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Social Media Use in Chronic Disease: A Systematic Review and Novel Taxonomy

      Abstract

      Purpose

      The purpose of this study is to evaluate clinical outcomes from applications of contemporary social media in chronic disease; to develop a conceptual taxonomy to categorize, summarize, and then analyze the current evidence base; and to suggest a framework for future studies on this topic.

      Methods

      We performed a systematic review of MEDLINE via PubMed (January 2000 to January 2015) of studies reporting clinical outcomes on leading contemporary social media (ie, Facebook, Twitter, Wikipedia, YouTube) use in 10 chronic diseases. Two reviewers independently performed data extraction and quality assessment; characterization of study outcomes as positive, negative, neutral, or undefined impact; and inductive, thematic analysis to develop our taxonomy.

      Results

      Of 378 citations identified, 42 studies examining the use of Facebook (n = 16), blogs (n = 13), Twitter (n = 8), wikis (n = 5), and YouTube (n = 4) on outcomes in cancer (n = 14), depression (n = 13), obesity (n = 9), diabetes (n = 4), heart disease (n = 3), stroke (n = 2), and chronic lower respiratory tract infection (n = 1) were included. Studies were classified as support (n = 16), patient education (n = 10), disease modification (n = 6), disease management (n = 5), and diagnosis (n = 5) within our taxonomy. The overall impact of social media on chronic disease was variable, with 48% of studies indicating benefit, 45% neutral or undefined, and 7% suggesting harm. Among studies that showed benefit, 85% used either Facebook or blogs, and 40% were based within the domain of support.

      Conclusions

      Using social media to provide social, emotional, or experiential support in chronic disease, especially with Facebook and blogs, appears most likely to improve patient care.

      Keywords

      Clinical Significance
      • Use of contemporary social media technology in chronic disease care can be categorized as: support, education, disease modification, disease diagnosis, or disease management.
      • Based on the current literature, contemporary social media is most likely to improve chronic disease care when used to provide social, emotional, or experiential support.
      • Few studies suggest any harm from the use of contemporary social media technology in chronic disease care.
      With well over 70% of all Internet users using some form of this technology, social media has become ubiquitous in America.

      Duggan M, Smith A. Social Media Update 2013. Pew Research Center; 2013. Available at: http://pewinternet.org/Reports/2013/Social-Media-Update.aspx. Accessed April 30, 2014.

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      The Social Life of Health Information, 2011.
      Such proliferation has provided patients a ne medium through which to exchange health-related information in innovative ways.
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      Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care.
      • Fox S.
      • Duggan M.
      Health Online 2013.
      Consequently, social media has become increasingly prominent in health and health care; in a recent survey, 23% of social media users reported following a friend's personal health updates, 15% sought health information on the Web, 11% posted about health-related matters, and 9% joined health-related groups.
      • Fox S.
      The Social Life of Health Information, 2011.
      These novel avenues of information acquisition and exchange have important implications for health and disease management. Rapid diffusion, low cost, and broad availability of social media make it an attractive platform for managing care, communication, and interventions in chronic disease. Yet, objective data to guide clinicians on how best to exchange information, measure progress, and intervene using social media is lacking. Existing narrative reviews on this topic highlight the complexity of evaluating this area of literature.
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      • Gray K.
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      Health outcomes and related effects of using social media in chronic disease management: a literature review and analysis of affordances.
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      Social media: a review and tutorial of applications in medicine and health care.
      In addition, many such articles primarily have reviewed the predecessors of contemporary social media such as forums, bulletin/message boards, and chatrooms.
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      The role of social media in online weight management: systematic review.
      In order to fully harness its promise, better understanding of the use and outcomes related to contemporary social media in chronic disease is needed.
      • Merolli M.
      • Gray K.
      • Martin-Sanchez F.
      Health outcomes and related effects of using social media in chronic disease management: a literature review and analysis of affordances.
      • Grajales F.J.
      • Sheps S.
      • Ho K.
      • Novak-Lauscher H.
      • Eysenbach G.
      Social media: a review and tutorial of applications in medicine and health care.
      To address these gaps, we performed a systematic review of the literature and developed a taxonomy of contemporary social media use in highly morbid, common chronic diseases. Next, we assessed the impact of social media by taxonomy category. In doing so, we sought to develop a conceptual schema that would offer clinical insights into how best to use social media, while also creating a blueprint for future studies on this topic.

      Methods

      We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations when performing this systematic review.
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      • Liberati A.
      • Tetzlaff J.
      • Altman D.G.
      Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
      Contemporary social media sites were selected based on well-established definitions and global Web traffic rankings.
      • Kaplan A.M.
      • Haenlein M.
      Users of the world, unite! The challenges and opportunities of Social Media.

      eBizMBA Inc. Top 15 most popular social networking sites. eBizMBA.com; 2013. Available at: http://www.ebizmba.com/articles/social-networking-websites. Accessed December 12, 2013. Green Island, New York

      We selected chronic diseases listed on the Centers for Disease Control Leading Causes of Death list including heart disease (eg, hypertension, heart failure, coronary artery disease, valvular disease, and cardiac arrhythmias); cancer; chronic lower respiratory tract infection (CLRTI); stroke; Alzheimer's disease; and diabetes mellitus (see Appendix, online).

      National Center for Health Statistics. FastStats: leading causes of death. CDC.gov; 2013. Available at: http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Accessed December 12, 2013. Atlanta, GA

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      • Xu J.
      Deaths: preliminary data for 2011.
      Depression was included as it is an antecedent condition to intentional self-harm (suicide); while obesity was included due to its established pathophysiologic association with many of the aforementioned diseases.
      • Williams G.
      • Hamm M.P.
      • Shulhan J.
      • Vandermeer B.
      • Hartling L.
      Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials.
      • Chang T.
      • Chopra V.
      • Zhang C.
      • Woolford S.J.
      The role of social media in online weight management: systematic review.

      Data Sources and Searches

      With the assistance of a medical research librarian, we performed serial electronic literature searches of MEDLINE via PubMed for English-language studies published between January 2000 and January 2015. Search strings were constructed using Boolean operators, combining comprehensive terms for contemporary social media with terms for the diseases of interest (Appendix). Controlled vocabularies (ie, MeSH terms) and manual searches using relevant Cochrane reviews identified synonyms for all diseases of interest.
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      Alprazolam for depression.
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      Acupuncture for depression.
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      Cinnamon for diabetes mellitus.
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      Additional studies also were identified by hand searches of bibliographies. No journal, study design, or subject filters were placed on the search; however, conference proceedings and abstracts were excluded. The search was last updated on January 3, 2015.

      Study Selection

      Two authors (RP and TC) independently assessed study eligibility; any difference of opinion was adjudicated by a third author (VC). Studies were included if they: involved adults >18 years of age; represented primary investigations of contemporary social media technology; and reported outcomes regarding the effect of social media use in a chronic disease of interest. We excluded studies that: were not original research (eg, discussions, editorials); did not study the chronic diseases of interest; did not report clinical outcomes (eg, educational, research, or public policy); or described patterns of social media use rather than impact on a chronic disease state.

      Data Extraction and Quality Assessment

      Three authors (RP, TC, and VC) independently abstracted data from all included studies to a template adapted from the Cochrane Collaboration.
      For all studies, we extracted the following variables: study design, objectives, geographic location, setting, inclusion criteria, method of participant selection, sample size, participant age, study procedure, social media technology, chronic disease, primary outcomes, and secondary outcomes. In addition, for each study, reviewers independently assessed and categorized the impact of social media on the chronic disease of interest. We categorized studies as positive impact if social media use or content was reported by the authors as being beneficial in the chronic disease of interest; conversely, outcomes that suggested social media use was harmful were categorized as negative impact. Impact was classified as undefined if a study reported both positive and negative outcomes, or the overall benefits or harm of social media were unclear. The term “neutral” was used for studies when no change or difference in outcomes was reported. Abstraction accuracy and agreement regarding impact of social media on the chronic disease state was evaluated in triplicate (RP, TC, and VC). Inter-rater agreement of abstraction accuracy and impact of social media on disease states were assessed using Cohen's κ statistic. Study authors were contacted for additional data when needed.
      Two authors (RP, VC) independently assessed study quality. Included studies were divided into quantitative or qualitative studies. We appraised risk of bias in quantitative studies using the Downs and Black tool as recommended by the Cochrane Collaboration.
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      Evaluating non-randomised intervention studies.
      The Downs and Black tool allows calculation of an overall score (max points = 28) for methodological quality in randomized and nonrandomized studies by asking 27 questions in 4 categories (reporting points = 11, external validity points = 3, internal validity – bias points = 7, and internal validity – confounding points = 6). Questions that we were unable to answer or did not apply received 0 points. Risk of bias for qualitative studies was determined by the Critical Appraisal Skills Program (CASP) tool, also recommended by the Cochrane Collaboration.

      Critical Appraisal Skills Programme (CASP). Critical Appraisal Skills Programme qualitative research checklist. 2013. Available at: http://media.wix.com/ugd/dded87_951541699e9edc71ce66c9bac4734c69.pdf. Accessed December 12, 2013.

      • Hannes K.
      Chapter 4: Critical appraisal of qualitative research.
      CASP asks 10 simple (“yes,” “no,” or “can't tell”) questions about study goals, methodology, bias, ethics, data analysis, and result reporting. We scored each study on a 10-point scale, considering studies with 1-4 points low quality, 4-7 points moderate quality, and 7-10 points as high quality. If a study contained quantitative and qualitative approaches, it was categorized as a mixed-methods study and was evaluated using both tools.

      Data Synthesis and Analysis

      Definition of Terms and Outcomes

      Social media encompasses a swath of technology that extends beyond specific Web sites or mobile applications.
      • Kaplan A.M.
      • Haenlein M.
      Users of the world, unite! The challenges and opportunities of Social Media.
      To operationalize our review, we used an existing classification of social media that includes 5 main categories: collaborative projects, blogs, content communities, social networking sites, and virtual worlds.
      • Kaplan A.M.
      • Haenlein M.
      Users of the world, unite! The challenges and opportunities of Social Media.
      Some blogs were further specified as microblogs (eg, Twitter) in which individual and aggregated posts are smaller than a traditional blog.
      • Wikipedia Contributors
      Microblogging.
      Based on global Web traffic rankings, we included Facebook, Twitter, Wikipedia, YouTube, Instagram, Pinterest, Google+, Flickr, Myspace, LiveJournal, LinkedIn, Orkut, WordPress, Photobucket, Tumblr, plus the terms “blogs” and “wikis” in our definition.

      eBizMBA Inc. Top 15 most popular social networking sites. eBizMBA.com; 2013. Available at: http://www.ebizmba.com/articles/social-networking-websites. Accessed December 12, 2013. Green Island, New York

      Forums, bulletin/message boards, and chatrooms were excluded, as these technologies evolved from the bulletin board system of the 1970s and are precursors to, not examples of, contemporary social media.
      • Kaplan A.M.
      • Haenlein M.
      Users of the world, unite! The challenges and opportunities of Social Media.
      • Wikipedia Contributors
      Internet forum.
      • Wikipedia Contributors
      Bulletin board system.
      Given the clinical and methodological heterogeneity of included studies, outcomes were defined as any quantitative or qualitative measure related to the medical well-being of patients.

      Taxonomy Development

      To better describe, classify, and analyze the current literature, we used inductive thematic analysis to develop a taxonomy for social media use in chronic diseases.
      • Guest G.
      • MacQueen K.
      • Namey E.
      Applied Thematic Analysis.
      All included studies were categorized according to this taxonomy. The taxonomy was developed as follows: as the authors (RP, VC, TC) performed full text review on articles to confirm eligibility, a list of short codes to answer the subjective question, “What was the overarching role of social media in the chronic disease state studied?” were generated. Authors independently reviewed their lists to eliminate redundancy and then reviewed all of the short codes as a group using an iterative process to search for common themes or divergent ideas. Ultimately, the themes identified by the authors were collapsed into the final categories of the taxonomy, which included: support, education, disease modification, diagnosis, and disease management. The support category comprised social, emotional, and experiential support of patients and families. The education category encompassed quality assessment of existing patient education content on social media sites, novel social media-based educational tools, and comparisons of social media-based vs traditional (eg, classroom or small group) learning. The disease modification category included all interventions (ie, clinical trials) using social media-based tools. The diagnosis category included formal diagnosis of disease as well as identification of patients at risk for developing chronic illness. Disease management articles explored medical decision-making and care of acute-on-chronic disease exacerbations.

      Statistical Analysis

      Given substantial heterogeneity within the included studies, formal meta-analyses were not attempted.

      Results

      Our initial search returned 378 articles, of which 247 were excluded at the title or abstract level. A full-text review was thus performed on 131 articles, of which 42 met inclusion criteria (Figure 1).
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      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
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      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
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      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
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      New mothers and media use: associations between blogging, social networking, and maternal well-being.
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      • Chung D.S.
      Characteristics of cancer blog users.
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Himelboim I.
      • Han J.Y.
      Cancer talk on Twitter: community structure and information sources in breast and prostate cancer social networks.
      • Rajagopalan M.S.
      • Khanna V.K.
      • Leiter Y.
      • et al.
      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
      • Leithner A.
      • Maurer-Ertl W.
      • Glehr M.
      • Friesenbichler J.
      • Leithner K.
      • Windhager R.
      Wikipedia and osteosarcoma: a trustworthy patients' information?.
      • Steinberg P.L.
      • Wason S.
      • Stern J.M.
      • Deters L.
      • Kowal B.
      • Seigne J.
      YouTube as source of prostate cancer information.
      • Clerici C.A.
      • Veneroni L.
      • Bisogno G.
      • Trapuzzano A.
      • Ferrari A.
      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
      • Tan M.L.H.
      • Kok K.
      • Ganesh V.
      • Thomas S.S.
      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
      • McDaniel B.T.
      • Coyne S.M.
      • Holmes E.K.
      New mothers and media use: associations between blogging, social networking, and maternal well-being.
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Moreno M.A.
      • Jelenchick L.A.
      • Egan K.G.
      • et al.
      Feeling bad on Facebook: depression disclosures by college students on a social networking site.
      • Moreno M.A.
      • Christakis D.A.
      • Egan K.G.
      • et al.
      A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      • Reavley N.J.
      • Mackinnon A.J.
      • Morgan A.J.
      • et al.
      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
      • Gruzd A.
      • Black F.A.
      • Le T.N.Y.
      • Amos K.
      Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c).
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      • Kim C.
      • Kang B.S.
      • Choi H.J.
      • et al.
      Nationwide online social networking for cardiovascular care in Korea using Facebook.
      • Kupferberg N.
      • Protus B.M.
      Accuracy and completeness of drug information in Wikipedia: an assessment.
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Turner-McGrievy G.
      • Tate D.
      Tweets, apps, and pods: results of the 6-month mobile pounds off digitally (Mobile POD) randomized weight-loss intervention among adults.
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Yu C.H.
      • Parsons J.A.
      • Mamdani M.
      • et al.
      A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      • Reavley N.J.
      • Pilkington P.D.
      Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      12 reported qualitative outcomes,
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      • Dickins M.
      • Thomas S.L.
      • King B.
      • Lewis S.
      • Holland K.
      The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      • Takao H.
      • Murayama Y.
      • Ishibashi T.
      • Karagiozov K.L.
      • Abe T.
      A new support system using a mobile device (smartphone) for diagnostic image display and treatment of stroke.
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      • Kim B.
      • Gillham D.
      Gender differences among young adult cancer patients.
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      and 3 were mixed-methods studies
      • Whitehill J.M.
      • Brockman L.N.
      • Moreno M.A.
      “Just talk to me”: communicating with college students about depression disclosures on Facebook.
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      (Table 1). Thirty-nine articles focused on a single chronic disease and social media technology,
      • Kim S.
      • Chung D.S.
      Characteristics of cancer blog users.
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Himelboim I.
      • Han J.Y.
      Cancer talk on Twitter: community structure and information sources in breast and prostate cancer social networks.
      • Rajagopalan M.S.
      • Khanna V.K.
      • Leiter Y.
      • et al.
      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
      • Leithner A.
      • Maurer-Ertl W.
      • Glehr M.
      • Friesenbichler J.
      • Leithner K.
      • Windhager R.
      Wikipedia and osteosarcoma: a trustworthy patients' information?.
      • Steinberg P.L.
      • Wason S.
      • Stern J.M.
      • Deters L.
      • Kowal B.
      • Seigne J.
      YouTube as source of prostate cancer information.
      • Clerici C.A.
      • Veneroni L.
      • Bisogno G.
      • Trapuzzano A.
      • Ferrari A.
      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
      • Tan M.L.H.
      • Kok K.
      • Ganesh V.
      • Thomas S.S.
      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
      • McDaniel B.T.
      • Coyne S.M.
      • Holmes E.K.
      New mothers and media use: associations between blogging, social networking, and maternal well-being.
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Moreno M.A.
      • Jelenchick L.A.
      • Egan K.G.
      • et al.
      Feeling bad on Facebook: depression disclosures by college students on a social networking site.
      • Moreno M.A.
      • Christakis D.A.
      • Egan K.G.
      • et al.
      A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
      • Reavley N.J.
      • Mackinnon A.J.
      • Morgan A.J.
      • et al.
      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
      • Gruzd A.
      • Black F.A.
      • Le T.N.Y.
      • Amos K.
      Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c).
      • Kim C.
      • Kang B.S.
      • Choi H.J.
      • et al.
      Nationwide online social networking for cardiovascular care in Korea using Facebook.
      • Kupferberg N.
      • Protus B.M.
      Accuracy and completeness of drug information in Wikipedia: an assessment.
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Turner-McGrievy G.
      • Tate D.
      Tweets, apps, and pods: results of the 6-month mobile pounds off digitally (Mobile POD) randomized weight-loss intervention among adults.
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      • Dickins M.
      • Thomas S.L.
      • King B.
      • Lewis S.
      • Holland K.
      The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      • Takao H.
      • Murayama Y.
      • Ishibashi T.
      • Karagiozov K.L.
      • Abe T.
      A new support system using a mobile device (smartphone) for diagnostic image display and treatment of stroke.
      • Whitehill J.M.
      • Brockman L.N.
      • Moreno M.A.
      “Just talk to me”: communicating with college students about depression disclosures on Facebook.
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Yu C.H.
      • Parsons J.A.
      • Mamdani M.
      • et al.
      A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      • Kim B.
      • Gillham D.
      Gender differences among young adult cancer patients.
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      • Reavley N.J.
      • Pilkington P.D.
      Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      while 1 article reviewed 5 chronic diseases,
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      and 2 articles reviewed multiple social media technologies.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      Inter-rater reliability for study abstraction and study quality adjudication were excellent (Cohen's κ = 0.88 and 0.85, respectively).
      Table 1Characteristics of Included Studies
      Author (Year)Social Media TechnologyTaxonomy CategoryDisease State StudiedClinical PurposeStudy DesignSample Size and DescriptionMethods SummarySocial Media Effect
      Quantitative Studies
       Afsar (2013)
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      Facebook and TwitterSupportDepressionInvestigate relationship between Facebook/Twitter use and multiple clinical parameters including Beck Depression InventoryCohort134 patients with ESRD recruited from a dialysis unitUnivariate/multivariate analysis of clinical history, examination, laboratory, and survey dataUndefined
       Clerici et al (2012)
      • Clerici C.A.
      • Veneroni L.
      • Bisogno G.
      • Trapuzzano A.
      • Ferrari A.
      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
      YouTubeSupportCancerExplore YouTube content relating to rhabdomyosarcoma and soft-tissue sarcomaCross-sectional134 videos selected from YouTubeContent review and quality evaluationUndefined
       Gruzd et al (2012)
      • Gruzd A.
      • Black F.A.
      • Le T.N.Y.
      • Amos K.
      Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c).
      BlogsEducationDiabetesExplore scientific literature citations in blogs on diabetesCohort3005 blogs selected from Google Blog Search, IceRocket, and TechnoratiSocial network and content analysisUndefined
       Hasty et al (2014)
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      WikipediaEducationDiabetes, heart disease, cancer, depression, CLRTICompare accuracy of Wikipedia entries to peer-reviewed sources on multiple chronic diseasesCross-sectional10 entries selected from WikipediaContent review and quality evaluationNegative
       Himelboim & Han (2014)
      • Himelboim I.
      • Han J.Y.
      Cancer talk on Twitter: community structure and information sources in breast and prostate cancer social networks.
      TwitterSupportCancerExplore Twitter use for support needs in breast and prostate cancerCross-sectional1000 Twitter users selected daily for 7 daysSocial network analysisUndefined
       Kim et al (2014)
      • Kim C.
      • Kang B.S.
      • Choi H.J.
      • et al.
      Nationwide online social networking for cardiovascular care in Korea using Facebook.
      FacebookManagementHeart diseaseExplore Facebook use by Emergency physicians in cardiovascular careCross-sectional298 users selected from a Facebook group in KoreaContent analysis of posts and reliability evaluation via user surveysPositive
       Kim & Chung (2007)
      • Kim S.
      • Chung D.S.
      Characteristics of cancer blog users.
      BlogsEducationCancerInvestigate blog impact in cancerCohort113 bloggers recruited from Google Blog SearchCluster analysis to evaluate use and perception of blogsNeutral
       Kupferberg & Protus (2011)
      • Kupferberg N.
      • Protus B.M.
      Accuracy and completeness of drug information in Wikipedia: an assessment.
      WikipediaEducationHeart diseaseInvestigate accuracy, comprehensiveness, and reliability of Wikipedia entries on statinsCross-sectional5 entries selected from WikipediaContent review and quality evaluationUndefined
       Leithner et al (2010)
      • Leithner A.
      • Maurer-Ertl W.
      • Glehr M.
      • Friesenbichler J.
      • Leithner K.
      • Windhager R.
      Wikipedia and osteosarcoma: a trustworthy patients' information?.
      WikipediaEducationCancerCompare accuracy and comprehensiveness of Wikipedia entries to other online information sources on osteosarcomaCross-sectional1 entry selected from WikipediaContent review and quality evaluationUndefined
       McDaniel et al (2012)
      • McDaniel B.T.
      • Coyne S.M.
      • Holmes E.K.
      New mothers and media use: associations between blogging, social networking, and maternal well-being.
      BlogsSupportDepressionInvestigate relationship between blog use and multiple maternal outcomes including social support and depressionCohort157 new mothers recruited from hospitals/clinicsStructural equation modeling and bivariate analysis to test proposed theoretical model for correlation between predictor and outcome variablesUndefined
       Moreno et al (2011)
      • Moreno M.A.
      • Jelenchick L.A.
      • Egan K.G.
      • et al.
      Feeling bad on Facebook: depression disclosures by college students on a social networking site.
      FacebookDiagnosisDepressionInvestigate prevalence and diagnostic validity of references to depression on FacebookCross-sectional200 profiles selected from FacebookScreening of Facebook profiles for DSM-IV major depressive episode criteriaUndefined
       Moreno et al (2012)
      • Moreno M.A.
      • Christakis D.A.
      • Egan K.G.
      • et al.
      A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
      FacebookDiagnosisDepressionInvestigate diagnostic validity of references to depression on FacebookCross-sectional224 undergraduates recruited from 2 large universitiesScreening of Facebook profiles for DSM-IV major depressive episode criteria with logistic regression to determine association with PHQ-9 scores via online surveyUndefined
       Napolitano et al (2013)
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      FacebookDisease modificationObesityEvaluate a Facebook-based weight-loss interventionRandomized controlled trial52 undergraduates from a large university3 arms: 1) private Facebook group with access to podcasts, handouts, polls, and local diet/exercise activities vs 2) private Facebook group plus texts and personalized feedback vs 3) usual carePositive
       Park et al (2013)
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      FacebookDiagnosisDepressionEvaluate a Facebook-based application to identify depression symptomsCohort55 undergraduates recruited from a large universityUnivariate analysis of data from Facebook-based mobile application used to survey depression symptoms and gather demographics and social activityPositive
       Mota Pereira (2014)
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      FacebookDisease modificationDepressionEvaluate a Facebook support group plus assigned psychiatrist Facebook friend to enhance antidepressant therapy in treatment-resistant depressionRandomized controlled trial57 patients with treatment-resistant depression recruited from a clinic3 arms: 1) private, self-help Facebook group vs 2) private, self-help Facebook group plus assigned psychiatrist Facebook friend vs 3) usual carePositive
       Rajagopalan et al (2011)
      • Rajagopalan M.S.
      • Khanna V.K.
      • Leiter Y.
      • et al.
      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
      WikipediaEducationCancerCompare accuracy and comprehensiveness of Wikipedia to National Cancer Institute patient-oriented Physician Data Query (PDQ) entries in 10 cancer typesCross-sectional10 entries selected from WikipediaContent review and quality evaluationNeutral
       Reavley et al (2012)
      • Reavley N.J.
      • Mackinnon A.J.
      • Morgan A.J.
      • et al.
      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
      WikipediaEducationDepressionCompare accuracy and comprehensiveness of Wikipedia entries to an encyclopedia and textbook on depressionCross-sectional10 entries selected from WikipediaContent review and quality evaluationUndefined
       Steinberg et al (2010)
      • Steinberg P.L.
      • Wason S.
      • Stern J.M.
      • Deters L.
      • Kowal B.
      • Seigne J.
      YouTube as source of prostate cancer information.
      YouTubeEducationCancerExplore YouTube content for quality and potential bias in prostate cancerCross-sectional51 videos selected from YouTubeContent review and quality evaluationNegative
       Tan et al (2014)
      • Tan M.L.H.
      • Kok K.
      • Ganesh V.
      • Thomas S.S.
      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
      YouTubeEducationCancerExplore YouTube content for quality and comprehensiveness in breast cancer reconstructionDescriptive100 videos selected from YouTubeContent review and quality evaluationUndefined
       Turner-McGrievy & Tate (2011)
      • Turner-McGrievy G.
      • Tate D.
      Tweets, apps, and pods: results of the 6-month mobile pounds off digitally (Mobile POD) randomized weight-loss intervention among adults.
      TwitterDisease modificationObesityEvaluate a Twitter-based weight-loss interventionRandomized controlled trial96 overweight/obese patients recruited from Raleigh/Durham area2 arms: 1) Podcasts plus diet/exercise app and Twitter vs 2) PodcastsNegative
       Valle et al (2013)
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      FacebookDisease modificationCancerEvaluate Facebook-based physical activity interventionRandomized trial86 young adult cancer survivors recruited from a single community2 arms: 1) private Facebook group providing social-cognitive theory interventions vs 2) private, self-help Facebook groupPositive
       Herring et al (2014)
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      FacebookDisease modificationObesityEvaluate a Facebook-based postpartum weight-loss interventionRandomized controlled trial18 disadvantaged, minority postpartum patients with obesity from 2 clinics in Philadelphia, PA2 arms: 1) Phone, text, and Facebook-based behavioral intervention vs 2) usual carePositive
       Modave et al (2014)
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      BlogsEducationObesityCompare the accuracy and comprehensiveness of blogs to other Web sites on weight managementCross-sectional7 blogs selected from GoogleContent review and quality evaluationPositive
       Reavley & Pilkington (2014)
      • Reavley N.J.
      • Pilkington P.D.
      Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.
      TwitterSupportDepressionExplore Twitter content on depression for supportive vs stigmatizing attitudesCross-sectional5907 Tweets selected from 2019 Twitter usersContent and thematic analysisUndefined
       Yu et al (2014)
      • Yu C.H.
      • Parsons J.A.
      • Mamdani M.
      • et al.
      A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
      BlogsDisease modificationDiabetesEvaluate a blog-based diabetes self-management Web siteCohort81 patients with diabetes recruited from 4 clinics in Toronto, CanadaMulti-faceted Web intervention with static content, interactive modules, self-monitoring, and blogsNeutral
       Hwang et al (2014)
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      BlogsSupportObesityInvestigate if blog use is associated with encouragement, information, or shared experience support in an online weight-loss programCross-sectional187 patients recruited from SparklePeople.comStructural equation modeling and regression analysis to test proposed theoretical model for correlation between predictor and outcome variablesPositive
       Wright et al (2013)
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      FacebookSupportDepressionInvestigate the influence of Facebook and face-to-face support networks on depression among college studentsCohort361 undergraduates selected from a large universityStructural equation modeling and bivariate analysis to test proposed theoretical model for correlation between predictor and outcome variablesPositive
      Author (Year)Social Media TechnologyTaxonomy CategoryDisease State StudiedClinical PurposeStudy DesignTotal PatientsMethodsSocial Media Effect
      Qualitative Studies
       Andersson et al (2013)
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      BlogsSupportCancerExplore blogging experiences of family members of cancer patientsCase series12 bloggers with family members who suffered from cancer recruited from the InternetContent analysis of telephone interview transcriptsPositive
       Chiu & Hsieh (2013)
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      BlogsSupportCancerExplore blogging experiences of cancer patientsCase series34 bloggers with family members or who themselves suffered from cancer recruited from the InternetThematic analysis of focus group transcriptsPositive
       Dickins et al (2011)
      • Dickins M.
      • Thomas S.L.
      • King B.
      • Lewis S.
      • Holland K.
      The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.
      BlogsSupportObesityExplore fat-acceptance blogs to determine impact on health, social behaviors, and well-beingCase series44 bloggers recruited from the Fatosphere Real Simple Syndication (RSS) feedThematic analysis of semi-structured interview transcriptsUndefined
       Greene et al (2011)
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.
      FacebookManagementDiabetesExplore Facebook use in diabetesCross-sectional680 wall posts and discussion topics selected from 15 Facebook groupsThematic analysis of Facebook wall posts and discussion boardsPositive
       Leggatt-Cook & Chamberlain (2012)
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      BlogsSupportObesityExplore the nature of discourse and engagement between weight-loss bloggers and readersCase series10 blogs selected from broad, ad hoc Internet searchThematic analysis of blog contentPositive
       Lowney & O'Brien (2012)
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      BlogsSupportCancerUse of a blog in the palliative care of a cancer patientCase report1 patientDescriptivePositive
       Mittal et al (2012)

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      FacebookDiagnosisStrokeUse of Facebook as a diagnostic tool in a stroke patientCase report1 patientDescriptivePositive
       Sugawara et al (2012)
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      TwitterSupportCancerExplore Twitter use in Japanese cancer patientsCross-sectional51 Twitter users selected from JapanSocial network and content analysisPositive
       Ahuja et al (2014)
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      FacebookManagementDepressionUse of Facebook to avert suicide then manage a severely depressed patientCase report1 patientDescriptivePositive
       Kim & Gillham (2015)
      • Kim B.
      • Gillham D.
      Gender differences among young adult cancer patients.
      BlogsSupportCancerExplore if blogs provide a more open support environment than offline environments in cancer patientsCross-sectional160 blogs selected from PlanetCancer.orgContent analysis of blog content with focus on sex differencesUndefined
       Kacvinsky & Moreno (2014)
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      FacebookDiagnosisDepressionExplore the acceptability and value of Facebook friendships to help identify college students at risk for depressionCross-sectional97 undergraduates recruited from a large universityThematic analysis of semi-structured interview and focus group transcriptsPositive
       Takao et al (2012)
      • Takao H.
      • Murayama Y.
      • Ishibashi T.
      • Karagiozov K.L.
      • Abe T.
      A new support system using a mobile device (smartphone) for diagnostic image display and treatment of stroke.
      TwitterManagementStrokeUse of smartphone app with Twitter integration as management tool in a stroke patientCase report1 patientDescriptivePositive
      Mixed-Method Studies
       Chou et al (2014)
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      Facebook, Twitter, YouTube, and blogsSupportObesityExplore the nature of discourse in Facebook, Twitter, YouTube, and blogs on obesityCross-sectional1.3 million social media posts selected from multiple sources (Facebook, Twitter, YouTube, and blogs)Generated descriptive statistics and contextual linguistic bigrams from keywords/posts, followed by discourse analysis on a small selection of paradigmatic data excerptsUndefined
       Pagoto et al (2014)
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      TwitterSupportObesityEvaluate the effect of positive and negative influences from online (Twitter and Facebook) vs offline friends and family during a weight-loss attemptCross-sectional100 Twitter users recruited via TweetsStatistical analysis of participant demographics and Twitter usage during a weight-loss attempt followed by thematic analyses of survey dataPositive
       Whitehill et al (2013)
      • Whitehill J.M.
      • Brockman L.N.
      • Moreno M.A.
      “Just talk to me”: communicating with college students about depression disclosures on Facebook.
      FacebookManagementDepressionIdentify preferred approach to depression references posted on FacebookCohort60 undergraduates selected from a large universityContent analysis of Facebook posts followed by thematic analysis of semi-structured interview transcriptsUndefined
      CLRTI = chronic lower respiratory tract infection; ESRD = end-stage renal disease; PDQ = National Cancer Institute's comprehensive cancer database.
      Of the 42 included articles, 14 focused on cancer,
      • Kim S.
      • Chung D.S.
      Characteristics of cancer blog users.
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Himelboim I.
      • Han J.Y.
      Cancer talk on Twitter: community structure and information sources in breast and prostate cancer social networks.
      • Rajagopalan M.S.
      • Khanna V.K.
      • Leiter Y.
      • et al.
      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
      • Leithner A.
      • Maurer-Ertl W.
      • Glehr M.
      • Friesenbichler J.
      • Leithner K.
      • Windhager R.
      Wikipedia and osteosarcoma: a trustworthy patients' information?.
      • Steinberg P.L.
      • Wason S.
      • Stern J.M.
      • Deters L.
      • Kowal B.
      • Seigne J.
      YouTube as source of prostate cancer information.
      • Clerici C.A.
      • Veneroni L.
      • Bisogno G.
      • Trapuzzano A.
      • Ferrari A.
      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
      • Tan M.L.H.
      • Kok K.
      • Ganesh V.
      • Thomas S.S.
      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      • Kim B.
      • Gillham D.
      Gender differences among young adult cancer patients.
      13 on depression,
      • McDaniel B.T.
      • Coyne S.M.
      • Holmes E.K.
      New mothers and media use: associations between blogging, social networking, and maternal well-being.
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Moreno M.A.
      • Jelenchick L.A.
      • Egan K.G.
      • et al.
      Feeling bad on Facebook: depression disclosures by college students on a social networking site.
      • Moreno M.A.
      • Christakis D.A.
      • Egan K.G.
      • et al.
      A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      • Reavley N.J.
      • Mackinnon A.J.
      • Morgan A.J.
      • et al.
      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      • Whitehill J.M.
      • Brockman L.N.
      • Moreno M.A.
      “Just talk to me”: communicating with college students about depression disclosures on Facebook.
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      • Reavley N.J.
      • Pilkington P.D.
      Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.
      9 on obesity,
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Turner-McGrievy G.
      • Tate D.
      Tweets, apps, and pods: results of the 6-month mobile pounds off digitally (Mobile POD) randomized weight-loss intervention among adults.
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      • Dickins M.
      • Thomas S.L.
      • King B.
      • Lewis S.
      • Holland K.
      The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      4 on diabetes,
      • Gruzd A.
      • Black F.A.
      • Le T.N.Y.
      • Amos K.
      Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c).
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.
      • Yu C.H.
      • Parsons J.A.
      • Mamdani M.
      • et al.
      A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
      3 on heart disease,
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      • Kim C.
      • Kang B.S.
      • Choi H.J.
      • et al.
      Nationwide online social networking for cardiovascular care in Korea using Facebook.
      • Kupferberg N.
      • Protus B.M.
      Accuracy and completeness of drug information in Wikipedia: an assessment.
      2 on stroke,

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      • Takao H.
      • Murayama Y.
      • Ishibashi T.
      • Karagiozov K.L.
      • Abe T.
      A new support system using a mobile device (smartphone) for diagnostic image display and treatment of stroke.
      and 1 on CLRTI.
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      The most common social media technology studied was Facebook (n = 16),
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Moreno M.A.
      • Jelenchick L.A.
      • Egan K.G.
      • et al.
      Feeling bad on Facebook: depression disclosures by college students on a social networking site.
      • Moreno M.A.
      • Christakis D.A.
      • Egan K.G.
      • et al.
      A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      • Kim C.
      • Kang B.S.
      • Choi H.J.
      • et al.
      Nationwide online social networking for cardiovascular care in Korea using Facebook.
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      • Whitehill J.M.
      • Brockman L.N.
      • Moreno M.A.
      “Just talk to me”: communicating with college students about depression disclosures on Facebook.
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      followed by blogs (n = 13),
      • Kim S.
      • Chung D.S.
      Characteristics of cancer blog users.
      • McDaniel B.T.
      • Coyne S.M.
      • Holmes E.K.
      New mothers and media use: associations between blogging, social networking, and maternal well-being.
      • Gruzd A.
      • Black F.A.
      • Le T.N.Y.
      • Amos K.
      Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c).
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      • Dickins M.
      • Thomas S.L.
      • King B.
      • Lewis S.
      • Holland K.
      The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.
      • Yu C.H.
      • Parsons J.A.
      • Mamdani M.
      • et al.
      A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      • Kim B.
      • Gillham D.
      Gender differences among young adult cancer patients.
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      Twitter (n = 8),
      • Himelboim I.
      • Han J.Y.
      Cancer talk on Twitter: community structure and information sources in breast and prostate cancer social networks.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      • Turner-McGrievy G.
      • Tate D.
      Tweets, apps, and pods: results of the 6-month mobile pounds off digitally (Mobile POD) randomized weight-loss intervention among adults.
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      • Takao H.
      • Murayama Y.
      • Ishibashi T.
      • Karagiozov K.L.
      • Abe T.
      A new support system using a mobile device (smartphone) for diagnostic image display and treatment of stroke.
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      • Reavley N.J.
      • Pilkington P.D.
      Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.
      Wikipedia or Wikis (n = 5),
      • Rajagopalan M.S.
      • Khanna V.K.
      • Leiter Y.
      • et al.
      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
      • Leithner A.
      • Maurer-Ertl W.
      • Glehr M.
      • Friesenbichler J.
      • Leithner K.
      • Windhager R.
      Wikipedia and osteosarcoma: a trustworthy patients' information?.
      • Reavley N.J.
      • Mackinnon A.J.
      • Morgan A.J.
      • et al.
      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
      • Kupferberg N.
      • Protus B.M.
      Accuracy and completeness of drug information in Wikipedia: an assessment.
      and YouTube (n = 4).
      • Steinberg P.L.
      • Wason S.
      • Stern J.M.
      • Deters L.
      • Kowal B.
      • Seigne J.
      YouTube as source of prostate cancer information.
      • Clerici C.A.
      • Veneroni L.
      • Bisogno G.
      • Trapuzzano A.
      • Ferrari A.
      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
      • Tan M.L.H.
      • Kok K.
      • Ganesh V.
      • Thomas S.S.
      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      Although some studies included specific clinical outcomes such as weight loss or changes in depression scale,
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Moreno M.A.
      • Christakis D.A.
      • Egan K.G.
      • et al.
      A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Turner-McGrievy G.
      • Tate D.
      Tweets, apps, and pods: results of the 6-month mobile pounds off digitally (Mobile POD) randomized weight-loss intervention among adults.
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Yu C.H.
      • Parsons J.A.
      • Mamdani M.
      • et al.
      A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
      most analyzed social media content and usage patterns to explore dimensions such as support, education, knowledge dissemination, or connectedness.
      Twenty studies reported a positive impact from social media use on outcomes in obesity (n = 6),
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      cancer (n = 5),
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      depression (n = 5),
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      stroke (n = 2),

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      • Takao H.
      • Murayama Y.
      • Ishibashi T.
      • Karagiozov K.L.
      • Abe T.
      A new support system using a mobile device (smartphone) for diagnostic image display and treatment of stroke.
      diabetes (n = 1),
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.
      and heart disease (n = 1).
      • Kupferberg N.
      • Protus B.M.
      Accuracy and completeness of drug information in Wikipedia: an assessment.
      The 20 positive studies included 11 studies that used Facebook,
      • Valle C.G.
      • Tate D.F.
      • Mayer D.K.
      • Allicock M.
      • Cai J.
      A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.
      • Park S.
      • Lee S.W.
      • Kwak J.
      • Cha M.
      • Jeong B.
      Activities on Facebook reveal the depressive state of users.
      • Mota Pereira J.
      Facebook enhances antidepressant pharmacotherapy effects.
      • Kim C.
      • Kang B.S.
      • Choi H.J.
      • et al.
      Nationwide online social networking for cardiovascular care in Korea using Facebook.
      • Napolitano M.A.
      • Hayes S.
      • Bennett G.G.
      • Ives A.K.
      • Foster G.D.
      Using Facebook and text messaging to deliver a weight loss program to college students.
      • Wright K.B.
      • Rosenberg J.
      • Egbert N.
      • Ploeger N.A.
      • Bernard D.R.
      • King S.
      Communication competence, social support, and depression among college students: a model of Facebook and face-to-face support network influence.
      • Greene J.A.
      • Choudhry N.K.
      • Kilabuk E.
      • Shrank W.H.
      Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.

      Mittal MK, Sloan JA, Rabinstein AA. Facebook: can it be a diagnostic tool for neurologists? BMJ Case Rep. 2012 Aug 21. http://dx.doi.org/10.1136/bcr-2012-006426.

      • Herring S.J.
      • Cruice J.F.
      • Bennett G.G.
      • Davey A.
      • Foster G.D.
      Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.
      • Kacvinsky L.E.
      • Moreno M.A.
      Facebook use between college resident advisors and their residents: a mixed methods approach.
      • Ahuja A.K.
      • Biesaga K.
      • Sudak D.M.
      • Draper J.
      • Womble A.
      Suicide on Facebook.
      6 studies that used blogs,
      • Andersson M.
      • Gustafsson E.
      • Hansson K.
      • Karlsson M.
      External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.
      • Chiu Y.-C.
      • Hsieh Y.-L.
      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
      • Lowney A.C.
      • O'Brien T.
      The landscape of blogging in palliative care.
      • Leggatt-Cook C.
      • Chamberlain K.
      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
      • Hwang K.O.
      • Etchegaray J.M.
      • Sciamanna C.N.
      • Bernstam E.V.
      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
      • Modave F.
      • Shokar N.K.
      • Peñaranda E.
      • Nguyen N.
      Analysis of the accuracy of weight loss information search engine results on the Internet.
      and 3 that used Twitter.
      • Sugawara Y.
      • Narimatsu H.
      • Hozawa A.
      • Shao L.
      • Otani K.
      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
      • Takao H.
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      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
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      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
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      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
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      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
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      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
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      YouTube as source of prostate cancer information.
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      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.
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      Using Facebook and text messaging to deliver a weight loss program to college students.
      Using our taxonomy, the included studies were categorized as follows: support (n = 16),
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      • Han J.Y.
      Cancer talk on Twitter: community structure and information sources in breast and prostate cancer social networks.
      • Clerici C.A.
      • Veneroni L.
      • Bisogno G.
      • Trapuzzano A.
      • Ferrari A.
      Videos on rhabdomyosarcoma on YouTube: an example of the availability of information on pediatric tumors on the Web.
      • McDaniel B.T.
      • Coyne S.M.
      • Holmes E.K.
      New mothers and media use: associations between blogging, social networking, and maternal well-being.
      • Afsar B.
      The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.
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      Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.
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      • Fukao A.
      Cancer patients on Twitter: a novel patient community on social media.
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      Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.
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      • Thomas S.L.
      • King B.
      • Lewis S.
      • Holland K.
      The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.
      • Pagoto S.
      • Schneider K.L.
      • Evans M.
      • et al.
      Tweeting it off: characteristics of adults who tweet about a weight loss attempt.
      • Chou W.S.
      • Prestin A.
      • Kunath S.
      Obesity in social media: a mixed methods analysis.
      • Kim B.
      • Gillham D.
      Gender differences among young adult cancer patients.
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      • Thomas E.J.
      Structural social support predicts functional social support in an online weight loss programme.
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      • Pilkington P.D.
      Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.
      education (n = 10),
      • Kim S.
      • Chung D.S.
      Characteristics of cancer blog users.
      • Rajagopalan M.S.
      • Khanna V.K.
      • Leiter Y.
      • et al.
      Patient-oriented cancer information on the Internet: a comparison of Wikipedia and a professionally maintained database.
      • Leithner A.
      • Maurer-Ertl W.
      • Glehr M.
      • Friesenbichler J.
      • Leithner K.
      • Windhager R.
      Wikipedia and osteosarcoma: a trustworthy patients' information?.
      • Steinberg P.L.
      • Wason S.
      • Stern J.M.
      • Deters L.
      • Kowal B.
      • Seigne J.
      YouTube as source of prostate cancer information.
      • Tan M.L.H.
      • Kok K.
      • Ganesh V.
      • Thomas S.S.
      Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com.
      • Reavley N.J.
      • Mackinnon A.J.
      • Morgan A.J.
      • et al.
      Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources.
      • Gruzd A.
      • Black F.A.
      • Le T.N.Y.
      • Amos K.
      Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c).
      • Hasty R.T.
      • Garbalosa R.C.
      • Barbato V.A.
      • et al.
      Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.