Abstract
Introduction:
Use of telehealth increased during the COVID-19 pandemic and continues to be a popular health resource. This study analyzed the frequency and sentiment of telehealth discussions on Reddit.
Methods:
The data set included 13,071 publicly available Reddit submissions containing keywords related to telehealth over a 3-year period. We identified 173 unique subreddit communities, which were coded into mutually exclusive categories: (1) general telehealth, (2) individual care, (3) professional, (4) news, and (5) COVID-19. The Vader lexicon-based machine was used to assign sentiment scores.
Results:
Most subreddits were coded as individual care (n = 112), professional (n = 26), and news (n = 22). The frequency of submissions increased during the first 2 months of the pandemic and dropped in June 2020, but remained consistent through October 2022. Most Reddit submissions were positive in sentiment (56%).
Conclusion:
Findings show a mostly positive view of telehealth among Reddit users and an increase in telehealth-related discussions since the COVID-19 pandemic.
Keywords: social media, telehealth, communication
Introduction
Telehealth use among patients and health care providers increased significantly during the COVID-19 pandemic1,2 and was covered by news media and other online information sources with discussions reflecting new technology, policy changes, business deals, and expanded legislation.3,4 While current use is lower than at the height of the pandemic, telehealth continues to complement in-person care.5,6 Understanding patient and provider telehealth experiences often rely on medical claims data,7 use tracking services (e.g., Fair Heath),8 electronic health record data,9 or patient and clinician experience surveys.10
To date, few investigations have explored the volume and content of telehealth discussions on social media platforms. Prior research has largely examined telehealth-focused tweets during the COVID-19 pandemic.3,11,12 For example, Pool et al. assessed the content and sentiment of Twitter posts related to telehealth and COVID-19, including digital health service delivery, pandemic response, communication and promotion, government action, health service domains, and pharma.13
One social media platform largely absent from the current telehealth literature is Reddit. Reddit is a discussion-based website centered around participation in topic-based, user-moderated “subreddit” communities. For example, the subreddit “r/telehealth” is a community dedicated to sharing information about the utility of technology in the health care industry. Redditors (i.e., Reddit users) can participate on the platform with their preferred degree of anonymity. Reddit use has substantially increased over the past few years and estimates from 2021 suggest nearly one-fifth of U.S. adults have used it.14 This growth speaks to the importance of understanding Reddit as a public sphere.
To our knowledge, only one investigation to date has examined telehealth discussions on Reddit. Shang et al. conducted a text-based, unsupervised topic model to assess broad themes underlying discussions about telehealth on Reddit.15 Prevalent themes in their results centered on physician conduct (e.g., ability to provide clear instructions to patients during a telehealth visit) and patient loyalty (e.g., mentions of therapeutic and wellness services offered to patients). However, these findings were collected during a singular month (June 2021) and do not reflect telehealth discussions on Reddit before or throughout the COVID-19 pandemic. In addition, their analyses did not assess telehealth discourse differentiated by platform characteristics such as subreddit community type (e.g., patient vs. provider).
This study sought to expand on the current telehealth and social media literature by identifying the frequency and sentiment of Reddit discussions. Specifically, we descriptively analyzed telehealth discussions among Redditors over a 3-year period (November 2019–October 2022), including the onset of the COVID-19 pandemic. As we emerge from the pandemic, findings can inform telehealth-related practices and policies to ensure they align with public opinions and concerns.
Methods
DATA COLLECTION AND CLEANING
Publicly available submissions (i.e., original posts) containing one or more of the following 15 telehealth-related keywords: “telehealth,” “tele-health,” “tele health,” “telemedicine,” “tele-medicine,” “tele medicine,” “televisit,” “tele-visit,” “tele visit,” “telemonitoring,” “tele-monitoring,” “tele monitoring,” “teleoncology,” “tele-oncology,” and “tele oncology” were extracted from Reddit. Broad digital health terms, such as “eHealth” and “mHealth” were excluded since the goal of this study was to examine Redditors' discussions of telehealth (and similar) services for medical encounters.
The 3-year data collection period covered November 2019 through October 2022. This period was chosen to capture discussion trends before and after the World Health Organization's declaration of COVID-19 a global pandemic (March 2020). Collection criteria were case-insensitive (e.g., “telehealth” and “TELEHEALTH” were treated identically). Autogenerated submissions published by subreddit moderator bots and since deleted Redditors were removed. The size of the extracted data set was N = 13,071. Metadata variables included Redditor username, the date/time submissions that were posted, and subreddits.
CATEGORIZING SUBREDDIT COMMUNITIES
We identified 173 unique subreddit communities. Subreddit names, descriptions, and example posts that were iteratively reviewed. Based on inductive assessments, we generated and coded the subreddits into six mutually exclusive community categories: (1) General telehealth—subreddits about general telehealth content such as clinical care informatics and digital health tools, (2) Individual care—subreddits focused on patient needs ranging from clinical questions to peer support, (3) Professional—subreddits comprised of providers (broadly defined) who were in professions that administer health care, and (4) News—subreddits focused on news and science articles, (5) COVID-19—subreddits about COVID-19 information, care, and peer-support, and (6) Other—all other subreddits.
Three study authors (R.E.J., A.H.M., C.A.S.) independently coded each of the subreddits into one of the above categories. Intercoder reliability (measured using ReCal2 software16) among coders was high (Krippendorff's α = 0.92; average agreement = 95%); remaining discrepancies were adjudicated by a fourth author (J.A.R.). See Table 1 for a descriptive overview of the subreddit community categories as well as example paraphrased Reddit submissions for each category.
Table 1.
Descriptive Overview of Subreddit Community Categories
| SUBREDDIT CATEGORY (NO. OF SUBREDDITS IN CATEGORY) | EXAMPLE SUBREDDITS | EXAMPLE POSTS |
|---|---|---|
| 1. General digital/telehealth (k = 4) | r/telehealth r/healthIT |
How telemedicine helps patients and doctors Best uses of telemedicine in the fight against COVID-19 |
| 2. Individual care (k = 112) | r/adderall r/HIVandAIDS |
Do I have to see my doctor for every Adderall refill? Looking for nonjudgmental sexual telehealth service providers in my rural area |
| 3. Professional (k = 26) | r/socialwork r/Psychiatry |
First week of telehealth outpatient therapy done! I work with kids so it feels like I spend the week staring at walls Fellow psychiatrists—does anyone work for large telehealth companies? What is that like? Does state licensure matter? |
| 4. News (k = 22) | r/news r/ABCaus |
Amazon telehealth service to be shut down Doctors hope for continuation of telehealth beyond the coronavirus pandemic |
| 5. COVID-19 (k = 9) | r/Coronavirus r/CoronavirusUS |
During the pandemic, Consumer Value Stores announces Aetna members will have no co-pay for telehealth visits for 3 months These seven telehealth services are providing free health care during the COVID-19 pandemic |
| 6. Other (k = 112) | r/Ineedmoney r/NoStupidQuestions |
[Job Opportunity- REMOTE]: Triage Nurse, Applications Open, Completely Remote Does anyone know why U.S. patients can't see international doctors to save? |
SENTIMENT ANALYSIS
The Vader lexicon-based machine classier was used to assign sentiment scores to Reddit submission text.17 Punctuation, numbers, and common English stop words (e.g., “which,” “before”) were removed before running the analyses to improve classification accuracy.18 Raw sentiment scores were converted to a trichotomous categorical outcome based on recommendations set by Vader. Specifically, compound sentiment scores ≤−0.05 were coded “negative,” ≥0.05 were coded “positive,” and values in-between were coded “neutral.”
DATA ANALYSIS
Descriptive statistics were used to characterize the metadata variables in the dataset (e.g., date submission was posted, Redditor username). In addition, the number of comments corresponding to each submission were extracted as well as the number of URLs (i.e., hyperlinks) included in the submissions, which were interpreted as proxy indicators of Redditor-to-Redditor engagement and information sharing behavior, respectively. Descriptive analyses were grouped by subreddit community categories. Subreddit submissions coded in the Other category were not analyzed due to community heterogeneity (e.g., r/conspiracy, r/wallstreetbets), resulting in a final analytic sample of N = 13,071 submissions.
Results
CHARACTERISTICS OF THE REDDIT DATASET
Telehealth posts were identified in 173 subreddits. As presented in Table 1, most subreddits were coded as follows: Individual care (n = 112), Professional (n = 26), and News (n = 22). Individual care subreddit communities spanned diverse topics from peer support for people struggling with mental health and chronic illness to transgender health support. Subreddits in the Professional category largely comprised posts related to health care professionals, such as doctors, optometrists, or psychiatrists. See Supplementary Material for a full list of subreddits included in coded categories.
There were more than 9,000 (69%) unique authors who posted a submission about telehealth during the 3-year period, with most of the content posted in Individual care (63%). Redditors posted, on average, 1.44 submissions (standard deviation [SD] = 5.47) across all subreddits analyzed. The average number of submissions per Redditor was highest in News communities (mean [M] = 6.19, SD = 26.04) and lowest in both Professional (M = 1.21, SD = 1.03) and COVID-19 communities (M = 1.21, SD = 1.34). About two-thirds (65%) of all submissions had one or more commenters, though engagement varied by subreddit community category ranging from News (4% any comments, mean 0.67 comments) to Individual care (74% any comments, mean = 4.18 comments). Finally, 11% of submissions shared one or more URLs (Table 2).
Table 2.
Characteristics of the Reddit Data by Subreddit Community Category
| GENERAL TELEHEALTH N = 700 |
INDIVIDUAL CARE N = 8,278 |
PROFESSIONAL N = 2,062 |
NEWS N = 1,461 |
COVID-19 N = 570 |
TOTAL N = 13,071 |
|
|---|---|---|---|---|---|---|
| N (%) OR M ± SD | N (%) OR M ± SD | N (%) OR M ± SD | N (%) OR M ± SD | N (%) OR M ± SD | N (%) OR M ± SD | |
| Unique Redditors | 354 (51%) | 6,546 (79%) | 1,702 (33%) | 236 (16%) | 472 (83%) | 9,073 (69%) |
| Submissions per Redditor | 1.98 ± 3.94 | 1.26 ± 3.53 | 1.21 ± 1.03 | 6.19 ± 26.04 | 1.21 ± 1.34 | 1.44 ± 5.47 |
| Submissions with comments | 152 (22%) | 6,128 (74%) | 1,663 (81%) | 60 (4%) | 441 (77%) | 8,444 (65%) |
| Comments per submission | 0.67 ± 4.49 | 4.18 ± 14.53 | 7.74 ± 16.48 | 0.26 ± 5.15 | 6.34 ± 11.02 | 4.21 ± 13.80 |
| Submissions sharing URLs | 171 (24%) | 738 (9%) | 194 (9%) | 234 (16%) | 91 (16%) | 1,428 (11%) |
| Submission sentiment | ||||||
| Positive | 365 (52%) | 4,578 (55%) | 1,390 (67%) | 635 (43%) | 293 (52%) | 7,261 (56%) |
| Neutral | 237 (34%) | 759 (9%) | 328 (16%) | 605 (42%) | 64 (11%) | 1,993 (15%) |
| Negative | 98 (14%) | 2,941 (36%) | 344 (17%) | 221 (15%) | 213 (37%) | 3,817 (29%) |
M, mean; n, sample size; SD, standard deviation.
TEMPORAL TRENDS IN TELEHEALTH DISCUSSIONS ON REDDIT
As shown in Figure 1, from November 2019 to February 2020, the monthly frequency of telehealth Reddit submissions was low (range: 49–100). The frequency of submissions increased substantially the first 2 months after COVID-19 was declared a global pandemic, with submissions of telehealth across all subreddit community categories peaking at 861 in April 2020; more than half of those posts (55%) were from Individual care communities. Overall frequency of telehealth submissions decreased to 407 in June 2020, but remained consistent through October 2022 (M = 372; range: 258–493). Individual care communities represented the majority of these posts ranging from (i.e., 51%–77%). Additionally, submissions about telehealth increased in Individual care communities, trending upward from 215 (June 2020) to 353 (October 2022). Other community categories showed negative or null frequency trends over the same period.
Fig. 1.
Frequency of Reddit submissions across subreddit community categories from 2019 to 2022; data left of dashed line indicates discussions of telehealth on Reddit before COVID-19 pandemic.
SENTIMENT OF THE REDDIT TELEHEALTH SUBMISSIONS
As shown in Table 2, most Reddit submissions were classified as positive (56%), followed by negative (29%) and neutral (15%). Negative sentiment was most prevalent in the Individual care (36%) and COVID-19 (37%) communities, but less frequent in General telehealth (14%), Professional (17%), and News (15%) communities. Positive sentiment was highest in Professional (67%) communities and neutral sentiment was most prevalent in News (42%) communities.
Discussion
Social media is a rich resource for understanding the public's perceptions of—and discussions about—emerging health information technologies and health care innovations. In the current study, we extended the current assessment of telehealth-related discussions on social media beyond Twitter (now X) to include Reddit, an increasingly popular communication platform that emphasizes topic-based community engagement and participation.
Over a 3-year period, including before and after the onset of the COVID-19 pandemic, over 13,000 Reddit submissions discussed telehealth. Complementary to prior research suggesting social media discussions of health information technologies are increasing over time,3,12,19 our study indicates a continued engagement and interest in telehealth from the public and health care providers postpandemic. This supports other recent social media research by identifying adoption of and sentiment toward telehealth that are consistent with the technology acceptance model,20 and further reinforces an expectation of continued use of telehealth services in a postpandemic world.3,21–25
Findings suggest that the majority of telehealth engagement on Reddit was driven by patient-oriented communities. In addition, some Individual care subreddits discussing telehealth, such as r/adderall, r/TherapeuticKetamine, and r/opiates, reflect public engagement in the role of telehealth in the prescription of controlled substances, a key policy issue as COVID-19 era telehealth waivers expire. Mental health-focused (e.g., r/TalkTherapy) subreddits communities were also prevalent. This is consistent with previous studies that found individual care issues such as mental health11–13 or cancer13–21 are increasingly supported by telehealth-related care delivery. In contrast, news-related subreddits showed an increase in early 2020, but no sustained engagement over time. This finding contrasts with research on other social media platforms suggesting journalists and politicians received the highest engagement on telehealth and COVID-19,21 highlighting an important difference in the type of communication and support offered by Reddit to individuals seeking telehealth information.
This study identified that over 50% of Reddit posts discussing telehealth were positive, consistent with sentiment analysis findings from Pool et al. who also found most telehealth-related opinions expressed in tweets were positive.13 However, this was driven by positive submissions from professional subreddit communities. By contrast, individual care community reported a much higher proportion of negative sentiment in telehealth posts. Although a few studies to date have examined patients' experience and satisfaction with recent telehealth, one study found over 39% of U.S. adults rate the quality of telehealth care as lower than in-person care26 and one-quarter report concerns about telehealth privacy.27 Notably, the current study did not assess the specific text of Reddit submissions, suggesting additional investigation of specific topics and themes present in negative and positive posts that are needed to further support these claims.
Strengths of this study include a large sample of Reddit submissions discussing telehealth published over a 3-year period across 173 diverse online communities. A primary limitation is that Reddit-only data were analyzed, meaning that results cannot be generalized to how individuals discuss telehealth on other popular social media platforms such as Facebook. Another limitation is our use of a machine-based dictionary classifier (i.e., Vader) to assess the sentiment of Reddit submissions. Although dictionary sentiment classifiers excel at analyzing large amounts of data, they struggle with nuance in discourse, such as sarcasm and subtext. Thus, additional research should consider testing other machine-based classification methods for analyzing the sentiment of complex text data, such as supervised machine learning approaches where models can be trained to understand specific text patterns.
Conclusion
Reddit data can provide a unique look into online community-driven conversations compared to other social media platforms. Study findings show an overall positive view of telehealth among Reddit users and an increased amount of telehealth-related conversation compared to before the COVID-19 pandemic. Posts related to individual care were most prevalent and tended to generate substantial engagement. Results may inform future clinical practice, health care delivery research, and related policy efforts. Future research can build on study findings by conducting other machine-based telehealth sentiment analysis on Reddit and other social media platforms.
Disclaimer
The opinions expressed by the authors are their own and this material should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the National Institutes of Health, or the National Cancer Institute.
Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.
Supplementary Material
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