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Online Social Networking by Patients with Diabetes: A Qualitative Evaluation of Communication with Facebook Jeremy A. Greene, MD, PhD 1 , Niteesh K. Choudhry, MD, PhD 1 , Elaine Kilabuk, BA 2 , and William H. Shrank, MD, MSHS 1,2 1 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women s Hospital and Harvard Medical School, Boston, MA, USA; 2 Center for American Political Studies, Harvard University, Boston, MA, USA. BACKGROUND: Several disease-specific information exchanges now exist on Facebook and other online social networking sites. These new sources of knowl- edge, support, and engagement have become important for patients living with chronic disease, yet the quality and content of the information provided in these digital arenas are poorly understood. OBJECTIVE: To qualitatively evaluate the content of communication in Facebook communities dedicated to diabetes. DESIGN: We identified the 15 largest Facebook groups focused on diabetes management. For each group, we downloaded the 15 most recent wall posts and the 15 most recent discussion topics from the 10 largest groups. PATIENTS: Four hundred eighty unique users were identified in a series of 690 comments from wall posts and discussion topics. MAIN MEASURES: Posts were abstracted and aggre- gated into a database. Two investigators evaluated the posts, developed a thematic coding scheme, and applied codes to the data. KEY RESULTS: Patients with diabetes, family mem- bers, and their friends use Facebook to share personal clinical information, to request disease-specific guid- ance and feedback, and to receive emotional support. Approximately two-thirds of posts included unsolicited sharing of diabetes management strategies, over 13% of posts provided specific feedback to information requested by other users, and almost 29% of posts featured an effort by the poster to provide emotional support to others as members of a community. Approx- imately 27% of posts featured some type of promotional activity, generally presented as testimonials advertising non-FDA approved, natural products. Clinically inac- curate recommendations were infrequent, but were usually associated with promotion of a specific product or service. Thirteen percent of posts contained requests for personal information from Facebook participants. CONCLUSIONS: Facebook provides a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes. However, promotional activity and personal data collection are also common, with no account- ability or checks for authenticity. KEY WORDS: social networks; online social media; information seeking behavior; Facebook; diabetes; disease management. J Gen Intern Med 26(3):287
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