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World Wide Web and Social Media in Dermatology (45) Medicine 2.0: Social Media, Open, Participatory, Collaborative Medicine (1666) Patient Education for Skin Conditions (22) Psychosocial Support for Skin Patients (14)

Published on in Vol 3, No 1 (2020): Jan-Dec

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/13424, first published .
Understanding Social Media Use and Engagement Among Dermatology Patients to Inform Dermatological Prevention and Care in Vietnam: Cross-sectional Study

Understanding Social Media Use and Engagement Among Dermatology Patients to Inform Dermatological Prevention and Care in Vietnam: Cross-sectional Study

Understanding Social Media Use and Engagement Among Dermatology Patients to Inform Dermatological Prevention and Care in Vietnam: Cross-sectional Study

Authors of this article:

Sau Huu Nguyen1, 2 Author Orcid Image ;   Giang Thu Vu3 Author Orcid Image ;   Long Hoang Nguyen4 Author Orcid Image ;   Cuong Tat Nguyen5, 6 Author Orcid Image ;   Thu Hoai Thi Le1, 2 Author Orcid Image ;   Tung Hoang Tran7 Author Orcid Image ;   Bach Xuan Tran8, 9 Author Orcid Image ;   Carl A Latkin9 Author Orcid Image ;   Wilson W S Tam3, 10 Author Orcid Image ;   Cyrus S H Ho11 Author Orcid Image ;   Roger C M Ho4, 12, 13 Author Orcid Image
Article Authors Cited by (4) Tweetations (1) Metrics

    Original Paper

    1National Hospital of Dermatology and Venereology, Hanoi, Vietnam

    2Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam

    3Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam

    4Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam

    5Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam

    6Faculty of Medicine, Duy Tan University, Da Nang, Vietnam

    7Institute of Orthopaedic and Trauma Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam

    8Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam

    9Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States

    10Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    11Department of Psychological Medicine, National University Hospital, Singapore, Singapore

    12Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    13Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore

    Corresponding Author:

    Bach Xuan Tran, PhD

    Institute for Preventive Medicine and Public Health

    Hanoi Medical University

    No 1 Ton That Tung Street

    Dong Da District

    Hanoi, 100000

    Vietnam

    Phone: 84 982228662

    Email: bach.ipmph@gmail.com


    Background: Social media has emerged as a common source of dermatological information. Monitoring the patterns of social media use and engagement is important to counteract the limitations of social media. However, evidence in Vietnamese dermatology patients is lacking.

    Objective: This study aimed to explore social media use and engagement by dermatology patients and to identify factors associated with social media use and engagement.

    Methods: A cross-sectional study was conducted with 519 participants at the Vietnam National Hospital of Dermatology and Venereology during September to November 2018. Data about sociodemographic characteristics, social media use, and social media engagement were collected. Multivariate logistic and tobit regression models were used to identify factors associated with social media use and engagement.

    Results: Interest in information about “cosmetic, beauty, and skincare techniques” was the greatest (184/519, 46.2%). The mean engagement score was 8.4 points (SD 2.4 points). Female patients were more likely to use social media (odds ratio [OR] 2.23, 95% CI 1.23-4.06) and be interested dermatological information on social media (OR 3.09, 95% CI 1.35-7.09). Women also had higher social media engagement scores (coefficient=0.68, 95% CI 0.17-1.18). Higher social media engagement scores were related with Instagram use (coefficient=0.58, 95% CI 0.00-1.15) and higher credibility scores for “family members” (coefficient=0.15, 95% CI 0.03-0.26) and “dermatology companies” (coefficient=0.22, 95% CI 0.04-0.39).

    Conclusions: This study discovered high social media usage among dermatology patients. However, only moderate utilization and credibility levels were reported regarding the use of social media as a source of dermatological information. More efforts should focus on involving dermatologists in the development of individualized information on social media targeting specific groups of dermatology patients.

    JMIR Dermatol 2020;3(1):e13424

    doi:10.2196/13424

    Keywords

    dermatology; social media; engagement; prevention; Vietnam 


    Dermatological diseases are popular health issues and the leading causes of disability and mortality worldwide. Skin diseases contributed to 1.79% of the global burden of diseases in 2017; of the skin diseases, dermatitis, acne vulgaris, psoriasis, and urticaria represented the greatest burden [1]. Dermatological diseases are also the most common reasons for health care service utilization [2,3], accounting for 8.4% of primary care visits [4]. People with dermatological diseases often have low quality of life [5] and self-esteem as well as feelings of stigmatization [6]. However, lack of access to dermatology services, particularly in low and middle-income countries [1], still challenges the provision of appropriate care for dermatology patients. As a result, patients seek other ways for self-treatment, including finding information on the internet and social media platforms.

    Internet has played a key role in health care by reducing the cost of health service delivery [7], providing health information for specific disorders [8,9], delivering behavioral interventions [10], reducing harm for adverse health habits [11,12], facilitating physical rehabilitation [13], providing access to potential patients during health care crises [14], and supporting caregivers [15,16]. Social media is a popular method of communication [17] that enables internet users to generate information and share their opinions or media (eg, photos, clips) [18,19]. The term social media encompasses a diversity of platforms such as social networking sites (eg, Facebook, Instagram), blogs (eg, Twitter, Tumblr), or media sharing (eg, YouTube) [20-22]. It is estimated that more than 3.1 billion people worldwide were active social media users in 2018 [23]. The use of social media by patients to access medical information has accelerated with overall internet use [24].

    Social media is well-recognized as a useful aid for health care providers to communicate and support patients [25-27]. Moreover, it empowers patients by encouraging active information seeking about disease prevention and treatment [28,29], providing support among peers [29,30], improving self-efficacy and self-management [27], supplementing information provided by health professionals [28], and facilitating the patient-health care professional relationship [31]. Social media is a dynamic teaching tool for health professionals [32,33] and has modernized dermatology training [34]. Although social media is a convenient source for health information, there is a paucity of literature that has evaluated the quality [35] and credibility [27] of the information on social media. Therefore, patient misinformation through social media use is a major concern among health professionals [25].

    Social media is frequently used by patients to solicit advice related to dermatological concerns, has the potential to advance professional training in dermatology, and can facilitate new research methods [36]. Additionally, for dermatology, social media has the advantages of enabling the sharing of visual components such as images and videos that are important for diagnosis and consultancy. Nonetheless, little is known about the impact of social media on dermatology patients in developing countries.

    Vietnam is among the countries with a high burden of dermatological diseases. A recent estimate indicates that skin disorders accounted for 2.3% of the disease burden in Vietnam in 2017 [1]. In addition, the growth in internet and social media use in Vietnam is substantial. In 2015, Vietnam had 44.4 million internet users, and this number grew to 55.8 million in 2018 [37,38]. Social media has been used widely in Vietnam, with about 46 million active users of some of the dominant social media platforms including Facebook, YouTube, Zalo, and Instagram [23]. Despite a call to understand social media use and engagement for seeking health information among dermatology patients or people interested in dermatological issues [39-43], no studies have determined social media use in this population in Vietnam. Hence, this study aimed to explore social media use and engagement by dermatology patients and to identify factors associated with social media use and engagement.


    Study Design and Sampling Method

    A cross-sectional study was performed at the Vietnam National Hospital of Dermatology and Venereology (NHDV) from September to November 2018. The NHDV was chosen due to the diversity of dermatology illnesses and the background of treated patients. As a leading hospital for dermatology and venereology diagnosis and treatment in Vietnam, the NHDV receives patient referrals from health facilities at various levels. A convenient sampling technique was adopted to recruit participants for this study. Sample size calculation was conducted using inputs determined based on a study of a similar topic in 13 European countries [44]: an expected mean social engagement score of 0.70, expected standard deviation of 0.20, and a confidence level of 95%. The calculation resulted in a minimum sample size of 385 participants. We selected from the pool of patients attending the outpatient department at the NHDV using the pre-determined eligibility criteria of age ≥18 years, a diagnosis of any dermatology disease, receiving services in the outpatient clinic, ability to provide coherent answers to the interview questions, and agreeing to participate by providing written consent. A total of 519 participants was successfully recruited for the study. The response rate was 100%.

    Measurements and Instruments

    We built a structured questionnaire to collect data concerning the sociodemographic status of participants and their social media use and engagement regarding dermatological issues and information. The questionnaire also assessed various aspects of health status and service utilization, based on data from other studies exploring these topics [45]. The questionnaire was first piloted in 10 patients to validate the language and logic of each item. After revising the questionnaire based on the patient feedback, face-to-face interviews were conducted by undergraduate medical students from the Hanoi Medical University, who were well-trained in conducting community interviews. A private room at the hospital was used to hold the interviews to ensure the confidentiality and comfort of the participants.

    Sociodemographic Characteristics

    Data about age, gender, education, marital status, occupation, and living location were collected.

    Social Media Use

    In this study, we collected information about the type of social network sites the participants visited and used frequently for dermatology care (eg, What are the social media sites that you use frequently for dermatology care?) and the types of dermatological information in which they were interested to find online. In addition, we asked the participants to rate the credibility of the dermatological information sources on social media including family members, friends/relatives, celebrities (including medical professionals/clinics), television programs/magazines, dermatological product retailers (people who sell dermatology-related products), and dermatology companies (companies manufacturing and selling dermatology-related products). To obtain the credibility score, each source was rated on a scale from 0 points (Totally not credible) to 10 points (Totally credible).

    Engagement With Social Media

    Data on social media engagement were collected using three questionnaire items: searching for dermatological information on social media, sharing dermatological information on social media, and applying dermatological information obtained from social media. Each item used a Likert scale with five response levels: “always” (5 points) to “never” (1 point). Then, we calculated the engagement score by summing the scores of the three items. The highest possible score was 15 points, and the lowest possible score was 3 points. This approach was adapted from the Social Media Engagement theory [46].

    Statistical Analysis

    We analyzed the data using Stata version 15.0 (Stata Corp. LP, College Station, TX). Multivariable logistic regression analysis was used to determine the factors correlated with social media use and interest in any dermatological information on social media. Multivariable tobit regression analysis was used to identify the factors associated with the engagement score. Potential explanatory variables included sociodemographic characteristics (age, gender, education, marital status, and occupation), social network platforms, and the credibility score. Stepwise forward selection strategies were combined with the multivariable regressions to reduce the models. A value of 0.2 of the log-likelihood’s P value was considered the threshold of variable selection. The results of a previous study indicated that engagement depended heavily on specific contexts, ie, specific social network platforms as well as the credibility of the information from each platform [47]. P<.05 was considered statistically significant.

    Ethical Approval

    The Institutional Review Board of the NHDV approved the study protocol (document number 855/HDDDBVDLTU dated September 7, 2018).


    Of the 519 dermatology patients participating in the study, 62.8% (326/519) resided in urban areas. The mean age was 35.7 years (SD 13.7 years), and the greatest proportion of participants was 18-30 years old. Participants were mostly women (282/506, 55.7%), had completed at least a vocational education (341/517, 66.0%), and were married or had a partner (323/518, 62.4%). The most commonly reported occupation was freelancing (176/518, 34.0%), followed by white-collar job (145/518, 28.0%). Atopic dermatitis accounted for the greatest proportion of dermatology diseases (127/519, 24.4%), followed by contact dermatitis (75/519, 14.5%) and skin fungal infections (57/519, 11.0%; Table 1).

    Facebook (359/392, 91.6%) and Zalo (247/392, 63.2%) were the most commonly used social media platforms. Information about “cosmetic, beauty, and skin care techniques” was sought by the most participants (184/397, 46.3%), followed by “general information about dermatology diseases” (168/397, 42.5%) and “medical institutions for dermatology disease treatment” (132/397, 32.6%). Regarding the credibility score of information sources on social media, “family members” and “television programs/magazines” scored the highest (mean 6.9 points, SD 2.3 points; mean 6.9 points, SD 2.2 points, respectively). Information from dermatological product retailers scored the lowest (mean 4.8 points, SD 2.3 points). No differences were found between men and women regarding the credibility of information sources or the social network platforms used (Table 2).

    Table 1. Sociodemographic and clinical characteristics of the participants, N=519.
    Characteristicsn (%)
    Living location

    		Urban326 (62.8)

    		Rural193 (37.2)
    Age group (n=507)

    		18-30 years239 (47.1)

    		31-40 years114 (22.5)

    		41-50 years72 (14.2)

    		51-60 years46 (9.1)

    		>60 years36 (7.1)
    Gender (n=506)

    		Male224 (44.3)

    		Female282 (55.7)
    Education (n=517)

    		Up to secondary school73 (14.1)

    		Upper secondary school103 (19.9)

    		Vocational education and higher341 (66.0)
    Marital status (n=518)

    		Single195 (37.6)

    		Having a partner/married323 (62.4)
    Occupation (n=518)

    		Unemployed13 (2.5)

    		Freelancer176 (34.0)

    		White-collar worker145 (28.0)

    		Blue-collar worker70 (13.5)

    		Student62 (12.0)

    		Other52 (10.0)
    Dermatology diseases (n=519)

    		Atopic dermatitis127 (24.4)

    		Contact dermatitis75 (14.5)

    		Psoriasis29 (5.6)

    		Skin infections13 (2.5)

    		Skin fungal infections57 (11.0)

    		Urticaria44 (8.5)

    		Warts16 (3.1)

    		Zona31 (6.0)
    Age (n=507), years35.7 (13.7)a

    aMean (SD).

    Table 2. Social media use among dermatology patients, with comparisons between genders.
    CharacteristicsTotal sampleMenWomenP value
    Uses a social network, n (%)(n=493)




    		Yes393 (79.7)156 (71.9)237 (85.9).00a

    		No100 (20.3)61 (28.1)39 (14.1)
    Social network platform, n (%)




    		Facebook (n=392)359 (91.6)144 (92.3)215 (91.1).67a

    		Instagram (n=391)103 (26.3)35 (22.4)68 (28.8).16a

    		Zalo (n=392)247 (63.2)89 (57.4)158 (66.9).06a

    		Other (n=392)18 (4.6)5 (3.2)13 (5.5).29a
    Type of dermatological information sought on social network sites, n (%)




    		Cosmetic, beauty, and skin care techniques (n=397)184 (46.3)30 (19.1)154 (64.2)<.001a

    		Medical institution for cosmetic surgery or beauty salons (n=397)95 (23.9)18 (11.5)77 (32.1)<.001a

    		Beauty or cosmetic surgery experts (n=397)60 (15.1)10 (6.4)50 (20.8).10a

    		General information about dermatology diseases (n=397)168 (42.3)68 (43.3)100 (41.7).75a

    		Preventive methods for dermatology disease (n=397)90 (22.7)41 (26.1)49 (20.4).19a

    		Treatment methods for dermatology diseases (n=397)95 (23.9)41 (26.1)54 (22.5).41a

    		Medical institutions for dermatology disease treatment (n=397)132 (33.2)51 (32.5)81 (33.8).79a

    		Medication for dermatology disease treatment (n=397)128 (32.2)54 (34.4)74 (30.8).46a

    		Treatment experiences from people who had undergone dermatology disease treatment (n=397)80 (20.2)28 (17.8)52 (21.7).35a

    		Others (n=396)8 (2.0)3 (1.9)5 (2.1).91a
    Credibility score regarding dermatological information sources on social media, mean (SD)


    		Family members (n=397)6.9 (2.3)7.1 (2.1)6.8.33b

    		Friends/relatives (n=392)6.5 (2.1)6.5 (2.1)6.5.60b

    		Celebrities (including famous medical professionals) (n=387)5.7 (2.4)5.7 (2.4)5.7.66b

    		Television programs/magazines (n=399)6.9 (2.3)7.1 (2.1)6.8.19b

    		Dermatological product retailers (n=386)4.8 (2.3)4.9 (2.3)4.8.65b

    		Dermatology companies (n=390)5.2 (2.4)5.1 (2.3)5.2.92b

    aChi-squared test.

    bMann-Whitney test.

    Table 3 outlines the social media engagement by dermatology patients. Actively searching for, actively sharing, and actively applying dermatological information were reported by 95.2% (380/399), 81.4% (323/397), and 85.4% (339/397) of the patients, respectively. Dermatological information on social media was perceived as useful or very useful by 57% (229/399) of the patients. The mean engagement score was moderate (mean 8.4, SD 2.4). The social media engagement score was significantly different between male and female patients (P<.001).

    Table 3. Engagement with social media among dermatology patients, with comparisons between genders.
    CharacteristicsTotal sampleMenWomenP value
    Actively searching for dermatological information on social media, n (%) (n=399)



    		No19 (4.8)10 (6.3)9 (3.8).24a

    		Yes380 (95.2)149 (93.7)231 (96.3)
    Actively sharing dermatological information on social media, n (%) (n=397)



    		No74 (18.6)36 (22.8)38 (15.9).09a

    		Yes323 (81.4)122 (77.2)201 (84.1)
    Actively applying dermatological information found on social media, n (%) (n=397)



    		No58 (14.6)30 (18.9)28 (11.8).05a

    		Yes339 (85.4)129 (81.1)210 (88.2)
    Perceived usefulness of dermatological information on social media, n (%) (n=399)



    		Very useful47 (11.8)17 (10.8)30 (12.4).39a

    		Useful182 (45.6)73 (46.2)109 (45.2)

    		Neutral154 (38.6)58 (36.7)96 (39.8)

    		Not useful14 (3.5)9 (5.7)5 (2.1)

    		Completely not useful2 (0.5)1 (0.6)1 (0.4)
    Social media engagement score, mean (SD) (n=399) 8.4 (2.5)8.0 (2.7)8.7 (2.2).00b

    aChi-squared test.

    bMann-Whitney test.

    The results of three multivariable regression models are displayed in Table 4. Among dermatology patients, women were more likely to use social media (odds ratio [OR] 2.23, 95% CI 1.23-4.06), while older patients were less likely to use social media. Compared with male patients, female patients were also more likely to be interested in dermatological information on social media (OR 3.09, 95% CI 1.35-7.09) and have higher social media engagement scores (coefficient 0.68, 95% CI 0.17-1.18).

    Respondents who were married/had a partner had a higher likelihood of being interested in dermatology information (OR 2.37, 95% CI 1.01-5.53). Regarding social media engagement, higher scores were present for patients using Instagram and who rated the credibility of “family members” and “dermatology companies” higher. Meanwhile, lower social media engagement scores were related with higher credibility scores for dermatological product retailers.

    Table 4. Factors associated with social media use and engagement in multivariable regression models.
    CharacteristicsUses social mediaInterest in any dermatological information on social mediaSocial media engagement score
    ORa95% CIP valueOR95% CIP valueCoefficient95% CIP value
    Gender









    		Malerefb —c — ref — — ref — —

    		Female2.231.23-4.06.0083.091.35-7.09.0080.680.17-1.18.009
    Age









    		18-30 yearsref — — — — — — — —

    		31-40 years0.450.16-1.27.132 — — — — — —

    		41-50 years0.070.03-0.19.000 — — — — — —

    		51-60 years0.020.01-0.06.000 — — — — — —

    		>60 years0.010.00-0.04.000 — — — — — —
    Occupation









    		Unemployedref — — — — — — — —

    		Freelancer1.480.16-13.61.729 — — — — — —

    		White-collar worker1.680.18-15.73.648 — — — — — —

    		Blue-collar worker0.400.04-3.81.428 — — — — — —

    		Student0.850.07-9.81.894 — — — — — —

    		Other1.740.16-18.57.648 — — — — — —
    Location of residence









    		Urban — — — ref — — — — —

    		Rural — — — 2.240.74-6.83.156 — — —
    Marital status









    		Single — — — ref — — — — —

    		Married — — — 2.371.01-5.53.047 — — —
    Uses Facebook









    		No — — — ref — — ref — —

    		Yes — — — 2.820.85-9.37.0900.64–0.26-1.55.163
    Uses Instagram









    		No — — — — — — ref — —

    		Yes — — — — — — 0.580.00-1.15.049
    Credibility score regarding dermatological information sources on social media




    		Family members — — — — — — 0.150.03-0.26.012

    		Dermatological product retailers — — — — — — –0.19–0.38-0.00.049

    		Dermatology companies — — — — — — 0.220.04-0.39.016

    aOdds ratio.

    bReference group.

    cNot applicable.


    Principal Findings

    Our study found that, despite social media use by a high proportion of dermatology patients, utilizing this platform as a source of credible information for dermatological issues remains modest. Women were more likely to be interested in dermatological information on social media and be engaged with social media. The findings suggest that increased dermatologist involvement in contributing to online dermatological content and more effort to develop targeted, individualized information should be considered to take advantage of social media platforms.

    Previous studies have documented the modest use of social media to find or share health-related content and particularly dermatology-related information. Despite reportedly high general social media engagement (85.0-99.3% of the participants reported regular access of at least one social media platform), only 19.0-31.7% of the participants reported accessing dermatology-related information [29,48]. We found that younger patients (aged 18-30 years) were significantly more likely to use social media. Young people in Asia are influenced more by social media than young people in Western countries because young people in Asia have a higher rate of smartphone use [49].

    The higher percentage of use found in our study may reflect the increased popularity of social media in health care, due to technological advances and recent changes in the public perception of social media [50]. Our findings support the argument that there has been a desire among patients to use social media as an additional medium to traditional platforms for obtaining medical information [48]. Thus, social networking sites can be utilized as a platform to distribute educational information regarding dermatological issues for a wider reach of the population and at a potentially lower cost, especially in resource-poor settings in developing countries [51,52].

    Regarding the sources of dermatological information on social media sites, our findings showed that the highest credibility scores were given to information received from family members, friends, televisions programs, and magazines. This popularity of informal information sources further highlights the lack of active contribution from dermatological health care providers and dermatologists to health information online. Dermatologists have expressed concern that patients might be misled by other social media indicators (eg, number of followers) without checking the educational background and clinical experience of information providers [53]. Increasing the involvement of medical professionals is crucial, as contributions by those with certified expertise would enhance the accuracy and reliability of information available online, reducing the possibility of incidents occurring as a result of misleading, inaccurate information [29,54]. Indeed, concerns over the quality of dermatology-related knowledge obtained online are a main barrier to enhancing the use of social media as a source of health information for health care service users [29]. Such concerns among service users may explain the medium level of engagement with social media for dermatological content reported in our study. Another possible reason for such low engagement may be participant concern about the privacy and security of personal data shared online [55,56]. Taking necessary measures to ensure the confidentiality of patient information over online platforms would also be important when attempting to boost the utilization of social media sites.

    In addition, the sociodemographic characteristics of our participants were associated with their level of concern regarding dermatological information on social media and social media engagement. Women, married respondents, and Facebook users were more likely to be interested in dermatological issues on social media. These findings suggest that Facebook, in particular, could serve as the primary social media platform for disseminating dermatological information to targeted groups of online users. For example, this information could focus on dermatological issues that are most relevant to women and married individuals. Previous studies have argued the potential of Facebook for knowledge distribution, owing to its large user base, versatility in providing information in various forms, and capacity to allow for interactions and connections between users [57,58]. The positive association between engagement and the credibility score given to family members and dermatology companies as sources of social media information may also be partially explained by the ability to facilitate communications between sources and receivers of information: the more credible the sources, the more those sources would be used.

    One of the implications that can be drawn from our findings is that the presence of dermatologists on social media platforms to provide official, scientific, evidence-based dermatological information should be increased. To facilitate this, the marketing capabilities of dermatology health facilities should be enhanced, so they can reach a wider population. And, patient-physician communication should be encouraged through social networking sites, notably Facebook, with careful consideration of privacy protection measures. The adoption of the Law on Cybersecurity in Vietnam provided stricter regulations on the content and transfer of data online and can be expected to impact the extent of online channel use by both patients and physicians. This should be taken into consideration when designing communication and education campaigns and programs. Regarding content, dermatological information should be created and distributed in an individually customized manner, targeting specific groups with relevant information.

    Limitations

    This study has certain limitations. First, the self-reported nature of the questionnaire may have introduced recall bias. Second, although effort was made to enhance the diversity of participants by conducting research at a central dermatological hospital, the adoption of a convenient sampling technique and the fact that the study was conducted at a single hospital could affect the generalizability of our study. In addition, although the instrument we used to measure social media engagement has a theoretical background and provides valuable insights on the topic, it has not been officially validated. There are also several possible research considerations and directions not yet covered in our study that may be recommended for further studies. Further research may benefit from studying other online media platforms such as Google and YouTube that have considerable influence on dermatology patients in developed countries [59,60] or exploring the relationship between social media and cutaneous concerns associated with stigmatized medical conditions (eg, substance abuse). Moreover, further research may consider examining the effect of dermatological conditions on family quality of life, such as atopic dermatitis [61], as well as the impact of social media on caregivers of dermatology patients [62].

    Conclusion

    In conclusion, this study found high levels of social media use among dermatology patients, but only a moderate level of utilization and credibility regarding the use of social media as a source of dermatological information. Sociodemographic characteristics were associated with dermatology-related social media use and engagement. The results of this study recommend enhancing the involvement of dermatologists on social media platforms, in terms of knowledge contribution through social media for both patients and the general public. In addition, more efforts should be given in developing individualized information that targets specific groups of dermatology patients.

    Acknowledgments

    Our thanks to Vietnam National Hospital of Dermatology and Venereology that gave us permission and support to conduct this study. In addition, we are grateful to all the patients who gave us their time and willingness to participate in this study.

    Conflicts of Interest

    None declared.

    1. Karimkhani C, Dellavalle RP, Coffeng LE, Flohr C, Hay RJ, Langan SM, et al. Global Skin Disease Morbidity and Mortality: An Update From the Global Burden of Disease Study 2013. JAMA Dermatol 2017 May 01;153(5):406-412 [FREE Full text] [CrossRef] [Medline]
    2. Schofield J, Fleming D, Grindlay D, Williams H. Skin conditions are the commonest new reason people present to general practitioners in England and Wales. Br J Dermatol 2011 Nov;165(5):1044-1050. [CrossRef] [Medline]
    3. Awadalla F, Rosenbaum DA, Camacho F, Fleischer AB, Feldman SR. Dermatologic disease in family medicine. Fam Med 2008;40(7):507-511. [Medline]
    4. Kerr O, Tidman M, Walker J, Aldridge R, Benton E. The profile of dermatological problems in primary care. Clin Exp Dermatol 2010 Jun;35(4):380-383. [CrossRef] [Medline]
    5. Hong J, Koo B, Koo J. The psychosocial and occupational impact of chronic skin disease. Dermatol Ther 2008;21(1):54-59. [CrossRef] [Medline]
    6. Fortune DG, Richards HL, Main CJ, Griffiths CE. What patients with psoriasis believe about their condition. Journal of the American Academy of Dermatology 1998 Aug;39(2):196-201. [CrossRef]
    7. Zhang M, Cheow E, Ho CS, Ng BY, Ho R, Cheok CCS. Application of low-cost methodologies for mobile phone app development. JMIR Mhealth Uhealth 2014;2(4):e55 [FREE Full text] [CrossRef] [Medline]
    8. Zhang MW, Ho RC, Loh A, Wing T, Wynne O, Chan SWC, et al. Current status of postnatal depression smartphone applications available on application stores: an information quality analysis. BMJ Open 2017 Nov 14;7(11):e015655 [FREE Full text] [CrossRef] [Medline]
    9. Rajagopalan A, Shah P, Zhang MW, Ho RC. Digital Platforms in the Assessment and Monitoring of Patients with Bipolar Disorder. Brain Sci 2017 Nov 12;7(11) [FREE Full text] [CrossRef] [Medline]
    10. Zhang MWB, Ho RCM, Cassin SE, Hawa R, Sockalingam S. Online and smartphone based cognitive behavioral therapy for bariatric surgery patients: Initial pilot study. Technol Health Care 2015;23(6):737-744. [CrossRef] [Medline]
    11. Zhang MWB, Fang P, Ho RCM. Global outreach and user preferences of a smartphone application developed for drinkers. Technol Health Care 2016 Jul 27;24(4):495-501 [FREE Full text] [CrossRef] [Medline]
    12. Tran BX, Le XTT, Nguyen PN, Le QNH, Mai HT, Nguyen HLT, et al. Feasibility of e-Health Interventions on Smoking Cessation among Vietnamese Active Internet Users. Int J Environ Res Public Health 2018 Dec 20;15(1) [FREE Full text] [CrossRef] [Medline]
    13. Zhang MWB, Ho RCM. Harnessing the potential of the Kinect sensor for psychiatric rehabilitation for stroke survivors. Technol Health Care 2016 Dec 04;24(4):599-602 [FREE Full text] [CrossRef] [Medline]
    14. Zhang MWB, Ho CSH, Fang P, Lu Y, Ho RCM. Methodology of developing a smartphone application for crisis research and its clinical application. Technol Health Care 2014;22(4):547-559. [CrossRef] [Medline]
    15. Leow MQH, Chan SWC. Evaluation of a video, telephone follow-ups, and an online forum as components of a psychoeducational intervention for caregivers of persons with advanced cancer. Palliat Support Care 2016 Dec;14(5):474-478 [FREE Full text] [CrossRef] [Medline]
    16. Zhang MWB, Chan S, Wynne O, Jeong S, Hunter S, Wilson A, et al. Conceptualization of an evidence-based smartphone innovation for caregivers and persons living with dementia. Technol Health Care 2016 Sep 14;24(5):769-773. [CrossRef] [Medline]
    17. Ho K, Peter WWP. Harnessing the social web for health and wellness: issues for research and knowledge translation. J Med Internet Res 2014;16(2):e34 [FREE Full text] [CrossRef] [Medline]
    18. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res 2008;10(3):e22 [FREE Full text] [CrossRef] [Medline]
    19. George DR, Rovniak LS, Kraschnewski JL. Dangers and opportunities for social media in medicine. Clin Obstet Gynecol 2013 Sep;56(3):453-462 [FREE Full text] [CrossRef] [Medline]
    20. Ventola CL. Social media and health care professionals: benefits, risks, and best practices. P T 2014 Jul;39(7):491-520 [FREE Full text] [Medline]
    21. Househ M, Borycki E, Kushniruk A. Empowering patients through social media: the benefits and challenges. Health Informatics J 2014 Mar;20(1):50-58. [CrossRef] [Medline]
    22. Grajales FJ, Sheps S, Ho K, Novak-Lauscher H, Eysenbach G. Social media: a review and tutorial of applications in medicine and health care. J Med Internet Res 2014;16(2):e13 [FREE Full text] [CrossRef] [Medline]
    23. We Are Social. 2018 Nov 19. Digital in 2018: World's Internet Users Pass the 4 Billion Mark   URL: https://wearesocial.com/uk/blog/2018/01/global-digital-report-2018 [accessed 2020-02-02]
    24. Travers RL. Social media in dermatology: moving to Web 2.0. Semin Cutan Med Surg 2012 Sep;31(3):168-173 [FREE Full text] [CrossRef] [Medline]
    25. Rupert DJ, Moultrie RR, Read JG, Amoozegar JB, Bornkessel AS, O'Donoghue AC, et al. Perceived healthcare provider reactions to patient and caregiver use of online health communities. Patient Educ Couns 2014 Sep;96(3):320-326. [CrossRef] [Medline]
    26. Ho Y, O'Connor BH, Mulvaney SA. Features of online health communities for adolescents with type 1 diabetes. West J Nurs Res 2014 Oct;36(9):1183-1198. [CrossRef] [Medline]
    27. Smailhodzic E, Hooijsma W, Boonstra A, Langley DJ. Social media use in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals. BMC Health Serv Res 2016 Aug 26;16:442 [FREE Full text] [CrossRef] [Medline]
    28. Hawn C. Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care. Health Aff (Millwood) 2009;28(2):361-368 [FREE Full text] [CrossRef] [Medline]
    29. Antheunis ML, Tates K, Nieboer TE. Patients' and health professionals' use of social media in health care: motives, barriers and expectations. Patient Educ Couns 2013 Sep;92(3):426-431. [CrossRef] [Medline]
    30. Hardiker NR, Grant MJ. Factors that influence public engagement with eHealth: A literature review. Int J Med Inform 2011 Jan;80(1):1-12. [CrossRef] [Medline]
    31. Bosslet GT, Torke AM, Hickman SE, Terry CL, Helft PR. The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med 2011 Oct;26(10):1168-1174 [FREE Full text] [CrossRef] [Medline]
    32. D'Souza K, Henningham L, Zou R, Huang J, O'Sullivan E, Last J, et al. Attitudes of Health Professional Educators Toward the Use of Social Media as a Teaching Tool: Global Cross-Sectional Study. JMIR Med Educ 2017 Aug 04;3(2):e13 [FREE Full text] [CrossRef] [Medline]
    33. Frisch NC, Borycki EM, Mickelson G, Atherton P, Novak-Lauscher H, Hooker D, et al. Use of social media and web 2.0 technologies to increase knowledge and skills of british columbia nurses. NI 2012 (2012) 2012;2012:117 [FREE Full text] [Medline]
    34. Wang JV, O'Donnell M, Albornoz CA, Keller M, Saedi N. Resident experiences with social media: modernizing dermatology training. Int J Dermatol 2018 Dec;57(12):e169-e170 [FREE Full text] [CrossRef] [Medline]
    35. Zhang MWB, Ho RCM, Hawa R, Sockalingam S. Analysis of the Information Quality of Bariatric Surgery Smartphone Applications Using the Silberg Scale. Obes Surg 2016 Jan;26(1):163-168. [CrossRef] [Medline]
    36. DeBord LC, Patel V, Braun TL, Dao H. Social media in dermatology: clinical relevance, academic value, and trends across platforms. J Dermatolog Treat 2018 Sep 28:1-30 [FREE Full text] [CrossRef] [Medline]
    37. Tran BX, Huong LT, Hinh ND, Nguyen LH, Le BN, Nong VM, et al. A study on the influence of internet addiction and online interpersonal influences on health-related quality of life in young Vietnamese. BMC Public Health 2017 Jan 31;17(1):138 [FREE Full text] [CrossRef] [Medline]
    38. Tran BX, Mai HT, Nguyen LH, Nguyen CT, Latkin CA, Zhang MWB, et al. Vietnamese validation of the short version of Internet Addiction Test. Addict Behav Rep 2017 Dec;6:45-50 [FREE Full text] [CrossRef] [Medline]
    39. Karimkhani C, Connett J, Boyers L, Quest T, Dellavalle RP. Dermatology on instagram. Dermatol Online J 2014 Jul 15;20(7) [FREE Full text] [Medline]
    40. Amir M, Sampson BP, Endly D, Tamai JM, Henley J, Brewer AC, et al. Social networking sites: emerging and essential tools for communication in dermatology. JAMA Dermatol 2014 Jan;150(1):56-60. [CrossRef] [Medline]
    41. Benabio J. The value of social media for dermatologists. Cutis 2013 Jun;91(6):269-270. [Medline]
    42. Patel RR, Yazd NKK, Dellavalle RP. Dermatology on Snapchat. Dermatol Online J 2017 Jul 15;23(7) [FREE Full text] [Medline]
    43. Falzone AE, Brindis CD, Chren M, Junn A, Pagoto S, Wehner M, et al. Teens, Tweets, and Tanning Beds: Rethinking the Use of Social Media for Skin Cancer Prevention. Am J Prev Med 2017 Sep;53(3S1):S86-S94 [FREE Full text] [CrossRef] [Medline]
    44. Balieva F, Kupfer J, Lien L, Gieler U, Finlay AY, Tomás-Aragonés L, et al. The burden of common skin diseases assessed with the EQ5D™: a European multicentre study in 13 countries. Br J Dermatol 2017 May;176(5):1170-1178. [CrossRef] [Medline]
    45. Nguyen SH, Dang AK, Vu GT, Nguyen CT, Le THT, Truong NT, et al. Lack of Knowledge about Sexually Transmitted Diseases (STDs): Implications for STDs Prevention and Care among Dermatology Patients in an Urban City in Vietnam. Int J Environ Res Public Health 2019 Mar 26;16(6) [FREE Full text] [CrossRef] [Medline]
    46. Di Gangi PM, Wasko M. Social Media Engagement Theory: Exploring the Influence of User Engagement on Social Media Usage. JOEUC 2016;28(2):53-73. [CrossRef]
    47. Voorveld HAM, van Noort G, Muntinga DG, Bronner F. Engagement with Social Media and Social Media Advertising: The Differentiating Role of Platform Type. Journal of Advertising 2018 Feb 13;47(1):38-54. [CrossRef]
    48. Ross NA, Todd Q, Saedi N. Patient seeking behaviors and online personas: social media's role in cosmetic dermatology. Dermatol Surg 2015 Feb;41(2):269-276 [FREE Full text] [CrossRef] [Medline]
    49. Mak K, Lai C, Watanabe H, Kim D, Bahar N, Ramos M, et al. Epidemiology of internet behaviors and addiction among adolescents in six Asian countries. Cyberpsychol Behav Soc Netw 2014 Nov;17(11):720-728. [CrossRef] [Medline]
    50. Russell J. Hootsuite Social Media Management. 2017 Jan 31. Social Media in Health Care: The Benefits, Challenges, and Opportunities   URL: http://www.marketinghub.today/social-media-in-health-care-the-benefits-challenges-and-opportunities/ [accessed 2020-02-02]
    51. Hanson AH, Krause LK, Simmons RN, Ellis JI, Gamble RG, Jensen JD, et al. Dermatology education and the Internet: traditional and cutting-edge resources. J Am Acad Dermatol 2011 Oct;65(4):836-842 [FREE Full text] [CrossRef] [Medline]
    52. Hay AA, Gamble RG, Huff LS, Dellavalle RP. Internet social networking sites and the future of dermatology journals: promises and perils. J Am Acad Dermatol 2011 Sep;65(3):e81-e83 [FREE Full text] [CrossRef] [Medline]
    53. Galadari HI. Social media and modern dermatology. Int J Dermatol 2018 Dec;57(1):110-111 [FREE Full text] [CrossRef] [Medline]
    54. George DD, Wainwright BD. Dermatology resources on the internet. Semin Cutan Med Surg 2012 Sep;31(3):183-190. [CrossRef] [Medline]
    55. Thompson LA, Dawson K, Ferdig R, Black EW, Boyer J, Coutts J, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008 Jul;23(7):954-957 [FREE Full text] [CrossRef] [Medline]
    56. Thompson MA, Younes A, Miller RS. Using social media in oncology for education and patient engagement. Oncology (Williston Park) 2012 Sep;26(9):782, 784-785, 791 [FREE Full text] [Medline]
    57. Kim WB, Marinas JEC, Vender RB. Public Engagement with Dermatology Contents on Facebook. J Cutan Med Surg 2015;19(3):304-308 [FREE Full text] [CrossRef] [Medline]
    58. Kim W, Vender R. Use of facebook as a tool for knowledge dissemination in dermatology. J Cutan Med Surg 2014 Oct;18(5):341-344 [FREE Full text] [CrossRef] [Medline]
    59. Hill MK, Patel RR, Anand P, Dellavalle RP. Dermatology on Google. Dermatol Online J 2018 Apr 15;24(4) [FREE Full text] [Medline]
    60. Boyers LN, Quest T, Karimkhani C, Connett J, Dellavalle RP. Dermatology on YouTube. Dermatol Online J 2014 Jun 15;20(6) [FREE Full text] [Medline]
    61. Chernyshov PV, Ho RC, Monti F, Jirakova A, Velitchko SS, Hercogova J, et al. An International Multi-center Study on Self-assessed and Family Quality of Life in Children with Atopic Dermatitis. Acta Dermatovenerol Croat 2015;23(4):247-253. [Medline]
    62. Ho RCM, Giam YC, Ng TP, Mak A, Goh D, Zhang MWB, et al. The influence of childhood atopic dermatitis on health of mothers, and its impact on Asian families. Pediatr Allergy Immunol 2010 May;21(3):501-507 [FREE Full text] [CrossRef] [Medline]

    ‎
    NHDV: National Hospital of Dermatology and Venereology.
    OR: odds ratio.

    Edited by G Eysenbach; submitted 18.01.19; peer-reviewed by HP Do, M El Tantawi, J Xu; comments to author 02.10.19; revised version received 25.11.19; accepted 26.01.20; published 23.03.20

    Copyright

    ©Sau Huu Nguyen, Giang Thu Vu, Long Hoang Nguyen, Cuong Tat Nguyen, Thu Hoai Thi Le, Tung Hoang Tran, Bach Xuan Tran, Carl A Latkin, Wilson W S Tam, Cyrus S H Ho, Roger C M Ho. Originally published in JMIR Dermatology (http://derma.jmir.org), 23.03.2020.

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