Text classification for assisting moderators in online health communities

ObjectivesPatients increasingly visit online health communities to get help on managing health. The large scale of these online communities makes it impossible for the moderators to engage in all conversations; yet, some conversations need their expertise. Our work explores low-cost text classification methods to this new domain of determining whether a thread in an online health forum needs moderators’ help.MethodsWe employed a binary classifier on WebMD’s online diabetes community data. To train the classifier, we considered three feature types: (1) word unigram, (2) sentiment analysis features, and (3) thread length. We applied feature selection methods based on χ² statistics and under sampling to account for unbalanced data. We then performed a qualitative error analysis to investigate the appropriateness of the gold standard.ResultsUsing sentiment analysis features, feature selection methods, and balanced training data increased the AUC value up to 0.75 and the F1-score up to 0.54 compared to the baseline of using word unigrams with no feature selection methods on unbalanced data (0.65 AUC and 0.40 F1-score). The error analysis uncovered additional reasons for why moderators respond to patients’ posts.DiscussionWe showed how feature selection methods and balanced training data can improve the overall classification performance. We present implications of weighing precision versus recall for assisting moderators of online health communities. Our error analysis uncovered social, legal, and ethical issues around addressing community members’ needs. We also note challenges in producing a gold standard, and discuss potential solutions for addressing these challenges.ConclusionSocial media environments provide popular venues in which patients gain health-related information. Our work contributes to understanding scalable solutions for providing moderators’ expertise in these large-scale, social media environments.     

Personas in online health communities

Many researchers and practitioners use online health communities (OHCs) to influence health behavior and provide patients with social support. One of the biggest challenges in this approach, however, is the rate of attrition. OHCs face similar problems as other social media platforms where user migration happens unless tailored content and appropriate socialization is supported. To provide tailored support for each OHC user, we developed personas in OHCs illustrating users’ needs and requirements in OHC use. To develop OHC personas, we first interviewed 16 OHC users and administrators to qualitatively understand varying user needs in OHC. Based on their responses, we developed an online survey to systematically investigate OHC personas. We received 184 survey responses from OHC users, which informed their values and their OHC use patterns. We performed open coding analysis with the interview data and cluster analysis with the survey data and consolidated the analyses of the two datasets. Four personas emerged—Caretakers, Opportunists, Scientists, and Adventurers. The results inform users’ interaction behavior and attitude patterns with OHCs. We discuss implications for how these personas inform OHCs in delivering personalized informational and emotional support.     

Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients’ perceived empathy

ObjectivePatient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance.MethodsThis study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses.ResultsWe received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients’ perceived affective and cognitive empathies, which positively impacted patient compliance.ConclusionsPatient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients’ perceived affective empathy is the preferred perspective to improve patient compliance.Practice implicationsPhysicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients’ experiences, feelings, and attitudes, understand patients’ demands and mental states, and show their patients that they can feel patients’ pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.     

Improving knowledge of patient skills thanks to automatic analysis of online discussions

Objective

Automatically analyze the online discussions related to diabetes and extract information on patient skills for managing this disease.

Methods

Two collections of about 7000 and 23,000 messages from online discussion fora and 174 skills from an available taxonomy are processed with Natural Language Processing methods and semantically enriched. Skills are projected on the messages to detect those skills which are mentioned by patients. Quantitative and qualitative evaluation is performed.

Results

The method recognizes almost all the aimed skills in fora. The quality of the skills’ recognition varies with the method's parameters. Most of the selected messages are relevant to at least one of the associated skills. Manual analysis shows a substantial number of messages is dedicated to daily self-care and psychosocial skills.

Conclusion

Study of real exchanges between patients leads to a better understanding of their skills in daily self-management of diabetes.

Practice implications

Our experiments can be useful for a better understanding and better knowledge of self-management of diseases by patients. They can also refine existing patient education programs.     

General and health-related social media use among adults with children in the household: Findings from a national survey in the United States

ObjectiveExamine predictors of social media use among a nationally representative sample of adults with children in the household.MethodsData were collected from the Health Information National Trends (HINTS) Survey from 2017 to 2020 (N = 3559). Multivariate logistic regression models assessed the association between sociodemographic variables and social networking site (SNS) use, SNS use to share health information, participation in online forum or support groups for health issues and watching health-related videos on YouTube.ResultsOlder adults and men were significantly less likely to use social media (p<.05). Non-Hispanic African American (aOR: 1.83; 95%CI: 1.30–2.57), Hispanic (aOR: 2.16; 95%CI: 1.56–2.99), and Asian (aOR: 2.82; 95%CI: 1.67–4.75) adults were more likely to watch health-related videos on YouTube.ConclusionsRacial/ethnic minorities with children in the household were more likely to seek health information on YouTube, highlighting opportunities to disseminate culturally relevant, accurate messages on the platform. Effective health communication targeted to specific demographics can help counter misinformation and promote health behavior particularly during public health emergencies.Practice ImplicationsProviders need to foster trust so that patients are comfortable to ask questions in addition to seeking information online. Providers can direct patients to credible resources to counter misinformation exposure and promote healthy behavior.     

Analyzing paths from online health information seeking to colorectal cancer screening using health literacy skills frame and cognitive mediation model

Objective

To test the hypothesized paths for Online Health Information Seeking (OHIS) behaviors in developing health literacy, leading to colorectal cancer (CRC) screening among Korean Americans (KAs) using Health Literacy Skills Frameworks (HLSF) and Cognitive Mediation Model (CMM).

Comparison of Electronic Health Record System Functionalities to support the patient recruitment process in clinical trials

ObjectivesReusing data from electronic health records for clinical and translational research and especially for patient recruitment has been tackled in a broader manner since about a decade. Most projects found in the literature however focus on standalone systems and proprietary implementations at one particular institution often for only one singular trial and no generic evaluation of EHR systems for their applicability to support the patient recruitment process does yet exist. Thus we sought to assess whether the current generation of EHR systems in Germany provides modules/tools, which can readily be applied for IT-supported patient recruitment scenarios.MethodsWe first analysed the EHR portfolio implemented at German University Hospitals and then selected 5 sites with five different EHR implementations covering all major commercial systems applied in German University Hospitals. Further, major functionalities required for patient recruitment support have been defined and the five sample EHRs and their standard tools have been compared to the major functionalities.ResultsIn our analysis of the site's hospital information system environments (with four commercial EHR systems and one self-developed system) we found that – even though no dedicated module for patient recruitment has been provided – most EHR products comprise generic tools such as workflow engines, querying capabilities, report generators and direct SQL-based database access which can be applied as query modules, screening lists and notification components for patient recruitment support. A major limitation of all current EHR products however is that they provide no dedicated data structures and functionalities for implementing and maintaining a local trial registry.ConclusionsAt the five sites with standard EHR tools the typical functionalities of the patient recruitment process could be mostly implemented. However, no EHR component is yet directly dedicated to support research requirements such as patient recruitment. We recommend for future developments that EHR customers and vendors focus much more on the provision of dedicated patient recruitment modules.     

Development of a cognitive framework of patient record summary review in the formative phase of user-centered design

Excellent usability characteristics allow electronic health record (EHR) systems to more effectively support clinicians providing care and contribute to better quality and safety. The Office of the National Coordinator for Health IT (ONC) therefore requires all vendors to follow a User-Centered Design (UCD) process to increase the usability of their products in order to meet certification criteria for the Safety-Enhanced Design part of the Meaningful Use (stage 2) EHR incentive program. This report describes the initial stage of a UCD process in which foundational design concepts were formulated. We designed a functional prototype of an EHR module intended to help clinicians to efficiently complete a summary review of an electronic patient record before an ambulatory visit. Cognitively-based studies were performed and the results used to develop a cognitive framework that subsequently guided design of a prototype. Results showed that clinicians categorized and reasoned with patient data in distinct patterns; they preferred to review relevant history in the assessment and plan section of the most recent note, to search for changes in health and for new episodes of care since the last visit and to look up current-day data such as vital signs. These basic concepts were represented in the design, for instance, by screen division into vertical thirds that had historical content to the left and most recent data to the right. Other characteristics such as visual association of contextual information or direct, one-click access to the assessment and plan section of visit notes were directly informed by our findings and refined in a series of UCD-specific iterative testing. Understanding of tasks and cognitive demands early in the UCD process was critically important for developing a tool optimized for reasoning and workflow preferences of clinicians.     

Implementation of an organisation-wide health literacy approach to improve the understandability and actionability of patient information and education materials: A pre-post effectiveness study

ObjectiveLimited examples exist globally of coordinated, organisation-wide health literacy approaches to systematically improve the understandability and actionability of patient health information. Even fewer have been formally evaluated. The aim of this study was to use the Patient Education Materials Assessment Tool (PEMAT) to evaluate the effectiveness of an organisation-wide, evidence-based approach to improve the understandability and actionability of patient information materials in regional health service in New South Wales, Australia.MethodsTwo independent raters (blinded to the document version) evaluated pre- and post-implementation versions of 50 randomly-selected patient information materials using the PEMAT, with differences in understandability and actionability analysed using paired samples tests.ResultsMean (±SD) overall scores for understandability increased significantly by 5% (95% CI 2–8; p = 0.002) up to 77%±10%, and mean actionability (±SD) increased significantly by 4% (95% CI 0–8; p = 0.046) up to 56%±22%.ConclusionThese results demonstrate that organisation-wide approaches with standardised processes for staff to prepare, review and store written patient information and education materials can be successfully implemented to address the impacts and risks of low health literacy.Practice implicationsThe success of this approach provides a framework for other health organisations to work in partnership with patients to make health information more understandable and actionable.