journal of medical internet research submission guidelines

About the Journal

Focus and scope.

The "Journal of Medical Internet Research" (JMIR; ISSN 1438-8871, Medline-abbreviation: J Med Internet Res ) (founded in 1999, now in its 25th year! ) is a leading health informatics and health services/health policy journal (ranking in the first quartile Q1 by Impact Factor in these disciplines) focusing on digital health, data science, health informatics and emerging technologies for health, medicine, and biomedical research. The journal is ranked #1 on Google Scholar in the 'Medical Informatics' discipline. 

JMIR was the first open access journal covering health informatics, and the first international scientific peer-reviewed journal on all aspects of research, information and communication in the healthcare field using Internet and Internet-related technologies; a broad field, which is known as "eHealth" [see also What is eHealth and What is eHealth (2) ], or now also " digital health ", which includes mHealth (mobile health). This field also has significant overlaps with what is called "consumer health informatics", health 2.0/medicine 2.0, or participatory medicine. This focus makes JMIR unique among other medical or medical informatics journals, which tend to focus on clinical informatics or clinical applications. As eHealth/mHealth is a highly interdisciplinary field we are not only inviting research papers from the medical sciences, but also from the computer, behavioral, social and communication sciences, psychology, library sciences, informatics, human-computer interaction studies, and related fields.

The term "Internet" is used in its broadest sense, so we are also interested in high impact studies and applications of digital medicine, mobile technologies, social media, novel wearable devices and sensors, connected home appliances, domotics etc.

The journal invites manuscripts that deal with the following topics ( the main themes/topics covered by this journal and sample papers can also be found here ):

• novel digital health approaches, methods, and devices
• large digital medicine / digital therapeutics trials with clinical impact
• data science, open data
• studies evaluating the impact of Internet/social media use or specific eHealth/mHealth interventions on individual health-related or social outcomes
• evaluations and implementations of innovative mhealth (mobile health) applications, social media apps, ubiquitous computing, or innovative and emerging technologies in health
• descriptions of the design and impact of Internet and mobile applications and websites or social media for consumers/patients or medical professionals
• use of the Internet, social media and mhealth in the context of clinical information and communication, including telemedicine
• use of the Internet, social media, and mhealth in medical research and the basic sciences such as molecular biology or chemistry (e.g. bioinformatics, online factual databases)
• medical information management and librarian sciences
• e-learning and knowledge translation, online-courses, social media, web-based and mobile programs for undergraduate and continuing education,
• eHealth/mHealth and social media applications for public health and population health technology (disease monitoring, teleprevention, teleepidemiology)
• evidence-based medicine and the Internet and mhealth (e.g. online development or dissemination of clinical guidelines, measuring agreement about management of a given clinical problem among physicians, etc.)
• the impact of eHealth/mHealth/pHealth/iHealth, social media, the Internet, or health care technologies on public health, the health care system and policy
• methodological aspects of doing Internet/mhealth/social media research, e.g. methodology of web-based surveys
• design and validation of novel web-based instruments
• ecological momentary assessment, sensors, mobile technologies for gathering and analyzing data in real-time
• analysis of e-communities, social media communities, or virtual social networks
• comparisons of effectiveness of health communication and information on the Internet/mHealth/social media compared with other methods of health communication,
• effects of the Internet/mhealth/social media and information/communication technology on the patient-physician relationship and impact on public health, e.g. the studies investigating how the patient-physician relationship changes as a result of the new ways of getting medical information
• ethical and legal problems as well as cross-border and cross-cultural issues of eHealth/mHealth
• systematic studies examining the quality of medical information available in various online venues
• methods of evaluation, quality assessment and improvement of Internet information or eHealth applications
• proposals for standards in the field of medical publishing on the Internet, including self-regulation issues, policies and guidelines to provide reliable healthcare information
• results and methodological aspects of Internet-based and social media studies, including medical surveys, psychological tests, quality-of-life studies, gathering and/or disseminating epidemiological data, use of the Internet/mobile apps/social media for clinical studies (e-trials), drug reaction reporting and surveillance systems etc.
• electronic medical publishing, Open Access publishing, altmetrics, and use of the Internet or social media for scholarly publishing (e.g. collaborative peer review)
• information needs of patients, consumers and health professionals, including studies evaluating search and retrieval behavior of patients
• web-based studies, e.g. online psychological experiments
• evaluations of mhealth (mobile) applications, as well as ambient / ubiquitous computing approaches, sensors, domotics, and other cutting edge technologies
• personal health records, patient portals, consumer health informatics applications
• behavior change technologies
• Reviews, viewpoint papers and commentaries touching on the issues and themes listed above are also welcome, but should be grounded in data and/or a thorough literature review

In addition, the Journal will occasionally publish original research, reviews and tutorials on more generic, related topics such as:

• Internet standards
• cybermetrics
• security and confidentiality issues
• Internet demographics
• social impact of the Internet
• digital imaging and multimedia
• health care records
• high-speed networks
• telecommunication
• electronic publishing
• software development

The Journal of Medical Internet Research is one of the flagship journals of JMIR Publications and is highly selective . We are not a megajournal that publishes everything regardless of impact. To ensure a rapid turnaround time, we encourage that authors consider other JMIR journal titles as well. While it is possible to transfer submissions from one journal to another before, during or after the review process (based on editorial suggestions), authors can avoid delays in decision-making by submitting to the right journal.

In order to be considered for J Med Internet Res, clinical informatics papers should have a clear connections to the major themes in this journal of consumer/patient empowerment and participatory healthcare, and/or evaluate the use of mobile/Internet-based/emerging technologies such as patient portals. Other clinical informatics studies with no relationship to consumer health informatics, or more technical papers are best submitted to other JMIR journal titles , such as Interactive Journal of Medical Research (i-JMR, a general medical journal with focus on innovation) , JMIR mHealth and uHealth , JMIR Medical Informatics , or JMIR Human Factors .

Machine-learning papers : Machine learning papers are now mostly published in JMIR Medical Informatics (see e-collection Machine Learning ), JMIR Formative Research or JMIR AI, or another sister journal, unless they have reached clinical maturity and are being used and validated in routine clinical use. Our flagship journal J Med Internet Res no longer publishes ML papers unless 1) they show a direct clinical effect or impact on care, 2) are validated using an independent dataset not used for training, 3) are written in a language that can be understood by a healthcare professional, and provide open source or a publicly available tool that can be used by others to validate or apply the findings. We also request that 4) reporting strictly adheres to the " Guidelines for Developing and Reporting Machine Learning Predictive Models in Biomedical Research ". Highly technical papers (with mathematical formulas) are unsuitable for J Med Internet Res or this information needs to be provided in a Multimedia Appendix. 

Digital psychiatry and digital mental health papers are best suited for JMIR Mental Health if they are impactful, otherwise JMIR Formative Research publishes early stage work.

Studies related to public health informatics and surveillance systems should preferably be submitted to JMIR Public Health & Surveillance . JPHS is also highly selective.

Papers with focus on games in health or gamification aspects of apps and theoretical issues/commentary on gaming are now primarily published in / transferred to JMIR Serious Games .

Studies evaluating systematically the quality of health information or present tools for social listening may be best suited for JMIR Infodemiology .

Formative work such as usability studies, pilot studies, and feasibility studies are no longer published in our flagship journals and should be submitted to JMIR Formative Research .

Protocols and proposals can be submitted to JMIR Research Protocols .

Submitted manuscripts are subject to a rigorous but speedy peer review process. We aim for a standard review time of less than 2 months, and a review time of 4 weeks for submission to initial decision for fast-tracked papers ).

The review process is designed to help authors to improve their manuscripts by giving them constructive comments on how to improve their paper, and to publish only those articles which comply to general quality criteria of a scholarly paper, especially originality, clarity, references to related work and validity of results and conclusions.

JMIR Publications is the leading open access digital health research publisher.

Announcing JMIRx - a new series of overlay journals for preprint repositories. Submit your paper today.

Welcome to JMIR Publications

JMIR Publications helps scientists to disseminate innovations, ideas, protocols, and research results to the widest possible audience. This includes not only other researchers, but also patients/consumers and other knowledge users.

We do so in a timely manner, adding value to the quality of the work and adhering to the highest ethical and quality standards.

Openness is at the heart of what we do. As one of the first open access publishers in the world, we have over 20 years of experience in scholarly communication . We use the internet and latest available technologies, organize conferences, create social media content, and develop other innovative knowledge translation products.

We also innovate in the scholarly communication space itself, experimenting with novel metrics, new business models, new models of peer review and dissemination, and new technologies.

We envision a world where people are empowered by health research and technology to make effective, informed decisions, take control of their health and well-being, and live happier and healthier lives.

Our mission

Through leading-edge thinking, community involvement, and continuous innovation, we help leaders in the health technology space to collaborate and disseminate their ideas and research results. We connect vetted, quality research outputs in novel, effective, and timely ways with those who need it.

Meet the team

The JMIR Publications team comprises a talented group of individuals in their respective fields. They have come together to work toward the JMIR mission and vision.

Simply put, we love what we do and who we do it for.

Our journals

Explore the latest research in the field of digital health, including innovations in health care technologies, patient and caregiver education, participatory medicine, biomedical engineering and medical informatics.

Journal of Medical Internet Research

The leading peer-reviewed journal for digital medicine and health and health care in the internet age. June 2023 - Journal Impact Factor: 7.4. Q1 journal in “Medical Informatics” and “Health Care Science & Services” categories.(Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR Public Health and Surveillance

A multidisciplinary journal that focuses on the intersection of public health and technology, public health informatics, mass media campaigns, surveillance, participatory epidemiology, and innovation in public health practice and research. June 2023 - Journal Impact Factor: 8.5. Q1 journal in “Public, Environmental & Occupational Health” category (Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR Mental Health

A journal focused on Internet interventions, technologies, and digital innovations for mental health and behavior change. Official journal of the Society for Digital Psychiatry. June 2023 - Journal Impact Factor: 5.2 (Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR mHealth and uHealth

Focused on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. June 2023 - Journal Impact Factor: 5.0. Q1 journal in “Health Care Science & Services” category. (Source: Journal Citation Reports™ 2023 from Clarivate™)

Digital health technologies, apps, and informatics for patient education, medicine and nursing, preventative interventions, and clinical care / home care for elderly populations. June 2023 - Journal Impact Factor: 4.9 (Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR Serious Games

A multidisciplinary journal on gaming and gamification including simulation and immersive virtual reality for health education/promotion, teaching, medicine, rehabilitation, and social change. June 2023 - Journal Impact Factor: 4.0 (Source: Journal Citation Reports™ 2023 from Clarivate™)

What people think about us

We had an extremely positive experience with JMIR's editorial process after publishing our research protocol in JMIR Research Protocols. The Editor was rapid and directive in his editorial decisions, which was appreciated. Highly recommended.

Review on SciRev

https://scirev.org/reviews/journal-of-medical-internet-research/

"Excellent"

"Very professional"

"Very fast"

"Extremely positive experience"

"Manuscript greatly improved"

I had an excellent experience submitting my manuscript to JMIR Medical Informatics. I received valuable feedback from editors that strengthen the paper. The review process was very clear and straightforward. I definitely recommend this journal to my colleagues.

I am very satisfied with their turnaround time in the review process. It is fast and precise. I also like the quality of the reviews. The reviewers carefully read the manuscript and provided very detailed and crucial comments to consider.

Park SungKyu Shaun

Turnaround and review process were very constructive, friendly and swift. Very good journal (JRP) to publish study protocols!

Esther Rind

Great publisher. The reviewer comments were very helpful and the process was fast. From submission to initial review to revised submission to final acceptance took less than 4 months.

The review process was very fair transparent and prompt. I wish other journals were like this.

Cornelia A. Pechmann

Fantastic turnaround on my paper and very efficient. I would highly recommend publishing with this journal and I hope to do so again in the near future.

Kareem Khan

A very forward-thinking publication with tough reviewers who are much appreciated. A true beacon of light for the digital health industry.

Jessica Shull

JMIR is an interesting and socially engaged enterprise worthed to publish with.

Alberto J. Revolware

Working with the Journal of Medical Internet Research as an author is always a top-level experience!

Bradford Hesse

JMIR has completely optimized the process of reviewing and publishing manuscripts. Other journals should follow suit.

Jereme Wilroy

We are working in partnership with.

JMIR mHealth and uHealth

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing, and domotics for health.

Lorraine R. Buis, PhD, MSI, Associate Professor, Department of Family Medicine, University of Michigan, USA

JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor:  5.0 ) is a leading peer-reviewed journal and one of the flagship journals of JMIR Publications. JMU has been published since 2013 and was the first mhealth journal indexed in PubMed. In June 2023,  JMU received a  Journal Impact Factor™ from Clarivate of 5.0  (5-year Journal Impact Factor™ : 5.7) and  continues to be a Q1 journal in the category of ‘Healthcare Sciences and Services.’  It is indexed in all major literature indices, including MEDLINE , PubMed ,  PubMed Central , Scopus , Psycinfo, SCIE , JCR, EBSCO/EBSCO Essentials, DOAJ , GoOA and others.

JMU focuses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. 

The journal adheres to rigorous quality standards, involving a rapid and thorough peer-review process, professional copyediting, and professional production of PDF, XHTML, and XML proofs.

Like all JMIR journals, JMU encourages Open Science principles and strongly encourages the publication of a protocol before data collection. Authors who have published a protocol in  JMIR Research Protocols  get a discount of 20% on the Article Processing Fee when publishing a subsequent results paper in any JMIR journal.

Recent Articles

Accurately assessing an individual’s diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message.

Past few years has witnessed a burgeoning interest in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in Human Immunodeficiency Virus (HIV) prevention and care continuum among men who have sex with men (MSM).

In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for gout patients requires significant labor and time costs, and its efficiency and coverage remain low, and mHealth seems to address these issues.

The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions.

Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context.

Telemedicine technology is a rapidly developing field that demonstrates immense potential in improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress, and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and its efficacy remains unclear.

The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with “adherence” playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension.

Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users’ acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential.

Metabolic flexibility is the ability of the body to rapidly switch between fuel sources based on their accessibility and metabolic requirements. High metabolic flexibility is associated with improved health outcomes and a reduced risk of several metabolic disorders. Metabolic flexibility can be improved through lifestyle changes, such as increasing physical activity and eating a balanced macronutrient diet. Lumen is a small handheld device that measures metabolic fuel usage through exhaled carbon dioxide (CO 2 ), which allows individuals to monitor their metabolic flexibility and make lifestyle changes to enhance it.

Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people’s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma.

Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs.

Despite being the gold standard method for objectively assessing sleep, polysomnography faces several limitations as it is expensive, time-consuming, labor-intensive, requires various equipment and technical expertise, and is impractical for long-term or in-home use. However, it has been shown that consumer wrist-worn wearables are able to monitor sleep parameters and thus could be used as an alternative for polysomnography. Following this, wearables gained immense popularity over the past few years. However, their accuracy has been a major concern for years.

Preprints Open for Peer-Review

Open Peer Review Period:

April 19, 2024 - June 14, 2024

April 11, 2024 - June 06, 2024

March 28, 2024 - May 23, 2024

March 26, 2024 - May 21, 2024

March 24, 2024 - May 19, 2024

March 19, 2024 - May 14, 2024

March 07, 2024 - May 02, 2024

We are working in partnership with

Vol. 24 (2022)

Vol 24, no 7 (2022): july.

Download Issue Citations: END BibTex RIS | View PDF

Brilliant Ideas Can Come in All Sizes: Research Letters

Rita Kukafka , Tiffany I Leung , Gunther Eysenbach

Download Citation: END BibTex RIS

Vol 24, No 2 (2022): February

Guest editorial.

A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation

Michael A Gisondi , Rachel Barber , Jemery Samuel Faust , Ali Raja , Matthew C Strehlow , Lauren M Westafer , Michael Gottlieb

Vol 24, No 1 (2022): January

Wearables and mhealth reviews.

Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature

Federico Germini , Noella Noronha , Victoria Borg Debono , Binu Abraham Philip , Drashti Pete , Tamara Navarro , Arun Keepanasseril , Sameer Parpia , Kerstin de Wit , Alfonso Iorio

Digital Health Reviews

Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials

Alexandre Mazeas , Martine Duclos , Bruno Pereira , Aïna Chalabaev

Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

Clemens Kruse , Katharine Heinemann

Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review

Karoliina Paalimäki-Paakki , Mari Virtanen , Anja Henner , Miika T Nieminen , Maria Kääriäinen

Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis

Roman Keller , Sven Hartmann , Gisbert Wilhelm Teepe , Kim-Morgaine Lohse , Aishah Alattas , Lorainne Tudor Car , Falk Müller-Riemenschneider , Florian von Wangenheim , Jacqueline Louise Mair , Tobias Kowatsch

Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review

Hadassah Joann Ramachandran , Ying Jiang , Jun Yi Claire Teo , Tee Joo Yeo , Wenru Wang

Social Media and Health Care (Part II): Narrative Review of Social Media Use by Patients

Deema Farsi , Hector R Martinez-Menchaca , Mohammad Ahmed , Nada Farsi

Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review

Taren Swindle , Anwesh B Poosala , Nan Zeng , Elisabet Børsheim , Aline Andres , Laura L Bellows

Understanding the Nature of Metadata: Systematic Review

Hannes Ulrich , Ann-Kristin Kock-Schoppenhauer , Noemi Deppenwiese , Robert Gött , Jori Kern , Martin Lablans , Raphael W Majeed , Mark R Stöhr , Jürgen Stausberg , Julian Varghese , Martin Dugas , Josef Ingenerf

Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review

Elizabeth W Woodcock

Digital Storytelling for Health-Related Outcomes in Older Adults: Systematic Review

Jennifer Stargatt , Sunil Bhar , Jahar Bhowmik , Abdullah Al Mahmud

Direct Access for Patients to Diagnostic Testing and Results Using eHealth: Systematic Review on eHealth and Diagnostics

Anke Versluis , Kyma Schnoor , Niels H Chavannes , Esther PWA Talboom-Kamp

Engagement Strategies to Improve Adherence and Retention in Web-Based Mindfulness Programs: Systematic Review

Natalie Winter , Lahiru Russell , Anna Ugalde , Victoria White , Patricia Livingston

Perceptions and Needs of Artificial Intelligence in Health Care to Increase Adoption: Scoping Review

Han Shi Jocelyn Chew , Palakorn Achananuparp

Risk of Accidents or Chronic Disorders From Improper Use of Mobile Phones: A Systematic Review and Meta-analysis

Xinxi Cao , Yangyang Cheng , Chenjie Xu , Yabing Hou , Hongxi Yang , Shu Li , Ying Gao , Peng Jia , Yaogang Wang

Web Portals for Patients With Chronic Diseases: Scoping Review of the Functional Features and Theoretical Frameworks of Telerehabilitation Platforms

Yuh Morimoto , Tetsuya Takahashi , Ryuichi Sawa , Masakazu Saitoh , Tomoyuki Morisawa , Nobuyuki Kagiyama , Takatoshi Kasai , Birthe Dinesen , Malene Hollingdal , Jens Refsgaard , Hiroyuki Daida

Methods for Human-Centered eHealth Development: Narrative Scoping Review

Hanneke Kip , Julia Keizer , Marcia C da Silva , Nienke Beerlage-de Jong , Nadine Köhle , Saskia M Kelders

Implementation Frameworks for Artificial Intelligence Translation Into Health Care Practice: Scoping Review

Fábio Gama , Daniel Tyskbo , Jens Nygren , James Barlow , Julie Reed , Petra Svedberg

JMIR Public Health and Surveillance

A multidisciplinary journal that focuses on the intersection of public health and technology, public health informatics, mass media campaigns, surveillance, participatory epidemiology, and innovation in public health practice and research..

Travis Sanchez, DVM, MPH, Emory University Rollins School of Public Health, USA

JMIR Public Health & Surveillance (JPHS, Editor-in-chief: Travis Sanchez, Emory University/Rollins School of Public Health) is a top-ranked (Q1)  Clarivate (SCIE, SSCI etc) , Scopus ,  PMC/PubMed -,  MEDLINE -, CABI, and EBSCO/EBSCO essentials indexed, peer-reviewed international multidisciplinary journal with a unique focus on the intersection of  innovation and technology in public health , and includes topics like public health informatics, surveillance (surveillance systems and rapid reports), participatory epidemiology, infodemiology and infoveillance, digital disease detection, digital epidemiology, electronic public health interventions, mass media/social media campaigns, health communication, and emerging population health analysis systems and tools. In June 2023, JPHS received an impact factor of 8.5.

JPHS has an international author- and readership and welcomes submissions from around the world.

We publish  regular articles, reviews, protocols/system descriptions and viewpoint  papers on all aspects of public health, with a focus on innovation and technology in public health.  The main themes/topics covered by this journal can be found here.

Apart from publishing traditional public health research and viewpoint papers as well as reports from traditional surveillance systems, JPH was one of the first (if not the only) peer-reviewed journals to publish papers with surveillance or pharmacovigilance data from non-traditional, unstructured big data and text sources such as social media and the Internet ( infoveillance , digital disease detection), or reports on novel participatory epidemiology projects, where observations are solicited from the public.  

Among other innovations, JPHS is also dedicated to support rapid open data sharing and rapid open access to surveillance and outbreak data. As one of the novel features we plan to publish rapid  or even real-time  surveillance reports and open data. The methods and description of the surveillance system may be peer-reviewed and published only once in detail, in a  "baseline report" (in a JMIR Res Protoc or a JMIR Public Health & Surveill paper), and authors then have the possibility to publish data and reports in frequent intervals rapidly and with only minimal additional peer-review (we call this article type "Rapid Surveillance Reports"). JMIR Publications may even work with authors/researchers and developers of selected surveillance systems on APIs for semi-automated reports (e.g. weekly reports to be automatically published in JPHS and indexed in PubMed, based on data-feeds from surveillance systems and minimal narratives and abstracts).

Furthermore, during epidemics and public health emergencies, submissions with critical data will be processed with expedited peer-review to enable publication within days or even in real-time.

We also publish descriptions of open data resources and open source software. Where possible, we can and want to publish or even host the actual software or dataset on the journal website.

Recent Articles

The World Health Organization aims for the global elimination of cervical cancer, necessitating modeling studies to forecast long-term outcomes.

The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear.

Healthy Davis Together was a program launched in September 2020 in the city of Davis, California, to mitigate the spread of COVID-19 and facilitate the return to normalcy. The program involved multiple interventions, including free saliva-based asymptomatic testing, targeted communication campaigns, education efforts, and distribution of personal protective equipment, community partnerships, and investments in the local economy.

Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV.

Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory.

Maternal preeclampsia is associated with a risk of autism spectrum disorders (ASD) in offspring. However, it is unknown whether the increased ASD risk associated with preeclampsia is due to preeclampsia onset or clinical management of preeclampsia after onset, as clinical expectant management of preeclampsia allows pregnant women with this complication to remain pregnant for potentially weeks depending on the onset and severity. Identifying the risk associated with preeclampsia onset and exposure provides evidence to support the care of high-risk pregnancies and reduce adverse effects on offspring.

Smoking ban policies (SBPs) are potent health interventions and offer the potential to influence antismoking behavior. The Korean government completely prohibited smoking in indoor sports facilities, including billiard halls, since the government revised the National Health Promotion Act in December 2017.

Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-Étienne (February 2021), we performed a survey of the general population.

Improved life expectancy has increased the prevalence of older adults living with multimorbidities, which likely deteriorates their health-related quality of life (HRQoL). Understanding which chronic conditions frequently co-occur can facilitate person-centered care tailored to the needs of individuals with specific multimorbidity profiles.

The decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions.

We reviewed the tools that have been developed to characterize and communicate seasonal influenza activity in the United States. Here we focus on systematic surveillance and applied analytics, including seasonal burden and disease severity estimation, short-term forecasting, and longer-term modeling efforts. For each set of activities, we describe the challenges and opportunities that have arisen because of the COVID-19 pandemic. In conclusion, we highlight how collaboration and communication have been and will continue to be key components of reliable and actionable influenza monitoring, forecasting, and modeling activities.

Varicella is a mild, self-limited disease caused by varicella-zoster virus (VZV) infection. Recently, the disease burden of varicella has been gradually increasing in China; however, the epidemiological characteristics of varicella have not been reported for Anhui Province.

Preprints Open for Peer-Review

Open Peer Review Period:

April 09, 2024 - June 04, 2024

April 05, 2024 - May 31, 2024

April 04, 2024 - May 30, 2024

March 15, 2024 - May 10, 2024

We are working in partnership with

About the Journal

About the publisher.

At JMIR Publications w e envision a world where people are empowered by health research and technology to make effective, informed decisions, take control of their health and well-being, and live happier and healthier lives.

Mission Statement

Through leading-edge thinking, community involvement, and continuous innovation, we help leaders in the health technology space to collaborate and disseminate their ideas and research results. We connect vetted, quality research outputs in novel, effective, and timely ways with those who need it.

JMIR Publications is a rapidly growing, leading open access publisher. The company was built on the success of JMIR (Journal of Medical Internet Research), which started in 1998 as a pioneering, small independent open access project hosted at a university, which subsequently grew into the most influential journal in medical informatics (ranked in Q1 by Impact Factor by Thomson Reuters as well as Scimago) and e-health services research. Due to the growth in influence and submissions, and to make the operations more sustainable and professional, the journal was incorporated as a company in 2011. Shortly after incorporation, several sister journals were launched. Currently, JMIR Publications Inc. publishes more than 3,500 articles annually in more than 30 journals. See the JMIR Publications site for more details.

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Journal of Medical Internet Research (JMIR)

Journal of Medical Internet Research (JMIR). Centre for Global eHealth Innovation: 190 Elizabeth Street, Toronto ON M5G 2C4, Canada. 416.340.4800; fax, 416.340.3595. moc.iy@rimj . http://www.jmir.org ; ISSN: 1438–8871; open access.

The Journal of Medical Internet Research (JMIR) began publishing in 1999 as a free, electronic, open access journal of cyber-medicine and electronic health (i.e., all aspects of the intersection of health and the Internet). The editor-in-chief and publisher since 2001 is Gunther Eysenbach, senior scientist, Centre for Global eHealth Information. JMIR is an international, interdisciplinary, scientific, peer-reviewed journal focused on research information and communication in the health care field using Internet-and intranet-related technologies. Fully indexed in seven services including MEDLINE, JMIR invites research papers from the medical sciences and from computer, behavioral, social, and communication sciences; psychology; library sciences; informatics; human-computer interaction studies; and related fields. JMIR is the official journal of both the Society for the Internet in Medicine (sponsors of the MedNet conference) and the Internet Healthcare Coalition.

JMIR's goal is to help health care and medical professionals and consumers maximize the use of the Internet to deliver quality health care and health information. To achieve this goal, JMIR publishes original research reporting the application, development, and evaluation of information technology related to the Internet, as well as proposals, reviews, and opinion papers on standards, policies, and legal and ethical issues of e-health. Some sample article titles from 2004 include:

• “Can Clinical Trials Requiring Frequent Participant Contact Be Conducted over the Internet?”
• “Pharmacist Computer Skills and Needs Assessment Survey”
• “Experience and Attitudes Towards Information Technology Among First-Year Medical Students in Denmark”
• “Using Claims Data to Examine Patients Using Practice-Based Internet Communication: Is There a Clinical Digital Divide?”

Journal sections have clearly defined editorial policies and identified contact editors. The sections are Editorials and Guest Editorials, Original Papers, Policy Papers and Proposals, Letters to the Editor, Reviews/Tutorials, Book Reviews and Critically Appraised Topics in Communication (CATCH-IT) Reports, Health Informatics, and Technology. Features of the journal include a rigorous but speedy peer-review process, an author acceptance rate of about 40%, and a $500 article fee with waivers and institutional memberships available. Advertisements are clearly identified, although their presence in the left-hand column and on page banners detracts from the scholarly appearance of the site.

The journal is a reliable, current, and well-maintained scientific publication. The current issue and archives are available through a search engine and the tables of contents on the journal Website and through Web search engines such as Google. An advantage of the electronic format is the incorporation of various dynamic multimedia capabilities in many articles, because the journal is not dependent on paper format. Emblematic of electronic publications, the JMIR is published continuously, offering information as it develops or as soon as articles are available (peer reviewed and copy edited). Articles are collated into four archival “issues” and one “volume” per year. Individuals can sign up to receive the table of contents of each issue via email.

JMIR is a nonprofit academic project, published free on the Internet. Institutional members may purchase subscriptions to print volumes for a fee. The editorial board is convinced that the Internet opens ways to publish and peer review scholarly work, independent of commercial publishers. They also think that research work should remain open to be shared and redistributed by others and that it should be available to anyone. JMIR serves as a “publishing laboratory” to explore and experiment with novel means of scholarly communication, including open source publishing, multimedia appendixes, and dynamic articles with real-time statistical analysis. The journal also experiments with cross-media publishing techniques, using extensible markup language (XML) and other technologies.

JMIR's disadvantages are related to the journal's advantages in that some fundamental issues are not yet clarified. For example, the openness of the information available through this research-oriented journal calls for the establishment of an ethical code of conduct for publishing raw data [ 1 ] and a better definition of the role of modern journals [ 2 ]. Neither of these issues has been clearly addressed by JMIR.

• Eysenbach G. Code of conduct is needed for publishing raw data . BMJ . 2001 Jul 21;  323 ( 7305 ):166. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Peek R. E-prints are gaining momentum . Inform Today . 2000 Oct;  17 ( 9 ):50. [ Google Scholar ]

JMIR Research Protocols

Ongoing trials and protocols, grant proposals, and current methods and approaches. , gunther eysenbach, md, mph, facmi, founding editor and publisher; adjunct professor, school of health information science, university of victoria, canada; xiaomeng (simone) ma, phdc, ms, bs, scientific editor at jmir publications, ontario, canada.

JMIR Research Protocols   (JRP, ISSN 1929-0748) is a unique  PubMed  and  Scopus -indexed journal, publishing peer-reviewed, openly accessible research ideas and grant proposals, study and trial protocols, reports of ongoing research, current methods and approaches, and preliminary results from pilot studies or formative research informing the design of medical and health-related research and technology innovations.

In 2023,  JMIR Research Protocols  received an inaugural Journal  Impact Factor™: 1.7  (Source: Journal Citation Reports™ from Clarivate, 2023).

With a Scopus Citescore of 2.6, the journal ranks in the higher Q2 61% (317/830) in the General Medicine category.

It should be stressed however that most authors do not publish their protocols for "impact" or citations, rather to document their ideas to how to design experiments, to document their successful grant proposals, or to publish (and maybe brag a little about) their already funded protocols (which do not require additional peer-review). We offer this platform for scientists to publish peer-reviewed protocols for a very low APF, and unfunded protocols for a reasonable fee that includes peer-review. 

While the original focus was on eHealth studies,  JRP  now publishes protocols and grant proposals  in all areas of medicine,  and their peer-review reports, if available (preliminary results from pilot studies, early results, and formative research should now be published in  JMIR Formative Research ).

While the original focus was on the design of medical and health-related research and technology innovations, JRP publishes research protocols, proposals, feasibility studies, methods and early results  in all areas of medical and health research .

JRP  is fully open access, with full-text articles deposited in PubMed Central.

Publishing research protocols, grant proposals, pilot/feasibility studies and early reports of ongoing and planned work encourages collaboration and early feedback, and reduces duplication of effort.

JRP  is compatible with the concept of "Registered Reports" and since May 2018, published protocols receive a Registered Report Identifier ( What is a Registered Report Identifier? ) and acceptance of the subsequent results paper is "in principle" guaranteed in any JMIR journal and partner journals - see  What is a Registered Report? . 

JRP  will be a valuable resource for researchers who want to learn about current research methodologies and how to write a winning grant proposal.

JRP  creates an early scientific record for researchers who have developed novel methodologies, software, innovations or elaborate protocols.

JRP  provides a "dry-run" for peer-review of the final results paper, and allows feedback/critique of the methods, often while they still can be fixed.

JRP  facilitates subsequent publication of results demonstrating that the methodology has already been reviewed, and reduces the effort of writing up the results, as the protocol can be easily referenced.

JRP  demonstrates to reviewers of subsequent results papers that authors followed and adhered to carefully developed and described a-priori methods.

Studies whose protocols or grant proposals have been accepted in  JRP  are "in principle accepted" for subsequent publication of results in other JMIR journals as long as authors adhere to their original protocol - regardless of study results (even if they are negative), reducing publication bias in medicine.

Authors publishing their protocols in JRP will receive a 20% discount on the article processing fee if they publish their results in another journal of the  JMIR journal family  (for example,  JMIR  for e-health studies,  i-JMR  for others).

Need more reasons? Read the Knowledge Base article on " Why should I publish my protocol/grant proposal "!

JMIR Research Protocols  is indexed in  National Library of Medicine (NLM)/MEDLINE ,  Sherpa Romeo,   DOAJ,   PubMed Central,   PubMed,   Scopus,   Web of Science(WoS)/ESCI/SCIE,  and EBSCO. 

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This paper is in the following e-collection/theme issue:

Published on 17.4.2024 in Vol 26 (2024)

This is a member publication of University College London (Jisc)

Twitter Analysis of Health Care Workers’ Sentiment and Discourse Regarding Post–COVID-19 Condition in Children and Young People: Mixed Methods Study

Authors of this article:

Original Paper

• Macarena Chepo 1 * , RN, BSN, MPH, PhD   ; 
• Sam Martin 2, 3 * , MSc, PhD   ; 
• Noémie Déom 2 , MSc   ; 
• Ahmad Firas Khalid 4 , MD, PhD   ; 
• Cecilia Vindrola-Padros 2 , BA, MA, PhD  

1 School of Nursing, Universidad Andrés Bello, Santiago, Chile

2 Department of Targeted Intervention, University College London, London, United Kingdom

3 Oxford Vaccine Group, Churchill Hospital, University of Oxford, Oxford, United Kingdom

4 Canadian Institutes of Health Research Health System Impact Fellowship, Centre for Implementation Research, Ottawa Hospital Research Institute, Otawa, ON, Canada

*these authors contributed equally

Corresponding Author:

Sam Martin, MSc, PhD

Department of Targeted Intervention

University College London

Charles Bell House 43-45

Foley Street

London, W1W 7TY

United Kingdom

Phone: 44 (0)20 3108 3232

Email: [email protected]

Background: The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post–COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post–COVID-19 condition on this demographic.

Objective: With a social media analysis of the discourse surrounding the prevalence of post–COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post–COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post–COVID-19 condition and identify critical areas and future directions for researchers and policy makers.

Methods: From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post–COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs.

Results: We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post–COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences.

Conclusions: The perceptions described on Twitter by HCWs concerning the presence of the post–COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post–COVID-19 condition.

Introduction

More than 3 years after the outbreak of the COVID-19 pandemic [ 1 ], the social, political, and economic impact of this phenomenon has been more than significant, considering >700 million worldwide cases and nearly 7 million people’s deaths [ 2 ]. Given the scale of the phenomenon, it is imperative for all countries to thoroughly examine the lessons gleaned from the pandemic, particularly regarding a matter that has raised significant concern among the populace: the long-term effects experienced by individuals who have had COVID-19, spanning weeks, months, or even years after their initial infection [ 3 ]. This phenomenon, referred to as post–COVID-19 condition (or more commonly “long COVID”), warrants careful consideration and analysis [ 4 ].

There is increasing information regarding the clinical manifestation of this condition, particularly in the adult population. The worldwide prevalence has been estimated at approximately 50% to 70% in individuals hospitalized during acute COVID-19 infection and 10% to 12% in vaccinated cases [ 5 ]. While children and young people have a low likelihood of severe COVID-19 infection [ 6 ], the information available to date indicates that the presence of post–COVID-19 condition in this group may be as disabling as in adults, reaching a prevalence rate of 23.4% (range 3.7%-66.5%) [ 7 ].

An agreed definition by the World Health Organization indicates that post–COVID-19 condition in children and young people is a condition that occurs “in individuals with a history of confirmed or probable SARS-CoV-2 infection when experiencing symptoms lasting at least two months which initially occurred within three months of acute COVID-19” [ 8 ]. Post–COVID-19 condition strongly impacts daily functioning and can develop or continue after COVID-19 infection and may fluctuate or relapse over time [ 4 , 8 , 9 ].

Among the symptoms most frequently attributable to post–COVID-19 condition in children and young people are fatigue, altered smell or anosmia, and anxiety [ 8 ]. However, other symptoms have also been reported, such as sleep disturbances, difficulty in concentrating, abdominal pain, myalgia or arthralgia, earache or ringing in ears, mood swings, persistent chest pain, stomach pain, light sensitivity, diarrhea, heart palpitations, and skin lesions [ 8 , 10 ]. One of England’s most significant studies is the Children and Young People With Long COVID study by Stephenson et al [ 11 ]. This national research matched longitudinal and cohort studies in adolescent individuals aged 11 to 17 years and found the presence of symptoms in 35.4% of the adolescent individuals who tested positive at baseline and 8.3% who of the adolescent individuals who tested negative at baseline. A total of 3 months after testing, 66.5% of those who tested positive and 53.3% of those who tested negative had any symptoms [ 11 ]. However, Stephenson et al [ 12 ] recently indicated that in a 6-month follow-up, the prevalence of specific symptoms reported at the time of the polymerase chain reaction testing decreased over time, where, for example, the prevalence of chills, fever, myalgia, cough, and sore throat among those who tested positive decreased from 10% to 25% to <3%.

As research on the symptoms, prevalence, and treatment of post–COVID-19 condition in children and young people continues, it is essential to add to the literature by developing studies that determine the condition’s impact on this group, considering that they are experiencing a range of unwanted symptoms that disrupt their quality of life and that of their families.

Considering that listening to the voices of families and health workers could be helpful to broaden the knowledge achieved in post–COVID-19 condition in children and young people, a powerful tool could be social media, such as Twitter (subsequently rebranded as X). With >3729 million daily active users, Twitter has become one of the most important social platforms in the world [ 13 ]. People used Twitter during the COVID-19 pandemic for different purposes, such as world leaders communicating with citizens [ 14 , 15 ], organizations monitoring movement [ 16 ], scientists studying public discourse around the pandemic [ 17 , 18 ], and researchers performing sentiment analysis [ 19 - 21 ]. In the case of physicians and health care workers (HCWs), Twitter has been used to share and evaluate scientific evidence, guidelines, and technical advice [ 22 - 24 ] and track the course and burden of disease [ 25 ].

Using the social media monitoring platform Pulsar [ 26 ], we aimed to explore HCWs’ perceptions concerning post–COVID condition in children and young people in the United Kingdom between January 2021 and January 2022. We aimed to contribute to the emerging knowledge on post–COVID-19 condition in children and young people and identify critical areas and future directions for researchers and policy makers.

We considered a mixed methods approach to be a pragmatic research paradigm. We analyzed data by conducting a Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts (LISTEN) [ 27 ]. This mixed methods analysis consisted of iterative cycles intercalating team discussion and using digital text and discourse analytics tools to analyze related social media data [ 27 ]. We used the LISTEN method to perform quantitative and qualitative analyses of Twitter posts, extracted through the Pulsar platform [ 26 ], related to the experience of post–COVID-19 condition in children and young people in the United Kingdom (eg, phrases, words, hashtags, videos, and images), published between January 1, 2021, and January 31, 2022. We created an advanced Boolean search for keywords mentioning “long COVID” and corelated words, hashtags, and symptoms; furthermore, we filtered for user accounts who identified as HCWs in their Twitter biography description ( Multimedia Appendix 1 ).

Quantitative analysis of all tweets included the following: (1) engagement analysis, where we specifically measured reactions to posts, for example, a retweet, a share, or a comment or quote made toward a tweet; (2) sentiment and emotion analysis, where we measured the positive or negative sentiment in the words and tone of each post within the context of post–COVID-19 condition and HCW’s roles ( Multimedia Appendix 2 ); (3) emotion analysis, where we measured the emotions expressed in the tweets, classified as sadness, anger, disgust, fear, and joy; (4) frequency analysis, where we observed the frequency of keywords and themes in the data set; (5) segmentation analysis, where we measured the key connections or relationships between keywords and their frequent use in the same context; (6) demographic analysis, where we measured the occupation, gender (man or woman or nonbinary or unknown), and city of origin related to the users posting tweets; and (7) analyses, where we evaluated the most influential accounts and the most mentioned websites.

Big qualitative analysis was carried out through thematic discourse analysis of the data sample, using InfraNodus [ 28 ], specifically analyzing the key themes and topics of concern expressed throughout the data set. A codebook was constructed based on the mapping of themes agreed upon by 3 researchers (ND, SM, and MC; Multimedia Appendix 3 ).

The principal investigators (ND, AFK, SM, and MC) interpreted and analyzed the data collected, following the recommendations for rigorous research provided by Creswell and Poth [ 29 ]. Using the LISTEN method [ 27 ], we aimed to show that the integration of qualitative insights through thematic analysis with the quantitative backing of topic modeling can offer a comprehensive view of the discourse. This mixed methods approach allows us to capture the richness of qualitative data while leveraging the objectivity of quantitative measures. Our initial data harvest of the larger corpus data from the Pulsar platform captured 300,000 tweets; this data harvest helped to underpin the software’s sentiment analysis modeling of this specific data set, providing a robust quantitative foundation. The addition of further qualitative data analyses from a smaller qualitative sample allowed for an in-depth understanding of nuanced conversations, particularly when exploring new or complex phenomena such as post–COVID-19 condition in children and young people, with the provision of insights into the context, subtext, and sentiment behind the tweets offering valuable snapshots of public perception and discourse. We used an iterative mixed methods approach, iterating between team discussions and using digital analytics tools to discern relevant themes from the Twitter data corpus. Specifically, we used InfraNodus for thematic analysis, which incorporates a topic modeling script for analyzing and identifying key topics of concern with a data set and provides a structured and objective interpretation of the data. The coding process involved 3 independent researchers (MC, SM, and ND), each with expertise in health care, social network analysis, and digital global health. When initial coding disagreements arose, we meticulously tagged any queries and discussed the posts in question. These instances led to 3 structured meetings wherein the research team deliberated collaboratively to resolve conflicting interpretations. This approach resulted in an 81.99% (2122/2588) initial intercoder agreement rate for the tweets analyzed. For the remaining instances where consensus was not initially reached, the majority rule was applied to finalize theme codings. To quantify the reliability of our coding procedure, with 81.99% (2122/2588) of the tweets coded identically, we used the Cohen κ score, which provides a measure of interrater agreement adjusted for chance. Including the calculation of all variations, this score was calculated to be approximately κ=0.70, indicating good agreement among the coders.

Ethical Considerations

The study only collected data from publicly accessible social networks that have been anonymized by various means, particularly by replacing all usernames and links with anonymous text and summaries of tweets that have been edited, retaining the original message, avoiding direct quotations being identifiable, and ensuring that no information is provided on the identity of the individuals who posted the content studied on the platform.

Internet research requires researchers to carefully consider guidelines to determine whether ethics approval and informed consent are needed [ 30 ]. On the basis of the terms set out by the Research Ethics Committee at the University College London [ 31 ], the study was considered exempt from formal ethics approval for the following reasons: (1) study involving information freely available in the public domain, such as published biographies, newspaper accounts of an individual’s activities, and published minutes of a meeting, that although is considered personal under the Data Protection Act, would not require ethics review; and (2) study involving anonymized records and data sets in the public domain, such as data sets available through the Office for National Statistics or the UK Data Archive where appropriate permissions have already been obtained and it is not possible to identify individuals from the information provided.

Therefore, we anonymized all records and data sets collected during the study to make identification impossible. We removed social media usernames from the data samples. No direct or easily traceable quotes have been included. These measures align with best practices [ 32 - 35 ]. While this study was beyond the scope of the human ethics committee, we adhered to the principles of ethics: beneficence, nonmaleficence, autonomy, and justice [ 36 ]. We collected and analyzed data through secure encrypted servers via the Meltwater and InfraNodus platforms.

Audience Analysis

During the period from January 2021 to January 2022, we obtained 300,000 tweets from 936 accounts. After filtering for relevant posts (refer to inclusion and exclusion criteria in Multimedia Appendix 1 ), we analyzed a sample of 2588 tweets using mixed methods analysis. In terms of gender (man, woman, nonbinary, or unknown), 32.88% (851/2588) were female individuals, 23.49% (608/2588) were male individuals, and 43.59% (1128/2588) were unknown. According to the description given in the user’s biography, the most frequently self-reported terms were “NHS” (582/2588, 22.49%), “health” (230/2588, 8.89%), “medical” (168/2588, 6.49%), “nurse” (166/2588, 6.41%), “clinical” (160/2588, 6.18%), “mum” (158/2588, 6.11%), “doctor” (145/2588, 5.6%), and “GP” (145/2588, 5.6%). In terms of city, tweets came mainly from London (958/2588, 37.02%), Newcastle upon Tyne (326/2588, 12.6%), Redcar (160/2588, 6.18%), Manchester (140/2588, 5.41%), and Bradford (111/2588, 4.29%).

Regarding profession described in the user’s biography, the most frequently mentioned roles were nurses (176/2588, 6.8%); medical roles, for example, paramedic and nursing assistant (173/2588, 6.68%); clinical roles, for example, surgeon, physiotherapist, and anesthesiologist (160/2588, 6.18%); general practitioners (GPs), for example, hospital GP or local surgery GP (142/2588, 5.49%); and physician (140/2588, 5.41%). The most frequent organization affiliated with was the National Health Service (587/2588, 22.68%).

Most Influential Accounts

One of the accounts that generated the highest number of mentions and, therefore, some of the most influence, as they were the ones that talked the most about post–COVID-19 condition in children and young people, was the account for @longcovidkids (593/2588, 22.91% tweets), related to the most shared website longcovidkids.org [ 37 ] , an international UK-based charity for families and children living with post–COVID-19 condition. Although the account was created in October 2020, it was first mentioned in our data collection timeline on January 1, 2021. It offers web support services, funding, and research participation and represents children and young people living with post–COVID-19 condition in expert forums, research panels, health organizations, and parliamentary groups. The other most shared web pages were theguardian.com (the United Kingdom) [ 38 ], bbc.co.uk (the United Kingdom) [ 39 ], peoplewith.com (the United States) [ 40 ], and ncbi.nlm.nih.gov (the United States) [ 41 ]. This shows that in the United Kingdom, there was a mixed influence of UK and US link resources linked to HCW Twitter users in the United Kingdom.

Keyword Analysis

The volume of social media engagement in the discussion about the post–COVID-19 condition experience in children and young people in the United Kingdom reached 1400 posts, 1550 engagements, and 1.9 million impressions. Overall, comments were very responsive to government decisions regarding the vaccination program and school closures ( Multimedia Appendix 4 ). During the first peak of comments in January 2021, the amount of discourse expanded leading up to March 2021, when there were different announcements of school closures, and the guidelines were delivered regarding the priority groups of the vaccination program (frontline HCW and people aged >80 years first). The highest engagement was between June and July 2021, which coincides with the government announcement regarding the availability of vaccines for people aged >18 years. The third peak of comments occurred in September 2021, the same month the authorities announced the extension of the vaccination program to children aged 12 to 15 years.

Top Keywords Analysis

The top words in posts associated with children and young people’s experience of post–COVID-19 condition in the United Kingdom were “Children” (352/2588, 13.6%), “kids” (160/2588, 6.18%), “people” (158/2588, 6.11%), “Young” (148/2588, 5.72%), and “schools” (83/2588, 3.21%). The top hashtags were #longcovid (1387/2588, 53.59%), #longcovidkids (448/2588, 17.31%), #covid19 (370/2588, 14.3%), and #covid (176/2588, 6.8%).

Sentiment and Emotions Analysis

According to sentiment analysis, 99.38% (2572/2588) of the posts reflected negative sentiments and 0.62% (16/2588) reflected positive sentiments. Negative sentiments were mainly associated with comments on hospitalization figures related to the COVID-19 pandemic, criticism of pandemic mitigation policies, and vaccination of children and young people. Furthermore, positive sentiments mainly concerned acknowledgments around decreasing numbers of community support groups.

The primary emotions identified were as follows:

• Sadness (1752/2588, 67.7%), such as in the following tweet:

@[Username] Really upset, after my tough on-call last night. Hospitalisations are still going up, and Gov announcement minismises the effect of long-COVID in adults and children. It’s so hard to keep spirits up today. But we’ll try and continue doing our best in the NHS.

• Joy (367/2588, 14.18%), such as in the following tweet:

@[Username] It’s been an amazing day! [...] I’ve been able to share the experience I’ve gained treating children and adolescents with Long COVID over the last year.

• Fear (233/2588, 9%), as seen in the following tweet:

@[Username] It’s really urgent that young people get the message that they need to get vaccinated. Long COVID is ruining many people’s lives! It’s not a lie or hypochondria, there are real, physiological changes, please understand!

Segmentation Analysis

This analysis revealed the critical clusters of conversation around the main topics of concern within the discourse network around post–COVID-19 condition. Comments were distributed in 4 key conversation segments as follows:

• People, schools, and prevention (1734/2588, 67%): Most of the comments related to measures taken in terms of COVID-19 prevention in schools, concern about the risk of exposure, and sharing experiences of infection in schools.
• Health, adults, and impact (401/2588, 15.49%): Comments mainly reflected concerns and uncertainty about the long-term effect of post–COVID-19 condition on both children and young people and adults.
• Cases, virus, and risk (326/2588, 12.6%): Comments reflected worries about the associated risks and long-term consequences attributable to post–COVID-19 condition (in both adults and children and young people) and the constant mutation of the virus, which will create a permanent risk in the population.
• Months, distress, and symptoms (106/2588, 4.1%): Some HCWs used Twitter to share how children and young people experience post–COVID-19 condition and the extent of these symptoms. Some HCWs exemplified certain typical manifestations, such as fatigue.

Discourse Analysis by Theme

To better understand the topics discussed from the segmentation analysis, we performed a discourse analysis of the key co-occurring themes and topics of concern shared within discussions regarding post–COVID-19 condition in children and young people. The following themes emerged ( Textbox 1 ): concern or uncertainty for the future, school attendance, mask protection from COVID-19, vaccine uptake, infection rates, policy (support or skepticism), understanding and visualizing symptoms, child mental health, access to care, community support, and research ( Figures 1 and 2 ).

• Concern for the future or uncertainty (615/2588, 23.76% tweets): Most comments showed a concern for the future, focusing on shared statistics regarding the rate and spread of infection in children and young people and how this would affect future health outcomes. Furthermore, this group expressed concern regarding political decisions; the presence of illness in loved ones; the eventual overload and response capacity of the health system in the face of an increase in post–COVID-19 condition cases; and the need for training of health care workers (HCWs) to deal with comorbid, potentially long-term symptoms ( Figure 1 A).
• Schools (460/2588, 17.77% tweets): Comments aimed to promote vaccination policies for schoolchildren and flexible measures regarding teachers’ work and attendance, considering cases of people with prolonged symptoms. In addition, several tweets expressed dissatisfaction with school risk mitigation measures, such as the use of face masks and air filters ( Figure 1 B).
• Vaccine (386/2588, 14.9% tweets): Most tweets from this group showed their disapproval of the constant changes in the government’s decisions regarding schools and priority groups for vaccination. Between March and June 2021, the first set of tweets criticized the lack of priority in the vaccination program for schoolchildren and other at-risk groups (such as teachers). Once the authorities announced a vaccination program for schoolchildren aged 12 to 15 years ( Multimedia Appendix 4 ), most comments promoted vaccination for this group. A few comments (78/2588, 3.01%) shared concerns about the vaccine’s efficacy for children, based on the experiences of COVID-19 reinfection in adults despite having received the recommended initial doses. However, to a lesser extent (26/2588, 1%), there was a refusal to vaccinate children, citing fear of possible adverse effects. Nonetheless, it is worth noting that the community frequently refuted such comments ( Figure 1 C).
• Share statistics (334/2588, 12.91% tweets): Frequently, HCWs shared statistical data, such as the number of affected children and young people, the number of post–COVID-19 condition cases, and hospital admissions and deaths. Some of these data were used to validate the existence of the post–COVID-19 phenomenon or to express concern about it ( Figure 1 D).
• Policy (316/2588, 12.21% tweets): The comments were responsive to the policies emanating from the authorities over time ( Multimedia Appendix 4 ). There were 5 main criticisms, including changes in school closure or opening policies; HCWs question why the authorities ignore the evidence of post–COVID-19 cases in children and young people, leading them to question whether decision makers have sufficient training to control the pandemic adequately; the failure to include teachers and school workers in the COVID-19 vaccination program as well as the younger population; the lack of mitigation measures in schools, such as improvements in ventilation systems and mandatory use of masks; and the herd immunity as a plan in the government’s hidden agenda , that is, to promote work and activate the economy ( Figure 1 E).
• “Proof” (280/2588, 10.82% tweets): Most tweets in this group argued regarding the existence of children and young people with post–COVID-19 condition through pictures; statistics; scientific papers; and personal, family, and professional experiences ( Figure 1 F).
• Signs and symptoms (189/2588, 7.3% tweets): Among the symptoms described, chronic fatigue and exhaustion were the most frequent symptoms, which prevent normal activities. Other symptoms were respiratory: dyspnea, chronic cough, and shortness of breath; gastrointestinal: acute or intense abdominal pain, nausea, bloating, gastroparesis, and change in smell or taste; muscular: severe joint pain, “painful foot” and difficulty with physical activity; mental health: anxiety and low mood; topical: rash, skin rashes, and redness and pain in the eyes; and nonspecific symptoms, such as chest pain, heart palpitations, constant high body temperature, precocious puberty, hormonal changes, and erectile dysfunction ( Figure 2 A).
• Face masks (119/2588, 4.6% tweets): Face masks were widely promoted, especially in schools, because HCWs considered them as a practical and straightforward strategy to control the pandemic ( Figure 2 B).
• Skepticism (101/2588, 3.9% tweets): Comments showed reticence toward post–COVID-19 condition in children and young people. Some of the arguments focused on a perceived lack of clarity in the clinical manifestations and stressed the need to better differentiate the post–COVID-19 condition from other related symptomatologies, such as mood disorders (eg, depression and anxiety due to confinement). In contrast, several arguments agreed on the need for more scientific evidence, arguing that post–COVID-19 condition in children and young people are isolated. Other users claimed not to know of such cases instead of calling post–COVID-19 condition in children and young people SMS text message an exaggeration. In addition, several arguments favored releasing restrictions for children and young people, particularly arguments related to the use of masks, because of possible associated risks, for example, hypoxia ( Figure 2 C).
• Mental health (54/2588, 2.09% tweets): Symptoms attributable to mental health problems in children and young people were also a concern. For instance, HCWs mentioned sadness, fear of infecting their family, anxiety regarding sick parents, stress, night terrors, self-harm, and suicidal ideation. Furthermore, users discussed a perceived lack of specific support for children and young people and their families in situations such as hospitalization; prolonged COVID-19 condition; admission to intensive care; and death of a family member, schoolmate, or teacher, all situations that triggered permanent stress in these groups ( Figure 2 D).
• Community support or asking for advice (93/2588, 3.59% tweets): Some HCWs used Twitter to ask for guidance on a specific issue or share experiences of having post–COVID-19 condition or caring for children and young people or family members. Furthermore, they shared informative infographics provided by experts regarding post–COVID-19 condition in children and young people ( Figure 2 E).
• Access to health care or treatment (72/2588, 2.78% tweets): Some HCWs mentioned the lack of specialist (cardiology) support, concerns regarding prolonged National Health Service burnout, and criticisms regarding how follow-up was carried out concerning the relative symptomatology of children and young people with post–COVID-19 condition. At the same time, opening new centers for children and young people with post–COVID-19 condition generated different reactions. On the one hand, some HCWs recognized it as a substantial development, but on the other hand, some HCWs recognized it as proof of the existence of post–COVID-19 condition in children and young people, which raised concerns for the future ( Figure 2 F).
• Research (52/2588, 2% tweets): Under this theme, tweets largely promoted study on post–COVID-19 condition in children and young people or highlighted the need for further study on the subject ( Figure 2 G).
• Images (57/2588, 2.2% tweets): Images shared were primarily from scientific studies, including infographics (from organizations such as National Health Service or @LongCovidKids) and visualization of children and young people’s symptoms, such as rashes, COVID-19 toe, and joint pain. Most infographics shared by organizations (and not individuals), such as the organization LongCovidKids, were related to statistics, such as the number of children and young people with post–COVID-19 condition or the quantification of the type of symptoms experienced. Shared photographs tended to show the more “visually recognizable” symptoms of post–COVID-19 condition, such as skin lesions, rashes, or inflammation. The less visible symptoms, such as chronic fatigue and neurological issues, were represented with photographs of children and young people lying, sleeping under blankets, or duvets or on hospital beds ( Figure 2 H).

Principal Findings

Our primary objective was to explore HCWs’ perceptions concerning post–COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. Our findings indicated that comments made by HCWs on Twitter were responsive to announcements issued by authorities regarding the management of the COVID-19 pandemic in the United Kingdom and associated regulations on the operation of schools. The most frequent feelings and emotions were negative, mainly sadness. In turn, we identified relevant themes for HCWs, such as uncertainty or concern about the future; policies; and regulations for the prevention, management, and addressing both COVID-19 and post–COVID-19 condition in children and young people; vaccination; and the use of Twitter as a strategy to share scientific literature, management strategies, and clinical and personal experiences.

Concern from HCWs regarding the policies for addressing the COVID-19 pandemic in the children and young people in the United Kingdom (including vaccination and schools) was a recurring theme in our findings. Furthermore, concern regarding the side effects of the COVID-19 vaccine and how the vaccine might interact with preexisting physiological symptoms of post–COVID-19 condition in children and young people was a topic of discussion. Similarly, the constant change in policy making in the United Kingdom, as public health bodies and governments have tried to understand and adapt to the emergence of post–COVID-19 condition, have added to the strength of this ongoing debate [ 42 ]. The lack of up-to-date evidence on post–COVID-19 condition in children and young people prompted HCWs to rely on Twitter during the pandemic to communicate relevant information. Twitter has a broad audience reach; is used as a communication tool by politicians, health bodies, and other key influences; and facilitates real-time updates [ 43 ]. During the pandemic, HCWs, primarily those in frontline roles and local response coordination, have often been challenged to become credible spokespersons for pandemic information [ 44 ]. Such credibility directly influences public confidence and decision-making, ultimately determining the success or failure of a public health intervention [ 43 ].

Furthermore, failures in risk communication could explain the presence of uncertainty and negative feelings associated with school regulations. When people are upset, distressed, or fearful, they often do not trust the authority, decrease the perceived validity of the communication received, and find information processing difficult [ 45 ]. In this regard, Fotheringham et al [ 46 ] indicated that during 2020, school leaders in the United Kingdom faced pressures and challenges related to translating and enacting school policies, particularly with the perceived lack of agency shared by the government concerning being able to translate centrally issued guidelines. In turn, Tomson et al [ 47 ] reported that the pandemic has negatively impacted the well-being of leaders in all types of schools and across all demographic groups, affecting their ability to think clearly and solve work-related problems. Given that the protection and care of children and young people health during the COVID-19 pandemic ultimately rests with school leaders, the search for support strategies that focus on the needs of these groups becomes an urgent necessity.

Findings in Relation to Other Studies

Using Twitter’s information, this is one of the first studies to capture health professionals’ perceptions of prolonged COVID-19 in the children and young people in the United Kingdom. However, other studies have addressed post–COVID-19 condition on this social network. Callard and Peregov [ 48 ] reviewed how, through social platforms such as Twitter, patients made the persistence and heterogeneity of COVID-19 symptoms visible, thus catapulting the inclusion of post–COVID-19 condition as a relevant phenomenon in clinical and policy debates. In contrast, other authors in the last 2 years have explored on various platforms (including Twitter) the persistence of symptoms and emotional impact after months of suspected and confirmed diagnosis of COVID-19 [ 49 - 55 ], including the period of vaccination. Furthermore, others have explored web discussions regarding this phenomenon [ 56 ]. Several of these authors agree on a perceived lack of support and specific resources from governmental bodies, a lack of information or clarity in the instructions given, and the absence of formal mechanisms to allow the voices of patients and the community to be heard. The above point is critical as it highlights the gap between the needs of the population and the response provided by policy makers, which not only translates into a gap in access to health services but also limits citizen participation in decision-making on the issues that affect their own health and increases distrust toward regulations and instructions issued by the government.

Implications for Policy and Practice

Several policy recommendations and implications are targeted at various stakeholders to consider while implementing future policy guidelines to address post–COVID-19 health care delivery. First, policy makers should consider investing appropriate resources to collect data regarding post–COVID-19 condition in children and young people, specifically on the impact of COVID-19 on the mental health of children and young people. This implies working closely with researchers to streamline data collection and reporting on post–COVID-19 condition. Second, policy makers should consider providing a basic level of psychosocial support with access to quality mental health and psychosocial support services for HCWs, school staff, parents, and children and young people experiencing post–COVID-19 condition. This implies strengthening health systems, community-based programming, and mobilization. Policies must include documenting the impact of mental health and psychosocial support interventions and innovative approaches to be more widely disseminated and scaled up across different contexts and target population groups. Third, to address the criticism around frequent changes in school closure and opening policies, decision makers should develop clear, easy-to-understand school mitigation plans informed by the best available evidence. The plans should incorporate teachers, school workers, and parents to ensure all voices are included in the policy plan. Fourth, policy makers should adopt a shared decision-making approach incorporating HCWs in the decision-making process for managing the COVID-19 pandemic. Finally, government decision makers should set post–COVID-19 pandemic recovery policies informed from a health equity perspective and how this affects children and young people living with post–COVID-19 condition, factoring in childhood, family income, housing, domestic violence, access to health care, and racism.

In terms of the needed clearer road map for recommendations to support training strategies for HCWs and school staff regarding post–COVID-19 condition in children and young people, we have outlined the following 10 steps.

Step 1: Data Collection and Analysis

Our study underlines the critical need for comprehensive data on post–COVID-19 condition’s impact on the mental health of children and young people. As a first step, it is recommended that policy makers should allocate resources for the systematic collection and analysis of data on post–COVID-19 condition in children and young people, particularly focusing on mental health outcomes. These data should be used to identify the most prevalent symptoms and the most effective treatment strategies. In this context, it is recommended that experts emphasize the importance of early detection and medical consultation for mental health issues in children and young people diagnosed with post–COVID-19 condition, including mood changes, irritability, social withdrawal, memory problems, difficulty in concentrating, anxiety, depression, posttraumatic stress, school absenteeism, and suicidal ideation [ 57 , 58 ]. This entails working closely with researchers to streamline data collection and reporting on post–COVID-19 condition.

Step 2: Psychosocial Support Framework

It has been noted that globally, programs for managing post–COVID-19 condition in children and young people are heterogeneous, ranging from the use of physiotherapy, pediatric occupational therapy, and psychological support to interventions aimed at lifestyle modifications [ 59 ]. This diversity could impact differential outcomes in the treatment, recovery, and timely and effective rehabilitation of children and young people with post–COVID-19 condition. Upon analyzing the wider literature and the social media data in this study, it is recommended that a basic level of psychosocial support should be established. This would involve ensuring access to quality mental health services for HCWs, school staff, parents, and children and young people with post–COVID-19 condition. This framework should be integrated into the health system and community-based programming, emphasizing the mobilization of resources and strengthening of support networks. It is suggested that the psychosocial support framework should facilitate access to quality mental health services and support networks that are robust and responsive. Community engagement gleaned from further Twitter discourse analysis should be a helpful guide in the development of these services to ensure they meet the real and expressed needs of children and young people with post–COVID-19 condition. Practical examples of basic psychosocial support include using web support services; individual or group therapy sessions; school-based emotional support programs; and counseling sessions aimed at parents, family members, or school staff.

Step 3: Educational Mitigation Plans

The frequent policy changes around school closures highlight the necessity for stable and clear educational mitigation plans. It is recommended that these plans should be directly informed by the evidence collected and further analysis of sentiments and emotions surrounding post–COVID-19 condition in schools. Incorporating the viewpoints of teachers, parents, and school staff, as identified in our thematic analysis, will ensure that the mitigation strategies are comprehensive, feasible, and sensitive to the psychosocial impact on children and young people. School staff and policy makers should collaborate to develop clear, evidence-informed educational mitigation plans. These plans should be straightforward and involve teachers, school workers, and parents in their creation, ensuring a unified approach that considers the voices of all stakeholders.

Step 4: Shared Decision-Making in Health Care

In health care settings, the adoption of a shared decision-making model is crucial, enabling HCWs to actively contribute to the formulation of COVID-19 and post–COVID-19 policies. This inclusive approach ensures that frontline workers can provide valuable insights toward policy development. To facilitate this, the establishment of advisory committees composed of representatives from HCWs is recommended. This committee can convene regularly to deliberate on key decisions pertaining to the COVID-19 pandemic management, including prevention measures, resource distribution, and vaccination strategies. Such collaborative groups have demonstrated effectiveness in identifying priority needs within the context of a pandemic [ 60 ].

Step 5: Health Equity in Policy Setting

Post–COVID-19 recovery policies should be set with a health equity lens. This means considering factors such as family income, housing, domestic violence, access to health care, and racism and how these factors affect children and young people living with post–COVID-19 condition. Our findings emphasize the importance of framing post–COVID-19 recovery policies through a lens of health equity. The concerns raised by HCWs regarding the socioeconomic impacts, such as family income and access to health care, underline the need for policies that address not just the medical aspects of post–COVID-19 condition but also the social determinants of health. An equitable approach will ensure that children and young people from diverse backgrounds receive appropriate support.

Step 6: Documenting and Disseminating Interventions

It is vital to document the impact of mental health and psychosocial support interventions. In this context, it is crucial to implement innovative strategies to disseminate unbiased information about post–COVID-19 condition among health care professionals and educators working with children and young people, ensuring it reaches different contexts and populations. These strategies may include creating interactive multimedia resources, such as videos and mobile apps; organizing webinars; actively using social media; and forming web support groups. These groups will provide a space where patients, health care professionals, and educators can share their experiences and knowledge regarding post–COVID-19 condition. These actions will not only help reduce isolation and social stigma but also strengthen support for these groups considered vulnerable [ 61 ].

Step 7: Developing a Clear Communication Strategy

Policy makers must develop a clear communication strategy to address frequent policy changes and mitigate confusion. This strategy should be informed by the data collected and analysis conducted in Step 1. The data reveal a palpable sense of uncertainty and frustration due to frequent policy shifts, underscoring the need for a clear and consistent communication strategy. This strategy should be grounded in the evidence gathered from the health care community’s discourse and aim to minimize confusion by providing timely, transparent, and reliable information regarding post–COVID-19 policies and support services.

Step 8: Training and Support Strategies

On the basis of the findings of the comprehensive data analysis, specific training and support strategies should be developed for HCWs and school staff. These strategies should be focused on the practical aspects of identifying and managing post–COVID-19 condition in children and young people. For instance, training sessions could include practical workshops on recognizing post–COVID-19 symptoms in children and adolescents, conducting diagnostic assessments, and implementing appropriate treatment and support interventions.

Step 9: Continuous Feedback and Policy Adaptation

The continuous evolution of the post–COVID-19 phenomenon demands an iterative approach to policy making. On the basis of our study, we recommend establishing feedback mechanisms with HCWs and school staff to monitor the reception and effectiveness of implemented policies. This feedback, coupled with ongoing research, should inform policy adaptations to ensure they remain aligned with the evolving landscape of post–COVID-19 condition and its impact on children and young people.

Step 10: Evaluation and Research

Finally, there should be a commitment to ongoing evaluation and research. This will involve not only monitoring the implementation of the abovementioned steps but also supporting new research to fill any remaining gaps in understanding the long-term effects of COVID-19 on children and young people.

This sequence of steps is designed to be iterative and responsive, ensuring that the recommendations from the study are translated into concrete actions that adapt to emerging data and research findings.

Strengths and Limitations

A key strength of this study is that our social media analysis of post–COVID-19 condition contributes toward an emerging understanding of reported experiential, emotional, and practical dimensions of post–COVID-19 condition in children and young people specifically and questions of vaccine hesitancy in children and young people with post–COVID-19 condition. This is one of the few studies to collect HCWs’ perceptions regarding post–COVID-19 condition in children and young people in the United Kingdom using information from Twitter. We identify key areas that need considering attention and focus, such as the provision of psychosocial support with access to quality mental health resources to alleviate the impact of post–COVID-19 condition in children and young people and the development of clear post–COVID-19 pandemic recovery guidelines that are informed by health equity perspective, and how this affects children and young people living with post–COVID-19 condition.

One of the limitations this study acknowledges is the definition of post–COVID-19 condition in children and young people. When data were collected, the lack of consensus on the definition of post–COVID-19 condition in children and young people forced us to formulate a definition of post–COVID-19 condition in children and young people based on the available literature. Furthermore, this study is limited to the perceptions of people who used descriptors in their web biography attributable to HCWs; therefore, our results only represent some HCWs in the United Kingdom and those in other countries. In turn, this research collected data from Twitter only; therefore, further inquiry into HCWs’ perceptions of post–COVID-19 condition in children and young people required expanding to other data sources or social networks and including languages other than English. We acknowledge that demographic factors, geographic location, and individual daily activities of social media users can significantly influence language use and word choice, introducing potential biases in tweet-based data. Such biases are inherent in any analysis of social media content and can affect the generalizability of findings. For instance, our study relies on Twitter data, which do not encompass the full spectrum of global or the UK public opinion on post–COVID-19 condition in children and young people. While Twitter serves as a valuable platform for capturing real-time sentiments and experiences, it is not fully representative of all demographics and geographic regions. Our results may reflect the perspectives of more vocal or active social media users, which may not correspond to the silent majority or those without access to social media. In addition, the absence of geotagged information for many users limits our ability to conduct a more nuanced spatial analysis of the sentiments expressed.

Furthermore, our study is built upon the recognition that social media data may overrepresent certain demographic groups while underrepresenting others, such as the older population or those without reliable internet access. This skew can influence the apparent prevalence of certain views or experiences of post–COVID-19 condition. Moreover, individuals’ patterns of daily life, reflected in their social media use and content, contribute additional layers of complexity and potential bias to the discourse analyzed.

Consistent with scholarly precedents on the subject [ 62 , 63 ], our study acknowledges these biases as intrinsic limitations of social media–based research. Although our analysis did not control for these factors, we recognize their potential impact on our results. Future studies would benefit from incorporating a broader array of data sources, including interviews or focus groups, to provide a more representative and comprehensive understanding of post–COVID-19 condition in children and young people. This approach would complement our Twitter-based findings and help mitigate the biases inherent in social media data.

Conclusions

More than a year after the start of the COVID-19 pandemic, the perceptions described on Twitter by HCWs concerning the presence of post–COVID-19 condition in children and young people appear to be a relevant and timely issue as well as very responsive to the declarations and guidelines issued by the health authorities over time. The most prominent group within the discourse studied was the activist or lobbying organization @LongCovidKids, which shared the most tweets and images over the period studied. We recommend that future research focus on how web health activism is organized and carried out for children and young people with post–COVID-19 condition. Such a strategy would allow for a better understanding of the scope and impact of this phenomenon and how it can influence decision-making. Furthermore, we suggest different mitigation strategies, support, and training of HCWs and school staff regarding manifestations and treatment of post–COVID-19 condition in children and young people across all demographic areas.

Acknowledgments

The authors would like to thank the Rapid Research Evaluation and Assessment Lab, Department of Targeted Intervention, University College London, London, United Kingdom, whose support has been essential for developing this project.

Conflicts of Interest

None declared.

Filters used for the search strategy on Twitter.

Sentiment analysis framework: attitudes toward post–COVID-19 condition in children and young people.

Theme codebook: examples of tweets that fit into main themes tagged for mention of children and young people with post–COVID-19 condition.

Timeline of national governmental policies and guidelines regarding children and young people.

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Abbreviations

Edited by A Mavragani; submitted 20.06.23; peer-reviewed by R Gore, A Wahbeh; comments to author 02.11.23; revised version received 14.02.24; accepted 08.03.24; published 17.04.24.

©Macarena Chepo, Sam Martin, Noémie Déom, Ahmad Firas Khalid, Cecilia Vindrola-Padros. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.04.2024.

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