C. What Influences Whether Someone Will Take Advantage Of Health Services?
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Social media utilize in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals
BMC Health Services Research volume xvi, Commodity number:442 (2016) Cite this article
Abstract
Background
Since the emergence of social media in 2004, a growing percentage of patients employ this engineering for health related reasons. To reflect on the alleged beneficial and potentially harmful furnishings of social media use by patients, the aim of this paper is to provide an overview of the extant literature on the furnishings of social media use for wellness related reasons on patients and their relationship with healthcare professionals.
Methods
We conducted a systematic literature review on empirical research regarding the effects of social media use past patients for health related reasons. The papers nosotros included met the following selection criteria: (1) published in a peer-reviewed journal, (ii) written in English, (3) full text bachelor to the researcher, (four) comprise chief empirical data, (v) the users of social media are patients, (6) the effects of patients using social media are clearly stated, (vii) satisfy established quality criteria.
Results
Initially, a total of i,743 articles were identified from which 22 were included in the study. From these articles six categories of patients' apply of social media were identified, namely: emotional, data, esteem, network support, social comparison and emotional expression. The types of apply were found to lead to seven identified types of effects on patients, namely improved self-management and control, enhanced psychological well-existence, and enhanced subjective well-being, diminished subjective well-being, habit to social media, loss of privacy, and being targeted for promotion. Social media use by patients was constitute to affect the healthcare professional and patient relationship, by leading to more equal communication between the patient and healthcare professional, increased switching of doctors, harmonious relationships, and suboptimal interaction between the patient and healthcare professional.
Conclusions
Our review provides insights into the emerging utilization of social media in healthcare. In particular, it identifies types of utilize by patients also as the furnishings of such use, which may differ between patients and doctors. Accordingly, our results framework and propositions can serve to guide hereafter research, and they also have practical implications for healthcare providers and policy makers.
Peer Review reports
Background
Previous studies on social media use in healthcare identified dissimilar furnishings of social media utilize by patients for wellness related reasons within the healthcare organization. Social media tin serve as an assist to patients. For example, it fosters their autonomy past complementing the data provided by healthcare professionals [1] and by providing psychosocial support [ii]. Social media apply past patients can as well be an aid to healthcare professionals by providing a tool to strengthen the organization's market position [iii, 4] and stimulating conversation for brand building and improved service delivery [4, 5]. In fact, social media may take effects on both patients, and on the wider healthcare system [6]. In particular, it allows patients to receive support [1], and to complement offline information [2], which may lead to enhancing the empowerment of patients [half-dozen]. However, social media use past patients does not but provide beneficial effects. It may too constitute a claiming within the healthcare system to both patients and healthcare professionals. Since everybody with access to social media can mail "advice" on how to deal with a certain health condition, it is of import to create reliable online communication channels to prevent health problems being exacerbated [7]. For instance, one misguided idea on Twitter urged Nigerians to drink excessive amounts of table salt h2o to combat Ebola. However, this may take led to two deaths and more than 12 admissions to infirmary [7]. Thus, many healthcare professionals fear that social media use past patients for health related purposes oft spreads misinformation amidst patients [1].
Use of social media past patients for wellness related reasons provides different effects, which can event in both benefits and challenges. It is important to identify these effects of social media for the healthcare organization, as "a growing pct of patients use social media for health-related reasons, and then health professionals volition have to reverberate on the alleged beneficial effects and the potential harmful furnishings of social media use by patients in healthcare" [8]. Hence, the review of these furnishings will contribute to a better understanding of potential benefits and challenges for both patients and healthcare professionals, only too other healthcare actors such as policy makers.
Therefore, this paper provides a systematic literature review of empirical studies on the effects of social media use by patients for wellness related reasons on patients and on their relationships with healthcare professionals. To our cognition no other systematic enquiry on this topic has been performed to appointment. Such review likewise provides the opportunity to extract general findings from the studies. Subsequently, healthcare professionals can learn from these findings near the effects of social media utilize by patients and share this noesis with other patients and use information technology to their ain advantage. We aim to answer the post-obit question:
According to recent empirical research, what are the furnishings of social media utilise past patients for wellness related reasons on patients and on their relationships with healthcare professionals?
To answer this question, the paper volition accost the following: (ane) the types of social media apply by patients (ii) the identified effects of social media apply past patient on patients (iii) the identified effects on the human relationship betwixt patients and their healthcare professionals and (4) the relationship between the effects on patients and healthcare professionals. By addressing the issue (4), nosotros attempt to join our findings from the issues (ii) and (3) and explore linking mechanisms between the effects patients experience and their subsequent link to the effects they experience in relationship with the healthcare professionals.
Report aim and terminology
The aim of this paper is to gain insights in the benefits and challenges of the effects of social media utilize by patients inside the healthcare system and particularly the effects on patients and on their relationships with healthcare professionals. The furnishings nosotros focus on in this newspaper can exist both causal and reciprocal, but always start with the use of social media by patients.
Despite the popularity of social media, there is a confusion about what is exactly meant by the term social media. Therefore, in this newspaper nosotros employ the definition provided in the highly cited newspaper by Kaplan and Haenlein [9]. They describe social media as "a group of Net-based applications that build on the ideological and technological foundations of Spider web two.0, and that let the creation and substitution of User Generated Content". The internet-based applications refer to the different categories of social media, which are blogs, content communities, social networking sites, collaborative projects, virtual game worlds and virtual social worlds. These types of social media are attainable to users to apply for, among other things, health related reasons.
The term "users of social media in healthcare" in this paper refer to the patients and their family unit members. Patients are treated as any person who self-proclaims to exist suffering from a certain status, whether officially diagnosed by a healthcare professional person or not. We ascertain healthcare professionals as those who study, propose on or provide preventive, curative, rehabilitative and promotional health services based on an extensive body of theoretical and factual knowledge in diagnosis and treatment of conditions and other health problems [ten].
Methods
In order to provide an overview of the dissimilar effects of social media utilize by patients for health related reasons on patients and on their relationships with healthcare professionals, nosotros conducted systematic literature review.
To identify the articles, we employed a search strategy consisting of 3 terms as follows
a) "social media" or blog* or "content communit*" or "social networking site*" or "online social network*" or "virtual world*" or "online communit*" or "online forum*" or Facebook or Twitter or Wikipedia or IMVU or "second life" or YouTube b) "Patient*" and c) "wellness* provider*" or "health* professional*" or "physician*" or "doctor*" or "hospital*". The total search cord is also included in the Appendix A (see Additional file 1). Additionally, as suggested past the referees of this newspaper, we also used the term "client*" instead of "patient*", together with the other two original categories of terms.
To perform this literature review, we followed the guidelines on conducting a systematic literature review as prescribed by the Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) [11].
To conduct the search, we chose relevant databases of Web of Science and EBSCOhost Complete. Past focusing on EBSCOhostCOMPLETE, we made sure that the healthcare databases are included such as "PsycINFO", "CINAHL" and "MEDLINE". We likewise included the databases such "Business organization source premier" to include findings with a business perspective. Search options were slightly different for each database. For EBSCO the irrelevant databases were excluded first and no specific search field was selected for one of the three terms. The list of databases is presented in the Appendix B (See Additional file 2). Additionally, the option to search only in scholarly (peer reviewed) journals was used and the publication dates were selected to be subsequently 2004. In the yr 2004 the term Web ii.0 was used for the first fourth dimension, which marks the start of the social media era [9]. On the other hand, we selected topic for all three terms in the Web of Science, which included the titles, abstracts, writer keywords, and keywords plus fields of the articles.
Selection criteria
For an article to be included in the report it had to come across several option criteria every bit follows: (1) published in a peer-reviewed journal, (2) written in English, (3) full text bachelor to the researcher, (four) contain main empirical data, (5) the users of social media are patients, (6) the effects of patients using social media are conspicuously stated, (vii) satisfy established quality criteria. The manufactures were assessed on their quality by using the standard quality assessment criteria every bit identified past [12].
Prior to final screening and selection of the papers, first and second writer agreed to independently read 100 abstracts and select the articles that would exist included in the study based on the selection criteria. After, the selected articles past the two authors were compared and there was complete concurrence on the category "yes, this one volition be included". For some of the manufactures that were marked equally "perhaps", first and second author had a cursory discussion to reach a consensus. This helped to attain higher reliability for the inclusion of the articles. Further in the process, the 2nd author consulted the starting time author whenever there was a uncertainty whether to include or exclude the article. In add-on, regular meetings with the third author also contributed to the overall process of the selection.
Data analysis
The resulting papers were characterized past the enquiry aim and the type of enquiry, which is reflected in the Table 1. The papers were farther categorized co-ordinate to the focus of the enquiry question and data. Each paper's empirical findings were categorized by looking at data and making starting time notes inductively. Following this, we looked at our notes on topics that emerged from analysed manufactures and compared them to before literature. In this way, concepts from prior literature helped the states to make the sense of data from different articles and categorize them. A good example for that is the concept of social back up, which we used to allocate types of employ. Afterward analysing the articles in this way, we formulated propositions in the discussion section.
Results
Search results
The searches were carried out in the period ending on March 17th, 2015. The application of the search strategy to the two search engines resulted initially in a total of 1,743 articles. Within the i,743 articles many duplicates were found also within the search engines as between the search engines. By removing duplicates the first constitute article was kept. In this way, nosotros identified and removed 468 duplicates leaving us with one,275 articles.
The remaining 1,275 articles were screened on championship and abstract with regards to the selection criteria. Whenever nosotros had doubts if an commodity is relevant or when title and abstract were not clear, we inspected the paper in more details by accessing full article. An article was removed when, for example, it became clear that the user of social media was not a patient but another user, similar the infirmary, a regular "healthy" person or healthcare professional. Additionally, several articles referred to internet use by patients for wellness related reasons and their furnishings, but did not specify the effects of social media. Therefore, such manufactures were removed. Moreover, manufactures that were written in a language other than English too as articles that did non incorporate primary data or did not elaborate on an consequence of patients using social media. This left us with 22 manufactures that met our criteria. In improver, as a issue of the referees' proffer to include term "client", nosotros identified i boosted article, making the entire listing of 23 articles for the quality cess.
Quality of the articles was assessed by using the Standard Quality Cess Criteria for Evaluating Master Research Papers by [12] equally presented in the Appendix C (See Boosted file 3). This assessment tool distinguishes betwixt qualitative and quantitative inquiry and provides unlike quality assessment criteria for each type of research. The criteria are rated on their presence in the respective article and are either completely addressed in the article (resulting in 2 points), partly addressed (resulting in 1 bespeak), or not addressed (resulting in 0 points). In case an commodity scored below the threshold of a 50 % score of the total amount of points possible, the commodity is assumed to exist of depression quality and removed from this paper. This cut-off point for inclusion is relatively liberal co-ordinate to the authors of the assessment tool [12]. One article had a quality score below the l % cut-betoken and was excluded, which left united states with the total of 22 articles for analysis.
The article selection process is shown in Fig. 1.
Flowchart of written report selection process
Overview of the manufactures
The Table 1 provides an overview of 22 articles included in the written report. All studies except for three were published in or after 2010. Moreover, xix articles were published in journals that are related to the medical field, whereas only three manufactures are published in journal that do not take a specific connectedness to medicine: Journal of Sociology, New Review of Hypermedia & Multimedia, and Information Research. Only two out of the 22 articles use a theory or a model to build their research on, namely the concept of masculinity [13] and the actant model [14]. The group of articles consists of 9 quantitative, vii qualitative and six mixed methods studies.
The analysis of articles with regard to the blazon of social media and conditions is presented in the Appendix D (See Boosted file 4), which shows that the 12 articles studied online support communities and most focused on chronic atmospheric condition. Other types of social media platforms and atmospheric condition were spread among the remaining articles.
Analysis of results
This department presents findings from 22 articles nosotros included in our study. Beginning of all, an overview of the extracted findings is presented regarding the types of social media employ by patients. Following this, we nowadays the furnishings of social media employ on patients. Subsequently, an overview of the extracted findings regarding effects of social media use by patients on the relationship between patients and healthcare professionals are presented, discussed, and categorized.
Types of social media employ by patients for health related reasons
Our analysis starts with the blazon of use and motivation for their use of social media. When analysing all articles it becomes clear that patients do not use social media to circumvent healthcare professionals, only rather apply it as a complement to healthcare professional person services to fulfil the patients' needs that cannot be met by the healthcare professional. The relationship between patients and healthcare professionals is viewed by the patients as a more than clinical i, where healthcare professionals provide expert cognition about the condition and recommend treatment based on their medical knowledge, only not on their showtime-hand feel [15].
Additionally, doctors frequently accept difficulty expressing empathy and that they filter information for the patient, where the patient would rather exist informed near all options. Patients also believe that doctors might not be aware of the latest breakthroughs [fifteen]. Moreover, one of the the main reasons for patients to join online wellness communities is their dissatisfaction with their healthcare professional person'due south disability to meet the patients' emotional and informational needs [i]. Another reason for patients to use social media was to bridge the gap between traditional health information about their condition and everyday life [xvi]. In detail, Facebook is seen every bit an important improver to traditional in-office counselling in improving patient cognition [17].
Therefore, the types of social media use past patients equally identified in this paper refer to the way in which patients utilize social media intended to meet an unfulfilled demand. These are identified in the manufactures are categorized as shown in Table 2 and explained below. Categories represent social support, consisting of emotional, esteem, informational, and network support [18], and other types of utilize, which are emotional expression and social comparison.
Social support
The nearly mutual type of social media apply by patients for health related reasons that we found is social support. Social support is defined as "the process of interaction in relationships which is intended to amend coping, esteem, belonging, and competence through actual or perceived exchanges of psychosocial resources" [nineteen]. Social support is represented through five different categories and four of these categories were constitute to exist common types of social media use past patients for wellness related purposes [18]. These four types, namely emotional support, esteem support, information support, and network support are explained below.
Emotional support. Emotional support is defined every bit "communication that meets an private's emotional or affective needs" [20]. It refers to support gained through expressions of care and concern, which serve to amend an private'due south mood. Emotional support helps patients to meet their emotional or melancholia needs. The employ of social media by patients for emotional support was identified in 13 articles. Examples of emotional support are "sharing of emotional difficulties" [21], "encountering support that feels similar a warm blanket wrapped around you" [22], and "share emotions with other people who are coping with like bug" [23].
Esteem support. Esteem support refers to "communication that bolsters an individual'south cocky-esteem or beliefs in their ability to handle a problem or perform a needed task" [xx]. The aim of this type of support is to encourage individuals to have the actions needed to successfully live with their condition. The apply of social media by patients for esteem back up was identified in 7 articles. Examples of esteem support include "getting support from other patient'due south encouragement" [24], "share experiences about a new treatment to find encouragement before starting it" [25], and "rituals of confirming each other'due south endeavours to follow health instructions" [14].
Information support. Information back up is "communication that provides useful or needed information" [20]. In particular, newly diagnosed patients are in a need for a lot of information near their condition and treatment options, which can be provided by patients who have already dealt with the condition for a longer period [20]. The utilize of social media by patients for information support was identified in all manufactures. Examples of information support are "receiving advice about treatments" [26], "assistance fellow sufferers by sharing experiences and relevant information about the disease" [24], and "ask questions about the condition" [25].
Network back up. Network support is defined as "communication that affirms an individual's belonging to a network or reminds him/her of support bachelor from the network" [20]. Hence, network back up is support that reminds people that no affair what situation they are facing, they are not alone. The utilize of social media by patients for network back up was identified in xiii articles. Examples of network support include "meeting other patients who had gone through like experiences" [27], "a ways to connect with others in like situations" [fifteen], and "fostering relationships based on shared attributes" [28].
Other types of use
In improver to the social back up, nosotros likewise identified two other types of employ, which could not be direct placed under one of the subcategories of social support. These are emotional expression and social comparison.
Emotional expression. Emotional expression refers to the unique opportunity provided past social media for patients (and other users) to express their emotions freely without having to be concerned about the firsthand feelings or reactions of those who stand close to them. As noted in one of the manufactures, "online communities provide the potential to allow patients to open and reduce the inhibitions felt in sharing experiences in face to face situations", e.one thousand. hurting other people's feelings [13]. Therefore, patients can utilise social media every bit a identify to limited their emotions freely, like, releasing negative emotions [24]. In contrast to emotional support, which is defined equally patients interacting in and receiving communication to encounter their affective needs, emotional expression refers to patients expressing their emotions regardless of whether someone will respond. The use of social media by patients for emotional expression was identified in 8 articles. Examples include "a place to vent about the disease" [25] and "an outlet for expressing your emotions freely" [15].
Social comparison. Patients use social media to compare themselves with other patients to run into how "bad" their condition is or to find out how the treatments piece of work. This social comparison can seem to overlap with social support, for instance, when patients compare themselves to peers to recognize that they are not the just person in this situation (network support) or when patients compare themselves to peers to notice out how other people suffer from or cope with the condition (esteem support, emotional support, or information support). However, social comparing was categorized separately as inside the manufactures the authors presented it equally a different blazon of use without specifying the details. The use of social media by patients for social comparison was identified in iv articles. Examples include "upward social comparison" [25] and "comparison with other members [23].
Effects of the different types of social media apply by patients on patients
In this section the effects of the apply of social media past patients for health related reasons are analysed and presented. The most common consequence of patients using social media for wellness related reasons is patient empowerment, which is represented through iii categories: enhanced subjective well-existence, enhanced psychological well-existence, and improved cocky-management and command. We likewise identified four other types of effects, which are less common in our literature review. These are: diminished subjective well-being, loss of privacy, addiction to social media, and being targeted for promotion. Identified categories are presented in Tabular array 3 and explained below.
Patient empowerment
In electric current literature, the concept of empowerment is defined as "an private trait, characterized past an emphasis on increased individual control over the aspects of one's life" [29]. Nosotros argue that the patient empowerment refers to "the discovery and development of i's inherent chapters to be responsible for one's own life. Hence, patients are empowered when they are in possession of the noesis, skills, and self-sensation necessary to identify and reach their own goals" [14]. Data support, esteem support, and emotional support were pregnant predictors of a patient's sense of empowerment [xxx]. Informational back up was the strongest predictor of increased sense of empowerment followed by esteem support and emotional back up. The 3 subcategories of empowerment, namely enhanced subjective well-being, enhanced psychological well-beingness, and improved self-direction and control, are discussed beneath.
Enhanced subjective well-being. Subjective well-being refers to "what people call up and how they experience about their lives in positive ways" [31]. In this paper, enhanced subjective well-beingness mainly refers to the pleasant emotions patients feel due to their social media utilise for wellness related reasons. "People feel enhanced subjective well-beingness when they experience many pleasant and few unpleasant emotions" [31]. Consequently, enhanced subjective well-being refers to an increment in the feel of pleasant emotions, which in plough heightens people's feeling of empowerment. The effect enhanced subjective well-beingness was identified in 12 articles. Examples from the articles concerning enhanced subjective well-existence are "increased optimism" [22], "increased acceptance of the illness" [23], "decrease anxiety" [26] and "increased sense of normalcy" [27].
Enhanced psychological well-being. Psychological well-beingness is defined in the literature as "focusing on eudemonic well-being, which is the fulfilment of human potential and a meaningful life" [32]. One of the components affecting psychological well-being is the feel of positive relations with others. It is argued that a central component of mental health is to exist in warm, trusting, interpersonal relations [33]. Moreover, "self-actualizers are described as having strong feelings of empathy and affection for all human beings and as being capable of greater love, deeper friendship, and more complete identification with others" [33]. Therefore, enhanced psychological well-existence refers to an increase in the patient's experience of positive relations with others through the use social media. The effect enhanced psychological well-being was identified in 14 articles. Examples from the manufactures include "feeling of being connected to other people" [34], "increased social network online too every bit offline" [27], and "promotion of deep relationships" [15].
Improved self-management and control. Improved self-management and sense of control refers to the improvement in the capability of patients to ameliorate handle their condition. As patients feel amend informed, their ability to brand decisions on their ain improves, which fosters self-management and perceived command over the status. Ability to deal with the day-to-mean solar day life with the condition also increases, for example due to learning near coping strategies, which as well fosters improved cocky-direction and perceived control. The effect of improved self-direction and sense of control was identified in fourteen articles. Examples from the articles include "increase patient'southward self-management" [34], "comeback in the ability to manage the disease" [16], and "fostering insight and universality" [26].
Other types of effects
In add-on to the patient empowerment, several other types of effects of social media utilise by patients on patients were identified. These are diminished subjective well-existence, loss of privacy, being targeted for promotion, and addiction to social media.
Diminished subjective well-being. Diminished subjective well-being is opposite of enhanced subjective well-beingness and indicates an increment in the experience of negative emotions due to the use of social media, such as an increase in feelings of worry and anxiety. It was identified in 6 articles. Diminished subjective well-being was the near common establish effect of patients using social media for health related reasons. Examples include "demoralization" [25], "hurt feelings due to negative feedback" [16], and "increased feelings of anxiety" [35].
Loss of privacy. Loss of privacy was mentioned in only ane article [16]. It refers to the finding that the patients lose their privacy when they mail personal videos on YouTube.
Being targeted for promotion. Existence targeted for promotion was as well mentioned in only one article past [16]. Information technology refers to the finding that patients who postal service videos on YouTube can be targets product promotions.
Addiction to social media. Addiction was an effect identified in ane article by [35]. It refers to the finding that sometimes patients experience their social media use for health related reasons to be addictive. Every bit such, it frequently took the time that they normally spent doing other tasks.
Effects of social media use past patients on the human relationship between patients and healthcare professionals
The apply of social media by patients for health related reasons does non only affect the patients themselves or other patients, but also the human relationship between patients and healthcare professionals. In full, nine articles discussed the furnishings of social media apply by patients on the relationship between patients and healthcare professionals, although six out of these nine manufactures only touch very briefly upon this subject area. The furnishings of social media utilize past patients for health related reasons on the relationship between patients and healthcare professionals that have been extracted from the articles are presented in Table 4 and discussed beneath.
The findings presented in Table 4 are divided into categories representing the effects on the human relationship between patients and healthcare professionals. These categories are more than equal communication between the patient and healthcare professional, increased switching of doctors, harmonious relationships, and suboptimal interaction between the patient and healthcare professional. The categories are discussed below.
More equal advice between the patient and healthcare professional
Social media use by patients for wellness related reasons can lead to more equal communication between the patient and healthcare professional person. This effect refers to patients feeling more confident in their relationship with the healthcare professional. In full, five articles referred to this effect. With the data from the social media platforms, patients can increment their cognition well-nigh treatment options. Consequently, they are better able to communicate with the healthcare professional person as they can better understand their condition [36]. Hence, patients may experience more than confident in their relationship with their physician [22, 23]. Patients feel that they are better prepared for consultations as they are more than informed about their condition and know better what questions to enquire [23]. Social support received through the use of social media eventually increases the likeliness to form an intention to actively communicate with the md during a medical consultation [30]. Moreover, the utilize of social media provides the opportunity to learn and increase health communication, which may lead to an increase in the patients' willingness to seek medical attention [37]. Hence, these findings propose that the utilize of social media for health related purposes tin can increment a patient's confidence and active advice in their human relationship with healthcare.
Increased switching of doctors
Social media utilize by patients for health related reasons tin can atomic number 82 to shorter relationships betwixt healthcare professionals and patients. Patients may change doctor due to online discussions about physicians or due to negative reactions from doctors about the patients' treatments supervised past their regular physicians. Two articles institute that patients inverse dr. considering of those patients' use of social media. For instance, negative reactions from physicians to the mentions of social media utilize by patients fabricated the patients to look for second opinion and even modify their doc [i]. On the other hand, some patients changed their doctor as a upshot of online word with other patients [36].
Harmonious relationships
Harmonious relationships between healthcare professionals and patients tin be established as social media provide a identify for patients to release negative emotions. Yet, the effect of harmonious relationships also comprises the fact that social media might empower individuals to follow doctor'south recommendations, which reduces discussions during clinical interaction. The result of harmonious relationships was identified in two articles. Social media provide a place for patients to limited their emotions and maintain harmony in the relationship betwixt healthcare professional and patient in offline consultations, which focuses on non-emotional aspects of the disease [24]. On the other hand, social media were empowering individual users to comply with doctors' recommendations equally a grouping, which affects the healthcare professional patient relationship by potentially reducing discussions during clinical interactions every bit patients stick to the recommended treatment [xiv]. Even so, it tin can also be viewed as a missed opportunity, as patients do not empower each other to discover alternative treatments [fourteen].
Suboptimal interaction between the patient and healthcare professional person
Equally patients utilise social media for health related reasons, this tin can affect the patient and healthcare professional relationship by leading to suboptimal interaction betwixt the patient and healthcare professional. When patients bring social media content to the consultation, this tin lead to increased processes of sorting information, transforming the potential risk to the healthcare professional, and challenging the healthcare professional's expertise [13]. Additionally, if the healthcare professional person reacts negatively to what patient learned from social media, this might decrease the patient's subjective well-existence [i]. The outcome of suboptimal interaction between the patient and healthcare professional was identified in ii articles. Discussion of the information from social media during the consultation was experienced as a threat by the physician [13]. Furthermore, healthcare professionals reacted negatively to online health customs content raised during clinical interactions, which made patients feel disempowered, but information technology did not change their online behaviour [1].
Human relationship between effects on patients and effects on the patient healthcare professional relationship
In the section virtually the outcome of "more equal communication between the patient and healthcare professional", nosotros already mentioned that increased communication during a consultation on behalf of the patient can be caused by patient empowerment. Patient empowerment refers to "the inherent chapters to exist responsible for one'south own life" [14]. In regards to the relationship between patients and healthcare professionals, the patients took more responsibility for their ain condition. Five articles find that the patient empowerment indeed affects the patients' confidence, ability and willingness to actively participate in clinical interactions. Patients increased their sense of empowerment through their intention to actively communicate with the md [thirty]. Additionally, the patient empowerment was associated with an increased conviction in dealing with the doctor [23]. Moreover, the convenience of social media use past patients is that it reduces the data gap between healthcare professionals and patients and patients have a better understanding of the healthcare professional during consultations [37]. Social media can empower patients past giving them access to information and opportunities for discussions, which increases the patient'due south involvement in clinical interactions [xv]. Finally, the patient empowerment increases the ability of patients to communicate with the healthcare professionals [22]. Hence, we argue that the patient empowerment contributes to more than equal advice betwixt the patient and the healthcare professional person.
Discussion
This review provides an insight into the electric current body of knowledge on the effects of social media use by patients for health related reasons and the effects on patients and on their human relationship with healthcare professionals. All of the studies were published in the past ten years, with only iii articles published earlier 2010. This tin can be explained past a contempo increase in the use of social media by patients for wellness related reasons.
Nosotros categorized articles into unlike types of use and effects. We identified that the most common type of utilize was social support, namely emotional support, esteem support, data support, and network back up. The types of social media use were most often establish to affect patients by empowering them through enhanced subjective well-being, enhanced psychological well-existence, and improved self-direction and control. However, the types of social media use past patients were also plant to affect patients through addiction to social media, diminished subjective well-existence, being targeted for promotion, and loss of privacy. Moreover, the identified types of social media employ past patients for health related reasons was also institute to affect the relationship between patients and healthcare professionals as it tin result in more equal communication between the patient and healthcare professional, shorter relationships, harmonious relationships, and suboptimal interaction between the patient and healthcare professional. Based on these findings, nosotros made 3 propositions.
Relationship between use and outcome: Network support and enhanced psychological well-beingness
When patients are diagnosed with a certain condition that nobody in their close (offline) network has experienced before, patients tin can feel very lonely [27]. Equally a diabetic patient states "I literally felt like the merely diabetic on the planet" [xvi]. However, social media provide an opportunity to easily connect with others and reduce this feeling of loneliness. Consequently, patients using social media for network support enhanced their psychological well-being. For example, social media provide means to connect with others in like situations and this can pause a patient'south loneliness [xv]. This is in line with earlier studies that have shown how the existence of network support contributes to a meliorate well-existence of the patients [41, 42]. Interestingly, [41] propose that the network support may not only do good the patients themselves, merely also their families who treat them. Yet, the relationship betwixt the network support and psychological well-being may depend on the level of self-esteem. For instance, higher students with depression self-esteem profited more from online social networking sites for bridging social uppercase and starting relationships than college students with high self-esteem [43]. In line with that, social networking sites provides the unique opportunity for patients to exist able to talk nigh the sensitive aspects of the condition, every bit online communities provide the potential to reduce inhibitions felt in sharing experiences face to face [13]. Such an inhibition could reflect depression self-esteem in terms of a reluctance to talk almost the status in face to face conversations.
Proposition 1: Social media utilize by patients for network back up leads to enhanced psychological well-being. This outcome is stronger for people with low self-esteem than for the people with high self-esteem.
Relationship betwixt content and event: Reading other people's stories, improved cocky-management and control and enhanced subjective well-being
Not all patients that make use of social media use it actively. Sometimes patients but use social media to read well-nigh other people's stories, without actively contributing themselves. These people are called lurkers. The lurking behaviour may be related to the level of privacy concerns and computer feet [44]. In particular, anxiety leads to increase in lurking. Ii articles in our sample were focused on the effects of patients using social media simply by reading other people's stories. From the ii articles, it becomes clear that the effects experienced by reading other people's stories are being ameliorate informed [22, 26]. Additionally, by reading other people'due south stories feet was found to significantly subtract [26]. Consequently, these findings suggest that reading other people's stories on social media can lead to enhanced subjective well-beingness and improved self-management and control. However, [22] and [26] do not elaborate on the content of the stories read. Contrasting findings were found in other articles regarding how content affects the effects of reading other people'southward stories. For example, cancer patients who read other people'due south stories enhanced their subjective well-existence [24]. Reading about success stories was found to enhance conviction to fight the condition, whereas reading almost bad experiences prepared the patient mentally for difficult times ahead. On the other hand, the patients suffering from an inflammatory bowel disease who read other people'south stories virtually a bad experience suffered from diminished subjective well-existence [25]. This is in line with before findings showing that the lack of sharing and feedback on this sharing may threaten the need for belonging [45]. Finally, patients suffering from infertility experienced diminished subjective well-being as the outcome of reading other people'south stories [35]. Reading stories virtually successful pregnancies led to increased feelings of jealousy, pain and a sense of alienation, whereas reading about bad experiences led to increased feelings of worry, anxiety and decreased optimism. Thus, this may lead to diminished subjective well-existence. On the other hand, one study in our sample shows that this actually may enhance subjective-well-being [24]. In detail, this paper focused on blogs whereas other studies focused on online support groups [24]. Among other uses, blogs can be used as personals diaries to limited thoughts, feelings, and stories [9]. Level of distress actually decreases when people weblog most their emotional difficulties [46].
Proposition 2: Reading other people'due south stories near a negative experience leads to macerated subjective well-beingness. This effect is weaker for patients who blog well-nigh their experiences than for those who practice not.
Relationship betwixt patients and healthcare professionals: shift in power residual and increased quality of decision making
The effects of social media use by patients for health related reasons show that social media apply by patients can lead to patient empowerment. Patient empowerment is an established concept in the medical research and has been promoted to foster patient autonomy [47]. Equally a event of the patient empowerment, patients may increasingly interact with their healthcare professional and get more involved in the decision making process [15]. In this case, social media can be seen as a "new" technology adopted by patients, which may shift the ability balance betwixt the healthcare professional and the patient. The employ of new technologies in healthcare has been suggested equally a manner to empower end-consumers by enabling speed and convenience in accessing health related information [48]. In this line, the patients are able to actively participate in the interactions with healthcare professionals. On the other hand, the healthcare professionals may feel a decrease in power in the decision making process. According to the political variant of the interaction theory [49], "a production of the interaction of system features with the intra-organizational distribution of ability, divers either considerately, in terms of horizontal or vertical power dimensions, or subjectively, in terms of symbolism can be resistance to the system". Hence, redistribution of power between patients and healthcare professionals may crusade the resistance from healthcare professionals. Still, the part of wellness professionals has to change because embracing patient empowerment in healthcare means making a change, which sometimes seem difficult due to traditional approach, which is embedded in their electric current training [50].
Notwithstanding, increased patient involvement in the clinical interaction could potentially increment the risk placed on the healthcare professionals [xiii]. Healthcare professional may not be in complete control of the information used during decision making as the patient besides has a voice, but the healthcare professional bears full responsibility for the decision taken. When patients bring in the data from social media to the consultation, this could pb to unnecessary processes of sorting relevant data from irrelevant information and can be experienced as challenging the healthcare professional's expertise [1, 13]. Hence, based on these findings it is possible for healthcare professionals to resist this shift in the balance of power. However, increased equalization of the healthcare professional and patient communication tin can be a positive and desired effect. In particular, healthcare professionals may become more than patient-centred, thus complementing the patient empowerment [51]. As a consequence of patient empowerment, we propose that the quality of clinical decision making may exist enhanced.
According to the concept of divisional rationality [52], not all information can be gained on all available treatment options past healthcare professionals, as the human mind has a express capacity to process the available information and oft fourth dimension is limited too. Hence, healthcare professionals are unable to know all the data regarding treatment options and the newest developments, which affects their decision making. Thus, patients tin extend this information base of operations of the healthcare professional by specializing themselves in their own status. This could provide an opportunity to increase the quality of the treatment decisions.
Suggestion 3: As a event of patient empowerment due to patients using social media for health related reasons, the power balance between healthcare professionals and patients becomes more than equalized, leading to increased quality of clinical decisions making.
Notwithstanding the interesting results described to a higher place, this research has some limitations which, along with the three propositions, suggest opportunities for further enquiry. It is possible that we missed some articles that could have used different terminology. Consequently, the results of this newspaper might non be generalizable for all social media platforms. For practical reasons, we excluded not-English language papers. Finally, a limitation of every literature review is that the authors of the included articles will have had dissimilar objectives and used different methods and means of interpretation in reaching their conclusions. In this paper, we highlighted the almost of import findings on our topic of written report and we categorized the primal effects of social media utilize on patients and on their relationships with healthcare professionals.
Conclusions
The use of social media by patients for health related reasons is growing. This systematic literature review reflects on beneficial and potentially harmful furnishings of social media use by patients for health related. The findings show that patients use social media mainly for social support, which is represented through data support, emotional support, esteem support, and network support. Other identified types of social media utilize by patients have found to be emotional expression and social comparing. These types of social media use by patients were found to most ordinarily pb to patient empowerment. Other effects of social media utilize past patients nosotros identified were diminished subjective well-being, addiction to social media, being targeted for promotion, and loss of privacy. The types of social media apply past patients were also found to affect the healthcare professional person and patient relationship by stimulating more equal advice between the patient and healthcare professional, shorter relationships, harmonious relationships, suboptimal interaction between the patient and healthcare professional. Whereas some of the articles discussed the effects of patients' employ of social media on relationship betwixt patients and healthcare professionals briefly, we encourage time to come inquiry to tackle this effect. We developed three propositions, which may also stimulate further enquiry in this respect.
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Acknowledgments
We thank Eveline Hage for providing insightful feedback in the course of manuscript preparation.
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Nosotros have non received any funding for conducting this study.
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Materials and data used in this literature review may be obtained from the first author.
Authors' contributions
ES was responsible for the research blueprint, significantly contributed to the pick and analysis of included papers and reworked an earlier draft of the manuscript. WH contributed with the newspaper selection and analysis and wrote a preliminary draft of the manuscript. AB made meaning contributions to the framework for analysis, estimation of selected papers and writing the manuscript. DJL made significant contribution to interpretation of the studies and participated in writing the terminal version of the manuscript. All authors read and canonical the final manuscript.
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Smailhodzic, E., Hooijsma, W., Boonstra, A. et al. Social media use in healthcare: A systematic review of furnishings on patients and on their relationship with healthcare professionals. BMC Health Serv Res 16, 442 (2016). https://doi.org/10.1186/s12913-016-1691-0
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DOI : https://doi.org/10.1186/s12913-016-1691-0
Keywords
- Social media
- Health
- Patients
- Healthcare professionals
C. What Influences Whether Someone Will Take Advantage Of Health Services?,
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