@Article{info:doi/10.2196/66058,
author="Zhang, Chenglin
and Mohamad, Emma
and Azlan, Anis Arina
and Wu, Anqi
and Ma, Yilian
and Qi, Yihan",
title="Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e66058",
keywords="eHealth literacy",
keywords="digital health literacy",
keywords="older adults",
keywords="social media",
keywords="health information",
keywords="systematic review",
abstract="Background: The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments. Objective: We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults' social media behaviors? and (4) What factors influence older adults' use of social media for health-related purposes? Methods: Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21\% (767/1591) of publications remained. Ultimately, 1\% (16/1591) of studies met the inclusion criteria. A research question--driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework. Results: The results indicated that older adults' general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75\%), followed by self-management (8/16, 50\%). Other themes included health decision-making (4/16, 25\%), telemedicine (3/16, 19\%), and health interventions (2/16, 13\%). Cross-thematic analysis confirmed that older adults' social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors. Conclusions: The reciprocal relationship between older adults' social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults. ",
doi="10.2196/66058",
url="https://www.jmir.org/2025/1/e66058"
}


@Article{info:doi/10.2196/64724,
author="Johnson, Rose Anna
and Longfellow, Anne Grace
and Lee, N. Clara
and Ormseth, Benjamin
and Skolnick, B. Gary
and Politi, C. Mary
and Rivera, M. Yonaira
and Myckatyn, Terence",
title="Social Media as a Platform for Cancer Care Decision-Making Among Women: Internet Survey-Based Study on Trust, Engagement, and Preferences",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="5",
volume="11",
pages="e64724",
keywords="shared decision-making",
keywords="SDM",
keywords="decision aids",
keywords="cancer treatment",
keywords="breast cancer",
keywords="digital health",
keywords="social media",
keywords="health communication",
keywords="online decision aids",
keywords="health information-seeking behavior",
keywords="trust in health information",
keywords="healthcare accessibility",
keywords="mhealth",
abstract="Background: Decision aids improve patient and clinician decision-making but are underused and often restricted to clinical settings. Objective: Given limited studies analyzing the feasibility of disseminating decision aids through social media, this study aimed to evaluate the acceptability, trust, and engagement of women with social media as a tool to deliver online decision aids for cancer treatment. Methods: To prepare for potential dissemination of a breast cancer decision aid via social media, a cross-sectional survey in February 2023 was conducted via Prime Panels, an online market research platform, of women aged 35-75 years in the United States. Demographics, health, cancer information-seeking behaviors, social media use, trust in social media for health information, as well as the likelihood of viewing cancer-related health information and clicking on decision aids through social media, were assessed. Statistical analyses included descriptive statistics, correlations, and multivariable ordinal regression. Results: Of 607 respondents, 397 (65.4\%) had searched for cancer information, with 185 (46.6\%) using the internet as their primary source. Facebook (Meta) was the most popular platform (511/607, 84.2\%). Trust in social media for health information was higher among Black (14/72, 19.4\%) and Asian respondents (7/27, 25.9\%) than among White respondents (49/480, 10.2\%; P=.003). Younger respondents aged 35-39 years (17/82, 20.7\%) showed higher trust than those aged 70-79 years (12/70, 17.1\%; P<.001). Trust in social media for health information was linked to a higher likelihood of viewing cancer information and accessing a decision aid online (P<.001). Participants who rated social media as ``Trustworthy'' (n=73) were more likely to view cancer information (61/73, 83.6\%) and click on decision aids (61/73, 83.6\%) than those who found it ``Untrustworthy'' (n=277; view: 133/277, 48.0\%; click: 125/277, 45.1\%). Engagement with social media positively correlated with viewing online cancer information (Spearman $\rho$=0.20, P<.001) and willingness to use decision aids ($\rho$=0.21, P<.001). Multivariable ordinal regression analyses confirmed that perception of social media's trustworthiness is a significant predictor of engagement with decision aids (untrustworthy vs trustworthy $\beta$=--1.826, P<.001; neutral vs trustworthy $\beta$=--0.926, P=.007) and of viewing cancer information (untrustworthy vs trustworthy $\beta$=--1.680, P<.001, neutral vs trustworthy $\beta$=--0.581, P=.098), while age and employment status were not significant predictors. Conclusions: This exploratory study suggests that social media platforms may increase access to health information and decision aids. No significant differences were observed between demographic variables and the use or trust in social media for health information. However, trust in social media emerged as a mediating factor between demographics and engagement with cancer information online. Before disseminating decision aids on social media, groups should identify existing trust and engagement patterns with different platforms within their target demographic. ",
doi="10.2196/64724",
url="https://cancer.jmir.org/2025/1/e64724",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053770"
}


@Article{info:doi/10.2196/55468,
author="Frederiksen, Steen Kristian
and Hahn-Pedersen, Julie
and Crawford, Rebecca
and Morrison, Ross
and Jeppesen, Rose
and Doward, Lynda
and Weidner, Wendy",
title="Traversing Shifting Sands---the Challenges of Caring for Someone With Alzheimer's Disease and the Impact on Care Partners: Social Media Content Analysis",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="18",
volume="27",
pages="e55468",
keywords="Alzheimer disease",
keywords="caregiver",
keywords="burden",
keywords="health-related quality of life",
keywords="social media",
abstract="Background: Social media data provide a valuable opportunity to explore the effects that Alzheimer disease (AD) has on care partners, including the aspects of providing care that have the greatest impacts on their lives and well-being and their priorities for their loved ones' treatment. Objective: The objective of this social media review was to gain insight into the impact of caring for someone with AD, focusing particularly on impacts on psychological and emotional well-being, social functioning, daily life and ability to work, health-related quality of life, social functioning, and relationships. Methods: We reviewed social media posts from 4 sources---YouTube (Google), Alzheimer's Association, Alzheimer Society of Canada, and Dementia UK---to gain insights into the impact of AD on care partners. English-language posts uploaded between May 2011 and May 2021 that discussed the impact of AD on care partners were included and analyzed thematically. Results: Of the 279 posts identified, 55 posts, shared by 70 contributors (4 people living with AD and 66 care partners or family members), met the review criteria. The top 3 reported or observed impacts of AD discussed by contributors were psychological and emotional well-being (53/70, 76\%), social life and relationships (37/70, 53\%), and care partner overall health-related quality of life (27/70, 39\%). An important theme that emerged was the emotional distress and sadness (24/70, 34\%) associated with the care partners' experience of ``living bereavement'' or ``anticipatory grief.'' Contributors also reported impacts on care partners' daily life (9/70, 13\%) and work and employment (8/70, 11\%). Care partners' emotional distress was also exacerbated by loved ones' AD-related symptoms (eg, altered behavior and memory loss). Caregiving had long-term consequences for care partners, including diminished personal well-being, family and personal sacrifices, loss of employment, and unanticipated financial burdens. Conclusions: Insights from social media emphasized the psychological, emotional, professional, and financial impacts on individuals providing informal care for a person with AD and the need for improved care partner support. A comprehensive understanding of care partners' experiences is needed to capture the true impact of AD. ",
doi="10.2196/55468",
url="https://www.jmir.org/2025/1/e55468"
}


@Article{info:doi/10.2196/59023,
author="Yang, Lu
and Lynch, Chris
and Lee, Tayu John
and Oldenburg, Brian
and Haregu, Tilahun",
title="Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="10",
volume="27",
pages="e59023",
keywords="digital divide",
keywords="health inequity",
keywords="China",
keywords="longitudinal study",
keywords="broadband",
keywords="internet connection",
keywords="internet",
keywords="well-being",
keywords="psychosocial",
keywords="middle age",
keywords="older adult",
keywords="inequality",
keywords="digital connectivity",
keywords="logistic regression",
keywords="questionnaire",
keywords="survey",
keywords="panel data approach",
abstract="Background: Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied. Objective: The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China. Methods: A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire. Results: We observed a substantial increase in digital connectivity from 29.5\% in 2015 to 59.8\% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95\% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95\% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95\% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas. Conclusions: This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity. ",
doi="10.2196/59023",
url="https://www.jmir.org/2025/1/e59023"
}


@Article{info:doi/10.2196/62730,
author="Wang, Wei
and Wang, Hui
and Hu, Xinru
and Yu, Qian
and Chen, Fangyi
and Qiu, Xirui
and Wang, Xiaoxiao",
title="The Association Between Posting WeChat Moments and the Risk of Depressive Symptoms Among Middle-Aged and Older Chinese Adults: Prospective National Cohort Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="13",
volume="11",
pages="e62730",
keywords="cohort study",
keywords="depression",
keywords="depressive symptoms",
keywords="mental health",
keywords="middle-aged adults",
keywords="modified Poisson regression",
keywords="older adults",
keywords="WeChat",
abstract="Background: The association between social media usage and the risk of depressive symptoms has attracted increasing attention. WeChat is a popular social media software in China. The impact of using WeChat and posting WeChat moments on the risk of developing depressive symptoms among community-based middle-aged and older adults in China is unknown. Objective: The objective was to assess the association between using WeChat and posting WeChat moments and the risk of depressive symptoms among middle-aged and older adults in China. Methods: A prospective national cohort study was designed based on the data obtained from the fourth and fifth waves of the China Health and Retirement Longitudinal Study (CHARLS). The strength of association between using WeChat and posting WeChat moments and the risk of depressive symptoms was estimated by modified Poisson regressions. Depressive symptoms were determined using the 10-item Center for Epidemiologic Studies Depression Scale. Meanwhile, the heterogeneity of the associations was explored through multiple subgroup analyses. Moreover, multiple sensitivity analyses were performed to verify the robustness of the associations between the exposures and depressive symptoms. Results: A total of 9670 eligible participants were included in the cohort study, and the incidence rate of depressive symptoms was 19.08\% (1845/9670, 95\% CI 19.07\%?19.09\%) from the fourth to fifth waves of the CHARLS. Using WeChat (adjusted relative risk [aRR] 0.691, 95\% CI 0.582?0.520) and posting WeChat moments (aRR 0.673, 95\% CI 0.552?0.821) reduced the risk of depressive symptoms among middle-aged and older Chinese adults. The association between the exposures and depressive symptoms was robust, proved through multiple sensitivity analyses (all P<.05). However, the associations were heterogeneous in certain subgroup catagories, such as solitude, duration of sleep at night, nap after lunch, physical activity, and having multiple chronic conditions. Conclusions: Using WeChat and especially posting WeChat moments can mitigate the risk of depressive symptoms among community-based middle-aged and older Chinese adults. However, there is likely a need for a longer follow-up period to explore the impact of the exposures on the risk of long-term depressive outcomes. ",
doi="10.2196/62730",
url="https://publichealth.jmir.org/2025/1/e62730"
}


@Article{info:doi/10.2196/60050,
author="Ni, Congning
and Song, Qingyuan
and Chen, Qingxia
and Song, Lijun
and Commiskey, Patricia
and Stratton, Lauren
and Malin, Bradley
and Yin, Zhijun",
title="Sentiment Dynamics Among Informal Caregivers in Web-Based Alzheimer Communities: Systematic Analysis of Emotional Support and Interaction Patterns",
journal="JMIR Aging",
year="2024",
month="Dec",
day="4",
volume="7",
pages="e60050",
keywords="informal caregivers",
keywords="Alzheimer disease",
keywords="dementias",
keywords="web-based community",
keywords="sentiment analysis",
keywords="topic modeling",
keywords="caregiving",
keywords="carers",
keywords="family care",
keywords="support group",
keywords="peer support",
keywords="gerontology",
keywords="geriatrics",
keywords="aging",
keywords="attitudes",
keywords="opinion",
keywords="perceptions",
keywords="perspectives",
keywords="sentiment",
keywords="cognitive",
keywords="web-based communities",
keywords="Linguistic Inquiry and Word Count",
keywords="machine learning",
keywords="Valence Aware Dictionary for Sentiment Reasoning",
abstract="Background: Alzheimer disease and related dementias (ADRD) are a growing global health challenge. ADRD place significant physical, emotional, and financial burdens on informal caregivers and negatively affects their well-being. Web-based social media platforms have emerged as valuable sources of peer support for these caregivers. However, there has been limited investigation into how web-based peer support might influence their mental well-being. Objective: This study aims to examine the dynamics of sentiment scores, a major indicator of mental well-being, among informal ADRD caregivers, specifically how their sentiment changes as they participate in caregiving experience discussions within 2 ADRD web-based communities. Methods: We collected data from 2 large web-based ADRD caregiving communities, ALZConnected (from November 2011 to August 2022) and TalkingPoint (from March 2003 to November 2022). Using the Valence Aware Dictionary for Sentiment Reasoning and Linguistic Inquiry and Word Count, we calculated sentiment scores for each post and evaluated how the initial sentiment score of a topic initiator evolves within a discussion thread. Structured topic modeling and regression analysis were used to identify the primary topics consistently associated with sentiment changes within these threads. We investigated longitudinal sentiment trends to identify patterns of sentimental stability or enhancement due to prolonged engagement in web-based communities by plotting linear interpolation lines of the sentiment values of each individual user. Results: The ALZConnected dataset comprised 532,992 posts, consisting of 57,641 topic threads and 475,351 comments. The TalkingPoint dataset was composed of 846,344 posts, consisting of 81,068 topic threads and 765,276 comments. Our research revealed that topic initiators experienced a notable increase in sentiment as they engaged in subsequent discussions within their threads, with a significant uptick in positivity in the short term. This phenomenon is part of a broader trend of steadily rising positive sentiment among ADRD caregivers. Using structured topic modeling, we cataloged a diverse range of topics that included both emotional aspects, such as family emotions, and practical concerns, such as diagnosis and treatment and everyday care practices. We observed that sentiment scores were positively aligned with discussions about family and daily routines life (coefficient=3.53; P<.001), while topics related to illness (coefficient=--1.37; P<.001) and caregiving facilities (coefficient=--1.98; P<.001) tended to correlate with lower sentiment scores. This evidence highlights the significant impact that both the time of participation and the posting content have on the sentiment changes of caregivers. Conclusions: This study identifies sentiment changes among informal ADRD caregivers through their interactions in 2 extensive web-based communities. These findings emphasize the importance of early emotional support within a topic thread and demonstrate a predominantly positive sentiment in these communities over time. These further highlight the value of web-based peer support and its potential to enhance the emotional well-being of informal ADRD caregivers. ",
doi="10.2196/60050",
url="https://aging.jmir.org/2024/1/e60050",
url="http://www.ncbi.nlm.nih.gov/pubmed/39630495"
}


@Article{info:doi/10.2196/56761,
author="Galinkala, Prathyusha
and Atkinson, Elise
and Campos-Castillo, Celeste",
title="Age Variation Among US Adults' Social Media Experiences and Beliefs About Who Is Responsible for Reducing Health-Related Falsehoods: Secondary Analysis of a National Survey",
journal="JMIR Aging",
year="2024",
month="Nov",
day="27",
volume="7",
pages="e56761",
keywords="social media",
keywords="health misinformation",
keywords="gray digital divide",
keywords="United States",
keywords="older adults",
keywords="aging",
keywords="health information",
keywords="false information",
keywords="falsehoods",
abstract="Background: We live in a digital age where social media has become an essential part of people's lives. It is also one of the leading platforms responsible for spreading health-related falsehoods. This study explores who adults of different age groups perceive as responsible for reducing health-related falsehoods on social media. Objective: Despite growing concern over older adults' exposure to false health information on social media, little research examines their beliefs on how to address the problem. This study examines how the age of US adults is associated with their reported experiences with health-related falsehoods on social media and their beliefs about who should be tasked with reducing such falsehoods. Methods: This study is a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey of US adults (18 years and older). Multivariable logistic regressions estimated how a respondent's age was associated with their self-reported social media use, their difficulty to detect health-related falsehoods on social media, their discussion of health information found on social media with medical providers, and their beliefs regarding who should be responsible for reducing health-related falsehoods on social media. Regression estimates were adjusted for respondents' sociodemographic and health characteristics. Results: Daily social media use decreased with respondents' age. Respondents aged 50?64 years (b=0.515, P=.01) and 65?74 years (b=0.697, P=.002) were more likely than respondents aged 18?34 years to report they strongly agree that it is difficult for them to detect health-related falsehoods on social media. Compared to younger adults, older adults (65?74 years: b=0.818, P=.002; 75 years and older: b=1.058, P<.001) were more likely to believe medical providers should be responsible for reducing online falsehoods. Conclusions: In addition to ongoing efforts by social media platforms to detect and remove falsehoods, the findings suggest medical providers should be tasked with discrediting health-related falsehoods on social media for older adults. However, time during the clinical visit is limited. Future research is needed to discover new approaches and tools tailored to older adults to assist with filtering and discrediting health-related falsehoods on social media. ",
doi="10.2196/56761",
url="https://aging.jmir.org/2024/1/e56761"
}


@Article{info:doi/10.2196/55086,
author="Chandrasekaran, Ranganathan
and Sadiq T, Muhammed
and Moustakas, Evangelos",
title="Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="6",
volume="26",
pages="e55086",
keywords="health misinformation",
keywords="digital divide",
keywords="racial disparities",
keywords="social media",
keywords="national survey-based analysis",
keywords="health information",
keywords="interventions",
abstract="Background: Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread. Objective: This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Methods: Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Results: Over 35.61\% (1740/4959) of respondents reported encountering ``a lot'' of misleading health information on social media, with an additional 45\% (2256/4959) reporting seeing ``some'' amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95\% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95\% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95\% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95\% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ?75 years exhibited challenges in assessing health information on social media (OR 0.63, 95\% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US \$50,000 and US \$75,000 (OR 1.74, 95\% CI 1.14-2.68, P<.01), and greater than US \$75,000 (OR 1.78, 95\% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. Conclusions: This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions. ",
doi="10.2196/55086",
url="https://www.jmir.org/2024/1/e55086"
}


@Article{info:doi/10.2196/52640,
author="Ch{\^a}tel, L. Bas D.
and Janssen, M. Jeroen H.
and Peeters, E. Geeske M. E.
and Corten, Rense
and Tieben, Rob
and Deen, Menno
and Hendriks, M. Elmy J.
and Olde Rikkert, M. Marcel G.",
title="Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study",
journal="JMIR Serious Games",
year="2024",
month="Oct",
day="16",
volume="12",
pages="e52640",
keywords="loneliness",
keywords="digital health",
keywords="serious gaming",
keywords="older adults",
keywords="recruitment",
keywords="feasibility study",
abstract="Background: Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact. Objective: This study aims to evaluate the feasibility of a social gaming app in reducing loneliness among older adults by evaluating recruitment strategies, data collection procedures, and gameplay activity. Methods: This mixed methods study recruited participants via newsletters, articles, and a social media campaign. We used semistructured interviews and descriptive analysis of questionnaire answers and game data to assess feasibility. Key measures included recruitment reach and efficiency, participant demographics, in-app activity, and app usability and engagement feedback. Results: The social media campaign reached 192,641 potential participants, resulting in 1363 game downloads. A total of 155 participants (aged 65 years and older: n=34, 21.9\% and aged less than 65 years: n=121, 78.1\%) provided informed consent, yielding a conversion rate of 0.08\%. The recruitment campaign focusing on distanced playful interaction had a significantly (P<.001) higher click-through rate (1.98\%) than a campaign focusing on research participation (click-through rate=0.51\%; P<.001). The overall conversion rate from advertisement exposure to research participation was 0.08\%. Participants had a mean age of 48 (SD 16) years. The 65 years and older group averaged 70 (SD 5) years, while the less 65 years group averaged 42 (SD 12) years. Additionally, 45.2\% (57/126) reported at least moderate levels of loneliness at baseline. Of the initial 554 players, 91 (16.4\%) remained active after the first week, and 32 (5.8\%) remained active for more than 90 days. Active participants tended to interact with those within their own age group, as indicated by a Pearson correlation of r=0.31 between the ages of the message sender and receiver. Interviews with 12 (48\%) participants (aged 65-79 years; female: n=12, 83\%) revealed barriers such as excessive chatbot questions and a mismatch between the target group and app design focus. Questionnaire completion rates dropped from 46\% at baseline to 10\% at follow-up. Conclusions: These findings underscore the challenges of recruitment and retention for older adults in a fully digital social gaming intervention. Effective recruitment strategies and targeted app design are crucial for engagement. Based on these insights, future interventions should focus on simplified interfaces, clear guidance for gameplay, and addressing the specific needs and preferences of older adults, thereby enhancing the effectiveness of digital mental health interventions. ",
doi="10.2196/52640",
url="https://games.jmir.org/2024/1/e52640",
url="http://www.ncbi.nlm.nih.gov/pubmed/39412863"
}


@Article{info:doi/10.2196/49688,
author="Fu, Liping
and Liu, Caiping
and Dong, Yongqing
and Ma, Xiaodong
and Cai, Quanling
and Li, Dongli
and Di, Kaisheng",
title="Mediating Effects of Information Access on Internet Use and Multidimensional Health Among Middle-Aged and Older Adults: Nationwide Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="9",
volume="26",
pages="e49688",
keywords="internet use",
keywords="health",
keywords="middle-aged and older adults",
keywords="information access",
keywords="mediation analysis",
abstract="Background: With the exacerbation of population aging, the health issues of middle-aged and older adults have increasingly become a focus of attention. The widespread use of the internet has created conditions for promoting the health of this demographic. However, little is known about the effects of information access in promoting the relationship between internet use and the health of middle-aged and older adults. Objective: This study aims to examine the relationship between internet use and multidimensional health in middle-aged and older adults, as well as the mediating effect of information access. Moreover, this study will explore the relationship between other dimensions of internet use (purposes and frequency) and health. Methods: Data were sourced from the China General Social Survey conducted in 2018. Health outcomes, including self-rated, physical, and mental health, were assessed using the 5-level self-rated health scale, the 5-level basic activities of daily living scale, and the 5-level depression scale, respectively. The ordinal logistic regression model was used to examine the relationship between internet use and health among middle-aged and older adults. Additionally, the Karlson-Holm-Breen decomposition method was used to examine the mediation effect of information access. To address endogeneity issues, the two-stage least squares approach was applied. Results: In our sample, nearly half (n=3036, 46.3\%) of the respondents use the internet. Regression analyses revealed that internet use was positively associated with self-rated health (odds ratio [OR] 1.55, 95\% CI 1.39-1.74; P<.001), physical health (OR 1.39, 95\% CI 1.25-1.56; P<.001), and mental health (OR 1.33, 95\% CI 1.19-1.49; P<.001) of middle-aged and older adults. Various dimensions of internet use positively contribute to health. In addition, information access significantly mediated the relationship between internet use and self-rated health ($\beta$=.28, 95\% CI 0.23-0.32), physical health ($\beta$=.40, 95\% CI 0.35-0.45), and mental health ($\beta$=.16, 95\% CI 0.11-0.20). Furthermore, there were significant differences in the relationship between internet use and health among advantaged and disadvantaged groups. Conclusions: The study showed that different dimensions of internet use are associated with better self-rated health, better physical health, and better mental health in middle-aged and older adults. Information access mediates the relationship between internet use and health. This result emphasizes the significance of promoting internet access as a means to enhance the health of middle-aged and older adults in China. ",
doi="10.2196/49688",
url="https://www.jmir.org/2024/1/e49688"
}


@Article{info:doi/10.2196/52555,
author="Roquet, Ang{\'e}lique
and Martinelli, Paolo
and Lampraki, Charikleia
and Jopp, S. Daniela",
title="Internet Use as a Moderator of the Relationship Between Personal Resources and Stress in Older Adults: Cross-Sectional Study",
journal="JMIR Aging",
year="2024",
month="Jul",
day="19",
volume="7",
pages="e52555",
keywords="internet use",
keywords="aging",
keywords="stress",
keywords="personal resources",
keywords="technical resources",
keywords="Hobfoll's Conservation of Resources theory",
keywords="COR theory",
abstract="Background: Internet use has dramatically increased worldwide, with over two-thirds of the world's population using it, including the older adult population. Technical resources such as internet use have been shown to influence psychological processes such as stress positively. Following the Conservation of Resources theory by Hobfoll, stress experience largely depends on individuals' personal resources and the changes in these resources. While personal resource loss has been shown to lead to stress, we know little regarding the role that technical resources may play on the relationship between personal resources and stress. Objective: This study aims to investigate the moderating effect of technical resources (internet use) on the relationship between personal resources and stress in younger and older adults. Methods: A total of 275 younger adults (aged 18 to 30 years) and 224 older adults (aged ?65 years) indicated their levels of stress; change in personal resources (ie, cognitive, social, and self-efficacy resource loss and gain); and internet use. Variance analyses, multiple regression, and moderation analyses were performed to investigate the correlates of stress. Results: Results showed that older adults, despite experiencing higher levels of resource loss (questionnaire scores: 1.82 vs 1.54; P<.001) and less resource gain (questionnaire scores: 1.82 vs 2.31; P<.001), were less stressed than younger adults (questionnaire scores: 1.99 vs 2.47; P<.001). We observed that the relationship among resource loss, resource gain, and stress in older adults was moderated by their level of internet use ($\beta$=.09; P=.05). Specifically, older adults who used the internet more frequently were less stressed when they experienced high levels of both loss and gain compared to their counterparts who used internet the less in the same conditions. Furthermore, older adults with low resource gain and high resource loss expressed less stress when they used the internet more often compared to those with low internet use. Conclusions: These findings highlight the importance of internet use in mitigating stress among older adults experiencing resource loss and gain, emphasizing the potential of digital interventions to promote mental health in this population. ",
doi="10.2196/52555",
url="https://aging.jmir.org/2024/1/e52555",
url="http://www.ncbi.nlm.nih.gov/pubmed/39028547"
}


@Article{info:doi/10.2196/51520,
author="Teano, L. Anthony
and Scott, Ashley
and Gipson, Cassandra
and Albert, Marilyn
and Pettigrew, Corinne",
title="Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study",
journal="JMIR Aging",
year="2024",
month="Jul",
day="9",
volume="7",
pages="e51520",
keywords="education",
keywords="social media",
keywords="outreach",
keywords="recruitment",
keywords="Alzheimer's disease",
keywords="Alzheimer disease",
abstract="Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media--based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center's social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform's native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P?.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. ",
doi="10.2196/51520",
url="https://aging.jmir.org/2024/1/e51520"
}


@Article{info:doi/10.2196/59294,
author="Pickett, C. Andrew
and Valdez, Danny
and Sinclair, L. Kelsey
and Kochell, J. Wesley
and Fowler, Boone
and Werner, E. Nicole",
title="Social Media Discourse Related to Caregiving for Older Adults Living With Alzheimer Disease and Related Dementias: Computational and Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Jun",
day="19",
volume="7",
pages="e59294",
keywords="caregiving",
keywords="dementia",
keywords="social support",
keywords="social media",
keywords="Reddit",
abstract="Background: In the United States, caregivers of people living with Alzheimer disease and Alzheimer disease--related dementias (AD/ADRD) provide >16 billion hours of unpaid care annually. These caregivers experience high levels of stress and burden related to the challenges associated with providing care. Social media is an emerging space for individuals to seek various forms of support. Objective: We aimed to explore the primary topics of conversation on the social media site Reddit related to AD/ADRD. We then aimed to explore these topics in depth, specifically examining elements of social support and behavioral symptomology discussed by users. Methods: We first generated an unsupervised topic model from 6563 posts made to 2 dementia-specific subreddit forums (r/Alzheimers and r/dementia). Then, we conducted a manual qualitative content analysis of a random subset of these data to further explore salient themes in the corpus. Results: The topic model with the highest overall coherence score (0.38) included 10 topics, including caregiver burden, anxiety, support-seeking, and AD/ADRD behavioral symptomology. Qualitative analyses provided added context, wherein users sought emotional and informational support for many aspects of the care experience, including assistance in making key care-related decisions. Users expressed challenging and complex emotions on Reddit, which may be taboo to express in person. Conclusions: Reddit users seek many different forms of support, including emotional and specific informational support, from others on the internet. Users expressed a variety of concerns, challenges, and behavioral symptoms to manage as part of the care experience. The unique (ie, anonymous and moderated) nature of the forum allowed for a safe space to express emotions free from documented caregiver stigma. Additional support structures are needed to assist caregivers of people living with AD/ADRD. ",
doi="10.2196/59294",
url="https://aging.jmir.org/2024/1/e59294",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896462"
}


@Article{info:doi/10.2196/55169,
author="Yin, Zhijun
and Stratton, Lauren
and Song, Qingyuan
and Ni, Congning
and Song, Lijun
and Commiskey, Patricia
and Chen, Qingxia
and Moreno, Monica
and Fazio, Sam
and Malin, Bradley",
title="Perceptions and Utilization of Online Peer Support Among Informal Dementia Caregivers: Survey Study",
journal="JMIR Aging",
year="2024",
month="May",
day="31",
volume="7",
pages="e55169",
keywords="informal dementia caregiver",
keywords="online health community",
keywords="social support",
keywords="survey",
keywords="online peer support",
keywords="caregiving challenges",
abstract="Background: Informal dementia caregivers are those who care for a person living with dementia and do not receive payment (eg, family members, friends, or other unpaid caregivers). These informal caregivers are subject to substantial mental, physical, and financial burdens. Online communities enable these caregivers to exchange caregiving strategies and communicate experiences with other caregivers whom they generally do not know in real life. Research has demonstrated the benefits of peer support in online communities, but this research is limited, focusing merely on caregivers who are already online community users. Objective: We aimed to investigate the perceptions and utilization of online peer support through a survey. Methods: Following the Andersen and Newman Framework of Health Services Utilization and using REDCap (Research Electronic Data Capture), we designed and administered a survey to investigate the perceptions and utilization of online peer support among informal dementia caregivers. Specifically, we collected types of information that influence whether an informal dementia caregiver accesses online peer support: predisposing factors, which refer to the sociocultural characteristics of caregivers, relationships between caregivers and people living with dementia, and belief in the value of online peer support; enabling factors, which refer to the logistic aspects of accessing online peer support (eg, eHealth literacy and access to high-speed internet); and need factors, which are the most immediate causes of seeking online peer support. We also collected data on caregivers' experiences with accessing online communities. We distributed the survey link on November 14, 2022, within two online locations: the Alzheimer's Association website (as an advertisement) and ALZConnected (an online community organized by the Alzheimer's Association). We collected all responses on February 23, 2023, and conducted a regression analysis to identifyn factors that were associated with accessing online peer support. Results: We collected responses from 172 dementia caregivers. Of these participants, 140 (81.4\%) completed the entire survey. These caregivers were aged 19 to 87 (mean 54, SD 13.5) years, and a majority were female (123/140, 87.9\%) and White (126/140, 90\%). Our findings show that the behavior of accessing any online community was significantly associated with participants' belief in the value of online peer support (P=.006). Moreover, of the 40 non--online community caregivers, 33 (83\%) had a belief score above 24---the score that was assigned when a neutral option was selected for each belief question. The most common reasons for not accessing any online community were having no time to do so (14/140, 10\%) and having insufficient online information--searching skills (9/140, 6.4\%). Conclusions: Our findings suggest that online peer support is valuable, but practical strategies are needed to assist informal dementia caregivers who have limited time or online information--searching skills. ",
doi="10.2196/55169",
url="https://aging.jmir.org/2024/1/e55169"
}


@Article{info:doi/10.2196/49608,
author="Ng, Reuben
and Indran, Nicole
and Liu, Luyao",
title="Advocating for Older Adults in the Age of Social Media: Strategies to Achieve Peak Engagement on Twitter",
journal="JMIR Aging",
year="2024",
month="May",
day="1",
volume="7",
pages="e49608",
keywords="age advocacy",
keywords="social media engagement",
keywords="older adults",
keywords="ageism",
keywords="data science",
abstract="Background: Over the last decade, many organizations dedicated to serving the needs and interests of older adults have turned to social media platforms, such as Twitter, subsequently rebranded X, to improve the visibility of age-related issues. However, notwithstanding their growing digital presence and participation, minimal attention has been paid to the use of social media among these advocacy groups. To achieve policy change, advocacy organizations must first be able to engage and mobilize audiences. Objective: Our study aims to elucidate how different tweet features affect the time it takes for posts uploaded by age advocacy organizations to reach peak engagement. Methods: We collated 204,905 tweets from 53 age advocacy organizations posted over a 12-year period. The engagement score of each tweet was calculated by combining well-established metrics, namely likes, retweets, quote tweets, and replies. We ran Cox models with tweet features as predictors and time-to-peak engagement as the outcome. ``Peak engagement'' (event) refers to engagement scores above the 75th percentile, and ``time'' refers to months taken to reach peak engagement per tweet. Results: Approximately 1 in 2 tweets (n=103,068, 50.3\%) had either no hashtags or just 1 hashtag. Around two-thirds (n=131,220, 64\%) of the tweets included a URL. Visual information was highly underused, with most tweets not including GIFs (n=204,202, 99.7\%), videos (n=199,800, 97.5\%), or photos (n=143,844, 70.2\%). Roughly half (n=101,470, 49.5\%) of the tweets contained mentions and 9.3\% (n=19,009) of tweets were replies. Only 4.5\% (n=9285) of tweets were quote tweets. Most tweets were uploaded in the afternoon (n=86,004, 42\%) and on a weekday (n=180,499, 88.1\%). As hypothesized, features associated with peak engagement were the inclusion of visual elements like photos, which increased peak engagement by 3 times (P<.001), and the use of 3 or more hashtags (P<.001). Quote tweets increased engagement by 3 times (P<.001), as compared to regular tweets, controlling for account-level covariates. Tweets from organizations with a higher tweet volume were 40\% less likely to reach peak engagement (P<.001). Conclusions: Social media as a networked platform has the potential to reach users on a global scale and at an exponential speed. Having uncovered the features that are more likely to reach peak engagement on Twitter, our study serves as an invaluable resource for age advocacy organizations in their movement to create a more age-inclusive world. ",
doi="10.2196/49608",
url="https://aging.jmir.org/2024/1/e49608"
}


@Article{info:doi/10.2196/45864,
author="Ng, Reuben
and Indran, Nicole",
title="\#ProtectOurElders: Analysis of Tweets About Older Asian Americans and Anti-Asian Sentiments During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="29",
volume="26",
pages="e45864",
keywords="AAPI",
keywords="anti-Asian hate",
keywords="anti-Asian",
keywords="Asian Americans and Pacific Islanders",
keywords="Asian-American",
keywords="content analysis",
keywords="coronavirus",
keywords="COVID-19",
keywords="discourse",
keywords="discriminate",
keywords="discrimination",
keywords="discriminatory",
keywords="Pacific Islander",
keywords="racial",
keywords="racism",
keywords="racist",
keywords="SARS-CoV-2",
keywords="social media",
keywords="tweet",
keywords="Twitter",
abstract="Background: A silver lining to the COVID-19 pandemic is that it cast a spotlight on a long-underserved group. The barrage of attacks against older Asian Americans during the crisis galvanized society into assisting them in various ways. On Twitter, now known as X, support for them coalesced around the hashtag \#ProtectOurElders. To date, discourse surrounding older Asian Americans has escaped the attention of gerontologists---a gap we seek to fill. Our study serves as a reflection of the level of support that has been extended to older Asian Americans, even as it provides timely insights that will ultimately advance equity for them. Objective: This study explores the kinds of discourse surrounding older Asian Americans during the COVID-19 crisis, specifically in relation to the surge in anti-Asian sentiments. The following questions guide this study: What types of discourse have emerged in relation to older adults in the Asian American community and the need to support them? How do age and race interact to shape these discourses? What are the implications of these discourses for older Asian Americans? Methods: We retrieved tweets (N=6099) through 2 search queries. For the first query, we collated tweets with the hashtag \#ProtectOurElders. For the second query, we collected tweets with an age-based term, for example, ``elderly'' or ``old(er) adults(s)'' and either the hashtag \#StopAAPIHate or \#StopAsianHate. Tweets were posted from January 1, 2020, to August 1, 2023. After applying the exclusion criteria, the final data set contained 994 tweets. Inductive and deductive approaches informed our qualitative content analysis. Results: A total of 4 themes emerged, with 50.1\% (498/994) of posts framing older Asian Americans as ``vulnerable and in need of protection'' (theme 1). Tweets in this theme either singled them out as a group in need of protection because of their vulnerable status or discussed initiatives aimed at safeguarding their well-being. Posts in theme 2 (309/994, 31\%) positioned them as ``heroic and resilient.'' Relevant tweets celebrated older Asian Americans for displaying tremendous strength in the face of attack or described them as individuals not to be trifled with. Tweets in theme 3 (102/994, 10.2\%) depicted them as ``immigrants who have made selfless contributions and sacrifices.'' Posts in this section referenced the immense sacrifices made by older Asian Americans as they migrated to the United States, as well as the systemic barriers they had to overcome. Posts in theme 4 (85/994, 8.5\%) venerated older Asian Americans as ``worthy of honor.'' Conclusions: The COVID-19 crisis had the unintended effect of garnering greater support for older Asian Americans. It is consequential that support be extended to this group not so much by virtue of their perceived vulnerability but more so in view of their boundless contributions and sacrifices. ",
doi="10.2196/45864",
url="https://www.jmir.org/2024/1/e45864",
url="http://www.ncbi.nlm.nih.gov/pubmed/38551624"
}


@Article{info:doi/10.2196/53025,
author="Castillo, R. Louise I.
and Tran, Vivian
and Brachaniec, Mary
and Chambers, T. Christine
and Chessie, Kelly
and Couros, Alec
and LeRuyet, Andre
and LeRuyet, Charmayne
and Thorpe, Lilian
and Williams, Jaime
and Wheelwright, Sara
and Hadjistavropoulos, Thomas",
title="The \#SeePainMoreClearly Phase II Pain in Dementia Social Media Campaign: Implementation and Evaluation Study",
journal="JMIR Aging",
year="2024",
month="Feb",
day="8",
volume="7",
pages="e53025",
keywords="knowledge translation",
keywords="Twitter",
keywords="older adults",
keywords="Facebook",
keywords="knowledge mobilization",
abstract="Background: Social media platforms have been effective in raising awareness of the underassessment and undertreatment of pain in dementia. Objective: After a successful pilot campaign, we aimed to scale our pain-in-dementia knowledge mobilization pilot initiative (ie, \#SeePainMoreClearly) to several social media platforms with the aid of a digital media partner. The goal of the initiative was to increase awareness of the challenges in the assessment and management of pain among people with dementia. A variety of metrics were implemented to evaluate the effort. Through this work, we endeavored to highlight key differences between our pilot initiative (which was a grassroots initiative), focusing largely on Twitter and YouTube, and the current science-media partnership. We also aimed to generate recommendations suitable for other social media campaigns related to health or aging. Methods: Evidence-based information about pain in dementia was summarized into engaging content (eg, videos) tailored to the needs of various knowledge users (eg, health professionals, families, and policy makers). We disseminated information using Facebook (Meta Platforms), Twitter (X Corp), YouTube (Alphabet Inc), Instagram (Meta Platforms), and LinkedIn (LinkedIn Corp) and measured the success of the initiative over a 12-month period (2020 to 2021). The evaluation methods focused on web analytics and questionnaires related to social media content. Knowledge users' web responses about the initiative and semistructured interviews were analyzed using thematic analysis. Results: During the course of the campaign, >700 posts were shared across all platforms. Web analytics showed that we drew >60,000 users from 82 countries to our resource website. Of the social media platforms used, Facebook was the most effective in reaching knowledge users (ie, over 1,300,000 users). Questionnaire responses from users were favorable; interview responses indicated that the information shared throughout the initiative increased awareness of the problem of pain in dementia and influenced respondent behavior. Conclusions: In this investigation, we demonstrated success in directing knowledge users to a resource website with practical information that health professionals could use in patient care along with pain assessment and management information for caregivers and people living with dementia. The evaluation metrics suggested no considerable differences between our pilot campaign and broader initiative when accounting for the length of time of each initiative. The limitations of large-scale health campaigns were noted, and recommendations were outlined for other researchers aiming to leverage social media as a knowledge mobilization tool. ",
doi="10.2196/53025",
url="https://aging.jmir.org/2024/1/e53025",
url="http://www.ncbi.nlm.nih.gov/pubmed/38329793"
}


@Article{info:doi/10.2196/41448,
author="Schramm, Emily
and Yang, C. Christopher
and Chang, Chia-Hsuan
and Mulhorn, Kristine
and Yoshinaga, Shushi
and Huh-Yoo, Jina",
title="Examining Public Awareness of Ageist Terms on Twitter: Content Analysis",
journal="JMIR Aging",
year="2023",
month="Sep",
day="11",
volume="6",
pages="e41448",
keywords="social media",
keywords="informatics",
keywords="aging",
keywords="ageism",
keywords="public",
keywords="COVID-19",
keywords="disease",
keywords="language",
keywords="older adults",
keywords="Twitter",
keywords="elderly",
keywords="term",
keywords="terminology",
keywords="pandemic",
keywords="tweets",
abstract="Background: The World Health Organization, the Centers for Disease Control and Prevention, and the Gerontological Society of America have made efforts to raise awareness on ageist language and propose appropriate terms to denote the older adult population. The COVID-19 pandemic and older adults' vulnerability to the disease have perpetuated hostile ageist discourse on social media. This is an opportune time to understand the prevalence and use of ageist language and discuss the ways forward. Objective: This study aimed to understand the prevalence and situated use of ageist terms on Twitter. Methods: We collected 60.32 million tweets between March and July 2020 containing terms related to COVID-19. We then conducted a mixed methods study comprising a content analysis and a descriptive quantitative analysis. Results: A total of 58,930 tweets contained the ageist terms ``old people'' or ``elderly.'' The more appropriate term ``older adult'' was found in 11,328 tweets. Twitter users used ageist terms (eg, ``old people'' and ``elderly'') to criticize ageist messages (17/60, 28\%), showing a lack of understanding of appropriate terms to describe older adults. Highly hostile ageist content against older adults came from tweets that contained the derogatory terms ``old people'' (22/30, 73\%) or ``elderly'' (13/30, 43\%). Conclusions: The public discourse observed on Twitter shows a continued lack of understanding of appropriate terms to use when referring to older adults. Effort is needed to eliminate the perpetuation of ageist messages that challenge healthy aging. Our study highlights the need to inform the public about appropriate language use and ageism. ",
doi="10.2196/41448",
url="https://aging.jmir.org/2023/1/e41448"
}


@Article{info:doi/10.2196/48786,
author="Meksawasdichai, Sununtha
and Lerksuthirat, Tassanee
and Ongphiphadhanakul, Boonsong
and Sriphrapradang, Chutintorn",
title="Perspectives and Experiences of Patients With Thyroid Cancer at a Global Level: Retrospective Descriptive Study of Twitter Data",
journal="JMIR Cancer",
year="2023",
month="Aug",
day="2",
volume="9",
pages="e48786",
keywords="data mining",
keywords="internet",
keywords="natural language processing",
keywords="sentiment analysis",
keywords="social media",
keywords="thyroid neoplasms",
keywords="twitter",
keywords="tweet",
keywords="tweets",
keywords="neoplasm",
keywords="neoplasms",
keywords="cancer",
keywords="oncology",
keywords="thyroid",
keywords="NLP",
keywords="perspective",
keywords="perspectives",
keywords="sentiment",
keywords="sentiments",
keywords="experience",
keywords="experiences",
abstract="Background: Twitter has become a popular platform for individuals to broadcast their daily experiences and opinions on a wide range of topics and emotions. Tweets from patients with cancer could offer insights into their needs. However, limited research has been conducted using Twitter data to understand the needs of patients with cancer despite the substantial amount of health-related data posted on the platform daily. Objective: This study aimed to uncover the potential of using Twitter data to understand the perspectives and experiences of patients with thyroid cancer at a global level. Methods: ?This retrospective descriptive study collected tweets relevant to thyroid cancer in 2020 using the Twitter scraping tool. Only English-language tweets were included, and data preprocessing was performed to remove irrelevant tweets, duplicates, and retweets. Both tweets and Twitter users were manually classified into various groups based on the content. Each tweet underwent sentiment analysis and was classified as either positive, neutral, or negative. Results: A total of 13,135 tweets related to thyroid cancer were analyzed. The authors of the tweets included patients with thyroid cancer (3225 tweets, 24.6\%), patient's families and friends (2449 tweets, 18.6\%), medical journals and media (1733 tweets, 13.2\%), health care professionals (1093 tweets, 8.3\%), and medical health organizations (940 tweets, 7.2\%), respectively. The most discussed topics related to living with cancer (3650 tweets, 27.8\%), treatment (2891 tweets, 22\%), diagnosis (1613 tweets, 12.3\%), risk factors and prevention (1137 tweets, 8.7\%), and research (953 tweets, 7.3\%). An average of 36 tweets pertaining to thyroid cancer were posted daily. Notably, the release of a film addressing thyroid cancer and the public disclosure of a news reporter's personal diagnosis of thyroid cancer resulted in a significant escalation in the volume of tweets. From the sentiment analysis, 53.5\% (7025/13,135) of tweets were classified as neutral statements and 32.7\% (4299/13,135) of tweets expressed negative emotions. Tweets from patients with thyroid cancer had the highest proportion of negative emotion (1385/3225 tweets, 42.9\%), particularly when discussing symptoms. Conclusions: ?This study provides new insights on using?Twitter data as a valuable data source to understand the experiences of patients with thyroid cancer. Twitter may provide an opportunity to improve patient and physician engagement or apply as a potential research data source. ",
doi="10.2196/48786",
url="https://cancer.jmir.org/2023/1/e48786",
url="http://www.ncbi.nlm.nih.gov/pubmed/37531163"
}


@Article{info:doi/10.2196/36871,
author="Erturk, Sinan
and Hudson, Georgie
and Jansli, M. Sonja
and Morris, Daniel
and Odoi, M. Clarissa
and Wilson, Emma
and Clayton-Turner, Angela
and Bray, Vanessa
and Yourston, Gill
and Cornwall, Andrew
and Cummins, Nicholas
and Wykes, Til
and Jilka, Sagar",
title="Codeveloping and Evaluating a Campaign to Reduce Dementia Misconceptions on Twitter: Machine Learning Study",
journal="JMIR Infodemiology",
year="2022",
month="Nov",
day="22",
volume="2",
number="2",
pages="e36871",
keywords="machine learning",
keywords="patient and public involvement",
keywords="codevelopment",
keywords="misconceptions",
keywords="stigma",
keywords="Twitter",
keywords="social media",
abstract="Background: Dementia misconceptions on Twitter can have detrimental or harmful effects. Machine learning (ML) models codeveloped with carers provide a method to identify these and help in evaluating awareness campaigns. Objective: This study aimed to develop an ML model to distinguish between misconceptions and neutral tweets and to develop, deploy, and evaluate an awareness campaign to tackle dementia misconceptions. Methods: Taking 1414 tweets rated by carers from our previous work, we built 4 ML models. Using a 5-fold cross-validation, we evaluated them and performed a further blind validation with carers for the best 2 ML models; from this blind validation, we selected the best model overall. We codeveloped an awareness campaign and collected pre-post campaign tweets (N=4880), classifying them with our model as misconceptions or not. We analyzed dementia tweets from the United Kingdom across the campaign period (N=7124) to investigate how current events influenced misconception prevalence during this time. Results: A random forest model best identified misconceptions with an accuracy of 82\% from blind validation and found that 37\% of the UK tweets (N=7124) about dementia across the campaign period were misconceptions. From this, we could track how the prevalence of misconceptions changed in response to top news stories in the United Kingdom. Misconceptions significantly rose around political topics and were highest (22/28, 79\% of the dementia tweets) when there was controversy over the UK government allowing to continue hunting during the COVID-19 pandemic. After our campaign, there was no significant change in the prevalence of misconceptions. Conclusions: Through codevelopment with carers, we developed an accurate ML model to predict misconceptions in dementia tweets. Our awareness campaign was ineffective, but similar campaigns could be enhanced through ML to respond to current events that affect misconceptions in real time. ",
doi="10.2196/36871",
url="https://infodemiology.jmir.org/2022/2/e36871",
url="http://www.ncbi.nlm.nih.gov/pubmed/37113444"
}


@Article{info:doi/10.2196/40049,
author="Bacsu, Juanita-Dawne
and Cammer, Allison
and Ahmadi, Soheila
and Azizi, Mehrnoosh
and Grewal, S. Karl
and Green, Shoshana
and Gowda-Sookochoff, Rory
and Berger, Corinne
and Knight, Sheida
and Spiteri, J. Raymond
and O'Connell, E. Megan",
title="Examining the Twitter Discourse on Dementia During Alzheimer's Awareness Month in Canada: Infodemiology Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="26",
volume="6",
number="10",
pages="e40049",
keywords="Twitter",
keywords="social media",
keywords="dementia",
keywords="Alzheimer disease",
keywords="awareness",
keywords="public health campaigns",
abstract="Background: Twitter has become a primary platform for public health campaigns, ranging from mental health awareness week to diabetes awareness month. However, there is a paucity of knowledge about how Twitter is being used during health campaigns, especially for Alzheimer's Awareness Month. Objective: The purpose of our study was to examine dementia discourse during Canada's Alzheimer's Awareness Month in January to inform future awareness campaigns. Methods: We collected 1289 relevant tweets using the Twint application in Python from January 1 to January 31, 2022. Thematic analysis was used to analyze the data. Results: Guided by our analysis, 4 primary themes were identified: dementia education and advocacy, fundraising and promotion, experiences of dementia, and opportunities for future actions. Conclusions: Although our study identified many educational, promotional, and fundraising tweets to support dementia awareness, we also found numerous tweets with cursory messaging (ie, simply referencing January as Alzheimer's Awareness Month in Canada). While these tweets promoted general awareness, they also highlight an opportunity for targeted educational content to counter stigmatizing messages and misinformation about dementia. In addition, awareness strategies partnering with diverse stakeholders (such as celebrities, social media influencers, and people living with dementia and their care partners) may play a pivotal role in fostering dementia dialogue and education. Further research is needed to develop, implement, and evaluate dementia awareness strategies on Twitter. Increased knowledge, partnerships, and research are essential to enhancing dementia awareness during Canada's Alzheimer's Awareness Month and beyond. ",
doi="10.2196/40049",
url="https://formative.jmir.org/2022/10/e40049",
url="http://www.ncbi.nlm.nih.gov/pubmed/36287605"
}


@Article{info:doi/10.2196/40171,
author="Hong, Alicia Y.
and Shen, Kang
and Lu, Kate Huixing
and Chen, Hsiaoyin
and Gong, Yang
and Ta Park, Van
and Han, Hae-Ra",
title="A Social Media--Based Intervention for Chinese American Caregivers of Persons With Dementia: Protocol Development",
journal="JMIR Aging",
year="2022",
month="Sep",
day="29",
volume="5",
number="3",
pages="e40171",
keywords="Alzheimer disease",
keywords="dementia",
keywords="caregivers",
keywords="Chinese Americans",
keywords="mHealth intervention",
keywords="mobile health",
keywords="WeChat",
keywords="social media",
keywords="aging",
abstract="Background: Racial/ethnic minority and immigrant caregivers of persons with dementia experience high rates of psychosocial stress and adverse health outcomes. Few culturally tailored mobile health (mHealth) programs were designed for these vulnerable populations. Objective: This study reports the development of a culturally tailored mHealth program called Wellness Enhancement for Caregivers (WECARE) to improve caregiving skills, reduce distress, and improve the psychosocial well-being of Chinese American family caregivers of persons with dementia. Methods: Community-based user-centered design principles were applied in the program development. First, the structure and curriculum of the WECARE program were crafted based on existing evidence-based interventions for caregivers with input from 4 experts. Second, through working closely with 8 stakeholders, we culturally adapted evidence-based programs into multimedia program components. Lastly, 5 target users tested the initial WECARE program; their experience and feedback were used to further refine the program. Results: The resulting WECARE is a 7-week mHealth program delivered via WeChat, a social media app highly popular in Chinese Americans. By subscribing to the official WECARE account, users can receive 6 interactive multimedia articles pushed to their WeChat accounts each week for 7 weeks. The 7 major themes include (1) facts of dementia and caregiving; (2) the enhancement of caregiving skills; (3) effective communication with health care providers, care partners, and family members; (4) problem-solving skills for caregiving stress management; (5) stress reduction and depression prevention; (6) the practice of self-care and health behaviors; and (7) social support and available resources. Users also have the option of joining group chats for peer support. The WECARE program also includes a back-end database that manages intervention delivery and tracks user engagement. Conclusions: The WECARE program represents one of the first culturally tailored social media--based interventions for Chinese American caregivers of persons with dementia. It demonstrates the use of community-based user-centered design principles in developing an mHealth intervention program in underserved communities. We call for more cultural adaptation and development of mHealth interventions for immigrant and racial/ethnic minority caregivers of persons with dementia. ",
doi="10.2196/40171",
url="https://aging.jmir.org/2022/3/e40171",
url="http://www.ncbi.nlm.nih.gov/pubmed/36173667"
}


@Article{info:doi/10.2196/38363,
author="Bacsu, R. Juanita-Dawne
and O'Connell, E. Megan
and Cammer, Allison
and Ahmadi, Soheila
and Berger, Corinne
and Azizi, Mehrnoosh
and Gowda-Sookochoff, Rory
and Grewal, S. Karl
and Green, Shoshana
and Knight, Sheida
and Spiteri, J. Raymond",
title="Examining the Impact of COVID-19 on People With Dementia From the Perspective of Family and Friends: Thematic Analysis of Tweets",
journal="JMIR Aging",
year="2022",
month="Jun",
day="27",
volume="5",
number="2",
pages="e38363",
keywords="coronavirus 2019",
keywords="COVID-19",
keywords="Twitter",
keywords="social media",
keywords="dementia",
keywords="Alzheimer disease",
keywords="thematic analysis",
keywords="aging",
keywords="older adult",
keywords="elderly population",
keywords="caregiver",
keywords="support service",
keywords="peer support",
keywords="online health community",
abstract="Background: The COVID-19 pandemic is taking a serious toll on people with dementia. Given the rapidly evolving COVID-19 context, policymakers and practitioners require timely, evidence-informed research to address the changing needs and challenges of people with dementia and their family care partners. Objective: Using Twitter data, the objective of this study was to examine the COVID-19 impact on people with dementia from the perspective of their family members and friends. Methods: Using the Twint application in Python, we collected 6243 relevant tweets over a 15-month time frame. The tweets were divided among 11 coders and analyzed using a 6-step thematic analysis process. Results: Based on our analysis, 3 main themes were identified: (1) frustration and structural inequities (eg, denied dignity and inadequate supports), (2) despair due to loss (eg, isolation, decline, and death), and (3) resiliency, survival, and hope for the future. Conclusions: As the COVID-19 pandemic persists and new variants emerge, people with dementia and their family care partners are facing complex challenges that require timely interventions. More specifically, tackling COVID-19 challenges requires revisiting pandemic policies and protocols to ensure equitable access to health and support services, recognizing the essential role of family care partners, and providing financial assistance and resources to help support people with dementia in the pandemic. Revaluating COVID-19 policies is critical to mitigating the pandemic's impact on people with dementia and their family care partners. ",
doi="10.2196/38363",
url="https://aging.jmir.org/2022/2/e38363",
url="http://www.ncbi.nlm.nih.gov/pubmed/35667087"
}


@Article{info:doi/10.2196/35677,
author="Bacsu, Juanita-Dawne
and Fraser, Sarah
and Chasteen, L. Alison
and Cammer, Allison
and Grewal, S. Karl
and Bechard, E. Lauren
and Bethell, Jennifer
and Green, Shoshana
and McGilton, S. Katherine
and Morgan, Debra
and O'Rourke, M. Hannah
and Poole, Lisa
and Spiteri, J. Raymond
and O'Connell, E. Megan",
title="Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="31",
volume="5",
number="1",
pages="e35677",
keywords="coronavirus 2019",
keywords="social media",
keywords="stigma",
keywords="dementia",
keywords="ageism",
keywords="COVID-19",
keywords="Twitter",
keywords="bias",
keywords="infodemiology",
keywords="attention",
keywords="risk",
keywords="impact",
keywords="misinformation",
keywords="belief",
keywords="cognition",
keywords="cognitive impairment",
abstract="Background: During the pandemic, there has been significant social media attention focused on the increased COVID-19 risks and impacts for people with dementia and their care partners. However, these messages can perpetuate misconceptions, false information, and stigma. Objective: This study used Twitter data to understand stigma against people with dementia propagated during the COVID-19 pandemic. Methods: We collected 1743 stigma-related tweets using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: Based on our analysis, 4 main themes were identified: (1) ageism and devaluing the lives of people with dementia, (2) misinformation and false beliefs about dementia and COVID-19, (3) dementia used as an insult for political ridicule, and (4) challenging stigma against dementia. Social media has been used to spread stigma, but it can also be used to challenge negative beliefs, stereotypes, and false information. Conclusions: Dementia education and awareness campaigns are urgently needed on social media to address COVID-19-related stigma. When stigmatizing discourse on dementia is widely shared and consumed amongst the public, it has public health implications. How we talk about dementia shapes how policymakers, clinicians, and the public value the lives of people with dementia. Stigma perpetuates misinformation, pejorative language, and patronizing attitudes that can lead to discriminatory actions, such as the limited provision of lifesaving supports and health services for people with dementia during the pandemic. COVID-19 policies and public health messages should focus on precautions and preventive measures rather than labeling specific population groups. ",
doi="10.2196/35677",
url="https://aging.jmir.org/2022/1/e35677",
url="http://www.ncbi.nlm.nih.gov/pubmed/35290197"
}


@Article{info:doi/10.2196/30388,
author="Hudson, Georgie
and Jansli, M. Sonja
and Erturk, Sinan
and Morris, Daniel
and Odoi, M. Clarissa
and Clayton-Turner, Angela
and Bray, Vanessa
and Yourston, Gill
and Clouden, Doreen
and Proudfoot, David
and Cornwall, Andrew
and Waldron, Claire
and Wykes, Til
and Jilka, Sagar",
title="Investigation of Carers' Perspectives of Dementia Misconceptions on Twitter: Focus Group Study",
journal="JMIR Aging",
year="2022",
month="Jan",
day="24",
volume="5",
number="1",
pages="e30388",
keywords="patient and public involvement",
keywords="dementia",
keywords="co-production",
keywords="misconceptions",
keywords="stigma",
keywords="Twitter",
keywords="social media",
keywords="Alzheimer's Disease",
abstract="Background: Dementia misconceptions on social media are common, with negative effects on people with the condition, their carers, and those who know them. This study codeveloped a thematic framework with carers to understand the forms these misconceptions take on Twitter. Objective: The aim of this study is to identify and analyze types of dementia conversations on Twitter using participatory methods. Methods: A total of 3 focus groups with dementia carers were held to develop a framework of dementia misconceptions based on their experiences. Dementia-related tweets were collected from Twitter's official application programming interface using neutral and negative search terms defined by the literature and by carers (N=48,211). A sample of these tweets was selected with equal numbers of neutral and negative words (n=1497), which was validated in individual ratings by carers. We then used the framework to analyze, in detail, a sample of carer-rated negative tweets (n=863). Results: A total of 25.94\% (12,507/48,211) of our tweet corpus contained negative search terms about dementia. The carers' framework had 3 negative and 3 neutral categories. Our thematic analysis of carer-rated negative tweets found 9 themes, including the use of weaponizing language to insult politicians (469/863, 54.3\%), using dehumanizing or outdated words or statements about members of the public (n=143, 16.6\%), unfounded claims about the cures or causes of dementia (n=11, 1.3\%), or providing armchair diagnoses of dementia (n=21, 2.4\%). Conclusions: This is the first study to use participatory methods to develop a framework that identifies dementia misconceptions on Twitter. We show that misconceptions and stigmatizing language are not rare. They manifest through minimizing and underestimating language. Web-based campaigns aiming to reduce discrimination and stigma about dementia could target those who use negative vocabulary and reduce the misconceptions that are being propagated, thus improving general awareness. ",
doi="10.2196/30388",
url="https://aging.jmir.org/2022/1/e30388",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072637"
}


@Article{info:doi/10.2196/23591,
author="Anderberg, Peter
and Abrahamsson, Linda
and Berglund, Sanmartin Johan",
title="An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study",
journal="JMIR Aging",
year="2021",
month="May",
day="17",
volume="4",
number="2",
pages="e23591",
keywords="internet",
keywords="older people",
keywords="social participation",
keywords="aging",
keywords="instrument",
keywords="elderly",
keywords="social platform",
keywords="perception",
keywords="connectedness",
abstract="Background: Older people's use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people's internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective: The aim of this study was to create an instrument to measure an older person's perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). Results: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach $\alpha$ coefficient was .92. The 1-factor solution explained 55\% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model ($\chi$26=13.985; $\chi$2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). Conclusions: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected. ",
doi="10.2196/23591",
url="https://aging.jmir.org/2021/2/e23591",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999004"
}


@Article{info:doi/10.2196/20321,
author="Shu, Sara
and Woo, P. Benjamin K.",
title="Digital Media as a Proponent for Healthy Aging in the Older Chinese American Population: Longitudinal Analysis",
journal="JMIR Aging",
year="2020",
month="Jun",
day="16",
volume="3",
number="1",
pages="e20321",
keywords="geriatrics",
keywords="health promotion",
keywords="health education",
keywords="social media",
keywords="Parkinson disease",
keywords="fall prevention",
keywords="oral health",
keywords="pulmonary disease",
keywords="gastrointestinal health",
abstract="Background: Ensuring health literacy among underserved populations is essential amid an aging population. Accessible and appropriate (both culturally and linguistically) information is important when considering digital media education for older Chinese Americans. Objective: This study aims to investigate how social media fare over time in disseminating health information and how we may most effectively educate this population. Methods: For this study, 5 geriatric-themed educational videos about Parkinson disease, fall prevention, gastrointestinal health, oral health, and pulmonary disease were uploaded to YouTube. Data were collected over a 40-month period. Descriptive statistics and chi-square analysis were used to compare results from the first and second 20-month periods. Results: In 40 months, the 5 videos in aggregate accrued 1171.1 hours of watch time, 7299 views, and an average view duration of 9.6 minutes. Comparing the first and second 20-month periods, there was a significant increase in mobile device usage, from 79.4\% (3541/4458) to 83.3\% (2367/2841). There was no significant difference in the usage of various external traffic sources and methods of sharing, with WhatsApp accounting for the majority of sharing in both 20-month periods. Conclusions: Our study provides insight into where to focus future strategies to optimize digital media content, and how to best recruit, direct, and disseminate health education to an older adult Chinese American population. Combining the success of YouTube, social media, and messaging platforms such as WhatsApp can help to transcend cultural and linguistic barriers to promote healthy aging. ",
doi="10.2196/20321",
url="http://aging.jmir.org/2020/1/e20321/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32543447"
}


@Article{info:doi/10.2196/11542,
author="Cheng, Yi-mei Tiffany
and Liu, Lisa
and Woo, KP Benjamin",
title="Analyzing Twitter as a Platform for Alzheimer-Related Dementia Awareness: Thematic Analyses of Tweets",
journal="JMIR Aging",
year="2018",
month="Dec",
day="10",
volume="1",
number="2",
pages="e11542",
keywords="social media",
keywords="Twitter",
keywords="dementia",
keywords="social support",
abstract="Background: Dementia is a prevalent disorder among adults and often subjects an individual and his or her family. Social media websites may serve as a platform to raise awareness for dementia and allow researchers to explore health-related data. Objective: The objective of this study was to utilize Twitter, a social media website, to examine the content and location of tweets containing the keyword ``dementia'' to better understand the reasons why individuals discuss dementia. We adopted an approach that analyzed user location, user category, and tweet content subcategories to classify large publicly available datasets. Methods: A total of 398 tweets were collected using the Twitter search application programming interface with the keyword ``dementia,'' circulated between January and February 2018. Twitter users were categorized into 4 categories: general public, health care field, advocacy organization, and public broadcasting. Tweets posted by ``general public'' users were further subcategorized into 5 categories: mental health advocate, affected persons, stigmatization, marketing, and other. Placement into the categories was done through thematic analysis. Results: A total of 398 tweets were written by 359 different screen names from 28 different countries. The largest number of Twitter users were from the United States and the United Kingdom. Within the United States, the largest number of users were from California and Texas. The majority (281/398, 70.6\%) of Twitter users were categorized into the ``general public'' category. Content analysis of tweets from the ``general public'' category revealed stigmatization (113/281, 40.2\%) and mental health advocacy (102/281, 36.3\%) as the most common themes. Among tweets from California and Texas, California had more stigmatization tweets, while Texas had more mental health advocacy tweets. Conclusions: Themes from the content of tweets highlight the mixture of the political climate and the supportive network present on Twitter. The ability to use Twitter to combat stigma and raise awareness of mental health indicates the benefits that can potentially be facilitated via the platform, but negative stigmatizing tweets may interfere with the effectiveness of this social support. ",
doi="10.2196/11542",
url="http://aging.jmir.org/2018/2/e11542/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518232"
}


@Article{info:doi/10.2196/10176,
author="Litchman, L. Michelle
and Snider, Christopher
and Edelman, S. Linda
and Wawrzynski, E. Sarah
and Gee, M. Perry",
title="Diabetes Online Community User Perceptions of Successful Aging With Diabetes: Analysis of a \#DSMA Tweet Chat",
journal="JMIR Aging",
year="2018",
month="Jun",
day="22",
volume="1",
number="1",
pages="e10176",
keywords="diabetes",
keywords="aging",
keywords="social media",
keywords="Twitter",
abstract="Background: According to the American Diabetes Association, there are approximately 30.3 million Americans with diabetes, and the incidence is growing by nearly 1.5 million cases per year. These individuals are at particularly high risk of developing secondary comorbid conditions related to diabetes and aging. Nearly 45\% of individuals aged 65 to 75 years use social media, and this number is steadily growing. The use of social media provides the opportunity to assess the perceptions and needs of this population. Objective: The purpose of this study was to examine stakeholder perceptions of successful aging with diabetes. Methods: This study presents a retrospective analysis of a tweet chat focused on aging with diabetes. Tweets were collected using Symplur Signals data analytics software (Symplur LLC) and analyzed for content analysis, sentiment, and participant demographics. Two authors reviewed discussion posts for accuracy of analysis. Results: A total of 59 individuals participated in this tweet chat generating 494 tweets and nearly 2 million impressions. Most (36/59, 63\%) tweet chat participants were people living with diabetes; 25\% (14/59) were caregivers and advocates. Seven countries were represented in the conversation. A majority (352/494, 71.3\%) of the tweets indicated positive sentiment related to aging with diabetes. Five major themes emerged from the qualitative analysis: (1) personal decline now and in the future, (2) limited access to treatment, (3) inability to provide self-care, (4) health care provider capacity to support aging with diabetes, and (5) life-long online peer health support to facilitate diabetes management. Conclusions: Individuals with diabetes are living longer and want to be supported with specialized care and access to technology that will allow them to successfully age. Aging- and diabetes-related changes may complicate diabetes management into old age. People with diabetes desire options including aging in place; therefore, special training for care partners and health care providers who care for older adults is needed. ",
doi="10.2196/10176",
url="http://aging.jmir.org/2018/1/e10176/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518231"
}