Multiplatform characterization of online permanent female contraception discussion among social media users: analysis...

Individuals choosing permanent female contraception (PFC) face barriers including age and parity. Prior literature has focused on regret, but rarely on understanding patient perspectives. Social media is increasingly used to obtain medical information; hence this study seeks to use popular platforms to evaluate motivations, barriers, and facilitators to obtaining PFC.

This study collected Twitter and Reddit posts from October 2020 to April 2023 and July 2017 to April 2023, respectively. Data was analyzed using Bidirectional Encoder Representations from Transformers (BERT), followed by manual deductive coding of relevant topic clusters to characterize user-generated PFC discussions. We collected 409,641 posts including 321,267 tweets and 88,374 Reddit posts and performed content analysis using a deductive coding schema using the socio-ecological model approach to determine which posts to include in the final analysis. Sentiment analysis was conducted to detect emotions and themes most correlated with post engagement.

We identified 2,356 posts, including 2,076 tweets (88.12%) and 280 subreddit posts (11.88%) from Reddit relevant to PFC discourse. Major themes included clinician (n = 246; 10.44%), patient (n = 1,388; 58.91%), interpersonal (n = 254; 10.78%), institutional (n = 311; 13.20%), and policy-level perspectives (n = 157; 6.66%) and derived 22 subthemes. The top subthemes included patients' seeking/sharing PFC advice (20.80%), discussion of successful completion or commitment/intent to undergo PFC (27.04%), interactions with healthcare providers and beliefs surrounding PFC regret (10.77%), the cost associated with PFC (7.05%), and the Dobbs V. Jackson ruling (6.66%). Additionally, there was a significant increase in posts on PFC following the Dobbs decision. Sentiment analysis shows that posts containing emotional words (both positive and negative) and words related to themes such as home, friends, and family were more likely to receive engagement on Reddit while sentiments related to health, optimism, and communication were correlated with tweet engagement.

As reproductive healthcare continues to face restrictions, online communities provide insight into the motivations and decision-making behaviors of people seeking PFC. Findings can help clinicians better understand patient perspectives, and improve our ability to provide person-centered contraception care for patients desiring PFC.