Abstract
Objective
This study aimed to investigate if social media (SM) impacts a patient’s provider choice in the field of reproductive endocrinology and infertility (REI).
Methods
This was a survey-based study completed in July 2022. A survey link was distributed using Amazon Mechanical Turk, which directed participants to a Qualtrics-based survey. Participants were 18–50 years old. The primary outcome was to identify the preferred method for finding a REI provider based on time spent on SM (< 1 h, 1–3 h, 3 + h).
Results
A total of 336 responses were analyzed. Fifty-four percent of respondents used SM < 1 h, 33.33% used 1–3 h, and 12.80% used 3 + h. The majority (69.05%) of respondents stated that they would seek out a REI provider/clinic if they had difficulty conceiving. Most respondents identified asking their primary care physician (44.64%) as the primary means for finding an REI provider/clinic and did not prefer to use SM. Although Facebook (< 1 h: 30.94%, 1–3 h: 31.25%, 3 + h: 27.91%) was the most utilized SM platform among respondents, YouTube was the preferred SM platform if respondents were to follow a REI clinic with a preference for posts focusing on education (< 1 h: 55.68%, 1–3 h: 43.12%, 3 + h: 58.14%) or stress management (< 1 h: 17.61%, 1–3 h: 29.36%, 3 + h: 20.94%).
Conclusion
Most respondents utilize traditional methods when choosing their REI provider or clinic and would not utilize SM. However, SM, primarily through YouTube, may be helpful for educating infertility patients and providing support and stress relief while they undergo treatment.
Supplementary Information
The online version contains supplementary material available at 10.1007/s10815-023-03012-6.
Keywords: Access, Choice, Infertility, Provider, Social media
Introduction
Patients are increasingly utilizing the internet to evaluate and select their healthcare providers. Physician rating websites where patients can leave reviews and discuss their experiences with different providers have grown in popularity [1]. A 2012 study found that 65% of Americans reported awareness of such websites, 36% reported having searched for a physician online, and 30% reported using physician rating websites before attending their visit [1–3]. With the rise of social media (SM), patients’ access to online information about their physicians has increased further. In 2021, the Pew Research Center found that 72% of Americans reported regularly using some form of SM with 69% using Facebook, 40% Instagram, 25% Snapchat, and 23% Twitter [4]. Clinicians are not immune from this rise in SM use. Approximately 88% of both physicians and nurses reported 1 h or more of daily SM use [5, 6]. As a result, SM is beginning to supplement physician rating websites.
Recent studies have examined how SM affects users’ physician and practice preference in the fields of dermatology and plastic surgery. A recent study in Saudi Arabia found that patients were almost ten times more likely to know about their dermatologist from SM than from newspapers, radio, or TV [7]. A 2019 study on periocular cosmetic surgeries found that almost half of participants (48.9%) knew their surgeons from SM with Instagram (64.1%) being the most common site [8].
Social media use is especially prevalent among reproductive-aged patients, which makes it an exciting tool to engage with patients in the field of reproductive endocrinology and infertility (REI). The American Society of Reproductive Medicine has published two practice guidelines on the use of social media in the field of reproductive medicine highlighting the advent of this avenue of communication in the field alongside its advantages and pitfalls [9, 10]. Broughton et al. performed a cross-sectional survey study in three US fertility clinics to understand patients’ preferences for SM utilization and content [11]. They found that 79.9% of respondents felt that having a SM presence was a benefit to the patient experience [11]. However, this study did not assess whether patients utilized SM to select a REI clinic or provider.
Given studies in other specialties have demonstrated that patients utilize SM to make decisions in choosing their provider [7, 8, 12] and the lack of corresponding data within the field of REI we sought to explore this knowledge gap. Therefore, this study aims to determine if SM use impacts how patients choose their physicians or clinics in the field of REI.
Materials and methods
Study participants
An anonymous 52-question survey was crowdsourced to subjects aged 18 to 50 years old within the USA using Amazon Mechanical Turk (MTurk) (Seattle, WA) linked to a Qualtrics survey platform (Seattle, WA) from July 5, 2022, to July 13, 2022. The survey was concluded due to reaching the maximum available funding. Amazon MTurk is a crowdsourcing online platform for work that requires human intelligence, and has been frequently used in recent studies in the fields of dermatology [7] and plastic surgery [8, 11] to gain information on public opinion. Participants were excluded if they had a < 97% survey completion rating on Amazon MTurk. Each Amazon MTurk user has a unique ID. Multiple entries from the same ID or concern for non-human participation (e.g., bots) based on Qualtrics data quality check were rejected to avoid duplicate or programmed responses. Participation in the study was voluntary, and consent was implied given completion of the survey. All data were de-identified. Participants received $0.50 for completion of the survey. A unique code was generated with completion of the survey, which respondents had to enter to receive compensation. This study was approved by the Brigham and Women’s Hospital Institutional Review Board (Protocol #2022P001110).
Why Amazon Mechanical Turk
Amazon MTurk is a crowdsourcing platform that has become increasingly used over the years in several academic fields. Amazon MTurk has been identified as a valid, efficient, and cost-effective approach to recruiting participants for studies while also producing high-quality data for analysis [13–15]. It has also been shown to produce a demographically diverse population compared to standard Internet survey and have comparable results when compared to traditional methods [15]. Given the aim of our study and advantages seen with Amazon MTurk, it was chosen as the platform for recruitment of our study instead of other conventional survey platforms, such as Survey Monkey or RedCap.
Survey design
Questions from similar studies in dermatology [7], plastic surgery [8, 11], and reproductive endocrinology and infertility [12] were used to guide survey design. Questions 1–15 collected demographic information including age, sex, race and ethnicity, sexual orientation, gender identity, region of the USA, education, salary and household income, marital status, children, and religious background. Questions 16–32 addressed participants own background and preferences regarding fertility care and regarding SM use. Questions 32–37 addressed views of infertility clinics’ SM presence, while questions 38–44 addressed views of infertility doctors’ SM presence. Finally, questions 45–52 investigated other factors that might influence one’s decision to choose a doctor or infertility clinic for fertility treatment. The final survey format can be found in Appendix A.
Statistical analysis
A total of 361 responses were obtained. Incomplete surveys were excluded from the analysis (n = 25) leaving 336 responses included in the analysis. Groups were stratified based on their time spent on SM: < 1 h (n = 181), 1–3 h (n = 112), and 3 + h (n = 43). Descriptive statistics were used to summarize patient demographics. Student’s t-tests were performed for continuous variables, and chi-squared tests or Fisher’s exact tests were used for categorical variables (Table 1). Log-binomial regression models were used for categorical outcomes. Relative risk and 95% confidence intervals were reported. Adjusted analyses controlling for age and household income were performed (Tables 2 and 3). SM use of 1–3 h was used as the reference group for log-binomial regression models. We also included a sub-analysis of respondents based on whether they have used fertility services, considered using fertility services, or would never use fertility services (Supplemental Table 1). Data reported in this study reflected statistical significance when p < 0.05. All analyses were performed using the SAS® version 9.4 (Cary, NC, USA).
Table 1.
Baseline characteristics by time spent on social media
|
< 1 h/day N (%) |
1–3 h/day N (%) |
3 + h/day N (%) |
Total N | p-value | |
|---|---|---|---|---|---|
| Total | 181 (100.00) | 112 (100.00) | 43 (100.00) | 336 | |
| Age (years) | |||||
| 18–24 | 13 (7.18) | 7 (6.25) | 5 (11.63) | 25 | 0.61 |
| 25–29 | 46 (25.41) | 25 (22.32) | 10 (23.26) | 81 | |
| 30–34 | 41 (22.65) | 23 (20.54) | 9 (20.93) | 73 | |
| 35–39 | 37 (20.44) | 18 (16.07) | 11 (25.58) | 66 | |
| 40–45 | 22 (12.15) | 23 (20.54) | 5 (11.63) | 50 | |
| 46–50 | 22 (12.15) | 16 (14.29) | 3 (6.98) | 41 | |
| Sex | |||||
| Male | 90 (50.00) | 48 (43.24) | 17 (40.48) | 155 | 0.37 |
| Female | 90 (50.00) | 63 (56.76) | 25 (59.52) | 178 | |
| Missing | 1 | 1 | 1 | ||
| Race | |||||
| White | 140 (82.35) | 91 (84.26) | 35 (83.33) | 266 | 0.86 |
| Black or African American | 11 (6.47) | 5 (4.63) | 4 (9.52) | 20 | |
| Asian | 15 (8.82) | 9 (8.33) | 2 (4.76) | 26 | |
| American Indian or Alaskan Native | 1 (0.59) | 2 (1.85) | 0 (0.00) | 3 | |
| Other | 3 (1.76) | 1 (0.93) | 1 (2.38) | 5 | |
| Missing | 11 | 4 | 1 | ||
| Ethnicity | |||||
| Hispanic | 44 (25.00) | 19 (17.27) | 7 (16.28) | 70 | 0.21 |
| Non-Hispanic | 132 (75.00) | 91 (82.73) | 36 (83.72) | 259 | |
| Missing | 5 | 2 | 0 | ||
| Sexual orientation | |||||
| Straight | 137 (76.54) | 79 (70.54) | 35 (81.40) | 251 | 0.38 |
| Lesbian | 4 (2.23) | 1 (0.89) | 1 (2.33) | 6 | |
| Gay | 0 (0.00) | 4 (3.57) | 0 (0.00) | 4 | |
| Bisexual | 32 (17.88) | 24 (21.43) | 6 (13.95) | 62 | |
| Queer/questioning | 0 (0.00) | 1 (0.89) | 0 (0.00) | 1 | |
| Pansexual | 4 (2.23) | 2 (1.79) | 1 (2.33) | 7 | |
| Asexual | 2 (1.12) | 1 (0.89) | 0 (0.00) | 3 | |
| Missing | 2 | 0 | 0 | ||
| Gender identity | |||||
| Man | 88 (49.16) | 49 (43.75) | 17 (39.53) | 154 | 0.66 |
| Woman | 88 (49.16) | 62 (55.36) | 26 (60.47) | 176 | |
| Nonbinary | 1 (0.56) | 1 (0.89) | 0 (0.00) | 2 | |
| Transgender female to male | 2 (1.12) | 0 (0.00) | 0 (0.00) | 2 | |
| Missing | 2 | 0 | 0 | ||
| Region | |||||
| Northeast | 35 (19.34) | 20 (17.86) | 7 (16.28) | 62 | 0.92 |
| Southeast | 49 (27.07) | 32 (28.57) | 14 (32.56) | 95 | |
| Southwest | 26 (14.36) | 13 (11.61) | 4 (9.30) | 43 | |
| West | 33 (18.23) | 17 (15.18) | 9 (20.93) | 59 | |
| Midwest | 38 (20.99) | 30 (26.79) | 9 (20.93) | 77 | |
| Education | |||||
| High school | 12 (6.63) | 8 (7.14) | 4 (9.30) | 24 | 1.00 |
| Vocational/technical/some college | 37 (20.44) | 21 (18.75) | 8 (18.60) | 66 | |
| College graduate | 100 (55.25) | 64 (57.14) | 23 (53.49) | 187 | |
| Some post-graduate work/master’s or higher graduate degree | 32 (17.68) | 19 (16.96) | 8 (18.60) | 59 | |
| Income | |||||
| < 30,000 | 43 (23.76) | 33 (29.46) | 11 (25.58) | 87 | 0.14 |
| 35,000–49,999 | 41 (22.65) | 17 (15.18) | 14 (32.56) | 72 | |
| 50,000–74,999 | 66 (36.46) | 39 (34.82) | 10 (23.26) | 115 | |
| 75,000–99,999 | 20 (11.05) | 11 (9.82) | 7 (16.28) | 38 | |
| 100,00 or more | 11 (6.08) | 12 (10.71) | 1 (2.33) | 24 | |
| Household income | |||||
| < 30,000 | 43 (23.76) | 33 (39.46) | 11 (25.58) | 50 | 0.03 |
| 35,000–49,999 | 41 (22.65) | 17 (15.18) | 14 (32.56) | 74 | |
| 50,000–74,999 | 66 (36.46) | 39 (34.82) | 10 (23.26) | 104 | |
| 75,000–99,999 | 20 (11.05) | 11 (9.82) | 7 (16.28) | 47 | |
| 100,00 or more | 11 (6.08) | 12 (10.71) | 1 (2.33) | 61 | |
| Marital status | |||||
| Single, never married | 56 (30.94) | 27 (24.11) | 11 (25.58) | 94 | 0.42 |
| Currently married/partnered | 118 (65.19) | 82 (73.21) | 32 (74.42) | 232 | |
| Previously married/partnered | 7 (3.87) | 3 (2.68) | 0 (0.00) | 10 | |
| Have children | |||||
| Yes | 108 (59.67) | 72 (64.29) | 24 (55.81) | 204 | 0.57 |
| No | 73 (40.33) | 40 (35.71) | 19 (44.19) | 132 | |
| Religion | |||||
| No organized religion | 20 (11.05) | 5 (4.46) | 6 (13.96) | 31 | 0.16 |
| Agnostic/atheist | 38 (20.99) | 26 (23.21) | 7 (16.28) | 71 | |
| Christian | 111 (61.33) | 75 (66.96) | 24 (55.81) | 210 | |
| Other | 12 (6.63) | 6 (5.36) | 6 (13.95) | 24 | |
Bolded values indicate significant values
Table 2.
Respondents’ preferences stratified by time spent on social media (relative risk ratios adjusted by age and household income)
| 1–3 h/day (ref) N = 112 n (%) |
< 1 h/day N = 181 n (%) |
RR (95% CI) | aRR (95% CI) | 3 + h/day N = 43 n (%) |
RR (95% CI) | aRR (95% CI) | |
|---|---|---|---|---|---|---|---|
| Consider seeing REI if difficulty conceiving | |||||||
| Yes | 72 (64.29) | 130 (71.82) | 30 (69.77) | ||||
| No/unsure | 40 (35.71) | 51 (28.18) | 1.12 (0.95, 1.32) | 1.12 (0.96, 1.32) | 13 (30.23) | 1.09 (0.85, 1.38) | 1.11 (0.85, 1.45) |
| Primary social media platform by time | |||||||
| 35 (31.25) | 56 (30.94) | 0.99 (0.70, 1.41) | 0.97 (0.70, 1.36) | 12 (27.91) | 0.89 (0.51, 1.55) | 0.90 (0.53, 1.55) | |
| 31 (27.68) | 49 (27.07) | 0.98 (0.67, 1.43) | 1.00 (0.70, 1.36) | 10 (23.26) | 0.84 (0.45, 1.56) | 0.93 (0.50, 1.73) | |
| Snapchat | 17 (15.18) | 27 (14.92) | 0.98 (0.67, 1.43) | 0.88 (0.51, 1.54) | 8 (18.60) | 1.23 (0.57, 2.63) | 0.91 (0.43, 1.96) |
| TikTok | 17 (15.18) | 16 (8.84) | 0.58 (0.31, 1.11) | 0.60 (0.31, 1.16) | 4 (9.30) | 0.61 (0.22, 1.72) | 0.62 (0.22, 1.77) |
| 4 (3.57) | 19 (10.50) | 2.94 (1.03, 8.42) | 2.89 (1.00, 8.38) | 5 (11.63) | 3.26 (0.92, 11.56) | 3.06* (0.86, 10.91) | |
| YouTube | 8 (7.14) | 14 (7.73) | 1.08 (0.47, 2.50) | 1.13 (0.48, 2.64) | 4 (9.30) | 1.30 (0.41, 4.10) | 1.69 (0.54, 5.30) |
| Would join infertility support group on social media | |||||||
| Yes | 78 (69.64) | 120 (66.67) | 29 (67.44) | ||||
| No | 34 (30.36) | 60 (33.33) | 0.96 (0.82, 1.12) | 0.99 (0.84, 1.15) | 14 (32.56) | 0.97 (0.76, 1.23) | 0.99 (0.77, 1.28) |
| Missing | 0 | 1 | 0 | ||||
| How often should REI clinic post on social media | |||||||
| 1–2 × per month | 10 (9.17) | 37 (21.02) | 2.29 (1.19, 4.42) | 2.53 (1.32, 4.85) | 5 (11.63) | 1.27 (0.46, 3.49) | 1.19 (0.44, 3.26) |
| 1–2 × per week | 81 (74.31) | 129 (73.30) | 0.99 (0.86, 1.14) | 0.99 (0.87, 1.13) | 31 (72.09) | 0.97 (0.78, 1.20) | 0.95 (0.76, 1.18) |
| Once a day | 14 (12.84) | 9 (5.11) | 0.40 (0.18, 0.89) | 0.35 (0.15, 0.79) | 6 (13.95) | 1.09 (0.45, 2.64) | 0.97 (0.38, 2.45) |
| > Twice per day | 4 (3.67) | 1 (0.57) | 0.15 (0.02, 1.37) | ** | 1 (2.33) | 0.63 (0.07, 5.51) | ** |
| Missing | 3 | 5 | 0 | ||||
| Preferred REI clinic social media posts | |||||||
| Education regarding infertility diagnosis, testing, and treatment | 47 (43.12) | 98 (55.68) | 1.29 (1.00, 1.66) | 1.29 (1.00, 1.66) | 25 (58.14) | 1.35 (0.97, 1.88) | 1.15 (0.82, 1.62) |
| Managing stress | 32 (29.36) | 31 (17.61) | 0.60 (0.39, 0.92) | 0.67 (0.43, 1.03) | 9 (20.93) | 0.71 (0.37, 1.37) | 0.85 (0.44, 1.67) |
| Myths and facts about infertility | 19 (17.43) | 17 (9.66) | 0.55 (0.30, 1.02) | 0.55* (0.30, 1.01) | 2 (4.65) | 0.27 (0.06, 1.10) | 0.27* (0.07, 1.11) |
| Research studies in the infertility field | 4 (3.67) | 13 (7.39) | 2.01 (0.76, 6.02) | ** | 0 (0.00) | ** | ** |
| Coping tips for waiting for results | 3 (2.75) | 8 (4.55) | 1.65 (0.45, 6.09) | ** | 4 (9.30) | 3.38 (0.79, 14.48) | ** |
| Patient success stories | 1 (0.92) | 4 (2.27) | 2.48 (0.28, 21.88) | ** | 3 (6.98) | 7.60 (0.81, 71.11) | ** |
| Other | 3 (2.75) | 5 (2.84) | 1.03 (0.25, 4.23) | ** | 0 (0.00) | ||
| Missing | 3 | 5 | 0 | ||||
| How often should REI MD post on social media | |||||||
| 1–2 × per month | 12 (11.01) | 33 (19.30) | 1.75 (0.95, 3.24) | 1.76 (0.96, 3.22) | 5 (11.90) | 1.08 (0.41, 2.88) | 0.95 (0.36, 2.50) |
| 1–2 × per week | 77 (70.64) | 124 (72.51) | 1.03 (0.88, 1.20) | 1.04 (0.99, 1.20) | 28 (66.67) | 0.94 (0.74, 1.21) | 0.95 (0.73, 1.24) |
| Once a day | 18 (16.51) | 12 (7.02) | 0.43 (0.21, 0.85) | 0.43 (0.21, 0.86) | 6 (14.29) | 0.87 (0.37, 2.03) | 0.91 (0.38, 2.17) |
| > Twice per day | 2 (1.83) | 2 (1.17) | 0.64 (0.09, 4.46) | ** | 3 (7.14) | 3.89 (0.67, 22.48) | ** |
| Missing | 3 | 10 | 1 | ||||
| Preferred REI social media posts | |||||||
| Education regarding infertility diagnosis, testing, and treatment | 62 (56.88) | 101 (59.06) | 1.04 (0.85, 1.28) | 1.02 (0.82, 1.26) | 19 (45.24) | 0.80 (0.55, 1.15) | 0.74 (0.51, 1.07) |
| Managing stress | 25 (22.94) | 34 (19.88) | 0.87 (0.55, 1.37) | 1.05 (0.66, 1.65) | 11 (26.19) | 1.14 (0.62, 2.11) | 1.22 (0.66, 2.26) |
| Myths and facts about infertility | 7 (6.42) | 14 (8.19) | 1.27 (0.53, 3.06) | 1.08 (0.44, 2.63) | 6 (14.29) | 2.22 (0.79, 6.24) | 1.81 (0.62, 5.29) |
| Research studies in the infertility field | 5 (4.59) | 9 (5.26) | 1.15 (0.39, 3.33) | ** | 3 (7.14) | 1.56 (0.39, 6.23) | ** |
| Coping tips for waiting for results | 3 (2.75) | 4 (2.34) | 0.85 (0.19, 3.72) | ** | 2 (4.76) | 1.73 (0.30, 6.23) | ** |
| Patient success stories | 2 (1.83) | 4 (2.34) | 1.27 (0.24, 6.84) | ** | 1 (2.38) | 1.30 (0.12, 13.94) | ** |
| Other | 5 (4.95) | 5 (2.92) | 0.64 (0.19, 2.15) | ** | 0 (0.00) | ** | ** |
| Missing | 3 | 10 | 1 | ||||
| Would more followers make you more likely to go to an REI clinic | |||||||
| Yes | 62 (56.88) | 93 (52.84) | 23 (53.49) | ||||
| No effect | 47 (43.12) | 83 (47.16) | 0.93 (0.75, 1.15) | 0.92 (0.76, 1.12) | 20 (46.51) | 0.94 (0.68, 1.30) | 0.99 (0.67, 1.20) |
| Missing | 3 | 5 | 0 | ||||
| How does website quality effect your perception of an REI clinic or MD | |||||||
| Would impact how I perceive them | 39 (37.50) | 70 (41.42) | 1.10 (0.81, 1.50) | 1.23 (0.91, 1.67) | 19 (45.24) | 1.21 (0.80, 1.83) | 1.33 (0.88, 2.01) |
| Would slightly impact how I perceive them | 43 (41.35) | 71 (42.01) | 1.02 (0.76, 1.36) | 0.99 (0.74, 1.31) | 18 (42.86) | 1.04 (0.68, 1.57) | 1.04 (0.68, 1.58) |
| No effect | 21 (20.19) | 26 (15.38) | 0.76 (0.45, 1.28) | 0.82* (0.50, 1.37) | 5 (11.90) | 0.59 (0.24, 1.46) | 0.65* (0.26, 1.58) |
| Would negatively impact how I perceive them | 1 (0.96) | 2 (1.18) | 1.23 (0.11, 13.41) | ** | 0 (0.00) | ** | ** |
| Missing | 8 | 12 | 1 | ||||
| Do you compare positive and negative reviews | |||||||
| Yes | 98 (94.23) | 147 (86.98) | 38 (90.48) | ||||
| No | 6 (5.77) | 22 (13.02) | 0.92 (0.86, 1.00) | 0.95 (0.79, 1.15) | 4 (9.52) | 0.96 (0.86, 1.07) | 0.97 (0.74, 1.27) |
| Missing | 8 | 12 | 1 | ||||
Bolded values indicate significant values
RR relative risk, aRR adjusted relative risk
*Calculated excluding household income
**Unable to run adjusted model
Table 3.
Social media preferences among those who currently follow an REI provider/clinic on social media stratified by time spent on social media (relative risk ratios adjusted for age and household income)
| 1–3 h/day (ref) N = 62 n (%) |
< 1 h/day N = 89 n (%) |
RR (95% CI) | aRR (95% CI) | 3 + h/day N = 24 n (%) |
RR (95% CI) | aRR (95% CI) | |
|---|---|---|---|---|---|---|---|
| Consider seeing REI MD if difficulty conceiving | |||||||
| Yes | 48 (77.42) | 70 (78.65) | 18 (75.00) | ||||
| No/unsure | 14 (22.58) | 19 (21.35) | 1.02 (0.85, 1.21) | 1.04* (0.84, 1.29) | 6 (25.00) | 0.97 (0.74, 1.27) | 1.03 (0.72, 1.47) |
| Primary social media platform by time | |||||||
| 22 (35.48) | 31 (34.83) | 0.98 (0.63, 1.52) | 0.96 (0.61, 1.51) | 9 (37.50) | 1.06 (0.57, 1.96) | 1.22 (0.66, 2.25) | |
| 22 (35.48) | 22 (24.72) | 0.70 (0.43, 1.14) | 0.75 (0.46, 1.23) | 6 (25.00) | 0.70 (0.33, 1.52) | 0.82 (0.38, 1.80) | |
| Snapchat | 9 (14.52) | 14 (15.73) | 0.93 (0.44, 1.95) | 0.88* (0.43, 1.81) | 5 (20.83) | 1.23 (0.48, 3.16) | 1.14* (0.46, 2.79) |
| TikTok | 6 (9.68) | 7 (7.78) | 0.81 (0.29, 2.30) | 0.94* (0.32, 2.77) | 1 (4.17) | 0.43 (0.05, 3.39) | 0.50* (0.06, 4.07) |
| 1 (1.61) | 10 (11.24) | 6.97 (0.92, 53.04) | 7.11* (0.91, 55.47) | 2 (8.33) | 5.17 (0.49, 54.38) | 4.85* (0.45, 52.22) | |
| YouTube | 2 (3.23) | 5 (5.62) | 1.74 (0.35, 8.69) | 1.92* (0.37, 10.04) | 1 (4.17) | 1.29 (0.12, 13.59) | 1.41* (0.13, 15.29) |
| Would join infertility support group on social media | |||||||
| Yes | 56 (90.32) | 78 (87.64) | 18 (75.00) | ||||
| No | 6 (9.68) | 11 (12.36) | 0.97 (0.87, 1.09) | 0.99 (0.85, 1.16) | 6 (25.00) | 0.83 (0.65, 1.06) | 0.91 (0.70, 1.18) |
| How often should REI clinic post on social media | |||||||
| 1–2 × per month | 4 (6.56) | 9 (10.34) | 1.58 (0.51, 4.89) | 1.63 (0.50, 5.32) | 4 (16.67) | 2.54 (0.69, 9.35) | 2.42 (0.70, 1.18) |
| 1–2 × per week | 48 (78.69) | 72 (82.76) | 1.05 (0.89, 1.24) | 1.02* (0.87, 1.19) | 14 (58.33) | 0.74 (0.52, 1.07) | 0.71* (0.50, 1.03) |
| Once a day | 8 (13.11) | 5 (5.75) | 0.44 (0.15, 1.28) | 0.58* (0.19, 1.76) | 6 (25.00) | 1.91 (0.74, 4.92) | 2.81* (0.96, 8.27) |
| > Twice per day | 1 (1.64) | 1 (1.15) | 0.70 (0.04, 10.99) | ** | 0 (0.00) | ** | ** |
| Missing | 1 | 2 | 0 | ||||
| Preferred REI clinic social media posts | |||||||
| Education regarding infertility diagnosis, testing, and treatment | 25 (40.98) | 47 (54.02) | 1.32 (0.92, 1.89) | 1.12 (0.85, 1.49) | 13 (54.17) | 1.32 (0.82, 2.13) | 1.08 (0.71, 1.66) |
| Managing stress | 22 (36.07) | 13 (14.94) | 0.41 (0.23, 0.76) | 0.51 (0.28, 0.94) | 6 (25.00) | 0.69 (0.32, 1.50) | 1.02 (0.42, 2.46) |
| Myths and facts about infertility | 8 (13.11) | 11 (12.64) | 0.96 (0.41, 2.26) | 1.07* (0.44, 2.58) | 2 (8.33) | 0.64 (0.15, 2.78) | 0.69* (0.16, 3.07) |
| Research studies in the infertility field | 1 (1.64) | 2 (2.30) | 1.40 (0.13, 15.12) | ** | 0 (0.00) | ** | ** |
| Coping tips for waiting for results | 1 (1.64) | 8 (9.20) | 5.61 (0.72, 43.70) | 5.44* (0.71, 41.89) | 2 (8.33) | 5.08 (0.48, 53.49) | 4.63* (0.45, 48.21) |
| Patient success stories | 1 (1.64) | 4 (4.60) | 2.80 (0.32, 24.48) | ** | 1 (4.17) | 2.54 (0.17, 39.02) | ** |
| Other | 3 (4.92) | 2 (2.30) | 0.47 (0.08, 2.71) | ** | 0 (0.00) | ** | ** |
| Missing | 1 | 2 | 0 | ||||
| How often should REI MD post on social media | |||||||
| 1–2 × per month | 4 (6.56) | 10 (11.76) | 1.79 (0.59, 5.45) | 1.67 (0.52, 5.34) | 2 (8.33) | 1.27 (0.25, 6.49) | 0.94 (0.18, 4.92) |
| 1–2 × per week | 43 (70.49) | 64 (75.29) | 1.07 (0.87, 1.31) | 1.03 (0.84, 1.27) | 14 (58.33) | 0.83 (0.57, 1.20) | 0.84 (0.56, 1.27) |
| Once a day | 12 (19.67) | 10 (11.76) | 0.60 (0.28, 1.29) | 0.76* (0.35, 1.68) | 6 (25.00) | 1.27 (0.54, 3.00) | 1.86* (0.74, 4.69) |
| > Twice per day | 2 (3.28) | 1 (1.18) | 0.36 (0.03, 3.87) | ** | 2 (8.33) | 2.54 (0.38, 17.03) | ** |
| Missing | 1 | 4 | 0 | ||||
| Preferred REI MD social media posts | |||||||
| Education regarding infertility diagnosis, testing, and treatment | 35 (57.38) | 43 (50.59) | 0.88 (0.65, 1.19) | 0.93 (0.75, 1.15) | 9 (37.50) | 0.65 (0.37, 1.14) | 0.83 (0.59, 1.16) |
| Managing stress | 12 (19.67) | 18 (21.18) | 1.08 (0.56, 2.07) | 1.39 (0.75, 2.58) | 9 (37.50) | 1.91 (0.92, 3.93) | 2.39 (1.06, 5.37) |
| Myths and facts about infertility | 4 (6.56) | 9 (10.59) | 1.61 (0.52, 5.00) | 1.69* (0.54, 5.30) | 3 (12.50) | 1.91 (0.46, 7.89) | 2.07* (0.50, 8.53) |
| Research studies in the infertility field | 4 (6.56) | 7 (8.24) | 1.26 (0.38, 4.10) | 1.46* (0.44, 4.90) | 1 (4.17) | 0.64 (0.07, 5.40) | 0.65* (0.08, 5.59) |
| Coping tips for waiting for results | 2 (3.28) | 3 (3.53) | 1.08 (0.19, 6.25) | 1.21* (0.20, 7.29) | 1 (4.17) | 1.27 (0.12, 13.37) | 1.23* (0.11, 13.42) |
| Patient success stories | 1 (1.64) | 3 (3.53) | 2.15 (0.23, 20.21) | ** | 1 (4.17) | 2.54 (0.17, 39.02) | ** |
| Other | 3 (4.92) | 2 (2.35) | 0.48 (0.08, 2.78) | ** | 0 (0.00) | ** | ** |
| Missing | 1 | 4 | 0 | ||||
| Would more followers make you more likely to go to an REI clinic | |||||||
| Yes | 48 (78.69) | 70 (80.46) | 17 (70.83) | ||||
| No effect | 13 (21.31) | 17 (19.54) | 1.02 (0.87, 1.21) | 1.01 (0.86, 1.20) | 7 (29.17) | 0.90 (0.67, 1.20) | 0.94 (0.73, 1.21) |
| Missing | 1 | 2 | 0 | ||||
| How does website quality effect your perception of an REI clinic or MD | |||||||
| Would impact how I perceive them | 27 (44.26) | 37 (44.05) | 1.10 (0.81, 1.50) | 1.23 (0.91, 1.67) | 11 (45.83) | 1.21 (0.80, 1.83) | 1.33 (0.88, 2.01) |
| Would slightly impact how I perceive them | 26 (42.62) | 44 (52.38) | 1.02 (0.76, 1.36) | 0.99 (0.74, 1.31) | 10 (41.67) | 1.04 (0.68, 1.57) | 1.04 (0.68, 1.58) |
| No effect | 7 (11.48) | 3 (3.57) | 0.76 (0.45, 1.28) | 0.82* (0.50, 1.37) | 3 (12.50) | 0.59 (0.24, 1.46) | 0.65 (0.26, 1.59) |
| Would negatively impact how I perceive them | 1 (1.64) | 0 (0.00) | 0 (0.00) | ||||
| Missing | 1 | 5 | 0 | ||||
| Do you compare positive and negative reviews | |||||||
| Yes | 56 (91.80) | 74 (88.10) | 21 (87.50) | ||||
| No | 5 (8.20) | 10 (11.90) | 0.96 (0.86, 1.07) | 0.97* (0.77, 1.21) | 3 (12.50) | 0.95 (0.81, 1.13) | 0.92* (0.58, 1.47) |
| Missing | 1 | 5 | 0 | ||||
Bolded values indicate significant values
RR relative risk, aRR adjusted relative risk
*Calculated excluding household income
**Unable to run adjusted model
Results
Study population
A total of 336 responses were analyzed; 65.48% of respondents were between 25 and 39 years old, and 52.98% of respondents were female. Fifty-four percent of respondents used SM < 1 h, 33.33% used SM 1–3 h, and 12.80% used SM 3 + h. The majority of baseline characteristics did not differ based on SM time (Table 1). The majority of respondents were a college graduate, were living in the Southeast, had an income of $50,000–74,999, identified as Christian, had children, and currently married or partnered. There was a statistically significant difference in household income between groups (p = 0.03). The majority of respondents reported that they would ask their primary care doctor (44.64%) or friends/family members (23.21%) when trying to find a REI provider (Fig. 1). Only 21.43% of respondents reported they would use SM to find an REI provider.
Fig. 1.
How respondents would prefer to find their IVF clinic or physician based on social media use
Effect of social media use
Table 2 reports that most respondents would visit an REI provider if they had difficulty conceiving (< 1 h: 71.82%, 1–3 h: 64.29%, 3 + h: 69.77%). There were no significant differences between groups when adjusted for age and household income (< 1 h: adjusted RR (aRR) 1.12, 95% CI 0.96–1.32; 3 + h: aRR 1.11, 95% CI 0.85–1.45). The primary SM platform used among all three groups was Facebook (< 1 h: 30.94%, 1–3 h: 31.25%, 3 + h: 27.91%) followed by Instagram (< 1 h: 27.07%, 1–3 h: 27.68%, 3 + h: 23.26%). There was no significant difference in primary SM platform between groups when adjusted (Table 2). When asked “which of the following social media platforms you would be most likely to follow if you had difficulty conceiving or if you were interested in fertility treatment,” respondents were found to prefer YouTube (< 1 h: 40.22%, 1–3 h: 59.46%, 3 + h: 70.00%) (data not shown).
In addition, 67.76% of respondents reported they would join an infertility support group (Table 2) and identified Facebook as the preferred SM platform regardless of time spent on SM (< 1 h: 47.90%, 1–3 h: 58.97%, 3 + h: 51.72%) followed by Instagram (< 1 h: 25.21%, 1–3 h: 21.79%, 3 + h: 17.24%) (data not shown). There were no significant differences found in the adjusted analyses (< 1 h: aRR 0.99, 95% CI 0.84–1.15; 3 + h: aRR 0.99, 95% CI 0.77–1.28).
Respondents were asked their preferred frequency and type of posts they would like to see on SM from an REI clinic or provider (Table 2). Seventy-three percent of respondents felt that REI clinics should post 1–2 times per week and 71.12% felt that an REI provider should also post 1–2 times per week. The preferred SM posts from an REI clinic were “Education regarding infertility diagnosis, testing, and treatment” (< 1 h: 55.68%, 1–3 h: 43.12%, 3 + h: 58.14%) and “managing stress” (< 1 h: 17.61%, 1–3 h: 29.36%, 3 + h: 20.93%). Respondents who use SM < 1 h were found to prefer managing stress post less when compared to those who use SM 1–3 h in unadjusted models (RR 0.60, 95% CI 0.39–0.92); however, this difference did not remain when adjusted for age and household income (aRR 0.67, 95% CI 0.43–1.03). Patient success stories were ranked the lowest among all groups (< 1 h: 2.27%, 1–3 h: 0.92%, 3 + h: 6.98%). Similar results were found for preferred posts from REI providers (Table 2).
The influence of factors such as number of followers, website quality, and effects of positive and negative reviews were evaluated between groups and no statistically significant differences were noted (Table 2). However, the majority (51.11%) of respondents responded that a clinic or provider with four or more negative reviews would make them decide to not see that clinic or provider (data not shown).
Effect of those who currently follow an REI provider/clinic
A sub-analysis with only those respondents who currently follow an REI provider or clinic on SM (n = 175) (Table 3) was performed to ascertain the expectations of this specific population. The majority of respondents would see an REI provider if they had difficulty conceiving (< 1 h: 78.65%, 1–3 h: 77.42%, 3 + h: 75.00%). There were no differences between groups (< 1 h: aRR 1.04, 95% CI 0.84–1.29; 3 + h: aRR 1.03, 95% CI 0.72–1.47). The primary SM platform used among all three groups continued to be Facebook (< 1 h: 34.83%, 1–3 h: 35.48%, 3 + h: 37.5%). Although the primary SM platform used by respondents was Facebook, respondents identified YouTube as the preferred SM platform to follow an REI provider or clinic (< 1 h: 26.42%, 1–3 h: 62.00%, 3 + h: 60.00%) (data not shown).
Approximately 86.86% of respondents reported they would join an infertility support group. Facebook remained the preferred SM platform for a support group regardless of time spent on SM (< 1 h: 36.36%, 1–3 h: 55.36%, 3 + h: 50.00%). Respondents who use SM < 1 h preferred Facebook less than those who used SM 1–3 h (< 1 h: RR 0.66, 95% CI 0.45–0.96); however, this difference did not persistent when controlled for age and household income (aRR 0.68, 95% CI 0.45–1.02) (data not shown).
When assessing posting frequency and types of posts, 77.91% of respondents felt that REI clinics should post 1–2 times per week and 71.18% felt that an REI provider should also post 1–2 times per week. The preferred SM posts from an REI clinic remained educational posts and posts about managing stress. Respondents who use SM < 1 h were less likely to prefer REI clinics post about stress management compared to those who use SM 1–3 h (aRR 0.51, 95% CI 0.28–0.94). Also, respondents who use SM 3 + h were more likely to prefer REI providers to post about managing stress compared to those who use SM 1–3 h (aRR 2.39, 95% CI 1.06–5.37) (Table 3). There were no statistically significant differences between groups regarding impact of number of followers, website quality, or reviews (Table 3).
Impact of SART and presence of trainees
Our survey also included two questions that related to the overall practice of REI: [1] “How would having trainees (e.g. medical students, residents, and fellows) involved in your care affect your choice in choosing an infertility clinic or doctor?” and 2) “Have you ever used the Society of Assisted Reproductive Technology (SART) webpage for information (www.sart.org)?” We found that a majority of respondents felt that having a trainee was a positive impact on their decision on choosing an REI provider/clinic (< 1 h: 48.62%, 1–3 h: 56.25%, 3 + h: 48.84%). We also found that 39.3% of all respondents have used the SART webpage for information (< 1 h: 40.24%, 1–3 h: 41.35%, 3 + h: 30.95%). When stratified by only respondents who have used fertility services (n = 72), 75.00% (n = 54) reported that they have used the SART webpage (Supplemental Table 1). Similarly, 68.05% (n = 115) of those who are following an REI clinic or provider (n = 169) have used the SART webpage.
Discussion
Significant findings
We found that the general public would not prefer to use SM to find their REI provider/clinic and that the majority of respondents would use traditional methods (i.e., using their primary care provider or asking friend/family) to locate an REI provider/clinic. In those who would follow an REI provider/clinic on SM, YouTube was the preferred platform and these respondents prioritized educational posts focusing on infertility diagnosis, tests, and treatment and how to manage stress. These results did not differ based on time spent on SM or if someone was currently following an REI provider or clinic on SM. These findings could be useful to REI practices, as they tailor their SM presence, to satisfy the needs of those following them.
We believe that the identification of YouTube as the preferred SM platform for those following a REI provider or clinic is primarily due to the preference and characteristics of posts. YouTube allows for longer videos to be posted with the addition of a commentary section for further discussion between viewers. Additionally, the preference for Facebook for support groups may be due to the notoriety of Facebook being a SM platform meant for groups and networking.
Other SM platforms, such as Twitter, Snapchat, and Instagram, do not have the ability to post long videos or create groups in the same regard, thereby making them less desirable for educational posts or support groups. However, we do acknowledge that a majority of SM platforms are interconnected. For example, the use of Linktree on an Instagram profile can provide links on that user’s account to other SM platforms (i.e., Twitter, YouTube) that they may also use. Therefore, it may still yield benefit to have multiple SM platforms as long as those platforms are interconnected and provide prospective patients the ability to obtain the information they desire in the setting or format they prefer.
Comparison to prior studies
This is the first study, to our knowledge, that has evaluated the effect of SM use on a patient’s provider choice in the field of REI. Our findings were consistent with prior studies showing that Facebook is the primary SM platform used among the general public [4]. Also, our findings were consistent with the study by Broughton et al. that demonstrated the most preferential post among patients is “Education regarding fertility testing” [12].
Our study differs from studies in dermatology [7] and plastic surgery [8] in that respondents from our study did not prefer to use SM to locate their REI provider and a majority of respondents were not following an REI provider or clinic on SM (37.8%). Therefore, the benefit that may be seen in other specialties with the use of SM may not be congruent to the field of REI. REI providers and clinics should take solace that not having a SM presence will not impede their current practice. However, having a SM presence may allow an REI provider or clinic to become visible to friends/family or primary care physicians who a potential patient could approach for referral, but we were not able to ascertain this type of logic from our study. Additionally, more than 75% of patients would favor a secure online avenue for communication with their provider or clinic, especially those of reproductive age [16]. Therefore, we cannot conclude that the absence of a SM platform does not have other potential effects on patient satisfaction with their care.
A 2018 study investigating patients’ perceptions on medical learners and medical education during clinical consultation in family medicine found that most patients have a positive perception of medical learners and also believe that their care is important to medical education [17]. Our study supports the presence of trainees in the field of REI as a positive influence. Therefore, we believe REI providers and clinics should strive to engage their trainees throughout the entire IVF process.
We found that 75% of respondents who have used fertility services have also utilized the SART webpage. This may be due to being referred to the benefits and utility of the website by their REI provider or clinic during the course of their fertility evaluation. Although encouraging that utilization amongst infertility patients is high, this study identifies an opportunity to increase awareness amongst the general population who might be starting to explore their fertility concerns. As an unbiased source of information, it is critical that SART optimize its search algorithms so that people are not dependent on fertility clinics or providers to raise awareness.
Future studies
Future studies should be directed towards discovering the path a prospective patient would use to find an REI provider to better understand which avenues or platforms have the highest and lowest use to promote better access to care. Social media continues to expand on an annual basis, and it may become more crucial in determining healthcare referrals in the upcoming years as the utilization of SM has changed in younger populations and thus might differ from respondents surveyed in our study (18). However, to better service the current population of infertile patients, we need to focus on providing other avenues of access and education. These may include the use of artificial intelligence, chatbots, webpages, or YouTube channels that can address frequently asked questions (FAQs) or basic infertility knowledge on diagnosis and evaluation.
Strengths and limitations
We acknowledge that our study has limitations. The results are affected by all the potential biases related to a survey-based study, such as recall bias and self-enrollment of participants with use of Amazon MTurk. Despite these limitations, we feel that the study population obtained is reflective of the current demographics of those who use fertility services in the USA (Caucasian, educated, middle-class). Also, we were able to obtain a large sample size with > 70% response rate.
Conclusion
Most respondents utilize traditional methods when choosing their REI provider/clinic and would not utilize SM regardless of time spent on SM. However, SM, primarily through YouTube, may be helpful for educating infertility patients and providing support and stress relief while they undergo treatment.
Supplementary Information
Below is the link to the electronic supplementary material.
Declarations
Conflict of interest
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Paper presentation information/submission declaration.
These findings were presented as a poster presentation at the Pacific Coast Reproductive Society 71st Annual Meeting in March of 2023. This work has otherwise not been published previously and is not under consideration elsewhere.
References
- 1.Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA [Internet] 2014 [cited 2022 Dec 6];311(7):734–5. Available from: https://pubmed.ncbi.nlm.nih.gov/24549555/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 2.Kadry B, Chu LF, Kadry B, Gammas D, MacArio A. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating. J Med Internet Res [Internet] 2011 [cited 2022 Dec 6];13(4). Available from: https://pubmed.ncbi.nlm.nih.gov/22088924/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 3.Rothenfluh F, Germeni E, Schulz PJ. Consumer decision-making based on review websites: are there differences between choosing a hotel and choosing a physician? J Med Internet Res [Internet] 2016 [cited 2022 Dec 6];18(6). Available from: https://pubmed.ncbi.nlm.nih.gov/27311623/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 4.Center PR. Social Media Use in 2021 [Internet]. [cited 2021 Apr 7];Available from: https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/. Accessed 6 Dec 2022.
- 5.Surani Z, Hirani R, Elias A, Quisenberry L, Varon J, Surani S, et al. Social media usage among health care providers. BMC Res Notes [Internet] 2017 [cited 2022 Dec 6];10(1). Available from: https://pubmed.ncbi.nlm.nih.gov/29187244/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 6.Lefebvre C, McKinney K, Glass C, Cline D, Franasiak R, Husain I, et al. Social media usage among nurses: perceptions and practices. J Nurs Adm [Internet] 2020 [cited 2022 Dec 6];50(3):135–41. Available from: https://pubmed.ncbi.nlm.nih.gov/32049701/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 7.Albeshri M, Alharithy R, Altalhab S, Alluhayyan OB, Farhat AM. The influence of modern social media on dermatologist selection by patients. Cureus [Internet] 2020 [cited 2022 Nov 23];12(12). Available from: https://pubmed.ncbi.nlm.nih.gov/33409064/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 8.Alshaalan HS, AlTamimi LA, Alshayie RA, Alsuhaibani AH. The impact of social media accounts on periocular cosmetic surgeries. Saudi J Ophthalmol Off J Saudi Ophthalmol Soc [Internet] 2021 [cited 2022 Nov 23];35(3):251–6. Available from: https://pubmed.ncbi.nlm.nih.gov/35601847/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 9.Guidance on the use of social media in reproductive medicine practice. Fertil Steril [Internet] 2021 [cited 2023 Aug 27];115(5):1151–5. Available from: https://pubmed.ncbi.nlm.nih.gov/33622564/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 10.Guidance for using text, email, and video communication in practices devoted to reproductive medicine. Fertil Steril [Internet] 2021 [cited 2023 Aug 27];115(5):1156–8. Available from: https://pubmed.ncbi.nlm.nih.gov/33823992/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 11.Fan KL, Graziano F, Economides JM, Black CK, Song DH. The public’s preferences on plastic surgery social media engagement and professionalism: demystifying the impact of demographics. Plast Reconstr Surg [Internet] 2019 [cited 2022 Nov 23];143(2):619–30. Available from: https://pubmed.ncbi.nlm.nih.gov/30688911/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 12.Broughton DE, Schelble A, Cipolla K, Cho M, Franasiak J, Omurtag KR. Social media in the REI clinic: what do patients want? J Assist Reprod Genet [Internet] 2018 [cited 2022 Dec 6];35(7):1259–63. Available from: https://pubmed.ncbi.nlm.nih.gov/29766400/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 13.Bartneck C, Duenser A, Moltchanova E, Zawieska K. Comparing the similarity of responses received from studies in Amazon’s Mechanical Turk to studies conducted online and with direct recruitment. PLoS One [Internet] 2015 [cited 2023 May 12];10(4). Available from: https://pubmed.ncbi.nlm.nih.gov/25876027/. Accessed 6 Dec 2022. [DOI] [PMC free article] [PubMed]
- 14.Peer E, Vosgerau J, Acquisti A. Reputation as a sufficient condition for data quality on Amazon Mechanical Turk. Behav Res Methods [Internet] 2014 [cited 2023 May 12];46(4):1023–31. Available from: https://pubmed.ncbi.nlm.nih.gov/24356996/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 15.Buhrmester M, Kwang T, Gosling SD. Amazon’s Mechanical Turk: a new source of inexpensive, yet high-quality, data? Perspect Psychol Sci [Internet] 2011 [cited 2023 May 12];6(1):3–5. Available from: https://pubmed.ncbi.nlm.nih.gov/26162106/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 16.Omurtag K, Turek P. Incorporating social media into practice: a blueprint for reproductive health providers. Clin Obstet Gynecol [Internet] 2013 [cited 2023 Aug 27];56(3):463–70. Available from: https://pubmed.ncbi.nlm.nih.gov/23722919/. Accessed 6 Dec 2022. [DOI] [PubMed]
- 17.Goerl K, Ofei-Dodoo S. Patient perception of medical learners and medical education during clinical consultation at a family medicine residency. Kansas J Med [Internet] 2018 [cited 2023 Oct 8];11(4):102. Available from: /pmc/articles/PMC6276969/. Accessed 6 Dec 2022. [PMC free article] [PubMed]
- 18.Teens, Social Media and Technology 2022 | Pew Research Center [Internet]. [cited 2023 Oct 8];Available from: https://www.pewresearch.org/internet/2022/08/10/teens-social-media-and-technology-2022/. Accessed 6 Dec 2022.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.