast* or qq or qzone or "really simple syndicat*" or reddit

or sermo or skype or skyrock or smartphone* or snapchat or stumbleupon or tagged or telegram or tiktok or trendsmap or tumblr or tweepsmap or

twitter or "user generated content" or weblog* or wechat or weibo or weixin or whatsapp or xing).ti. (65,844)

33 or/31–32 (71,355)

34 30 and 33 (465)

35 limit 34 to english language (411)

***************************

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authors. NJV and JS then identiﬁed codes for the descrip-

tive data based on main topics discussed in the articles

and organized the articles into thematic groups. e

thematic groups grouped articles based on the identi-

ﬁed commonly discussed topics. NJV and JS also cre-

ated a narrative discussing how these results connect to

the research question. Moreover, NJV and JS identiﬁed

knowledge gaps in the current literature. JYN reviewed

all of the aforementioned tasks, and any discrepancies

were discussed and resolved by all authors.

Results

Search results

Searches retrieved 1714 items following deduplication,

of which 1620 titles and abstracts were eliminated, leav-

ing 94 full-text articles to be considered. Of those, 28

were not eligible because they did not ﬁt our deﬁnition of

social media (e.g., newspapers or magazines), 18 did not

ﬁt our deﬁnition of CAM, 7 did not focus on how social

media is used in the context of CAM, 6 were an abstract,

and 6 were a review. is left 29 articles for inclusion in

this scoping review [44–72]. In Fig.1, a PRISMA diagram

can be founddepicting this process.

Eligible article characteristics

Eligible articles were published from 2012 to 2020 and

were conducted by researchers from the United States

(n = 17), Canada (n = 4), Australia (n = 2), France (n = 1),

Germany (n = 1), Spain (n = 1), and Taiwan (n = 1).

Additionally, one study was conducted by researchers

from China, Australia, and the United Kingdom (n = 1),

and another study was conducted by researchers from

Iraq and Jordan (n = 1). Of these 29 eligible articles, 10

focused on a study population from a single country,

meaning that only social media content posted by users

from a speciﬁed country was included in the study.

ese countries included the United States (n = 5), Aus-

tralia (n = 1), Germany (n = 1), Iraq (n = 1), Spain (n = 1),

and Taiwan (n = 1). e remaining 19 eligible articles

focused on social media content from more than one

country, 13 of which focused on an international sam-

ple of social media content (i.e., all of Twitter). While a

diverse array of CAM was explored, the most common

were yoga (n = 4), medicinal cannabis (n = 4), dance ther-

apy (n = 2), music therapy (n = 2), and spinal manipula-

tion (n = 2). While nutrition is not typically deﬁned as

CAM, we included articles such as the one by Chan etal.

despite their focus on nutrition because they included

CAM representation and discourse, such as the theme of

promoting alternative medicine while challenging con-

ventional medicine [46]. e most commonly discussed

social media platforms were Twitter (n = 6), Facebook

(n = 5), and YouTube (n = 4). e articles used a variety

of qualitative and mixed methods in their social media

research approaches. Of the 29 eligible articles, 24 were

described generically as qualitative without naming a

speciﬁc design or were described in terms of data col-

lection techniques (e.g., focus group and interview) or

analytic techniques (e.g., content analysis and discourse

analysis). Of the remaining 5 eligible articles, two were

Fig. 1 PRISMA Diagram. *List of Abbreviations: CAM = complementary and alternative medicine, CADTH = Canadian Agency for Drugs and

Technologies in Health

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identiﬁed by the authors as following a case study design,

one was identiﬁed as following quantitative approaches,

and two were identiﬁed as mixed methods studies based

on its methodology and the presence of a combination of

qualitative and quantitative approaches. e details asso-

ciated with all eligible article characteristics, including

study aims, can be found in Table2; the main ﬁndings,

challenges encountered, and conclusions of all eligible

studies can be found in Table3. No studies reported any

secondary outcomes.

Findings fromthematic analysis

ree main themes were identiﬁed through our thematic

analysis. ese themes are described in the paragraphs

below.Sample excerpts from included studiesrepresent-

ative of each of these themes are shown in Table4.

Theme 1: To share user beliefs, attitudes, andexperiences

aboutCAM

Several studies provided insight into the beliefs, attitudes,

and experiences of CAM users [49, 50, 52, 54, 55, 57, 59,

62, 63, 67, 69]. ree subthemes developed among the

studies: negative beliefs and attitudes about CAM use,

positive beliefs and attitudes about CAM use, and posi-

tive and negative experiences of using CAM. Studies

included in this theme described a range of beliefs, atti-

tudes and/or experiences related to CAM which were

coded into categories based on whether they reﬂected

predominantly positive or negative views.

Subtheme 1.1: Negative beliefs andattitudes aboutCAM use

The first of the three subthemes found among the

studies was negative beliefs and attitudes about CAM

use. A number of studies identified negative beliefs

and attitudes about CAM treatments that were posted

on social media [52, 54, 63, 67]. One study sought to

“analyze the sceptical movement’s discourse on com-

plementary therapies in Spain, as well as compre-

hend its mobilisation against these therapies” [52].

The authors reviewed more than 6000 posted tweets

and found that 79.1% were against or not in favour

of CAM treatments. The common themes conveying

concerns about CAM among the tweets were “anti-sci-

ence”, “fighting against harmful, for-profit practices”,

and protecting “the most vulnerable [who have] little

knowledge of science”. In a differentstudy, research-

ers investigated the presence of critiques and debates

surrounding the effectiveness and risk of chiropractic

and spinal manipulation therapy (SMT) on Twitter

[67]. It was found that the efficacy of these CAM treat-

ments was rarely questioned or doubted. Additionally,

the potential risks were rarely mentioned or debated.

However, of the few tweets that were skeptical or

critical about the use of chiropractic and SMT, most

had been liked and retweeted, demonstrating that

many skeptical or critical perspectives of CAM use

elicited high engagement among social media users

even though their voices were marginal in number.

Subtheme 1.2: Positive beliefs andattitudes aboutCAM use

ree studies intended to analyze the public beliefs and

attitudes expressed about CAM use on social media

and assess whether they were predominantly in favour

of or against CAM use [49, 62, 69]. One study analyzed

descriptions of CAM treatments used by young women

diagnosed with cancer who kept an online cancer blog

[69]. e descriptions of CAM treatments were uni-

formly expressed in a positive and empowering manner

by the young women. Additionally, two studies assessed

how cannabidiol (CBD) products were presented on

popular social media platforms, including Twitter and

Pinterest [49, 62]. Both studies found that the majority of

posts presented CBD in a positive light, with many cit-

ing physical or mental beneﬁts, such as relief from anxi-

ety, depression, pain, and inﬂammation. Similarly, a study

investigating posts on Instagram related to yoga found

that most posts emphasized the physical beneﬁts of yoga

and used words like “ﬁtness” when describing yoga [55].

Another study that focused on cannabis-related conver-

sations on Twitter discovered that the topics of conversa-

tion ranged from using cannabis for the ﬁrst time to the

legality and therapeutic value of cannabis [50]. Regard-

ing the therapeutic value, posts discussed numerous

medical conditions such as Crohn’s disease, cancer, post-

traumatic stress disorder, anxiety, and depression that

are being treated or have the potential to be treated by

cannabis.

Subtheme 1.3: Positive andnegative experiences ofusing

CAM

Four studies found that the information most sought by

consumers on social media sites was relating to the expe-

riences of past users of CAM treatments [57, 59, 63, 69].

For example, one study analyzed questions posted on

Yahoo! Answers relating to dietary supplement ingredi-

ents under thesubsection, “Alternative medicine” under

the section, “Health” [59]. It was found that the informa-

tion most sought by consumers, deﬁned by the greatest

number of posts, was relating to the uses and adverse

eﬀects of dietary supplements. e most common uses

of the dietary supplements were respiratory, thoracic &

mediastinal disorders, cardiovascular & lymphatic sys-

tem disorders, and psychiatric disorders, while the most

common adverse eﬀects were diarrhea, abdominal pain,

palpitations, and headaches. Another study examined

descriptions of CAM use among women diagnosed with

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Table 2 General Characteristics of Eligible Studies

First

Author and

Year

Country of

Authors Study Setting Article Type Objective Population

and Sample

Size

CAM

Discussed/

Used

Social Media

Discussed/Used Primary

Outcomes How Primary Outcomes Were Measured

Al-Samaray

et al. 2020

[44]

Iraq and

Jordan Iraq Qualitative

study To evaluate

the impact of

social media

on consum-

ers’ decisions

to use dental

products

made

primarily

from herbal

ingredients

rather than

well-known

chemical

formulas

n = 300

(n = 100

pharmacists,

n = 100

dentists and

n = 100 con-

sumers)

Herbal dental

products Social media (not

speciﬁed), but

Facebook and

Twitter men-

tioned in results

Consumers’ inter-

view answers Face to face interviews

Barnes et al.

2020 [45]Australia Australia Case study To describe

how

Facebook

was used to

recruit a tar-

geted sample

of expect-

ant and

breastfeeding

mothers to

participate

in a national

online survey

1418

participants

enrolled in

the study, 810

completed

the 20-min

(70 question)

survey

CAM Facebook Recruitment

post success and

response rates

Reach, impressions, link clicks, post clicks,

and click through rates were used to deter-

mine the success of the post, as well as

the cost per day and cost per engagement

with the post for boosted posts. Data from

the Facebook ‘Insights’ page was used to

calculate response rates in a variety of ways

Chan et al.

2020 [46]United States International Content

analysis To con-

trast and

compare the

nutrition

advice given

by registered

dieticians

(RDs) and

non-RD

bloggers on

blogs

n = 400 blog

posts Nutrition Blogs Codes and themes

from each blog

post’s coding;

Readability of RD

and non-RD blog

posts using the

Simple Measure

of Gobbledygook

(SMOG)

To minimise error, all posts in the sample

were printed and given identiﬁcation

codes for each researcher to use in their

analysis. After a lengthy analysis process,

each post was subjected to a text-based

content analysis using open coding to

identify trends in the data and develop

themes. A Simple Measure of Gobbledy-

gook (SMOG) readability measure was

used to assess the diﬀerences in readability

between RD and non-RD blogs based on

themes found in RD and non-RD blogs,

respectively

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Table 2 (continued)

First

Author and

Year

Country of

Authors Study Setting Article Type Objective Population

and Sample

Size

CAM

Discussed/

Used

Social Media

Discussed/Used Primary

Outcomes How Primary Outcomes Were Measured

Gierth et al.

2020 [47]Germany Germany Exploratory

experimental

study design

To look into

the eﬀects

of science-

critical user

comments

attacking

Facebook

posts that

made scien-

tiﬁc claims

There were

2 smaller

studies in the

larger study:

1. 144 par-

ticipants (98

were female),

median age

was 22 years,

84% were stu-

dents 2. 160

participants

(114 of which

were female),

median age

was 23 years,

80% were

students

Homeopathy Facebook Participants’

attitudes toward

and self-reported

knowledge and

involvement in the

topics discussed

in the Facebook

posts; their agree-

ment with the

research claims,

perceived study

credibility, agree-

ment with the user

comment with

one item each, and

source trustworthi-

ness judgement

Questionnaires with ﬁve 5-point Likert-type

scale items for each topic to determine

participants’ attitudes toward the topics

were used. Single items to assess self-

reported knowledge and involvement in

each subject were also used. The Muenster

Epistemic Trustworthiness Inventory was

used which assesses three aspects of

a scientist’s trustworthiness: expertise,

benevolence, and integrity. It has a total

of fourteen 7-point semantic diﬀerentials,

six of which make up the expertise scale

and four make up the benevolence and

honesty scales, respectively

Kawchuk

et al. 2020

[48]

Canada,

Denmark and

Switzerland

International (all

of Twitter) Content

analysis To detail

how Twitter

activity can

be used to

discuss mis-

information

claiming a

link between

spinal

manipulation

therapy and

increased

immunity

1118 Tweets

were gener-

ated from

search one,

778 of which

were not

relevant, 187

were promot-

ing SMT for

immunity, 141

refuting and

12 neutral, 809

tweets didn’t

mention a

professional,

7 mentioning

a professional

irrelevant to

the study

Spinal manipu-

lative therapy

(SMT)

Twitter Tweet mentions

(tweets with search

terms) over time,

tweet coding

and sentiment

(emotional expres-

sion), themes and

word frequency,

profession cod-

ing (professions

mentioned), inﬂu-

encers (tweet

authors with an

engagement score

greater than zero),

and tweet author

demographics

The primary search (Search #1) was built

using Boolean syntax and consisted of

three main components. Four evaluators

scored this sample of 86 tweets indepen-

dently to calibrate their use of the Twitter

Tone Index (TTI). The TTI was then used by

these same evaluators to independently

assess each tweet resulting from Search

#1. Tweets with less than three evaluators

in agreement were discussed and a ﬁfth

evaluator broke any unresolved ties. Impor-

tantly, only whether tweets mentioned

a profession could be coded; it was not

possible to determine whether or how

the author was associated with a speciﬁc

profession

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Table 2 (continued)

First

Author and

Year

Country of

Authors Study Setting Article Type Objective Population

and Sample

Size

CAM

Discussed/

Used

Social Media

Discussed/Used Primary

Outcomes How Primary Outcomes Were Measured

Merten et al.

2020 [49]United States International

(Pinterest) Content

analysis To see how

cannabidiol

(CBD) prod-

ucts were

presented on

226 pins of

the 1280 can-

nabidiol and

CBD related

pins were

analyzed

Marijuana (CBD) Pinterest Pin coding and

engagement Using code categories from previous

health-related Pinterest studies, a code-

book for CBD products was developed,

tested, and used for this research. A pilot

set of 58 Pinterest pins was used to test

the codebook. Researchers independently

coded the pins before meeting to address

coding inconsistencies and challenges.

Engagement was measured using previ-

ous studies’ methods, which included

the amount of saves (formerly known as

repins) and comments

Allem et al.

2019 [50]United States International

(Twitter) Content

analysis To quickly

capture and

describe

the public’s

recent experi-

ences with

cannabis

using publicly

accessible

data from

Twitter

n = 60 861

tweets Cannabidiol

(CBD) Twitter Topic classiﬁcation

of the tweets Based on the presence of at least one

topic-related pattern, each tweet was

assigned to one or more topics. This was

done by examining each tweet for the

presence of a speciﬁed set of patterns

representing a topic using a rule-based

classiﬁcation script written in Python

Aubrey et al.

2019 [51]United States United States Experimental

study To see how

self-objec-

tiﬁcation,

appearance

anxiety, and

product pref-

erences are

aﬀected by

how health

advice for

adolescent

girls is framed

154 girls Yoga YouTube Girls’ self-stated

thoughts on self-

objectiﬁcation,

appearance anxi-

ety, and preference

for appearance-

enhancing

products

Self-objectiﬁcation and having participants

describe themselves using 10 words of

a 40-word bank. Attempted to balance

negative and positive descriptors in each

category. Used the Trait Self-Objectiﬁcation

Questionnaire (described in the “Trait Self-

Objectiﬁcation” section, r = .25, p = .002).

Study also looked at appearance anxiety

and preference for appearance-enhancing

products

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Table 2 (continued)

First

Author and

Year

Country of

Authors Study Setting Article Type Objective Population

and Sample

Size

CAM

Discussed/

Used

Social Media

Discussed/Used Primary

Outcomes How Primary Outcomes Were Measured

Cano-Orón

2019 [52]Spain Spain Content

analysis,

qualitative

discourse

analysis and

in-depth

interviews

To investigate

the discourse

of Spanish

sceptics on

Twitter and

under-

stand the

mobilisation

against these

therapies by

the sceptical

movement

6252 tweets

from the

#StopPseudo-

ciencias cam-

paign were

identiﬁed and

912 of these

were used as

the basis of

the content

analysis

CAM Twitter Analysis of tweets

and discourse

related to CT

skepticism. Vari-

ables were created

ad hoc using the

casuistry of the

campaign as a

basis and looking

into the stand-

ard of the other

research

The diﬀerent campaign hashtags’ tweets

were collected with the data scraping tool

data-miner.io. For the content analysis, the

three variables tweets were analyzed on

were (a) positioning (whether the tweet

was sceptical, neutral or favourable to CTs,

or whether it was irrelevant to the topic,

(b) type of information sources contained

in the messages and (c) use of mentions.

Following this, a content analysis meth-

odology was applied to the description

that they put in their bios and the vari-

ables analyzed were (a) the account type

(anonymous/corporate/personal), and, for

those personal accounts, (b) the profession

and (c) whether they were specialised

in biomedicine. Manual content analysis

and a qualitative discourse analysis of the

tweets was also performed using Nvivo, in

order to categorise the arguments raised

by the users

Hasan et al.

2019 [53]United King-

dom Did not specify Experimen-

tal, quantita-

tive study

To evaluate

the eﬀective-

ness of hyp-

notherapy

on skype for

IBS patients

and draw a

comparison

of it with

face-to-face

treatment

n = 20 Hypnotherapy Skype IBS Symptom

Severity A minimum 50-point reduction in the IBS

Symptom Severity Score (IBS-SSS)

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Table 2 (continued)

First

Author and

Year

Country of

Authors Study Setting Article Type Objective Population

and Sample

Size

CAM

Discussed/

Used

Social Media

Discussed/Used Primary

Outcomes How Primary Outcomes Were Measured

Hu et al.

2019 [54]International

(China,

United King-

dom, Aus-

tralia, United

States)

Did not specify

(Online) Content

analysis/

Comparative

analysis

To look at the

consistency

of adverse

events (AEs)

and adverse

drug reac-

tions (ADRs)

documented

in the litera-

ture, as well

as in monitor-

ing and social

media data

660 posts (351

Baidu post

bar themes

and 309 Sina

micro-blogs)

Chinese patent

medicine Baidu post bar

and Sina micro-

blog

Safety related

information about

Chinese patent

medicine on Baidu

post bar and Sina

The contents of the post bar and blogs

were screened by two reviewers separately,

and agreements were reached. The

reporter abstracted information relevant to

protection, including manifestations, sever-

ity, length, eﬀects, combined interventions,

and causal-relation judgments. All of the

information gathered was categorised

as AEs. The ADR words are based on the

following guidelines: 1) Names of AE/

ADRs found in various resources that were

compatible with WHO-ART words were

speciﬁcally used; 2) For records where

the AE/ADR names did not ﬁt WHO-ART,

the names were coded according to the

thorough deﬁnition of the AE/ADRs; 3) for

records where the names and descriptions

of AE/ADRs did not match, descriptions

were used as the key proof of coding; 4)

for records with ambiguous names and

descriptions where coding was diﬃcult,

the records were labelled as "unable to

code"

The frequencies and relative frequencies of

AEs, ADRs, and the systems-organs groups

they aﬀect were counted. Each individual

symptom or abnormality was counted

when more than one AEs or ADRs occurred

in the same patient. When a single AE or

ADR was graded into two or more WHO-

ART system-organ groups, it was counted

multiple times. The top ﬁve AEs, ADRs, and

aﬀected system-organ groups were then

ranked

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Table 2 (continued)

First

Author and

Year

Country of

Authors Study Setting Article Type Objective Population

and Sample

Size

CAM

Discussed/

Used

Social Media

Discussed/Used Primary

Outcomes How Primary Outcomes Were Measured

Lacasse et al.

2019 [55]Canada Did not specify

if they focused

on posts of a

speciﬁc country

Text, content,

and image

analysis

To inves-

tigate the

themes and

patterns that

prominently

emerge

within the

engagement

(comments,

conversa-

tions) from

posts tagged

#yoga on

Instagram

Content:

n = 35,000—

Analysis of

100 unique

authors and

images from

the unique

data set

Yoga Instagram Netlytic categories;

coding of themes

by 2 researchers

independently

To identify the most popular words in the

dataset, Netlytic and content category

analysis was used to determine the themes

within the discussion. After identifying the

terms, the prevalence of the use of the

popular YouTube videos.

Discussion

e purpose of our scoping review was to provide a sum-

mary of the research on the ways in which social media is

used in the context of CAM. is study identiﬁed 29 eligi-

ble articles which were published between 2012 and 2020.

e amount of available literature on this topic, while not

overly voluminous, presents a broad range of social media

platforms analyzing a variety of CAM treatments such as

chiropractic, yoga, Chinese patent medicine, and medici-

nal cannabis. To our knowledge, this is the ﬁrst study to

perform a systematic search of the peer-reviewed and

grey literature on this topic. As CAM-related health ther-

apies and products are highly mediatized with a strong

presence on social media platforms which can inﬂuence

individual’s health beliefs, attitudes, and subsequent

behaviours,the present study’s ﬁndings may be of value to

both healthcarepractitioners and researchersalike.

Resources forpractitioners, researchers, andpatients:

abundant, butofunclear quality

is scoping review also provides readers with the list of

eligible articles included in the present study which may

aid in their understanding of how CAM is portrayed in

social media. While the eligible articles that were included

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in this scoping review have been developed and evalu-

ated to some degree by academic researchers, the pre-

sent study was only designed to scope out the number

of CAM-related social media studies and their key char-

acteristics. As expected, most eligible studies analyzed

well-known social media platforms such as Instagram

[55, 57, 60] and Twitter [50, 62, 67], however, some others

examined lesser-known social media platforms including

online illness blogs [69] and patient forums [56]. Further-

more, 12 eligible articles lacked generalizability due to

challenges with conducting social media research includ-

ing the inherent sampling biases [45, 48, 50, 54, 59, 61,

62, 64, 69, 71], the rigid privacy standards of social media

platforms [45, 49, 56], and the diﬃculty identifying posts

that represent the actual attitudes of the public [61, 62]. In

addition, most studies analyzed data about a single type

of CAM treatment (e.g., chiropractic) instead of multiple

types of CAM treatments, which may have resulted in a

lack of generalizability of study ﬁndings to other social

media platforms and/or other CAM treatments.

Comparative literature

Discussion ofTheme 1: toshare user beliefs, attitudes,

andexperiences aboutCAM

With regard to comparative literature pertaining to

the use of social media to share user beliefs, attitudes,

and experiences about CAM therapies, several stud-

ies reported that social media can be a useful tool for

patients, physicians, and other health care profession-

als because it pools information on patients’ evalua-

tions of, and health outcomes from CAM therapies [43,

63, 64]. For example, one study explored the interest of

patients with breast cancer in CAM-related social media

posts [43]. e study indicated that patients during and

after treatments for breast cancer had a strong inter-

est in social media posts about CAM interventions to

complement their approved treatments. Another study

found that 8% of cancer related information shared on

Facebook was about CAM therapies [63]. Moreover, one

study found that social media has been used to discuss

CAM related therapies for glaucoma, with 40% of glau-

coma related tweets associated with CAM therapies [64].

Discussion oftheme 2: Misinformation aboutCAM onSOCIAL

Media

A number of published studies have explored health

care misinformation on social media, with four studies

focusing explicitly on CAM misinformation. In regard

to these four studies that speciﬁcally explored CAM

misinformation on social media, one study looked into

the use of social media in the promotion of alternative

oncology and data about cancer [34]. e study found

social media to be a useful channel for sharing patients’

experiences with alternative oncology, but also an ideal

environment for spreading false information. Moreover,

one study identiﬁed Twitter users who were propagat-

ing information on CAM treatments claiming to treat or

cure cancer and found that cancer treatment misinfor-

mation is frequently spread by actors other than patients

[74]. Another study that evaluated how hypertension is

portrayed on YouTube found that 33% of the videos were

misleading and 70% of the misleading videos were about

unproven alternative treatments [23]. A similar study

that evaluated the reliability and quality of information

in YouTube videos on traditional Chinese medicine and

inﬂammatory arthritis found that almost half (46%) of

included videos provided misleading information [75].

In regard to the studies that explored health misinfor-

mation on social media, one systematic review identiﬁed

the main health misinformation topics and their preva-

lence across various social media platforms [76]. Health

misinformation was the most prevalent on Twitter and

YouTube and on issues related to vaccines and smoking

products or drugs. Additionally, one pilot study tracked

the sharing of posts containing health misinformation in

the Polish language social media [77]. According to the

study, roughly 40% of health information posts that were

shared contained links that were identiﬁed as misinfor-

mation. Furthermore, in another study, researchers inves-

tigated the dissemination of gynecologic cancer-related

misinformation on Weibo [78]. While the majority of

gynecologic cancer-related tweets contained medically

accurate information, almost 35% of them contained false

or inaccurate information. Non-governmental organiza-

tions, andpublic health and government agencies have

all been cited as critical in generating the fast response

needed to communicate accurate information and rectify

misinformation on social media [79–81].

Discussion oftheme 3: Challenges withsocial media research

inthecontext ofCAM

A preliminary review of the literature found two studies

that described the diﬃculties encountered while conduct-

ing health-related social media research. e ﬁrst study

looked at health-related misinformation on Twitter, spe-

ciﬁcally in relation to alternative medications that claim

to treat or cure cancer, and found a multitude of chal-

lenges that limited the study’s generalizability [74]. ese

challenges included the diﬃculty in detecting legitimate

personal accounts (as opposed to bots or organizational

accounts), accessibility issues such as a visual impair-

ment or other constraints to engaging insocial media,

and the fact that some health conditions are associated

with a social stigma, which may limit their discussion on

social media. Another study that explored social media

research in gastroenterology highlighted the challenges

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in reliability and ethical considerations [82]. Speciﬁcally,

it discussed the excess amount of meaningless data such

as data from bots and organizational accounts (e.g., phar-

maceutical companies) which can compromise the reli-

ability of results. Furthermore, the study discussed the

ethical challenges of conducting social media research,

particularly the threats to privacy and informed consent

that can occur as data from subjects is often collected

without the user’s directknowledge.

Areas identied forfurther research

We have identiﬁed a few areas for future research based

on our ﬁndings.

Currently, there exists more information on social

media about the use of CAM, CAM products, and CAM

adverse events than ever before, yet the quality of stud-

ies exploring social media research in the context of

CAM is unknown [24, 83–86]. We hypothesize that this

research gap can be explained based on a number of rea-

sons, including a lack of academic research funding, the

prioritization of conventional medicine research, as well

as methodological and ethical obstacles which make it

diﬃcult to conduct high quality CAM research [87–90].

Speciﬁcally with regard to methodological obstacles, the

physical nature of CAM therapies (e.g., massage therapy,

acupuncture) makes it diﬃcult for researchers to con-

struct an acceptable placebo control [89]. With regard to

the ethical challenges, informed consent is often diﬃcult

to obtain because in CAM-related research, patients are

often predisposed to strongly prefer a CAM treatment

over a control (placebo or non-CAM) treatment [89].

Patients, healthcare professionals, researchers, and poli-

cymakers all require reliable, credible, and up-to-date

information as well as shared experiences and engage-

ment with CAM [87–90]. is justiﬁes a need for an

updated review of social media research in the context

of CAM along with a quality appraisal of relevant stud-

ies. In addition, while several published studies examined

the eﬃcacy of social media as a platform for delivering

health care information, to our knowledge, there were

none that measured the eﬃcacy of social media as a plat-

form for delivering CAM-related information. us, fur-

ther research is needed to explore the eﬃcacy of social

media as a platform for delivering CAM-related informa-

tion. Furthermore, in addition to future research contin-

uing to examine social media platforms, patient-authored

texts in online health forums and medical blogs could

oﬀer a valuable resource to further understand individu-

als’ attitudes and beliefs regarding CAM treatments [91,

92]. Additionally, if a critical appraisal tool is developed, a

future direction could include critically appraising social

media-related studies.

Moreover, research has shown that group polariza-

tion is prevalent on social media platforms involving

controversial issues, which limits information dissemi-

nation among those with opposing views [93–97]. How-

ever, to our knowledge, it has not yet been explored as

to whether this is also the case with CAM discussion on

social media. If it is the case that the increasingly per-

sonalized algorithms on popular social media platforms

expose individuals more often to posts that reinforce

their beliefs and less often to posts containing novel

information, it is possible that the conﬁrmation bias is

being magniﬁed [98–101]. As an example, one study

found that social media users who were exposed to

health articles that conformed to their initial beliefs were

more likely to share the article on social media [102].

Further research should explore the degree to which

information is shared among dissimilar individuals on

social media in the context of CAM [67, 94].

Strengths andlimitations

A main strength of the study includes the fact thatmulti-

ple bibliographic databases were systematically searched,

in addition to the grey literature. Further to this, the title

and abstract screening, and data extraction were com-

pleted independently and in duplicate. Limitations of

this study include the factthat only articles written in the

English language were included, thus, important ﬁnd-

ings from non-English language articles may have been

missed. Furthermore, while not a limitation in itself,many

of the types of studies included in our review did not uti-

lize commonly used research study designs for which a

reporting guideline or validated quality appraisal tool was

available (e.g., social media analyses), thus future work is

warranted in this area. Additionally, CAMis an umbrella

term that represents a very wide range of therapies that

diﬀer widely in nature. us, while our search strategy and

the deﬁnition of CAM we used when determining arti-

cle eligibility were comprehensive, certain types of CAM

may have been missed. Similarly, many types of social

media exist. us, while our search strategy likely cap-

tured the most prominent types, some forms of less well-

known social media may have alsobeen missed. We also

acknowledge that because our searches were primarily

restricted to biomedical and health databases, literature

from the ﬁelds of marketing, strategic communication,

anthropology, sociology, and medical humanities may not

have been fully capturedin this review.

Conclusions

e present scoping review involved a systematic search

of the literature to identify the quantity and type of stud-

ies investigating the ways in which social media is used

in the context of CAM. From 29 eligible articles, we

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Ngetal. BMC Complementary Medicine and Therapies (2023) 23:32

identiﬁed three major themes including: 1) social media

is used to share user/practitioner beliefs, attitudes, and

experiences about CAM, 2) social media acts as a vehi-

cle for the spread of misinformation about CAM, and 3)

there are unique challenges with conducting social media

research in the context of CAM, speciﬁcally regarding

collecting a representative sample of data. Additionally,

we highlight that while a substantial number of articles

are available to practitioners, patients, and research-

ers, the quality and update frequency for many of these

articles vary widely, and until formally assessed, remain

unknown. Furthermore, we identify that a need exists to

conduct an updated and systematically searched review

of CAM-related health care or research resources on

social media.

Abbreviations

CADTH Canadian Agency for Drug and Technologies in Health

CAM Complementar y and alternative medicine

CBD Cannabidiol

IBS Irritable bowel syndrome

NCCIH National Center for Complementary and Integrative Health

NICU Neonatal intensive care unit

PTSD Posttraumatic stress disorder

RCT Randomized control trial

SMT Spinal manipulation therapy

SSS Severity scoring system

Acknowledgements

We gratefully acknowledge Simran Dhaliwal for her assistance with data

collection.

Authors’ contributions

JYN: designed and conceptualized the study, collected and analyzed data,

critically revised the manuscript, and gave ﬁnal approval of the version to be

published. NJV: collected and analysed data, co-drafted the manuscript, and

gave ﬁnal approval of the version to be published. JS: collected and analyzed

data, co-drafted the manuscript, and gave ﬁnal approval of the version to be

published. The author(s) read and approved the ﬁnal manuscript.

Funding

JYN was awarded a Research Scholarship and an Entrance Scholarship from

the Department of Health Research Methods, Evidence and Impact, Faculty of

Health Sciences at McMaster University.

Availability of data and materials

All relevant data are included in this manuscript.

Declarations

Ethics approval and consent to participate

This study involved a scoping review of peer-reviewed literature only; it did

not require ethics approval or consent to participate.

Consent for publication

All authors consent to this manuscript’s publication.

Competing interests

The authors declare that they have no competing interests.

Received: 11 December 2021 Accepted: 20 January 2023

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Social Media and the Transformation of the Physician-Patient Relationship: A Viewpoint (Preprint)

Article

Full-text available

Oct 2020
J MED INTERNET RES

As many as 80% of internet users seek health information online. The social determinants of health (SDoH) are intimately related to who has access to the internet and health care as a whole. Those who face more barriers to care are more likely to benefit from accessing health information online, assuming the information they are retrieving is accurate. Virtual communities on social media platforms are beginning to serve as venues for seeking health information online because peers have been shown to influence health behavior more than almost anything else. As a positive mediator of health, social media can be used as a direct or indirect mode of communication between physicians and patients, a venue for health promotion and health information, and a community support network. However, false or misleading content, social contagion, confirmation bias, and security and privacy concerns must be mitigated to realize the full potential of social media as a positive mediator of health. This paper presents the shifting dynamics of how such communities are affecting physician-patient relationships. With the intersections between the SDoH, social media, and health evolving, physicians must take into consideration these factors when establishing their relationships with patients. We argue a paradigm shift in the physician-patient relationship is warranted, one where physicians acknowledge the impacts of the SDoH on information-seeking behavior, recognize the positive and negative roles of social media as a mediator of health through the lens of the SDoH, and use social media to catalyze positive changes in the physician-patient relationship. We discuss how the physician-patient relationship must evolve to accommodate for the ever-increasing role of social media in health and to best use social media as a tool to improve health outcomes. Finally, we present a fluid and multicomponent diagram that we believe will assist in framing future research in this area. We conclude that it is ineffective and even counterproductive for physicians to ignore the relationship between social media, the SDoH and health, their impact on one another, and the effect it has on designing the medical encounter and the delivery of care under the definition of precision medicine.

Challenges and Opportunities in Social Media Research in Gastroenterology

Article

Full-text available

Jul 2021
DIGEST DIS SCI

In recent years, social media has transformed how we as gastroenterologists communicate with each other and has grown into an arena of knowledge and peer support for patients. Gastroenterologists commonly use social media for education networking, patient populations use social media for peer support and advocacy, but little is known about how gastroenterologists can use social media to conduct thoughtful and rigorous patient-centered research. Therefore, we aim to introduce the scope of social media research, highlight prominent examples in gastroenterology, and review innovative opportunities and unique challenges to using and studying social media for research.

Social Media Usage for Health Purposes: Systematic Review (Preprint)

Article

Full-text available

Jan 2020
J MED INTERNET RES

Background Social media has been widely used for health-related purposes, especially during the COVID-19 pandemic. Previous reviews have summarized social media uses for a specific health purpose such as health interventions, health campaigns, medical education, and disease outbreak surveillance. The most recent comprehensive review of social media uses for health purposes, however, was conducted in 2013. A systematic review that covers various health purposes is needed to reveal the new usages and research gaps that emerge in recent years. Objective This study aimed to provide a systematic review of social media uses for health purposes that have been identified in previous studies. Methods The researchers searched for peer-reviewed journal articles published between 2006 and 2020 in 12 databases covering medicine, public health, and social science. After coding the articles in terms of publication year, journal area, country, method, social media platform, and social media use for health purposes, the researchers provided a review of social media use for health purposes identified in these articles. ResultsThis study summarized 10 social media uses for various health purposes by health institutions, health researchers and practitioners, and the public. Conclusions Social media can be used for various health purposes. Several new usages have emerged since 2013 including advancing health research and practice, social mobilization, and facilitating offline health-related services and events. Research gaps exist regarding advancing strategic use of social media based on audience segmentation, evaluating the impact of social media in health interventions, understanding the impact of health identity development, and addressing privacy concerns.

What social media told us in the time of COVID-19: a scoping review

Article

Full-text available

Jan 2021

With the onset of the COVID-19 pandemic, social media has rapidly become a crucial communication tool for information generation, dissemination, and consumption. In this scoping review, we selected and examined peer-reviewed empirical studies relating to COVID-19 and social media during the first outbreak from November, 2019, to November, 2020. From an analysis of 81 studies, we identified five overarching public health themes concerning the role of online social media platforms and COVID-19. These themes focused on: surveying public attitudes, identifying infodemics, assessing mental health, detecting or predicting COVID-19 cases, analysing government responses to the pandemic, and evaluating quality of health information in prevention education videos. Furthermore, our Review emphasises the paucity of studies on the application of machine learning on data from COVID-19-related social media and a scarcity of studies documenting real-time surveillance that was developed with data from social media on COVID-19. For COVID-19, social media can have a crucial role in disseminating health information and tackling infodemics and misinformation.

Complementary and Alternative Medicine in Patients With Breast Cancer: Exploratory Study of Social Network Forum Data

Article

Full-text available

Jan 2019

Prevalence of Health Misinformation on Social Media: Systematic Review

Article

Full-text available

Jan 2021
J MED INTERNET RES

Background: Although at present there is broad agreement among researchers, health professionals, and policy makers on the need to control and combat health misinformation, the magnitude of this problem is still unknown. Consequently, it is fundamental to discover both the most prevalent health topics and the social media platforms from which these topics are initially framed and subsequently disseminated. Objective: This systematic review aimed to identify the main health misinformation topics and their prevalence on different social media platforms, focusing on methodological quality and the diverse solutions that are being implemented to address this public health concern. Methods: We searched PubMed, MEDLINE, Scopus, and Web of Science for articles published in English before March 2019, with a focus on the study of health misinformation in social media. We defined health misinformation as a health-related claim that is based on anecdotal evidence, false, or misleading owing to the lack of existing scientific knowledge. We included (1) articles that focused on health misinformation in social media, including those in which the authors discussed the consequences or purposes of health misinformation and (2) studies that described empirical findings regarding the measurement of health misinformation on these platforms. Results: A total of 69 studies were identified as eligible, and they covered a wide range of health topics and social media platforms. The topics were articulated around the following six principal categories: vaccines (32%), drugs or smoking (22%), noncommunicable diseases (19%), pandemics (10%), eating disorders (9%), and medical treatments (7%). Studies were mainly based on the following five methodological approaches: social network analysis (28%), evaluating content (26%), evaluating quality (24%), content/text analysis (16%), and sentiment analysis (6%). Health misinformation was most prevalent in studies related to smoking products and drugs such as opioids and marijuana. Posts with misinformation reached 87% in some studies. Health misinformation about vaccines was also very common (43%), with the human papilloma virus vaccine being the most affected. Health misinformation related to diets or pro–eating disorder arguments were moderate in comparison to the aforementioned topics (36%). Studies focused on diseases (ie, noncommunicable diseases and pandemics) also reported moderate misinformation rates (40%), especially in the case of cancer. Finally, the lowest levels of health misinformation were related to medical treatments (30%). Conclusions: The prevalence of health misinformation was the highest on Twitter and on issues related to smoking products and drugs. However, misinformation on major public health issues, such as vaccines and diseases, was also high. Our study offers a comprehensive characterization of the dominant health misinformation topics and a comprehensive description of their prevalence on different social media platforms, which can guide future studies and help in the development of evidence-based digital policy action plans.

Political Polarization on Twitter

Article

Aug 2021

In this study we investigate how social media shape the networked public sphere and facilitate communication between communities with different political orientations. We examine two networks of political communication on Twitter, comprised of more than 250,000 tweets from the six weeks leading up to the 2010 U.S. congressional midterm elections. Using a combination of network clustering algorithms and manually-annotated data we demonstrate that the network of political retweets exhibits a highly segregated partisan structure, with extremely limited connectivity between left- and right-leaning users. Surprisingly this is not the case for the user-to-user mention network, which is dominated by a single politically heterogeneous cluster of users in which ideologically-opposed individuals interact at a much higher rate compared to the network of retweets. To explain the distinct topologies of the retweet and mention networks we conjecture that politically motivated individuals provoke interaction by injecting partisan content into information streams whose primary audience consists of ideologically-opposed users. We conclude with statistical evidence in support of this hypothesis.

Social media enabled interactions in healthcare: Towards a taxonomy

Article

Oct 2021
SOC SCI MED

Healthcare users and providers increasingly utilize social media to interact with one another. For a future understanding of when and how these interactions supplement or replace offline doctor-patient interactions, it is essential to understand who interacts, about what, and how these interactions can be categorized in a taxonomy. We draw on affordance theory and employ a mixed-methods approach to study social media interactions among healthcare users and providers. We first engage in qualitative content analysis, which is followed by cluster analysis. We identify five archetypal interactions and categorize these in a taxonomy that adds to current literature on how social media is utilized in the healthcare context. We also provide a clear and systematic overview of the interactions in different social media categories that can stimulate future research regarding doctor-patient interactions. Furthermore, we identify a new and distinct type of social media enabled interaction in healthcare, namely lifestyle support, focusing on prevention.

Evaluation of the Quality of YouTube Videos on Traditional Chinese Medicine and Inflammatory Arthritis

Article

Sep 2021

Introduction YouTube is used by patients to obtain healthcare related information, but its quality of videos is controversial. We aimed to assess the reliability and quality of YouTube videos as a source of patient education about Traditional Chinese Medicine for inflammatory arthritis. Methods We searched YouTube with the following keywords (in English and Mandarin): “traditional Chinese medicine”, “rheumatoid arthritis”, “ankylosing spondylitis”, “spondyloarthritis”, “psoriatic arthritis” and “inflammatory arthritis”. We excluded videos that were neither in English nor Mandarin, irrelevant or duplicates. We assessed video reliability and quality using the modified 5-point DISCERN tool and 5-point Global Quality Scale respectively. We categorized videos as having useful information, misleading information or personal experience. Results Out of the 1032 videos obtained from the search, we included 108 videos for analysis. We categorized 36 (33.33%) videos as providing useful information, 50 (46.30%) as misleading information and 22 (20.37%) as personal experience. Misleading videos gave partially accurate or inaccurate explanations and some were used for promotional purposes, with minimal information on Traditional Chinese Medicine. Videos uploaded by news sources had the highest reliability and quality, with 73.08% containing useful information. Conclusion There is a lack of useful videos about Traditional Chinese Medicine for inflammatory arthritis on YouTube, with about half containing incorrect information. Rheumatologists and Traditional Chinese Medicine practitioners should actively enquire and discuss with patients about their online search, to guide patients in discriminating useful videos from misleading ones. Both healthcare professionals can collaborate to produce videos with content of a higher quality.

The impact of group polarization on the quality of online debate in social media: A systematic literature review

Article

Jun 2021
TECHNOL FORECAST SOC

Social media are often accused of worsening the quality of online debate. In this paper, we focus on group polarization in the context of social media-enabled interaction, a dysfunctional group dynamic by which participants become more extreme in their initial position on an issue. Through a systematic literature review, we identified a corpus of 121 research papers investigating polarization in social media and other online conversational platforms and reviewed the main empirical findings, as well as theoretical and methodological approaches. We use this knowledge base to assess some recurrent accusations against social media in terms of their supposed tendency to worsen online debate. Our analysis shows that, while some concerns have been exaggerated , social media do contribute to increase polarization either by amplifying and escalating social processes that also occur offline or in specific ways enabled by their design affordances, which also make these platforms prone to manipulation. We argue against suggestions aimed at reducing freedom of speech in cyberspace and identify in inadequate regulation and lack of ethical design as the leading causes of social media-enabled group dysfunctions, highlighting research areas that can support the creation of higher quality online discursive spaces.

What are the ways in which social media is used in the context of complementary and alternative medicine in the health and medical scholarly literature? a scoping review

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