Bringing Conversations on Contraception from Social Media to Clinical Practice
Deborah Bartz
Deborah Bartz, MD, MPH, an attending physician in the Department of Obstetrics and Gynecology at BWH, has long observed social media’s influence on health outcomes. As more patients came into their visits with information, questions or concerns rooted in content they have encountered on social platforms, Bartz recognized the importance of understanding how these platforms disseminate information on contraception. Over the last few years, Bartz has published research analyzing the content, tone and accuracy of social media conversations about contraception across TikTok and X (the platform previously known as Twitter).
In this Q&A, Bartz discusses what her research shows about the content patients consume and share online and how clinicians and patients can navigate conversations about contraception in the clinic in today’s social media climate.
Q: Why study contraception-related content on social media?
DB: As physicians, we’ve noticed a growing number of patients coming into our exam rooms with a foundational understanding of their symptoms, potential medical conditions, and associated treatments, much of which they obtained from social media.
This trend is positive, in my opinion, as it reflects greater patient engagement and ownership of their health care. Historically, the healthcare system has had a level of gatekeeping that disproportionately affects marginalized patient populations. Empowering patients with information before their healthcare visits can be beneficial.
Certain aspects of medicine, such as wellness and preventative care, garner higher engagement from the general population due to their broader relevance and implications. Contraception is commonly used by a younger demographic, often starting in their early teens and spanning for decades. This demographic also overlaps those who engage with social media, where discussions about contraceptive methods, including side effects, are prevalent within social circles.
As clinicians, we must understand where and how patients get information on contraception so that we can effectively work with them to help them make the best decisions regarding contraception use that align with their values and optimize their health and well-being.
Q: What can we learn from social media that we can’t in the clinic or research setting?
DB: Social media provides valuable insights into the patient experience by showcasing a range of perspectives and priorities that may not come up in one-on-one interactions.
For instance, I’ve noticed a common trend on platforms like TikTok where individuals share their reactions to the lengthy information sheet included with their birth control. Many find this information incredibly overwhelming. Hearing patients talk about this on TikTok helps me address my patients’ concerns more effectively in the clinic. Knowing that my patients may prefer more concise communication about their medication options, risks, and benefits, I can deliver that to them in a digestible way. It also prompts me to consider how to present a balanced perspective on how the risks and side effects of birth control compare to the risks and side effects of pregnancy.
I think patients have a level of comfort discussing concerns online that they don’t always have in their doctor’s office. Taking the time to hear their perspectives on social media allows me to preemptively educate myself on common concerns and misconceptions so that I can have more effective discussions about birth control with my patients in clinical settings.
Q: How should healthcare providers go about tackling misinformation regarding contraception on social media?
DB: In a 2021 study published in the American Journal of Obstetrics and Gynecology, we analyzed tweets from 2006 (the year Twitter was founded) until 2019. We saw that conversations about contraception have become much more polarized over time. This speaks to the nature of social media in that what you see is highly curated to align with your values and those of your social circle. These spaces can become echo chambers, making getting accurate educational material to social media users difficult.
This year, we published a study in Contraception and Reproductive Medicine showing that only roughly six percent of all contraception-related content is posted by an official news or healthcare source. That’s where health professionals come in: We see that birth control information posted by health professionals receives high engagement from Twitter/X users, indicating that people want to hear from health experts online. Health professionals can start combating misinformation by going online, creating a social media presence and sharing their educated perspectives.
Q: How should providers approach conversations with patients about contraception knowing the information available to them on social media?
DB: We cannot ignore that contraception users are highly active on social media and that they are often making decisions about whether, what, and how to use birth control based on information they obtain online. I think that when discussing birth control options in clinical settings, rather than ignore that social media exists, providers should take the time to ask patients about their perception of birth control and evaluate what information they may already have.
When making choices about birth control and reproductive health, people often turn to their social circles, which may include family, friends, or social media spaces, to hear from those they trust about their experiences using different types of contraception.
We must recognize that patients may place more trust in anecdotal experiences shared by friends or family members than the advice they receive in a healthcare setting. There remains a sense of distrust in health care, and it takes time and effort to gain our patients’ trust. As providers, we must not only bring our medical knowledge into these conversations but also consider how different methods of contraception align or contrast with our patients’ values and lifestyles.
To me, this is why longitudinal relationships between patients and providers are so meaningful. Gaining patient trust requires listening and understanding every patient’s unique situation –understanding the education and lived experiences they are bringing to the clinic. Maintaining trust is vital to improving reproductive health outcomes.