Background: Digital media memes have emerged as influential tools in health communication, particularly during the COVID-19 pandemic. While they offer opportunities for emotional engagement and community resilience, they also act as vectors for health misinformation, contributing to the global infodemic. Despite growing interest in their communicative power, the role of memes in shaping public perception and misinformation diffusion remains underexplored in infodemiology.
Objective: This integrative review aims to analyze how memes influence emotional, behavioral, and ideological responses to health crises, and to examine their dual role as both contributors to and potential mitigators of infodemics. The paper also explores strategies for integrating memes into public health campaigns and infodemic management.
Methods: A comprehensive literature search was conducted across 3 major databases (MEDLINE, Scopus, and Web of Science), identifying a total of 386 records. Following duplicate removal and eligibility screening, 14 peer-reviewed studies published between 2020 and 2025 were included. An integrative narrative approach was used to synthesize evidence on social media behavior, misinformation dynamics, and digital health campaigns. The analysis was grounded in infodemiological and infoveillance frameworks as established by Eysenbach, incorporating insights from psychology, media studies, and public health.
Results: Memes function as emotionally salient and visually potent carriers of health-related narratives. While they can simplify complex messages and foster adaptive humor during crises, they are also susceptible to distortion, particularly in echo chambers and conspiracy communities. Findings reveal that misinformation-laden memes often leverage humor and disgust to bypass critical thinking, and their viral potential is linked to emotional intensity. However, memes have also been successfully integrated into prebunking strategies, increasing engagement and reducing susceptibility to false claims when culturally tailored. The review identifies key mechanisms that enhance or hinder the infodemiological value of memes, including political orientation, digital literacy, and narrative framing.
Conclusions: Memes are a double-edged sword in the context of infodemics. Their integration into infodemic surveillance and digital health campaigns requires a nuanced understanding of their emotional, cultural, and epistemic effects. Public health institutions should incorporate meme analysis into real-time infoveillance systems, apply evidence-based meme formats in prebunking efforts, and foster digital literacy that enables critical meme consumption. Future infodemiology research should further explore the long-term behavioral impacts of memetic misinformation and the scalability of meme-based interventions.
背景:数字媒体模因已成为卫生传播的重要工具,特别是在2019冠状病毒病大流行期间。虽然它们为情感参与和社区复原力提供了机会,但它们也成为健康错误信息的载体,助长了全球信息流行。尽管人们对模因的传播能力越来越感兴趣,但在信息流行病学中,模因在塑造公众认知和错误信息传播方面的作用仍未得到充分探讨。目的:本综述旨在分析模因如何影响对健康危机的情绪、行为和意识形态反应,并研究它们作为信息流行病的贡献者和潜在缓解者的双重作用。本文还探讨了将模因整合到公共卫生运动和信息管理中的策略。方法:在MEDLINE、Scopus和Web of Science 3个主要数据库中进行文献检索,共检索到386条记录。在重复删除和资格筛选之后,纳入了2020年至2025年间发表的14项同行评议研究。综合叙事方法用于综合有关社交媒体行为、错误信息动态和数字健康运动的证据。该分析以Eysenbach建立的信息流行病学和信息监测框架为基础,结合了心理学、媒体研究和公共卫生的见解。结果:模因是健康相关叙事的情感显著和视觉有效载体。虽然它们可以简化复杂的信息,并在危机期间培养适应性幽默,但它们也容易被扭曲,尤其是在回音室和阴谋团体中。研究结果显示,含有错误信息的表情包经常利用幽默和厌恶来绕过批判性思维,它们的传播潜力与情绪强度有关。然而,模因也成功地融入了预掩体策略,在文化上量身定制的情况下,增加了参与度,降低了对虚假声明的易感性。该审查确定了增强或阻碍模因信息流行病学价值的关键机制,包括政治取向、数字素养和叙事框架。结论:在信息传播的背景下,模因是一把双刃剑。将它们整合到信息流行病监测和数字卫生运动中,需要对它们的情感、文化和认知影响有细致的了解。公共卫生机构应将模因分析纳入实时信息监测系统,在预掩体工作中应用基于证据的模因格式,并培养数字素养,使关键的模因消费成为可能。未来的信息流行病学研究应进一步探讨模因错误信息的长期行为影响和模因干预的可扩展性。
{"title":"Internet Memes as Drivers of Health Narratives and Infodemics: Integrative Review.","authors":"Alvaro Carmona Pestaña, Iván Herrera-Peco, Beatriz Jiménez-Gómez, Carolina Suárez-Llevat","doi":"10.2196/77029","DOIUrl":"https://doi.org/10.2196/77029","url":null,"abstract":"<p><strong>Background: </strong>Digital media memes have emerged as influential tools in health communication, particularly during the COVID-19 pandemic. While they offer opportunities for emotional engagement and community resilience, they also act as vectors for health misinformation, contributing to the global infodemic. Despite growing interest in their communicative power, the role of memes in shaping public perception and misinformation diffusion remains underexplored in infodemiology.</p><p><strong>Objective: </strong>This integrative review aims to analyze how memes influence emotional, behavioral, and ideological responses to health crises, and to examine their dual role as both contributors to and potential mitigators of infodemics. The paper also explores strategies for integrating memes into public health campaigns and infodemic management.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across 3 major databases (MEDLINE, Scopus, and Web of Science), identifying a total of 386 records. Following duplicate removal and eligibility screening, 14 peer-reviewed studies published between 2020 and 2025 were included. An integrative narrative approach was used to synthesize evidence on social media behavior, misinformation dynamics, and digital health campaigns. The analysis was grounded in infodemiological and infoveillance frameworks as established by Eysenbach, incorporating insights from psychology, media studies, and public health.</p><p><strong>Results: </strong>Memes function as emotionally salient and visually potent carriers of health-related narratives. While they can simplify complex messages and foster adaptive humor during crises, they are also susceptible to distortion, particularly in echo chambers and conspiracy communities. Findings reveal that misinformation-laden memes often leverage humor and disgust to bypass critical thinking, and their viral potential is linked to emotional intensity. However, memes have also been successfully integrated into prebunking strategies, increasing engagement and reducing susceptibility to false claims when culturally tailored. The review identifies key mechanisms that enhance or hinder the infodemiological value of memes, including political orientation, digital literacy, and narrative framing.</p><p><strong>Conclusions: </strong>Memes are a double-edged sword in the context of infodemics. Their integration into infodemic surveillance and digital health campaigns requires a nuanced understanding of their emotional, cultural, and epistemic effects. Public health institutions should incorporate meme analysis into real-time infoveillance systems, apply evidence-based meme formats in prebunking efforts, and foster digital literacy that enables critical meme consumption. Future infodemiology research should further explore the long-term behavioral impacts of memetic misinformation and the scalability of meme-based interventions.</p>","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e77029"},"PeriodicalIF":2.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandro Zacher, Jürgen Kasper, Julia Lauberger, Julia Lühnen, Lisa-Marie Redlich, Anke Steckelberg
Background: Patients with knee osteoarthritis have a considerable need for information about their condition, its progression, and available treatments. Decision-making is often complex and requires evidence-based health information material (HIM). When medical consultations do not sufficiently address patients' needs, many seek additional information independently.
Objective: This study aimed to examine the quality of German-language HIM on knee osteoarthritis treatment and its suitability for supporting informed choice. In particular, the study analyzed the content of the HIM and assessed the balance in the presentation of treatment options.
Methods: A descriptive cross-sectional study was conducted. HIM was identified through a combination of search strategies, including a systematic internet search using commonly used German terms related to the treatment of knee osteoarthritis. Identified HIMs were independently assessed by 2 raters using the validated Mapping the Quality of Health Information (MAPPinfo) checklist, which operationalizes the criteria of the Guideline Evidence-Based Health Information. Information quality was calculated on a scale from 0% to 100%, representing compliance with the quality standard. A descriptive content analysis was also carried out to examine the range and balance of treatment options presented, as well as the reporting of benefits and complications associated with total knee arthroplasty (TKA). The presence of certification was recorded.
Results: A total of 94 HIMs were included. On average, the material met 14.6% (SD 9.4%) of the quality criteria. HIM from public and nonprofit providers performed better (mean 40.1%, SD 3.6% and mean 37.2%, SD 23.1%, respectively) than those from other providers. Overall, 14 HIMs presented treatment options in a balanced manner. Among the 78 HIMs that covered TKA, 38.5% (n=30) did not report any benefits, and 35.9% (n=28) omitted potential complications. Certified HIMs showed only moderately higher information quality than uncertified material (mean 26.8%, SD 16% vs mean 12.7%, SD 5.9%).
Conclusions: Our results highlight the urgent need to improve the quality of German-language HIM on knee osteoarthritis. The deficits identified are fundamental and affect all dimensions of information quality. Although HIM from public or nonprofit organizations has better information quality, this does not facilitate informed choice. The frequent omission of complications and benefits of TKA and the unbalanced presentation of treatment options can influence decisions. Until structural improvements are made, patients seeking quality information should favor material from public or nonprofit providers. Additionally, the MAPPinfo checklist could form the basis of a differentiated certification system to make information quality more transparent for patients.
{"title":"Mapping the Quality of German-Language Health Information on the Treatment of Knee Osteoarthritis: Cross-Sectional Analysis.","authors":"Sandro Zacher, Jürgen Kasper, Julia Lauberger, Julia Lühnen, Lisa-Marie Redlich, Anke Steckelberg","doi":"10.2196/78007","DOIUrl":"10.2196/78007","url":null,"abstract":"<p><strong>Background: </strong>Patients with knee osteoarthritis have a considerable need for information about their condition, its progression, and available treatments. Decision-making is often complex and requires evidence-based health information material (HIM). When medical consultations do not sufficiently address patients' needs, many seek additional information independently.</p><p><strong>Objective: </strong>This study aimed to examine the quality of German-language HIM on knee osteoarthritis treatment and its suitability for supporting informed choice. In particular, the study analyzed the content of the HIM and assessed the balance in the presentation of treatment options.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted. HIM was identified through a combination of search strategies, including a systematic internet search using commonly used German terms related to the treatment of knee osteoarthritis. Identified HIMs were independently assessed by 2 raters using the validated Mapping the Quality of Health Information (MAPPinfo) checklist, which operationalizes the criteria of the Guideline Evidence-Based Health Information. Information quality was calculated on a scale from 0% to 100%, representing compliance with the quality standard. A descriptive content analysis was also carried out to examine the range and balance of treatment options presented, as well as the reporting of benefits and complications associated with total knee arthroplasty (TKA). The presence of certification was recorded.</p><p><strong>Results: </strong>A total of 94 HIMs were included. On average, the material met 14.6% (SD 9.4%) of the quality criteria. HIM from public and nonprofit providers performed better (mean 40.1%, SD 3.6% and mean 37.2%, SD 23.1%, respectively) than those from other providers. Overall, 14 HIMs presented treatment options in a balanced manner. Among the 78 HIMs that covered TKA, 38.5% (n=30) did not report any benefits, and 35.9% (n=28) omitted potential complications. Certified HIMs showed only moderately higher information quality than uncertified material (mean 26.8%, SD 16% vs mean 12.7%, SD 5.9%).</p><p><strong>Conclusions: </strong>Our results highlight the urgent need to improve the quality of German-language HIM on knee osteoarthritis. The deficits identified are fundamental and affect all dimensions of information quality. Although HIM from public or nonprofit organizations has better information quality, this does not facilitate informed choice. The frequent omission of complications and benefits of TKA and the unbalanced presentation of treatment options can influence decisions. Until structural improvements are made, patients seeking quality information should favor material from public or nonprofit providers. Additionally, the MAPPinfo checklist could form the basis of a differentiated certification system to make information quality more transparent for patients.</p>","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e78007"},"PeriodicalIF":2.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Po-Chun Chang, Tsung-Hsien Tsai, Shih-Chieh Shao, Chi-Chin Sun
<p><strong>Background: </strong>A high prevalence of dry eye disease (DED) has intensified public health concerns in Taiwan. With the growing reliance on online resources for health information, platforms such as Google Trends (GT) provide a valuable method for capturing public interest. This approach also allows for the exploration of potential associations between public interest in DED and environmental parameters, which may further elucidate underlying factors contributing to the disease's rising prevalence.</p><p><strong>Objective: </strong>This study aims to (1) analyze public interest in DED in Taiwan using GT data, (2) investigate correlations between search interest and environmental parameters, and (3) identify shifts in the focus of search over time.</p><p><strong>Methods: </strong>We analyzed GT data from December 2018 to July 2024, focusing on relative search volume (RSV) for DED across Taiwan and its 6 special municipalities. Temporal trends in RSV were assessed using spline regression models, and monthly variations were assessed using the Kruskal-Wallis test. The Spearman correlation analysis was used to evaluate the association between RSV and environmental parameters, while dynamic time warping analysis clarified the temporal alignment of RSV with these parameters. Rising search queries were analyzed to identify shifts in public interest over time. Furthermore, top Google search results for DED-related keywords were assessed for topic coverage, quality, and readability.</p><p><strong>Results: </strong>A significant rising trend in RSV for DED was observed over the study period in Taiwan (mean instantaneous derivative=0.445; P<.001) and across all 6 special municipalities. Environmental parameters such as methane (CH4), total hydrocarbons, and nonmethane hydrocarbons were identified as novel pollutants strongly correlated with RSV (P<.001), along with known pollutants such as nitric oxide (NO), nitrogen dioxide (NO2), sulfur dioxide (SO2), nitrogen oxides (NOx), and carbon monoxide (CO). Dynamic time warping analysis revealed the strongest temporal alignment was between RSV and hydrocarbons, including CH4 and total hydrocarbons, further emphasizing their potential role in influencing public interest. Assessment of web-based DED information of 80 websites revealed generally low quality (DISCERN score: mean 2.14, SD 0.40), and the average readability corresponded to a college reading level (grade: mean 21.1, SD 4.5). Rising search queries shifted from diagnostic and treatment methods before the COVID-19 pandemic to natural remedies during the COVID-19 lockdown and self-diagnosis and treatment options after the pandemic. Gaps were also identified between public interest and the availability of online information.</p><p><strong>Conclusions: </strong>Public interest in DED has increased significantly in Taiwan from 2018 to 2024, with hydrocarbons identified as strongly associated environmental parameters. The shifts in related queries
{"title":"Public Interest in Dry Eye Disease and Its Association With Environmental Parameters in Taiwan: Google Trends Infodemiology Study.","authors":"Po-Chun Chang, Tsung-Hsien Tsai, Shih-Chieh Shao, Chi-Chin Sun","doi":"10.2196/74317","DOIUrl":"10.2196/74317","url":null,"abstract":"<p><strong>Background: </strong>A high prevalence of dry eye disease (DED) has intensified public health concerns in Taiwan. With the growing reliance on online resources for health information, platforms such as Google Trends (GT) provide a valuable method for capturing public interest. This approach also allows for the exploration of potential associations between public interest in DED and environmental parameters, which may further elucidate underlying factors contributing to the disease's rising prevalence.</p><p><strong>Objective: </strong>This study aims to (1) analyze public interest in DED in Taiwan using GT data, (2) investigate correlations between search interest and environmental parameters, and (3) identify shifts in the focus of search over time.</p><p><strong>Methods: </strong>We analyzed GT data from December 2018 to July 2024, focusing on relative search volume (RSV) for DED across Taiwan and its 6 special municipalities. Temporal trends in RSV were assessed using spline regression models, and monthly variations were assessed using the Kruskal-Wallis test. The Spearman correlation analysis was used to evaluate the association between RSV and environmental parameters, while dynamic time warping analysis clarified the temporal alignment of RSV with these parameters. Rising search queries were analyzed to identify shifts in public interest over time. Furthermore, top Google search results for DED-related keywords were assessed for topic coverage, quality, and readability.</p><p><strong>Results: </strong>A significant rising trend in RSV for DED was observed over the study period in Taiwan (mean instantaneous derivative=0.445; P<.001) and across all 6 special municipalities. Environmental parameters such as methane (CH4), total hydrocarbons, and nonmethane hydrocarbons were identified as novel pollutants strongly correlated with RSV (P<.001), along with known pollutants such as nitric oxide (NO), nitrogen dioxide (NO2), sulfur dioxide (SO2), nitrogen oxides (NOx), and carbon monoxide (CO). Dynamic time warping analysis revealed the strongest temporal alignment was between RSV and hydrocarbons, including CH4 and total hydrocarbons, further emphasizing their potential role in influencing public interest. Assessment of web-based DED information of 80 websites revealed generally low quality (DISCERN score: mean 2.14, SD 0.40), and the average readability corresponded to a college reading level (grade: mean 21.1, SD 4.5). Rising search queries shifted from diagnostic and treatment methods before the COVID-19 pandemic to natural remedies during the COVID-19 lockdown and self-diagnosis and treatment options after the pandemic. Gaps were also identified between public interest and the availability of online information.</p><p><strong>Conclusions: </strong>Public interest in DED has increased significantly in Taiwan from 2018 to 2024, with hydrocarbons identified as strongly associated environmental parameters. The shifts in related queries ","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e74317"},"PeriodicalIF":2.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12617964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katharina Sieferle, Tiziana Guidi, Florence Dorr, Eva Maria Bitzer
<p><strong>Background: </strong>Social media platforms are increasingly used for both sharing and seeking health-related information online. TikTok has become one of the most widely used social networking platforms. One health-related topic trending on TikTok recently is attention-deficit/hyperactivity disorder (ADHD). However, the accuracy of health-related information on TikTok remains a significant concern. Misleading information about ADHD on TikTok can increase stigmatization and lead to false "self-diagnosis," pathologizing of normal behavior, and overuse of care.</p><p><strong>Objective: </strong>This study aims to investigate the quality and usefulness of popular TikTok videos about ADHD and to explore how this content is perceived by the viewers based on an in-depth analysis of the video comments.</p><p><strong>Methods: </strong>We scraped data from the 125 most liked ADHD-related TikTok videos uploaded between July 2021 and November 2023 using a commercial scraping software. We categorized videos based on the usefulness of their content as "misleading," "personal experience," or "useful" and used the Patient Education Materials Assessment Tool for Audiovisual Materials to evaluate the video quality regarding understandability and actionability. By purposive sampling, we selected 6 videos and analyzed the content of 100 randomly selected user comments per video to understand the extent of self-identification with ADHD behavior among the viewers. All qualitative analyses were carried out independently by at least 2 authors; the disagreement was resolved by discussion. Using SPSS (version 27; IBM Corp), we calculated the interrater reliability between the raters and the descriptive statistics for video and creator characteristics. We used one-way ANOVA to compare the usefulness of the videos.</p><p><strong>Results: </strong>We assessed 50.4% (63/125) of the videos as misleading, 30.4% (38/125) as personal experience, and 19.2% (24/125) as useful. The Patient Education Materials Assessment Tool for Audiovisual Materials scores for all videos for understandability and actionability are 79.5% and 5.1%, respectively. With a score of 92.3%, useful videos scored significantly higher for understandability than misleading and personal experience videos (P<.001). For actionability, there was no statistically significant difference depending on the videos' usefulness (P=.415). Viewers resonated with the ADHD-related behaviors depicted in the videos in 220 out of 600 (36.7%) of the comments and with ADHD in 32 out of 600 (5.3%) of the comments. Self-attribution of behavioral patterns varied significantly, depending on the usefulness of the videos, with personal experience videos showing the most comments on self-attribution of behavioral patterns (102/600, 17% of comments; P<.001). For self-attribution of ADHD, we found no significant difference depending on the usefulness of the videos (P=.359).</p><p><strong>Conclusions: </strong>The high number of
背景:社交媒体平台越来越多地用于在线分享和寻求与健康相关的信息。抖音已经成为使用最广泛的社交网络平台之一。最近在TikTok上流行的一个与健康相关的话题是注意力缺陷/多动障碍(ADHD)。然而,TikTok上与健康有关的信息的准确性仍然是一个重大问题。TikTok上关于多动症的误导性信息会增加污名化,导致错误的“自我诊断”,将正常行为病态化,以及过度使用护理。目的:本研究旨在通过对视频评论的深入分析,调查热门TikTok视频的质量和有用性,并探讨观众对这些内容的看法。方法:我们使用商业抓取软件从2021年7月至2023年11月上传的125个最受欢迎的与adhd相关的TikTok视频中抓取数据。我们根据视频内容的有用性将其分类为“误导性”、“个人经验”或“有用”,并使用视听材料患者教育材料评估工具来评估视频质量,包括可理解性和可操作性。通过有目的抽样,我们选取了6个视频,并对每个视频随机抽取的100条用户评论内容进行分析,以了解观众对ADHD行为的自我认同程度。所有定性分析均由至少2位作者独立进行;分歧通过讨论得到解决。使用SPSS (version 27; IBM Corp),我们计算了评分者与视频和创作者特征的描述性统计数据之间的相互信度。我们使用单因素方差分析来比较视频的有用性。结果:50.4%(63/125)的视频具有误导性,30.4%(38/125)的视频具有个人经验,19.2%(24/125)的视频具有实用性。患者教育材料评估工具对所有视频的可理解性和可操作性得分分别为79.5%和5.1%。有用视频的可理解性得分为92.3%,明显高于误导性视频和个人体验视频(p结论:TikTok上大量关于ADHD的误导性视频,以及对这些视频中呈现的症状和行为进行自我认同的用户比例很高,可能会增加误诊。这突出表明需要严格评估社交媒体上的卫生信息,并要求卫生保健专业人员解决这些平台产生的误解。
{"title":"Quality and Perception of Attention-Deficit/Hyperactivity Disorder Content on TikTok: Cross-Sectional Study.","authors":"Katharina Sieferle, Tiziana Guidi, Florence Dorr, Eva Maria Bitzer","doi":"10.2196/75973","DOIUrl":"10.2196/75973","url":null,"abstract":"<p><strong>Background: </strong>Social media platforms are increasingly used for both sharing and seeking health-related information online. TikTok has become one of the most widely used social networking platforms. One health-related topic trending on TikTok recently is attention-deficit/hyperactivity disorder (ADHD). However, the accuracy of health-related information on TikTok remains a significant concern. Misleading information about ADHD on TikTok can increase stigmatization and lead to false \"self-diagnosis,\" pathologizing of normal behavior, and overuse of care.</p><p><strong>Objective: </strong>This study aims to investigate the quality and usefulness of popular TikTok videos about ADHD and to explore how this content is perceived by the viewers based on an in-depth analysis of the video comments.</p><p><strong>Methods: </strong>We scraped data from the 125 most liked ADHD-related TikTok videos uploaded between July 2021 and November 2023 using a commercial scraping software. We categorized videos based on the usefulness of their content as \"misleading,\" \"personal experience,\" or \"useful\" and used the Patient Education Materials Assessment Tool for Audiovisual Materials to evaluate the video quality regarding understandability and actionability. By purposive sampling, we selected 6 videos and analyzed the content of 100 randomly selected user comments per video to understand the extent of self-identification with ADHD behavior among the viewers. All qualitative analyses were carried out independently by at least 2 authors; the disagreement was resolved by discussion. Using SPSS (version 27; IBM Corp), we calculated the interrater reliability between the raters and the descriptive statistics for video and creator characteristics. We used one-way ANOVA to compare the usefulness of the videos.</p><p><strong>Results: </strong>We assessed 50.4% (63/125) of the videos as misleading, 30.4% (38/125) as personal experience, and 19.2% (24/125) as useful. The Patient Education Materials Assessment Tool for Audiovisual Materials scores for all videos for understandability and actionability are 79.5% and 5.1%, respectively. With a score of 92.3%, useful videos scored significantly higher for understandability than misleading and personal experience videos (P<.001). For actionability, there was no statistically significant difference depending on the videos' usefulness (P=.415). Viewers resonated with the ADHD-related behaviors depicted in the videos in 220 out of 600 (36.7%) of the comments and with ADHD in 32 out of 600 (5.3%) of the comments. Self-attribution of behavioral patterns varied significantly, depending on the usefulness of the videos, with personal experience videos showing the most comments on self-attribution of behavioral patterns (102/600, 17% of comments; P<.001). For self-attribution of ADHD, we found no significant difference depending on the usefulness of the videos (P=.359).</p><p><strong>Conclusions: </strong>The high number of","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e75973"},"PeriodicalIF":2.3,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12614393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Becky K White, Fernan Talamayan, Tara Rose Aynsley, Richard Bahizire Riziki, Catherine Bertrand-Ferrandis, Kai Von Harbou, Rocio Lopez Inigo, Thomas Moran, Reuben Samuel, David Scales, Sandra Varaidzo Machiri
<p><strong>Background: </strong>With the advances in digital information sharing channels, democratization of content, and access, as well as social shifts in information exchange, we live in increasingly complex information environments. How people process and manage this is layered with multiple determinants that can impact information seeking, health behaviors, and public health. Understanding the dynamics of the information environment in priority populations and its impact on communities and individuals is critical for those working in public health and health emergencies.</p><p><strong>Objective: </strong>This study aimed to provide an overview of the approaches to and implementation of information environment assessments as they relate to public health and health emergencies.</p><p><strong>Methods: </strong>We conducted a rapid scoping review of the approaches to, and implementation of information environment assessments. The search followed guidance from the Joanna Briggs Institute on conducting systematic scoping reviews, and our reporting is in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. We included both academic and gray literature in the English language. As this is an emerging field, an additional step involved input from an informal expert group to identify any further tools or approaches. Studies that assessed, described, or discussed approaches to assessing the information environment were included. We excluded papers where the information environment was not the primary focus, or the focus was on individual components only. Two authors (BKW and SVM) independently screened results for inclusion.</p><p><strong>Results: </strong>A total of 17 publications were identified through the structured literature and internet searches, with an additional 5 sourced from the informal expert group. The review highlighted a significant variety in the breadth and number of domains covered in an assessment, including information needs, seeking, access, production, engagement, information quality, and reach. Some assessments adopted a comprehensive, systems-oriented approach, examining factors influencing information beyond the individual level to encompass broader systemic dynamics, while others were significantly narrower in scope.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic has intensified interest in understanding how the information environment shapes people's access to, engagement with, and ability to act on health information. Assessing the information environment is a critical step in identifying and understanding barriers and facilitators that impact different populations and identifying opportunities for strengthening systems. However, a universally accepted approach for such assessments in public health and health emergencies is currently lacking. This paper contributes to the literature by synthesizing current knowledge on assessment tools and fr
{"title":"Current Approaches To and Implementation of Information Environment Assessments in the Context of Public Health: Rapid Review.","authors":"Becky K White, Fernan Talamayan, Tara Rose Aynsley, Richard Bahizire Riziki, Catherine Bertrand-Ferrandis, Kai Von Harbou, Rocio Lopez Inigo, Thomas Moran, Reuben Samuel, David Scales, Sandra Varaidzo Machiri","doi":"10.2196/72165","DOIUrl":"10.2196/72165","url":null,"abstract":"<p><strong>Background: </strong>With the advances in digital information sharing channels, democratization of content, and access, as well as social shifts in information exchange, we live in increasingly complex information environments. How people process and manage this is layered with multiple determinants that can impact information seeking, health behaviors, and public health. Understanding the dynamics of the information environment in priority populations and its impact on communities and individuals is critical for those working in public health and health emergencies.</p><p><strong>Objective: </strong>This study aimed to provide an overview of the approaches to and implementation of information environment assessments as they relate to public health and health emergencies.</p><p><strong>Methods: </strong>We conducted a rapid scoping review of the approaches to, and implementation of information environment assessments. The search followed guidance from the Joanna Briggs Institute on conducting systematic scoping reviews, and our reporting is in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. We included both academic and gray literature in the English language. As this is an emerging field, an additional step involved input from an informal expert group to identify any further tools or approaches. Studies that assessed, described, or discussed approaches to assessing the information environment were included. We excluded papers where the information environment was not the primary focus, or the focus was on individual components only. Two authors (BKW and SVM) independently screened results for inclusion.</p><p><strong>Results: </strong>A total of 17 publications were identified through the structured literature and internet searches, with an additional 5 sourced from the informal expert group. The review highlighted a significant variety in the breadth and number of domains covered in an assessment, including information needs, seeking, access, production, engagement, information quality, and reach. Some assessments adopted a comprehensive, systems-oriented approach, examining factors influencing information beyond the individual level to encompass broader systemic dynamics, while others were significantly narrower in scope.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic has intensified interest in understanding how the information environment shapes people's access to, engagement with, and ability to act on health information. Assessing the information environment is a critical step in identifying and understanding barriers and facilitators that impact different populations and identifying opportunities for strengthening systems. However, a universally accepted approach for such assessments in public health and health emergencies is currently lacking. This paper contributes to the literature by synthesizing current knowledge on assessment tools and fr","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e72165"},"PeriodicalIF":2.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12594438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Grigori Sidorov, Muhammad Ahmad, Pierpaolo Basile, Muhammad Waqas, Rita Orji, Ildar Batyrshin
Background: Opioid overdose is a global public health emergency, with the United States experiencing high rates of morbidity and mortality due to prescription and illicit opioid use. Traditional public health monitoring systems often fail to provide real-time insights, limiting their capacity for early detection and intervention. Social media platforms, especially Reddit, offer a promising alternative for timely toxicovigilance due to the abundance of user-generated, real-time content.
Objective: This study aimed to explore the use of Reddit as a real-time, high-volume source for toxicovigilance and develop an automated system that can classify and analyze opioid-related social media posts to detect behavioral patterns and monitor the evolution of public discourse on opioid use.
Methods: To investigate evolving social media discourse around opioid use, we collected a large-scale dataset from Reddit spanning 6 years, from January 1, 2018, to December 30, 2023. Using a comprehensive opioid lexicon-including formal drug names, street slang, common misspellings, and abbreviations-we filtered relevant posts for further analysis. A subset of these data was manually annotated according to well-defined annotation guidelines into 4 categories: self-misuse, external misuse, information, and unrelated, with distributions of 37.21%, 27.25%, 27.57%, and 7.97%, respectively. To automate the classification of opioid-related chatter, we developed a robust natural language processing pipeline leveraging classical machine learning algorithms, deep learning models, and transformer-based architecture, and fine-tuned a state-of-the-art large language model (LLM; OpenAI GPT-3.5 Turbo). In the final stage, the trained LLM was deployed on an unlabeled dataset comprising 74,975 additional Reddit chatter posts. This enabled a detailed temporal analysis of opioid-related discussions, aligned with 6 years of opioid-related death records from the Centers for Disease Control and Prevention (CDC). For this study, self-misuse and external misuse were merged into a misuse category for direct comparison with the CDC's mortality data, examining whether trends in social media discourse on opioid misuse reflect patterns in real-world mortality statistics.
Results: The fine-tuned GPT-3.5 Turbo model achieved the highest classification accuracy of 0.93, outperforming the baseline (random forest 0.85) by representing a performance improvement of 9.14% over the machine learning model. The temporal analysis of the unlabeled data revealed evolving trends in opioid-related discussions, indicating shifts in user behavior and overdose-related chatter over time. To quantify this relationship, we calculated the Pearson correlation coefficient between misuse-related posts and CDC death records (r=0.854). This correlation was statistically significant (P<.001), indicating a strong positive relationship betwe
{"title":"Monitoring Opioid-Related Social Media Chatter Using Natural Language Processing and Large Language Models: Temporal Analysis.","authors":"Grigori Sidorov, Muhammad Ahmad, Pierpaolo Basile, Muhammad Waqas, Rita Orji, Ildar Batyrshin","doi":"10.2196/77279","DOIUrl":"10.2196/77279","url":null,"abstract":"<p><strong>Background: </strong>Opioid overdose is a global public health emergency, with the United States experiencing high rates of morbidity and mortality due to prescription and illicit opioid use. Traditional public health monitoring systems often fail to provide real-time insights, limiting their capacity for early detection and intervention. Social media platforms, especially Reddit, offer a promising alternative for timely toxicovigilance due to the abundance of user-generated, real-time content.</p><p><strong>Objective: </strong>This study aimed to explore the use of Reddit as a real-time, high-volume source for toxicovigilance and develop an automated system that can classify and analyze opioid-related social media posts to detect behavioral patterns and monitor the evolution of public discourse on opioid use.</p><p><strong>Methods: </strong>To investigate evolving social media discourse around opioid use, we collected a large-scale dataset from Reddit spanning 6 years, from January 1, 2018, to December 30, 2023. Using a comprehensive opioid lexicon-including formal drug names, street slang, common misspellings, and abbreviations-we filtered relevant posts for further analysis. A subset of these data was manually annotated according to well-defined annotation guidelines into 4 categories: self-misuse, external misuse, information, and unrelated, with distributions of 37.21%, 27.25%, 27.57%, and 7.97%, respectively. To automate the classification of opioid-related chatter, we developed a robust natural language processing pipeline leveraging classical machine learning algorithms, deep learning models, and transformer-based architecture, and fine-tuned a state-of-the-art large language model (LLM; OpenAI GPT-3.5 Turbo). In the final stage, the trained LLM was deployed on an unlabeled dataset comprising 74,975 additional Reddit chatter posts. This enabled a detailed temporal analysis of opioid-related discussions, aligned with 6 years of opioid-related death records from the Centers for Disease Control and Prevention (CDC). For this study, self-misuse and external misuse were merged into a misuse category for direct comparison with the CDC's mortality data, examining whether trends in social media discourse on opioid misuse reflect patterns in real-world mortality statistics.</p><p><strong>Results: </strong>The fine-tuned GPT-3.5 Turbo model achieved the highest classification accuracy of 0.93, outperforming the baseline (random forest 0.85) by representing a performance improvement of 9.14% over the machine learning model. The temporal analysis of the unlabeled data revealed evolving trends in opioid-related discussions, indicating shifts in user behavior and overdose-related chatter over time. To quantify this relationship, we calculated the Pearson correlation coefficient between misuse-related posts and CDC death records (r=0.854). This correlation was statistically significant (P<.001), indicating a strong positive relationship betwe","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e77279"},"PeriodicalIF":2.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The quality of health information on social media is a major concern, especially during the early stages of public health crises. While the quality of the results of the popular search engines related to particular diseases has been analyzed in the literature, the quality of health-related information on social media, such as X (formerly Twitter), during the early stages of a public health crisis has not been addressed.
Objective: This study aims to evaluate the quality of health-related information on social media during the early stages of a public health crisis.
Methods: A cross-sectional analysis was conducted on health-related tweets in the early stages of the most recent public health crisis (the COVID-19 pandemic). The study analyzed the top 100 websites that were most frequently retweeted in the early stages of the crisis, categorizing them by content type, website affiliation, and exclusivity. Quality and reliability were assessed using the DISCERN and JAMA (Journal of the American Medical Association) benchmarks.
Results: Our analyses showed that 95% (95/100) of the websites met only 2 of the 4 JAMA quality criteria. DISCERN scores revealed that 81% (81/100) of the websites were evaluated as low scores, and only 11% (11/100) of the websites were evaluated as high scores. The analysis revealed significant disparities in the quality and reliability of health information across different website affiliations, content types, and exclusivity.
Conclusions: This study highlights a significant issue with the quality, reliability, and transparency of online health-related information during a public health challenge. The extensive shortcomings observed across frequently shared websites on Twitter highlight the critical need for continuous evaluation and improvement of online health content during the early stages of future health crises. Without consistent oversight and improvement, we risk repeating the same shortcomings in future, potentially more challenging situations.
{"title":"Quality Assessment of Health Information on Social Media During a Public Health Crisis: Infodemiology Study.","authors":"Rozita Haghighi, Mohsen Farhadloo","doi":"10.2196/70756","DOIUrl":"10.2196/70756","url":null,"abstract":"<p><strong>Background: </strong>The quality of health information on social media is a major concern, especially during the early stages of public health crises. While the quality of the results of the popular search engines related to particular diseases has been analyzed in the literature, the quality of health-related information on social media, such as X (formerly Twitter), during the early stages of a public health crisis has not been addressed.</p><p><strong>Objective: </strong>This study aims to evaluate the quality of health-related information on social media during the early stages of a public health crisis.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted on health-related tweets in the early stages of the most recent public health crisis (the COVID-19 pandemic). The study analyzed the top 100 websites that were most frequently retweeted in the early stages of the crisis, categorizing them by content type, website affiliation, and exclusivity. Quality and reliability were assessed using the DISCERN and JAMA (Journal of the American Medical Association) benchmarks.</p><p><strong>Results: </strong>Our analyses showed that 95% (95/100) of the websites met only 2 of the 4 JAMA quality criteria. DISCERN scores revealed that 81% (81/100) of the websites were evaluated as low scores, and only 11% (11/100) of the websites were evaluated as high scores. The analysis revealed significant disparities in the quality and reliability of health information across different website affiliations, content types, and exclusivity.</p><p><strong>Conclusions: </strong>This study highlights a significant issue with the quality, reliability, and transparency of online health-related information during a public health challenge. The extensive shortcomings observed across frequently shared websites on Twitter highlight the critical need for continuous evaluation and improvement of online health content during the early stages of future health crises. Without consistent oversight and improvement, we risk repeating the same shortcomings in future, potentially more challenging situations.</p>","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e70756"},"PeriodicalIF":2.3,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12551971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Youlian Zhou, Liang Yang, Li Luo, Lianghai Cao, Jun Qiu
{"title":"Correction: Quality Assessment of Videos About Dengue Fever on Douyin: Cross-Sectional Study.","authors":"Youlian Zhou, Liang Yang, Li Luo, Lianghai Cao, Jun Qiu","doi":"10.2196/85305","DOIUrl":"10.2196/85305","url":null,"abstract":"","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e85305"},"PeriodicalIF":2.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Agnes Huguet-Feixa, Wasim Ahmed, Eva Artigues-Barberà, Joaquim Sol, Pere Godoy, Marta Ortega Bravo
Background: The analysis of social networks should be considered by institutions and governments alongside surveys and other conventional methods for assessing public attitudes toward vaccines. X (formerly known as Twitter) has emerged as a significant source for studying vaccine hesitancy.
Objective: The aim of the study is to examine the main arguments and narratives in favor and against vaccination expressed in Spanish- and Catalan-language posts, comments, and opinions on the social media platform X.
Methods: Spanish and Catalan posts were collected from X using NodeXL Pro between March and December 2021, resulting in 479,734 posts. For qualitative analysis, a random subsample of 384 tweets was selected using Cochran's formula (95% confidence and ±5% margin of error). A bespoke code frame was developed in collaboration with medical and social media experts, and posts were translated into English. Intercoder reliability, assessed on 20% of the sample, yielded 93.4% agreement and a Cohen κ of 0.92.
Results: A total of 479,734 posts were retrieved from 29,706 users. After an inductive review of the data, six themes were identified, which formed the basis of our code frame: (theme 1) vaccine acquisition and distribution, (theme 2) vaccine skepticism and criticism, (theme 3) provaccination stance, (theme 4) global COVID-19 situation, (theme 5) vaccine politics and international relations, and (theme 6) miscellaneous news and posts. Vaccine skepticism and criticism was the most frequent theme (93/384, 24.2%), whereas vaccine politics and international relations was the least (25/384, 6.5%). We observed that while some posts supported vaccination, others expressed concerns about vaccine safety and efficacy, promoted conspiracy theories, disseminated misinformation, or opposed scientific consensus. Challenges related to vaccine acquisition and distribution within specific countries were also identified, along with political and economic factors, such as the politicization of vaccines, which hindered equitable distribution between vaccine-producing and vaccine-needing countries. Additionally, the pandemic's social impact fostered community support initiatives and solidarity.
Conclusions: Our findings can inform measures to promote vaccine acceptance and reinforce trust in health care systems, professionals, and scientific perspectives, thereby improving vaccination coverage. These insights may serve as a foundation for developing sociopolitical strategies to enhance vaccination management and address future pandemics or new vaccination campaigns.
{"title":"Vaccination Conversations on X in Spanish and Catalan: Qualitative Content Analysis.","authors":"Agnes Huguet-Feixa, Wasim Ahmed, Eva Artigues-Barberà, Joaquim Sol, Pere Godoy, Marta Ortega Bravo","doi":"10.2196/67942","DOIUrl":"10.2196/67942","url":null,"abstract":"<p><strong>Background: </strong>The analysis of social networks should be considered by institutions and governments alongside surveys and other conventional methods for assessing public attitudes toward vaccines. X (formerly known as Twitter) has emerged as a significant source for studying vaccine hesitancy.</p><p><strong>Objective: </strong>The aim of the study is to examine the main arguments and narratives in favor and against vaccination expressed in Spanish- and Catalan-language posts, comments, and opinions on the social media platform X.</p><p><strong>Methods: </strong>Spanish and Catalan posts were collected from X using NodeXL Pro between March and December 2021, resulting in 479,734 posts. For qualitative analysis, a random subsample of 384 tweets was selected using Cochran's formula (95% confidence and ±5% margin of error). A bespoke code frame was developed in collaboration with medical and social media experts, and posts were translated into English. Intercoder reliability, assessed on 20% of the sample, yielded 93.4% agreement and a Cohen κ of 0.92.</p><p><strong>Results: </strong>A total of 479,734 posts were retrieved from 29,706 users. After an inductive review of the data, six themes were identified, which formed the basis of our code frame: (theme 1) vaccine acquisition and distribution, (theme 2) vaccine skepticism and criticism, (theme 3) provaccination stance, (theme 4) global COVID-19 situation, (theme 5) vaccine politics and international relations, and (theme 6) miscellaneous news and posts. Vaccine skepticism and criticism was the most frequent theme (93/384, 24.2%), whereas vaccine politics and international relations was the least (25/384, 6.5%). We observed that while some posts supported vaccination, others expressed concerns about vaccine safety and efficacy, promoted conspiracy theories, disseminated misinformation, or opposed scientific consensus. Challenges related to vaccine acquisition and distribution within specific countries were also identified, along with political and economic factors, such as the politicization of vaccines, which hindered equitable distribution between vaccine-producing and vaccine-needing countries. Additionally, the pandemic's social impact fostered community support initiatives and solidarity.</p><p><strong>Conclusions: </strong>Our findings can inform measures to promote vaccine acceptance and reinforce trust in health care systems, professionals, and scientific perspectives, thereby improving vaccination coverage. These insights may serve as a foundation for developing sociopolitical strategies to enhance vaccination management and address future pandemics or new vaccination campaigns.</p>","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e67942"},"PeriodicalIF":2.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12569495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Hand, foot, and mouth disease (HFMD) is a global health concern requiring a risk assessment framework based on systematic factors analysis for prevention and control.
Objective: This study aims to construct a comprehensive HFMD risk assessment framework by integrating multisource data, including historical incidence information, environmental parameters, and web-based search behavior data, to improve predictive performance.
Methods: We integrated multisource data (HFMD cases, meteorology, air pollution, Baidu Index, and public health measures) from Bao'an District of Shenzhen city in Southern China (2014-2023). Correlation analysis was used to assess the associations between HFMD incidence and systematic factors. The impacts of environmental factors were analyzed using the Distributed Lag Nonlinear Model. Seasonal Autoregressive Integrated Moving Average model and advanced machine learning methods were used to predict HFMD 1-4 weeks ahead. Risk levels for the 1- to 4-week-ahead forecasts were determined by comparing the predicted weekly incidence against predefined thresholds.
Results: From 2014 to 2023, Bao'an District reported a total of 118,826 cases of HFMD. Environmental and search behavior factors (excluding sulfur dioxide) were significantly associated with HFMD incidence in nonlinear patterns. For 1-week-ahead prediction, Seasonal Autoregressive Integrated Moving Average using case data alone performed best (R²=0.95, r=0.98, mean absolute error=53.34, and root-mean-square error=99.31). For 2- to 4-week-ahead forecasting, machine learning models incorporating web-based and environmental data showed superior performance (R²=0.83, 0.75, and 0.64; r=0.92, 0.87, and 0.80; mean absolute error=87.84, 112.41, and 132.47; and root-mean-square error=185.08, 229.13, and 276.81). The predicted HFMD risk levels matched the observed levels with accuracies of 96%, 87%, 88%, and 83%, respectively.
Conclusions: The epidemic dynamics of HFMD are influenced by multiple factors in a nonlinear manner. Integrating multisource data, particularly web-based search behavior, significantly enhances the accuracy of short- and midterm forecasts and risk assessment. This approach offers practical insights for developing digital surveillance and early warning systems in public health.
{"title":"Hand, Foot, and Mouth Disease Risk Prediction in Southern China: Time Series Study Integrating Web-Based Search and Epidemiological Surveillance Data.","authors":"Yixiong Chen, Xue Zhang, Sheng Zhang, Wenjie Han, Ziqi Wang, Jian Chen, Jinfeng Liu, Jingru Feng, Jiayi Shi, Haoyu Long, Zicheng Cao, Jie Zhang, Yuan Li, Xiangjun Du, Xindong Zhang, Meng Ren","doi":"10.2196/75434","DOIUrl":"10.2196/75434","url":null,"abstract":"<p><strong>Background: </strong>Hand, foot, and mouth disease (HFMD) is a global health concern requiring a risk assessment framework based on systematic factors analysis for prevention and control.</p><p><strong>Objective: </strong>This study aims to construct a comprehensive HFMD risk assessment framework by integrating multisource data, including historical incidence information, environmental parameters, and web-based search behavior data, to improve predictive performance.</p><p><strong>Methods: </strong>We integrated multisource data (HFMD cases, meteorology, air pollution, Baidu Index, and public health measures) from Bao'an District of Shenzhen city in Southern China (2014-2023). Correlation analysis was used to assess the associations between HFMD incidence and systematic factors. The impacts of environmental factors were analyzed using the Distributed Lag Nonlinear Model. Seasonal Autoregressive Integrated Moving Average model and advanced machine learning methods were used to predict HFMD 1-4 weeks ahead. Risk levels for the 1- to 4-week-ahead forecasts were determined by comparing the predicted weekly incidence against predefined thresholds.</p><p><strong>Results: </strong>From 2014 to 2023, Bao'an District reported a total of 118,826 cases of HFMD. Environmental and search behavior factors (excluding sulfur dioxide) were significantly associated with HFMD incidence in nonlinear patterns. For 1-week-ahead prediction, Seasonal Autoregressive Integrated Moving Average using case data alone performed best (R²=0.95, r=0.98, mean absolute error=53.34, and root-mean-square error=99.31). For 2- to 4-week-ahead forecasting, machine learning models incorporating web-based and environmental data showed superior performance (R²=0.83, 0.75, and 0.64; r=0.92, 0.87, and 0.80; mean absolute error=87.84, 112.41, and 132.47; and root-mean-square error=185.08, 229.13, and 276.81). The predicted HFMD risk levels matched the observed levels with accuracies of 96%, 87%, 88%, and 83%, respectively.</p><p><strong>Conclusions: </strong>The epidemic dynamics of HFMD are influenced by multiple factors in a nonlinear manner. Integrating multisource data, particularly web-based search behavior, significantly enhances the accuracy of short- and midterm forecasts and risk assessment. This approach offers practical insights for developing digital surveillance and early warning systems in public health.</p>","PeriodicalId":73554,"journal":{"name":"JMIR infodemiology","volume":"5 ","pages":"e75434"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}