Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): A Mixed-Method Study

TY - JOUR

T1 - Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST)

T2 - A Mixed-Method Study

AU - Peerawong, Thanarpan

AU - Phenwan, Tharin

AU - Makita, Meiko

AU - Supanitwatthana, Sojirat

AU - Puttarak, Panupong

AU - Siammai, Naowanit

AU - Sunthorn, Prakaidao

PY - 2024/12/24

Y1 - 2024/12/24

N2 - Background: After medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis-related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown, needing further evaluation. Objectives: To analyze the factors determining cannabis-related content quality for breast cancer care on internet sources and social media platforms and examine the characteristics of such contents accessed and consumed by Thai breast cancer survivors. Methods: A mixed-methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis-related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST inter-observer reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P < 0.05. Fairclough’s Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34%), government sources (16/62, 26%), healthcare providers (12/62, 19%), and alternative medicine providers (12/62, 19%). Most of the contents (30/62, 48%) were uploaded to YouTube, whereas 31% (19/62) appeared on websites and Facebook. Forty of 62 content items (64%) were news-related and generic cannabis advertisements. Eight of 62 (13%) content items had no identifiable date. The inter-observer QUEST score correlation was 0.86 (P<0.001). The mean QUEST score was 12.1±7.6. Contents were considered “high” when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81% and 98%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis-related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue.

AB - Background: After medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis-related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown, needing further evaluation. Objectives: To analyze the factors determining cannabis-related content quality for breast cancer care on internet sources and social media platforms and examine the characteristics of such contents accessed and consumed by Thai breast cancer survivors. Methods: A mixed-methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis-related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST inter-observer reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P < 0.05. Fairclough’s Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34%), government sources (16/62, 26%), healthcare providers (12/62, 19%), and alternative medicine providers (12/62, 19%). Most of the contents (30/62, 48%) were uploaded to YouTube, whereas 31% (19/62) appeared on websites and Facebook. Forty of 62 content items (64%) were news-related and generic cannabis advertisements. Eight of 62 (13%) content items had no identifiable date. The inter-observer QUEST score correlation was 0.86 (P<0.001). The mean QUEST score was 12.1±7.6. Contents were considered “high” when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81% and 98%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis-related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue.

KW - Cannabis

KW - Medical Cannabis

KW - Thailand

KW - Critical Discourse Analysis

KW - Mixed-method

KW - Breast Cancer

KW - Digital literacy

KW - Legislation

KW - Health Literacy

KW - Internet

U2 - 10.2196/55300

DO - 10.2196/55300

M3 - Article

C2 - 39727276

SN - 2369-1999

VL - 10

JO - JMIR Cancer

JF - JMIR Cancer

M1 - e55300

ER -