JMIR Publications

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.


Journal Description

JMIR Public Health & Surveillance (JPHS, Editor-in-chief: Travis Sanchez, Emory University/Rollins School of Public Health) is a PubMed-indexed, peer-reviewed sister journal of the Journal of Medical Internet Research (JMIR), the top cited journal in health informatics (Impact Factor 2016: 5.175). JPH is a multidisciplinary journal with a unique focus on the intersection of innovation and technology in public health, and includes topics like health communication, public health informatics, surveillance, participatory epidemiology, infodemiology and infoveillance, digital disease detection, digital public health interventions, mass media/social media campaigns, and emerging population health analysis systems and tools. 

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.

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 journal which publishes 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, JPH 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 minmal narratives and abstracts).

Furthermore, duing 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:

  • A smoking scene from My Boss, My Teacher (Korean Movie, 2006). Source: My Boss, My Teacher, 2006; Copyright: Zenith Entertainment; URL:; License: Fair use/fair dealings.

    Effect of Viewing Smoking Scenes in Motion Pictures on Subsequent Smoking Desire in Audiences in South Korea


    Background: In the modern era of heightened awareness of public health, smoking scenes in movies remain relatively free from public monitoring. The effect of smoking scenes in movies on the promotion of viewers’ smoking desire remains unknown. Objective: The study aimed to explore whether exposure of adolescent smokers to images of smoking in fılms could stimulate smoking behavior. Methods: Data were derived from a national Web-based sample survey of 748 Korean high-school students. Participants aged 16-18 years were randomly assigned to watch three short video clips with or without smoking scenes. After adjusting covariates using propensity score matching, paired sample t test and logistic regression analyses compared the difference in smoking desire before and after exposure of participants to smoking scenes. Results: For male adolescents, cigarette craving was significantly higher in those who watched movies with smoking scenes than in the control group who did not view smoking scenes (t307.96=2.066, P<.05). In the experimental group, too, cigarette cravings of adolescents after viewing smoking scenes were significantly higher than they were before watching smoking scenes (t161.00=2.867, P<.01). After adjusting for covariates, more impulsive adolescents, particularly males, had significantly higher cigarette cravings: adjusted odds ratio (aOR) 3.40 (95% CI 1.40-8.23). However, those who actively sought health information had considerably lower cigarette cravings than those who did not engage in information-seeking: aOR 0.08 (95% CI 0.01-0.88). Conclusions: Smoking scenes in motion pictures may increase male adolescent smoking desire. Establishing a standard that restricts the frequency of smoking scenes in films and assigning a smoking-related screening grade to films is warranted.

  • Source: Image created by the authors; Copyright: N Tran; URL:; License: Creative Commons Attribution (CC-BY).

    Online Reviews as Health Data: Examining the Association Between Availability of Health Care Services and Patient Star Ratings Exemplified by the Yelp...

    Authors List:


    Background: There have been public health interventions that aim to reduce barriers to health care access by extending opening hours of health care facilities. However, the impact of opening hours from the patient’s perspective is not well understood. Objective: This study aims to investigate the relationship between temporal accessibility of health care services and how patients rate the providers on Yelp, an online review website that is popular in the United States. Using crowdsourced open Internet data, such as Yelp, can help circumvent the traditional survey method. Methods: From Yelp’s limited academic dataset, this study examined the pattern of visits to health care providers and performed a secondary analysis to examine the association between patient rating (measured by Yelp’s rating) and temporal accessibility of health care services (measured by opening hours) using ordinal logistic regression models. Other covariates included were whether an appointment was required, the type of health care service, the region of the health care service provider, the number of reviews the health care service provider received in the past, the number of nearby competitors, the mean rating of competitors, and the standard deviation of competitors’ ratings. Results: From the 2085 health care service providers identified, opening hours during certain periods, the type of health care service, and the variability of competitors’ ratings showed an association with patient rating. Most of the visits to health care service providers took place between normal working hours (9 AM-5 PM) from Sunday to Thursday, and the least on Saturday. A model fitted to the entire sample showed that increasing hours during normal working hours on Monday (OR 0.926, 95% CI 0.880-0.973, P=0.03), Saturday (OR 0.897, 95% CI 0.860-0.935, P<0.001), Sunday (OR 0.904, 95% CI 0.841-0.970, P=0.005), and outside normal working hours on Friday (OR 0.872, 95% CI 0.760-0.998, P=0.048) was associated with receiving lower ratings. But increasing hours during outside normal working hours on Sunday was associated with receiving higher ratings (OR 1.400, 95% CI 1.036-1.924, P=0.03). There were also observed differences in patient ratings among the health care services types, but not geographically or by appointment requirement. Conclusions: This study shows that public health interventions, especially those involving opening hours, could use crowdsourced open Internet data to enhance the evidence base for decision making and evaluation in the future. This study illustrates one example of how Yelp data could be used to understand patient experiences with health care services, making a case for future research for exploring online reviews as a health dataset.

  • Situational assessment field visits. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Feasibility of Establishing HIV Case-Based Surveillance to Measure Progress Along the Health Sector Cascade: Situational Assessments in Tanzania, South...


    Background: To track the HIV epidemic and responses to it, the World Health Organization recommends 10 global indicators to collect information along the HIV care cascade. Patient diagnosis and medical record data, harnessed through case-based surveillance (CBS), can be used to measure 8 of these. While many high burden countries have well-established systems for monitoring patients on HIV treatment, few have formally adopted CBS. Objective: In response to the need for improved strategic HIV information and to facilitate the development of CBS in resource-limited countries, we aimed to conduct situational assessments of existing data collection systems in Tanzania, South Africa, and Kenya. Methods: We developed a standardized protocol and a modularized data collection tool to be adapted for the particular focus of the assessments within each country. The three countries were selected based on their stage of readiness for CBS. The assessment included three parts: a desk review of relevant materials on HIV surveillance and program monitoring, stakeholder meetings, and site visits. Results: In all three countries, routine HIV program monitoring is conducted, and information on new HIV diagnoses and persons accessing HIV care and treatment services is collected. Key findings from the assessments included substantial stakeholder support for the development of CBS, significant challenges in linking data within and between systems, data quality, the ability to obtain data from multiple sources, and information technology infrastructure. Viral load testing capacity varied by country, and vital registry data were not routinely linked to health systems to update medical records. Conclusions: Our findings support the development of CBS systems to systematically capture routinely collected health data to measure and monitor HIV epidemics and guide responses. Although there were wide variations in the systems examined, some of the current program and patient monitoring systems can be adapted to function effectively for CBS, especially if supported by an improved patient registration system with shared unique health identifiers.

  • Study logo. Source: Image created by the authors; Copyright: The authors; License: Creative Commons Attribution (CC-BY).

    Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women...


    Background: Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective: The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods: Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results: Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions: Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen.

  • Person using website on a phone and on a desktop (montage). Source: The Authors /; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    A Platform for Crowdsourced Foodborne Illness Surveillance: Description of Users and Reports


    Background: Underreporting of foodborne illness makes foodborne disease burden estimation, timely outbreak detection, and evaluation of policies toward improving food safety challenging. Objective: The objective of this study was to present and evaluate, an openly accessible Internet-based crowdsourcing platform that was launched in 2009 for the surveillance of foodborne illness. The goal of this system is to collect data that can be used to augment traditional approaches to foodborne disease surveillance. Methods: Individuals affected by a foodborne illness can use this system to report their symptoms and the suspected location (eg, restaurant, hotel, hospital) of infection. We present descriptive statistics of users and businesses and highlight three instances where reports of foodborne illness were submitted before the outbreaks were officially confirmed by the local departments of health. Results: More than 49,000 reports of suspected foodborne illness have been submitted on since its inception by individuals from 89 countries and every state in the United States. Approximately 95.51% (42,139/44,119) of complaints implicated restaurants as the source of illness. Furthermore, an estimated 67.55% (3118/4616) of users who responded to a demographic survey were between the ages of 18 and 34, and 60.14% (2776/4616) of the respondents were female. The platform is also currently used by health departments in 90% (45/50) of states in the US to supplement existing programs on foodborne illness reporting. Conclusions: Crowdsourced disease surveillance through systems such as uses the influence and familiarity of social media to create an infrastructure for easy reporting and surveillance of suspected foodborne illness events. If combined with traditional surveillance approaches, these systems have the potential to lessen the problem of foodborne illness underreporting and aid in early detection and monitoring of foodborne disease outbreaks.

  • Training course of the WHO CC for HIV Strategic Information. Source: WHO Collaborating Centre for HIV Strategic Information; Copyright: WHO Collaborating Centre for HIV Strategic Information; URL:; License: Creative Commons Attribution (CC-BY).

    HIV Strategic Information in Non-European Union Countries in the World Health Organization European Region: Capacity Development Needs


    Background: Capacity building of the national HIV strategic information system is a core component of the response to the HIV epidemic as it enables understanding of the evolving nature of the epidemic, which is critical for program planning and identification of the gaps and deficiencies in HIV programs. Objective: The study aims to describe the results of the assessment of the needs for further development of capacities in HIV strategic information systems in the non-European Union (EU) countries in the World Health Organization European Region (EUR). Methods: Self-administered questionnaires were distributed to national AIDS programs. The first questionnaire was sent to all countries (N=18) to find out, among other issues, the priority level for strengthening a range of HIV surveillance areas and their key gaps and weaknesses. The second questionnaire was sent to 15 countries to more specifically determine capacities for the analysis of the HIV care cascade. Results: Responses to the first questionnaire were received from 10 countries, whereas 13 countries responded to the second questionnaire. Areas that were most frequently marked as being of high to moderate priority for strengthening were national electronic patient monitoring systems, evaluation of HIV interventions and impact analysis, implementation science, and data analysis. Key weaknesseses were lack of electronic reporting of HIV cases, problems with timeliness and completeness of reporting in HIV cases, under-estimates of the reported number of HIV-related deaths, and limited CD4 count testing at the time of HIV diagnosis. Migrant populations, internally displaced persons, and refugees were most commonly mentioned as groups not covered by surveillance, followed by clients of sex workers and men who have sex with men. The majority of countries reported that they were able to provide the number of people diagnosed with HIV who know their HIV status, which is important for the analysis of cross-sectional and longitudinal HIV care cascades. Ability to report on some of the key impact indicators of HIV programs—viral load suppression and mortality—should be considerably strengthened. Conclusions: The assessment found a substantial need to invest in surveillance capacities, which is a cornerstone in the development of an evidence-informed response to HIV epidemics.

  • Source: The authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Filtering Entities to Optimize Identification of Adverse Drug Reaction From Social Media: How Can the Number of Words Between Entities in the Messages Help?


    Background: With the increasing popularity of Web 2.0 applications, social media has made it possible for individuals to post messages on adverse drug reactions. In such online conversations, patients discuss their symptoms, medical history, and diseases. These disorders may correspond to adverse drug reactions (ADRs) or any other medical condition. Therefore, methods must be developed to distinguish between false positives and true ADR declarations. Objective: The aim of this study was to investigate a method for filtering out disorder terms that did not correspond to adverse events by using the distance (as number of words) between the drug term and the disorder or symptom term in the post. We hypothesized that the shorter the distance between the disorder name and the drug, the higher the probability to be an ADR. Methods: We analyzed a corpus of 648 messages corresponding to a total of 1654 (drug and disorder) pairs from 5 French forums using Gaussian mixture models and an expectation-maximization (EM) algorithm . Results: The distribution of the distances between the drug term and the disorder term enabled the filtering of 50.03% (733/1465) of the disorders that were not ADRs. Our filtering strategy achieved a precision of 95.8% and a recall of 50.0%. Conclusions: This study suggests that such distance between terms can be used for identifying false positives, thereby improving ADR detection in social media.

  • Gay couple enjoying the outdoors. Source: iStock by Getty Images; Copyright: Pekic; URL:; License: Licensed by the authors.

    Perceptions of HIV Seriousness, Risk, and Threat Among Online Samples of HIV-Negative Men Who Have Sex With Men in Seven Countries


    Background: Rates of new HIV infections continue to increase worldwide among men who have sex with men (MSM). Despite effective prevention strategies such as condoms and pre-exposure prophylaxis (PrEP), low usage of both methods in many parts of the world hinder prevention efforts. An individual’s perceptions of the risk of acquiring HIV and the seriousness they afford to seroconversion are important drivers of behavioral risk-taking. Understanding the behavioral factors suppressing the uptake of HIV prevention services is a critical step in informing strategies to improve interventions to combat the ongoing HIV pandemic among MSM. Objective: The study aimed to examine cross-national perceptions of HIV/AIDS seriousness, risk, and threat and the association between these perceptions and sociodemographic characteristics, relationships, and high-risk sexual behaviors among MSM. Methods: Participants in Australia, Brazil, Canada, Thailand, South Africa, the United Kingdom, and the United States were recruited for a self-administered survey via Facebook (N=1908). Respondents were asked to rate their perceived seriousness from 1 (not at all serious) to 5 (very serious) of contracting HIV, their perceived risk from 1 (no risk) to 10 (very high risk) of contracting HIV based on their current behavior, and their perception of the threat of HIV—measured as their confidence in being able to stay HIV-negative throughout their lifetimes—on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). Covariates included sociodemographic factors, sexual behavior, HIV testing, drug use, and relationship status. Three ordered logistic regression models, one for each outcome variable, were fit for each country. Results: Contracting HIV was perceived as serious (mean=4.1-4.6), but perceptions of HIV risk (mean=2.7-3.8) and threat of HIV (mean=1.7-2.2) were relatively low across countries. Older age was associated with significantly lower perceived seriousness of acquiring HIV in five countries (Australia: odds ratio, OR 0.97, 95% CI 0.94-0.99; Brazil: OR 0.95, 95% CI 0.91-0.98; Canada: OR 0.96, 95% CI 0.93-0.98; South Africa: OR 0.96, 95% CI 0.94-0.98; United Kingdom: OR 0.95, 95% CI 0.92-0.98). Being in a male-male sexual relationship was associated with significantly lower perceived risk of HIV in four countries (Australia: OR 0.47, 95% CI 0.30-0.75; Canada: OR: 0.54, 95% CI 0.35-0.86; United Kingdom: OR 0.38, 95% CI 0.24-0.60; United States: OR 0.5, 95% CI 0.31-0.82). Drug use in the previous year was associated with greater threat of contracting HIV in two countries (Canada: OR 1.81, 95% CI 1.13-2.91; United Kingdom: OR 1.7, 95% CI 1.06-2.74). Conclusions: Few measures of behavioral or sexual risk-taking were significantly associated with perceived HIV seriousness, risk, or threat across countries. Overall, low levels of reported risk were identified, and results illustrate important gaps in the understanding of risk among MSM across societies that could be addressed through culturally-tailored prevention messaging.

  • Young key populations participating in research. Source: The Authors; Copyright: Youth LEAD; URL:; License: Creative Commons Attribution (CC-BY).

    Ensuring Inclusion of Adolescent Key Populations at Higher Risk of HIV Exposure: Recommendations for Conducting Biological Behavioral Surveillance Surveys


    Ending acquired immune deficiency syndrome (AIDS) depends on greater efforts to reduce new human immunodeficiency virus (HIV) infections and prevent AIDS-related deaths among key populations at highest HIV risk, including males who have sex with males, sex workers, and people who inject drugs. Although adolescent key populations (AKP) are disproportionately affected by HIV, they have been largely ignored in HIV biological behavioral surveillance survey (BBSS) activities to date. This paper reviews current ethical and sampling challenges and provides suggestions to ensure AKP are included in surveillance activities, with the aim being to enhance evidence-informed, strategic, and targeted funding allocations and programs toward ending AIDS among AKP. HIV BBSS, conducted every few years worldwide among adult key populations, provide information on HIV and other infections’ prevalence, HIV testing, risk behaviors, program coverage, and when at least three of these surveys are conducted, trend data with which to evaluate progress. We provide suggestions and recommendations on how to make the case to ethical review boards to involve AKP in surveillance while assuring that AKP are properly protected. We also describe two widely used probability sampling methods, time location sampling and respondent driven sampling, and offer considerations of feature modifications when sampling AKP. Effectively responding to AKP’s HIV and sexual risks requires the inclusion of AKP in HIV BBSS activities. The implementation of strategies to overcome barriers to including AKP in HIV BBSS will result in more effective and targeted prevention and intervention programs directly suited to the needs of AKP.

  • Source: The Authors; Copyright: Jennifer Jabson; URL:; License: Creative Commons Attribution (CC-BY).

    Understanding Health Information Seeking on the Internet Among Sexual Minority People: Cross-Sectional Analysis From the Health Information National Trends...


    Background: Individuals who face barriers to health care are more likely to access the Internet to seek health information. Pervasive stigma and heterosexism in the health care setting are barriers to health care for sexual minority people (SMP, ie, lesbian, gay, and bisexual people); therefore, SMP may be more likely to use the Internet as a source of health information compared to heterosexual people. Objective: Currently, there is a dearth of published empirical evidence concerning health information seeking on the Internet among SMP; the current project addresses this gap. Methods: Data from the 2015 Health Information National Trends Survey Food and Drug Administration Cycle were used to describe and summarize health information seeking among SMP (n=105) and heterosexual people (n=3405). Results: Almost all of the SMP in this sample reported having access to the Internet (92.4%, 97/105). SMP were equally as likely as heterosexual people to seek health information on the Internet (adjusted odds ratio [aOR] 0.94, 95% CI 0.56-1.66) and to report incidental exposure to health information online (aOR 1.02, 95% CI 0.66-1.60). SMP were 58% more likely to watch a health-related video on YouTube than heterosexual people (aOR 1.58, 95% CI 1.00-2.47). Incidental exposure to health information was associated with seeking health information for oneself (aOR 3.87, 95% CI 1.16-14.13) and for someone else (aOR 6.30, 95% CI 2.40-17.82) among SMP. Conclusions: SMP access the Internet at high rates and seek out health information online. Their incidental exposure could be associated with seeking information for self or others. This suggests that online interventions could be valuable for delivering or promoting health information for SMP.

  • U.S. Air Force Senior Airman Brandi Spriggs, 97th Medical Operations Squadron health technician, sets up a dry ice trap to catch mosquitoes. Source: Airman 1st Class Cody Dowell; Copyright: N/A; URL:; License: Public Domain (CC0).

    What Are People Tweeting About Zika? An Exploratory Study Concerning Its Symptoms, Treatment, Transmission, and Prevention


    Background: In order to harness what people are tweeting about Zika, there needs to be a computational framework that leverages machine learning techniques to recognize relevant Zika tweets and, further, categorize these into disease-specific categories to address specific societal concerns related to the prevention, transmission, symptoms, and treatment of Zika virus. Objective: The purpose of this study was to determine the relevancy of the tweets and what people were tweeting about the 4 disease characteristics of Zika: symptoms, transmission, prevention, and treatment. Methods: A combination of natural language processing and machine learning techniques was used to determine what people were tweeting about Zika. Specifically, a two-stage classifier system was built to find relevant tweets about Zika, and then the tweets were categorized into 4 disease categories. Tweets in each disease category were then examined using latent Dirichlet allocation (LDA) to determine the 5 main tweet topics for each disease characteristic. Results: Over 4 months, 1,234,605 tweets were collected. The number of tweets by males and females was similar (28.47% [351,453/1,234,605] and 23.02% [284,207/1,234,605], respectively). The classifier performed well on the training and test data for relevancy (F1 score=0.87 and 0.99, respectively) and disease characteristics (F1 score=0.79 and 0.90, respectively). Five topics for each category were found and discussed, with a focus on the symptoms category. Conclusions: We demonstrate how categories of discussion on Twitter about an epidemic can be discovered so that public health officials can understand specific societal concerns within the disease-specific categories. Our two-stage classifier was able to identify relevant tweets to enable more specific analysis, including the specific aspects of Zika that were being discussed as well as misinformation being expressed. Future studies can capture sentiments and opinions on epidemic outbreaks like Zika virus in real time, which will likely inform efforts to educate the public at large.

  • Tech. Sgt. Bryan Gray hands out mosquito nets to a Cham-Muslim woman in a village. Source: Master Sgt. Adam Johnston; Copyright: US Air Force; URL:; License: Creative Commons Attribution (CC-BY).

    Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia


    Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems’ developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of “best practices” but also accelerates global and regional malaria elimination efforts. In this article, Cambodia’s experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination.

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  • Public Health Echo Chambers in the Digital Media Ecosystem

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 17, 2017 - Jul 31, 2017

    Background: With the digitization and disintermediation of the information landscape, conflicting information online is pervasive. The World Economic Forum named digital misinformation as one of the m...

    Background: With the digitization and disintermediation of the information landscape, conflicting information online is pervasive. The World Economic Forum named digital misinformation as one of the main threats to society today. We’ve also witnessed a widespread decline in trust in major institutions. The breadth of information available online complicates the problem of mistrust. Given a broad selection of media, audiences tend to select information that conforms to their pre-existing beliefs, even when their chosen information is counter to fact. This complicates the process of disseminating evidence-based information, with particular consequences for the field of health. Objective: Homophily in social networks fosters an environment that reinforces pre-existing opinions, even when contrary to evidence. This creates sub-communities known as "echo chambers." Here, we analyze the digital media ecosystem to better understand information communities for public health topics. Methods: Using the open online platform Media Cloud, we developed the novel suite of tools to create a searchable archive of over 25,000 online media sources, including US and UK newspapers, broadcast media networks, and other influential publications. We analyzed hyperlink behavior and word frequency, investigating the phenomena of echo chambers for three case studies: Ebola, Zika and vaccines. Results: We identified information sub-communities for each case study, based on hyperlink citations between sources and similar framing of the topic. Information authorities existed in each sub-community, linking more frequently to sources in their own sub-community than to those in different sub-communities. Each information network studied contained a distinct, isolated public health sub-community. Conclusions: Echo chambers likely complicate the dissemination of evidence-based public health information. This illuminates the need for innovation in public health communications, and strategies for directly engaging with a variety of online communities.