Table 3.

The challenges faced by patients in taking, sharing, and examining images (N=110 articles).

Challenge			Description		Articles, n (%)		Photos, n (%)		Videos, n (%)
Image-taking challenges
	Accessibility	Lack of access to camera phone; poor app usability; difficulty in taking photos of feet or back		16 (14.5)		16 (14.5)		0 (0)
	Incomplete image sets	Lapses in food photos over long periods or when people (fail to) reach goal; camera error		23 (20.9)		22 (20)		1 (0.9)
	Image quality	Image not in focus or not well lit; image not showing relevant details (body part or food)		16 (14.5)		15 (13.6)		1 (0.9)
Sharing challenges
	Adoption by health professionals	Time and effort required; increased sense of responsibility; limited technical support		4 (3.6)		4 (3.6)		1 (0.9)
	Privacy	Potential risk to patients and health care professionals captured; lack of safe image transfer; invisible social media audiences		10 (9.1)		8 (7.3)		3 (2.7)
	Misinformation	Inaccurate or misleading social media images (vaccination); unhealthy behaviors (anorexia)		17 (15.5)		7 (6.4)		10 (9.1)
	Harmful feedback	Web-based feedback harming people who quit smoking or who share stories of depression		7 (6.4)		4 (3.6)		3 (2.7)
Examination challenges
	Interpretability	Not enough information in images to assess dietary intake or to diagnose skin lesions		10 (9.1)		10 (9.1)		1 (0.9)
	Relevancy	Clinicians do not examine images; patients stop when food photos show no new information		6 (5.5)		6 (5.5)		0 (0)
	Emotional labor	Anxiety about potential infection or cancer diagnosis; stress from revisiting past struggles with surgery or mental illness		7 (6.4)		6 (5.5)		2 (1.8)