Generating Contextual Variables From Web-Based Data for Health Research: Tutorial on Web Scraping, Text Mining, and Spatial Overlay Analysis.

BACKGROUND: Contextual variables that capture the characteristics of delimited geographic or jurisdictional areas are vital for health and social research. However, obtaining data sets with contextual-level data can be challenging in the absence of monitoring systems or public census data. OBJECTIVE: We describe and implement an 8-step method that combines web scraping, text mining, and spatial overlay analysis (WeTMS) to transform extensive text data from government websites into analyzable data sets containing contextual data for jurisdictional areas. METHODS: This tutorial describes the method and provides resources for its application by health and social researchers. We used this method to create data sets of health assets aimed at enhancing older adults' social connections (eg, activities and resources such as walking groups and senior clubs) across the 374 health jurisdictions in Catalonia from 2015 to 2022. These assets are registered on a web-based government platform by local stakeholders from various health and nonhealth organizations as part of a national public health program. Steps 1 to 3 involved defining the variables of interest, identifying data sources, and using Python to extract information from 50,000 websites linked to the platform. Steps 4 to 6 comprised preprocessing the scraped text, defining new variables to classify health assets based on social connection constructs, analyzing word frequencies in titles and descriptions of the assets, creating topic-specific dictionaries, implementing a rule-based classifier in R, and verifying the results. Steps 7 and 8 integrate the spatial overlay analysis to determine the geographic location of each asset. We conducted a descriptive analysis of the data sets to report the characteristics of the assets identified and the patterns of asset registrations across areas. RESULTS: We identified and extracted data from 17,305 websites describing health assets. The titles and descriptions of the activities and resources contained 12,560 and 7301 unique words, respectively. After applying our classifier and spatial analysis algorithm, we generated 2 data sets containing 9546 health assets (5022 activities and 4524 resources) with the potential to enhance social connections among older adults. Stakeholders from 318 health jurisdictions registered identified assets on the platform between July 2015 and December 2022. The agreement rate between the classification algorithm and verified data sets ranged from 62.02% to 99.47% across variables. Leisure and skill development activities were the most prevalent (1844/5022, 36.72%). Leisure and cultural associations, such as social clubs for older adults, were the most common resources (878/4524, 19.41%). Health asset registration varied across areas, ranging between 0 and 263 activities and 0 and 265 resources. CONCLUSIONS: The sequential use of WeTMS offers a robust method for generating data sets containing contextual-level variables from internet text data. This study can guide health and social researchers in efficiently generating ready-to-analyze data sets containing contextual variables.

The Role of Social Media in Building Pandemic Resilience in an Urban Community: A Qualitative Case Study.

This paper explores the influence of social media in fostering resilience within an urban spatial context, specifically in Bangalore, India, during the COVID-19 lockdown, a period marked by a surge in digital communication due to movement restrictions. To control the rapid spread of the virus, over 1.38 billion people were given stay-at-home orders by the government of India during the onset of the pandemic. The restrictions in movement forced individuals to shift to online modes of connection and communication. As the field of digital epidemiology, that is, the use of digital tools and data to understand and improve health took center stage during the pandemic, the focus shifted towards the social media landscape, which is often associated with its negative aspects, such as misinformation. However, this paper delves into social media's potential to build resilience on a local scale, particularly given its increased usage during the pandemic. Through in-depth online interviews with eight urban residents, we conducted a thematic analysis to understand social media's role during the lockdown. Results indicate that social media facilitated effective information exchange and fostered a sense of community. Furthermore, it engendered an environment conducive to prosocial behavior, a known resilience amplifier. We also highlight the importance of baseline context regarding the users directly engaged in social media data generation with respect to digital epidemiology analytics tools for large-scale social media data and the need for qualitative input feeding into their design. Our study highlights the need for a balanced perspective on social media use in times of crisis, recognizing its potential to boost community resilience in an urban setting, and further enriching digital epidemiology approaches.

Sustainable Smart Cities-Social Media Platforms and Their Role in Community Neighborhood Resilience-A Systematic Review.

The COVID-19 pandemic took most communities off guard and has highlighted gaps in community preparedness and resilience in spite of the numerous technological advancements and the variety of available social media platforms that many relied on during lockdown periods. This served to emphasise the necessity for exploring the roles of social media and smart city technologies in mitigating pandemic impacts. In this systematic literature review, we examined twelve articles on social media usage and smart city technologies and their contributions to community resilience during COVID-19. The analysis focused on the use of social media platforms and smart city technologies during and after lockdown periods, examining their role in fostering community resilience. Results indicate that social media and smart city technologies were instrumental in helping communities adapt and recover from the pandemic. While past studies have examined community resilience, social media, or smart cities separately, there is limited literature collating insights on the three elements combined. We therefore argue that these technologies, employed collaboratively, enhance community resilience during crises. Nevertheless, further research is recommended, particularly on urban resilience and comparative analyses to deepen our understanding of the complex interplay between these variables.

Tools for local health in all policies implementation: evidence from an explanatory case study of Kuopio, Finland.

AIMS: This paper describes the use of three governance tools for health in all policies utilised to facilitate implementation in the municipality of Kuopio, Finland: impact assessments, a city mandate (the Kuopio strategy), and shared budgets. METHODS: An explanatory case study was used. Data sources included semistructured interviews with 10 government employees and scholarly literature. Realist scientific methods were used to reveal mechanisms underlying the use of tools in health in all policies. RESULTS: Strong evidence was found supporting initial and new theory/hypotheses regarding the use of each tool in achieving positive implementation outcomes. Impact assessments facilitated health in all policies by enhancing understanding of health implications. The Kuopio strategy aided in implementation by giving credence to health in all policies work via formal authority. Shared budgets promoted intersectoral discussions and understanding, and a sense of ownership, in addition to allowing time to be spent on health in all policies work and not financial deliberation. CONCLUSIONS: Findings confirm the efficacious use of three governance tools in implementing health in all policies in Kuopio. Knowledge and evidence-based guidelines on local health in all policies implementation are needed as this policy approach continues to be recognised and adopted as a means to promote population health and health equity.

How and why buy-in for health in all policies was facilitated in Ecuador: a realist case study of Plan Nacional para el Buen Vivir.

BACKGROUND: In 2008, Ecuador introduced Plan Nacional para el Buen Vivir (PNBV; National Plan for Good Living), which was widely recognized as a promising example of Health in All Policies (HiAP) due to the integration of policy sectors on health and health equity objectives. PBNV was implemented through three successive plans (2009-2013, 2013-2017, 2017-2021). In a time of widening global health inequities, there is growing interest in understanding how politics and governance shape HiAP implementation. The objective of this study was to test specific hypotheses about how, why, to what extent, and under what circumstances HiAP was implemented in Ecuador. METHODS: An explanatory case study approach (HiAP Analysis using Realist Methods on International Case Studies-HARMONICS) was used to understand the processes that hindered or facilitated HiAP implementation. Realist methods and systems theory were employed to test hypotheses through analysis of empirical and grey literature, and 19 key informant interviews. This case study focused on processes related to buy-in for a HiAP approach by diverse policy sectors, particularly in relation to the strong mandate and transformative governance approach that were introduced by then-President Rafael Correa's administration to support PNBV. RESULTS: The mandate and governance approach of the HiAP approach achieved buy-in for implementation across diverse sectors. Support for the hypotheses was found through direct evidence about buy-in for HiAP implementation by policy sectors; and indirect evidence about allocation of governmental resources for HiAP implementation. Key mechanisms identified included: influence of political elites; challenges in dealing with political opposition and 'siloed' ways of thinking; and the role of strategies and resources in motivating buy-in. CONCLUSION: In Ecuador, political elites were a catalyst for mechanisms that impacted buy-in and government funding for HiAP implementation. They raised awareness among policy sectors initially opposed to PNBV about the rationale for changing governance practices, and they provided financial resources to support efforts related to PNBV. Specific mechanisms help explain these phenomena further. Future studies should examine ways that PNBV may have been an impediment to health equity for some marginalized groups while strengthening HiAP implementation.

Opportunities and challenges of using social media big data to assess mental health consequences of the COVID-19 crisis and future major events.

The present commentary discusses how social media big data could be used in mental health research to assess the impact of major global crises such as the COVID-19 pandemic. We first provide a brief overview of the COVID-19 situation and the challenges associated with the assessment of its global impact on mental health using conventional methods. We then propose social media big data as a possible unconventional data source, provide illustrative examples of previous studies, and discuss the advantages and challenges associated with their use for mental health research. We conclude that social media big data represent a valuable resource for mental health research, however, several methodological limitations and ethical concerns need to be addressed to ensure safe use.

A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland.

BACKGROUND: Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS: A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS: Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION: At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.

Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada.

Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario.

Piloting the Use of Concept Mapping to Engage Geographic Communities for Stress and Resilience Planning in Toronto, Ontario, Canada.

The physical and social characteristics of urban neighborhoods engender unique stressors and assets, contributing to community-level variation in health over the lifecourse. Actors such as city planners and community organizations can help strengthen resilience in places where chronic stress is endemic, by learning about perceived stressors and assets from neighborhood users themselves (residents, workers, business owners). This study piloted a methodology to identify Toronto neighborhoods experiencing chronic stress and to engage them to identify neighborhood stressors, assets, and solutions. Crescent Town was identified as one neighborhood of interest based on relatively high levels of emotional stress in Twitter Tweets produced over two one-year periods (2013-2014 and 2017-2018) and triangulation using other neighborhood-level data. Using concept mapping, community members (n = 23) created a ten-cluster concept map describing neighborhood stressors and assets, and identified two potential strategies, a Crescent Town Residents' Association and a community fair to promote neighborhood resources and build social networks. We discuss how this knowledge has circulated through the City of Toronto and community-level organizations to date, and lessons for improving this methodology.

Correction: What influences the clinical decision-making of dentists? A cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0233652.].

Classism and Everyday Racism as Experienced by Racialized Health Care Users: A Concept Mapping Study.

In Toronto, Canada, 51.5 % of the population are members of racialized groups. Systemic labor market racism has resulted in an overrepresentation of racialized groups in low-income and precarious jobs, a racialization of poverty, and poor health. Yet, the health care system is structured around a model of service delivery and policies that fail to consider unequal power social relations or racism. This study examines how racialized health care users experience classism and everyday racism in the health care setting and whether these experiences differ within stratifications such as social class, gender, and immigration status. A concept mapping design was used to identify mechanisms of classism and everyday racism. For the rating activity, 41 participants identified as racialized health care users. The data analysis was completed using concept systems software. Racialized health care users reported "race"/ethnic-based discrimination as moderate to high and socioeconomic position-/social class-based discrimination as moderate in importance for the challenges experienced when receiving health care; differences within stratifications were also identified. To improve access to services and quality of care, antiracist policies that focus on unequal power social relations and a broader systems thinking are needed to address institutional racism within the health care system.

Experiences of everyday racism in Toronto's health care system: a concept mapping study.

BACKGROUND: In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS: This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS: Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS: Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.

The Elaboration of an Intersectoral Partnership to Perform Health Impact Assessment in Urban Planning: The Experience of Quebec City (Canada).

Health impact assessments (HIA) allow evaluation of urban interventions' potential effects on health and facilitate decision-making in the urban planning process. However, few municipalities have implemented this method in Canada. This paper presents the approach developed with partners, the process, and the outcomes of HIA implementation after seven years of interinstitutional collaborations in Quebec City (ten HIA). Using direct observation and meeting minutes, information includes: perceived role of each institution taking part in HIA beforehand, how the HIA process was implemented, if it was appreciated, and which outcomes were observed. The intersectoral interactions contributed to the development of a common language, which sped up the HIA process over time and fostered positive collaborations in unrelated projects. It was an effective tool to share concerns and responsibilities among independent institutions. This experience resulted in the creation of an informal group of stakeholders from four different institutions that perform HIA to this day in collaboration with researchers.

What influences the clinical decision-making of dentists? A cross-sectional study.

Clinical decision-making is a complex process influenced by clinical and non-clinical factors. The aim of this study was to investigate the association between provider, patient, and practice factors with clinical decision-making among dentists in Ontario, Canada's most populated province and its largest dental care market. This was a cross-sectional, self-administered survey of a random sample of general dentists in Ontario (n = 3,201). The 46-item survey collected demographic, professional, and practice information. The outcome (treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative in their treatment decisions. Associations were assessed using bivariate analysis and logistic regressions. One thousand and seventy-five dentists responded (33.6% response rate). Age (p = 0.001), place of initial training (p<0.001), number of dependents (p = 0.001), number of hygienists employed (p = 0.001), and perceptions of practice loans (p = 0.020) were associated with treatment intensity. Dentists who were <40-years old (OR = 2.06, 95% CI:1.39-3.06, p<0.001), American-trained (OR = 2.48, 95% CI:1.51-4.06, p<0.001), and perceived their practice loans as large (OR = 1.57, 95% CI:1.02-2.42, p = 0.039), were relatively more aggressive in their treatment decisions. Various non-clinical factors appear to influence the clinical decision-making of dentists in Ontario.

The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany.

BACKGROUND: Over the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history-the 2005 Hartz IV reform in Germany-with a focus on estimating its effect on the health of the unemployed. METHODS: We employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders. RESULTS: The Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time. CONCLUSION: Governments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.

Does competition affect the clinical decision-making of dentists? A geospatial analysis.

OBJECTIVES: To investigate the association between dentists' geographic density and perceptions of market competition with clinical decision-making among a representative sample of dentists in Ontario, Canada's most populated province. METHODS: Competition was quantified using dentist density, defined as the number of dental clinics lying within a one kilometre radius around the respondents' clinic address and by self-reported perceived pressure from other dental clinics. The outcome (clinical decision-making or treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative. Associations were assessed using bivariate analysis and logistic and linear regression. RESULTS: Dentists who perceived large competitive pressure from other dentists (OR = 1.63, 95% CI: 1.07-2.49) were relatively more aggressive in their treatment choices. Interestingly, dentists located in very low dentist density areas (OR = 1.31, 95% CI: 1.03-1.68) were also relatively more aggressive in their treatment choices. CONCLUSION: This study is the first to explore the impact of competition on the clinical decision-making of dentists in a Canadian context. It presents a valuable addition to the competition literature and helps to understand current dynamics in the Canadian dental care market.

How and why do win-win strategies work in engaging policy-makers to implement Health in All Policies? A multiple-case study of six state- and national-level governments.

BACKGROUND: Much of the research about Health in All Policies (HiAP) implementation is descriptive, and there have been calls for more evaluative evidence to explain how and why successes and failures have occurred. In this cross-case study of six state- and national-level governments (California, Ecuador, Finland, Norway, Scotland and Thailand), we tested hypotheses about win-win strategies for engaging policy-makers in HiAP implementation drawing on components identified in our previous systems framework. METHODS: We used two sources of data - key informant interviews and peer-reviewed and grey literature. Using a protocol, we created context-mechanism-outcome pattern configurations to articulate mechanisms that explain how win-win strategies work and fail in different contexts. We then applied our evidence for all cases to the systems framework. We assessed the quality of evidence within and across cases in terms of triangulation of sources and strength of evidence. We also strengthened hypothesis testing using replication logic. RESULTS: We found robust evidence for two mechanisms about how and why win-win strategies build partnerships for HiAP implementation - the use of shared language and the value of multiple outcomes. Within our cases, the triangulation was strong, both hypotheses were supported by literal and contrast replications, and there was no support against them. For the third mechanism studied, using the public-health arguments win-win strategy, we only found evidence from Finland. Based on our systems framework, we expected that the most important system components to using win-win strategies are sectoral objectives, and we found empirical support for this prediction. CONCLUSIONS: We conclude that two mechanisms about how and why win-win strategies build partnerships for HiAP implementation - the use of shared language and the value of multiple outcomes - were found as relevant to the six settings. Both of these mechanisms trigger a process of developing synergies and releasing potentialities among different government sectors and these interactions between sectors often work through sectoral objectives. These mechanisms should be considered when designing future HiAP initiatives and their implementation to enhance the emergence of non-health sector policy-makers' engagement.

The effect of unemployment benefits on health: A propensity score analysis.

In the wake of the Great Recession, an expanding body of research has highlighted the role of social protection policies in mitigating the deleterious effects of adverse socioeconomic experiences. In this paper, we examine whether unemployment benefits - a key pillar of national social protection systems - can offset the negative health consequences of unemployment. Using cross-sectional nationally representative data from the Canadian Community Health Survey covering the period between 2009 and 2014, we employed propensity score matching to estimate the effect of receiving unemployment benefits on self-rated health among the unemployed. After matching benefit recipients to comparable non-recipient 'controls', we found that receiving unemployment benefits was associated with better health outcomes. In our main analyses, benefit recipiency reduced the probability of reporting poor self-rated health among the unemployed by up to 4.9% (95% CI -7.3, -2.5). Sensitivity analyses stratified by socioeconomic position revealed stronger treatment effects among lower income and less educated individuals. By contrast, treatment effects were small or negligible among higher income and more educated individuals. Our findings provide evidence that unemployment benefits can play an important role in offsetting the negative health consequences of unemployment among the socioeconomically disadvantaged. These findings lend support to recent calls, including many from within the field of public health, for governments to respond to current labor market trends by expanding the generosity and scope of social protection policies.

A unified ecological framework for studying effects of digital places on well-being.

Social media has greatly expanded opportunities to study place and well-being through the availability of human expressions tagged with physical location. Such research often uses social media content to study how specific places in the offline world influence well-being without acknowledging that digital platforms (e.g., Twitter, Facebook, Youtube, Yelp) are designed in unique ways that structure certain types of interactions in online and offline worlds, which can influence place-making and well-being. To expand our understanding of the mechanisms that influence social media expressions about well-being, we describe an ecological framework of person-place interactions that asks, "at what broad levels of interaction with digital platforms and physical environments do effects on well-being manifest?" The person is at the centre of the ecological framework to recognize how people define and organize both digital and physical communities and interactions. The relevance of interactions in physical environments depends on the built and natural characteristics encountered across modes of activity (e.g., domestic, work, study). Here, social interactions are stratified into the meso-social (e.g., local social norms) and micro-social (e.g., personal conversations) levels. The relevance of interactions in digital platforms is contingent on specific hardware and software elements. Social interactions at the meso-social level include platform norms and passive use of social media, such as observing the expressions of others, whereas interactions at the micro-level include more active uses, like direct messaging. Digital platforms are accessed in a physical location, and physical locations are partly experienced through online interactions; therefore, interactions between these environments are also acknowledged. We conclude by discussing the strengths and limitations of applying the framework to studies of place and well-being.