Analyzing Patient Safety Discussions in a Public Facebook Group Community

Introduction. Medical errors rank as a preventable cause of disability and death in the United States. The emergence of digital platforms such as social media has facilitated patient engagement in this topic and offers new avenues for understanding patient experiences. Methods. The first chapter of this thesis presents an overview of literature related to patient safety research as well as current challenges and trends with this research. Next, this thesis presents a stand-alone journal article consisting of a study analyzing content posted to a public patient safety Facebook group called the Patient Safety Action Network Community (PSANC) from November 21, 2022, to June 23, 2023. For this study, 200 posts were manually extracted and double-coded using a codebook developed through a grounded theory approach. The analysis involved descriptive statistics, cross-tabulations, and qualitative analysis. Results: The literature review uncovered a steadily increasing effort to include patient perspectives in patient safety research, but barriers remain. The analysis of Facebook posts revealed that 70.5% (n=141) were directly relevant to patient safety. Of relevant posts, the majority had a link to additional information (85.8%, n=121). Cross-tabulations showed a statistically significant association between posts containing links and discussions on patient empowerment and advocacy, infection-related discussions in the context of vulnerable populations, and between policy and advocacy discussions. Qualitative analysis revealed themes related to the emotional and physical impacts of medical errors on individuals and families, systemic challenges and advocacy, empowerment though education, and community support and shared experiences. Conclusions. Findings from the literature search and analysis of Facebook posts affirm persistent safety concerns and the evolving role of patients in healthcare discourse. Findings also suggest the necessity for nuanced policy reforms and the potential of digital engagement in enhancing patient safety and advocacy. These findings are important for public health in that they highlight the possibility of addressing healthcare disparities and managing costs through more inclusive and patient-centered care strategies

Puff Bars, Tobacco Policy Evasion, and Nicotine Dependence: Content Analysis of Tweets

BackgroundPuff Bars are e-cigarettes that continued marketing flavored products by exploiting the US Food and Drug Administration exemption for disposable devices. ObjectiveThis study aimed to examine discussions related to Puff Bar on Twitter to identify tobacco regulation and policy themes as well as unanticipated outcomes of regulatory loopholes. MethodsOf 8519 original tweets related to Puff Bar collected from July 13, 2020, to August 13, 2020, a random 20% subsample (n=2661) was selected for qualitative coding of topics related to nicotine dependence and tobacco policy. ResultsOf the human-coded tweets, 2123 (80.2%) were coded as relevant to Puff Bar as the main topic. Of those tweets, 698 (32.9%) discussed tobacco policy, including flavors (n=320, 45.9%), regulations (n=124, 17.8%), purchases (n=117, 16.8%), and other products (n=110, 15.8%). Approximately 22% (n=480) of the tweets referenced dependence, including lack of access (n=273, 56.9%), appetite suppression (n=59, 12.3%), frequent use (n=47, 9.8%), and self-reported dependence (n=110, 22.9%). ConclusionsThis study adds to the growing evidence base that the US Food and Drug Administration ban of e-cigarette flavors did not reduce interest, but rather shifted the discussion to brands utilizing a loophole that allowed flavored products to continue to be sold in disposable devices. Until comprehensive tobacco policy legislation is developed, new products or loopholes will continue to supply nicotine demand

Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content

Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use-associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages ( tweets ) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19-related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging