Resumo (abstract):
This digital qualitative study conducted an inductive content analysis of 1,000 Facebook comments about the use of amber necklaces for teething symptom relief, aiming to understand users' perceptions of this practice. The comments were divided into units of analysis (n=2,166) and coded into thematic categories in QDAMiner. Using Word Stat software, category frequencies, word clouds, and cluster analysis were determined. The Chi-square test was used to compare the distribution of categories across three distinct time points. Most comments were made by users with white personas (81.8%), female gender (96.3%), and Brazilian nationality (97.8%). The most frequent categories were "the information is useful or potentially useful" (18.8%) and "acquisition or intention to acquire the necklace" (12.1%), with respective increases of 5.9% to 23.6% and 15.7% to 24.5% over time. The frequencies of "concern/anxiety about the use of the amber necklace" and "teething experience" decreased from 5.8% to 2.0% and from 12.0% to 3.1%, respectively. Despite the reduction in reports of teething symptoms, there is a growing trend among Brazilians to consider the amber necklace a valid solution for teething symptoms.
Palavras-chave (keywords):
Tooth Eruption, Amber, Social Media, Qualitative Research.
Ler versão inglês (english version)
Conteúdo (article):
Teething Beliefs and Amber Necklaces: A Content Analysis of Users Perspectives from Facebook Comments
Olívia Santana Jorge¹, Jean Ribeiro Leite¹, Douglas William de Almeida¹, Matheus Lotto¹, Thiago Cruvinel¹
1Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
olivia.jorge@usp.br (ORCID: 0000-0002-5266-5798)
jeanleite@usp.br (ORCID: 0000-0003-0122-7146)
douglas.dwa@live.com (ORCID: 0009-0002-5572-4180)
matheus.lotto.souza@gmail.com (ORCID: 0000-0002-0121-4006)
thiagocruvinel@fob.usp.br (ORCID: 0000-0001-7095-908X)
ABSTRACT
This digital qualitative study conducted an inductive content analysis of 1,000 Facebook comments about the use of amber necklaces for teething symptom relief, aiming to understand users\' perceptions of this practice. The comments were divided into units of analysis (n=2,166) and coded into thematic categories in QDAMiner. Using Word Stat software, category frequencies, word clouds, and cluster analysis were determined. The Chi-square test was used to compare the distribution of categories across three distinct time points. Most comments were made by users with white personas (81.8%), female gender (96.3%), and Brazilian nationality (97.8%). The most frequent categories were "the information is useful or potentially useful" (18.8%) and "acquisition or intention to acquire the necklace" (12.1%), with respective increases of 5.9% to 23.6% and 15.7% to 24.5% over time. The frequencies of "concern/anxiety about the use of the amber necklace" and "teething experience" decreased from 5.8% to 2.0% and from 12.0% to 3.1%, respectively. Despite the reduction in reports of teething symptoms, there is a growing trend among Brazilians to consider the amber necklace a valid solution for teething symptoms.
Keywords: Tooth Eruption, Amber, Social Media, Qualitative Research.
INTRODUCTION
Despite the lack of high-quality scientific evidence, especially prospective cohort studies and systematic reviews based on primary studies, symptoms such as pain, drooling, fever, and irritability are often associated with the eruption of deciduous teeth1. This causes many parents and caregivers to approach the process with apprehension, seeking solutions1-3. Consequently, the amber necklace has emerged as a popular non-pharmacological option among several approaches promising to reduce the discomfort observed during teething. It supposedly works through the analgesic properties of succinic acid, which is released from amber beads and absorbed through the skin. However, the effects of these amulets have been demonstrated to be implausible, as succinic acid-containing amber beads cannot be released without their liquefaction. This would require high-temperature thresholds incompatible with human life4. Additionally, it is well-documented several health risks caused by amber necklaces to babies, such as strangulation, aspiration, ingestion of beads, allergic reactions, and microbial proliferation5-8. Even considering these findings, people are still interested in social media content about amber necklaces for combating teething-related discomfort9.
With over 3 billion monthly active users, Facebook remains the most widely used social media platform worldwide. In this scenario, Brazil represents the largest Latin American market for this platform, being ranked fourth in the highest number of users in the world10. A previous study demonstrated that Facebook users significantly interact with posts containing false information about the effectiveness of amber teething necklaces in relieving symptoms of deciduous teeth eruption11. A population consuming information burdened by myths can contribute to the formation of negative beliefs that shape health discourse, leading individuals to adopt harmful behaviors, which may result in adverse public health consequences, such as discrediting health sciences and professionals12.
Social media activity, including the creation, consumption, and interaction with health content, offers researchers valuable insights into people\'s health experiences and behaviors. In this context, this study aimed to qualitatively explore Facebook users\' beliefs, experiences, impressions, knowledge, and interests related to amber necklaces. For that, it examined comments in Portuguese about posts that promoted amber necklaces for teething symptoms relief. For surveillance purposes, this analysis also focused on the timing of the comments and the sociodemographic characteristics of the commenters.
To the best of our knowledge, no other studies have explored users\' comments on social media to assess parents\' and caregivers\' opinions regarding tooth eruption, highlighting the originality of this approach. This study may contribute to dentists and public health professionals in developing strategies that address caregivers\' perceptions and reduce the impact of misinformation on this topic.
MATERIAL AND METHODS
The authors followed the recommendations of the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Study design
This is a qualitative digital study with a complementary quantitative approach that conducted a content analysis of comments on Facebook posts containing supportive messages about using amber necklaces to alleviate teething symptoms. These comments were sourced from a primary study that employed the CrowdTangle platform to collect and evaluate posts. One investigator collected a sample of 1,000 comments, which included authors’ sociodemographic characteristics related to their personas (gender, race, and location) and the time since their posting on Facebook (number of days). To perform an inductive thematic content analysis, the investigator used QDAMiner software to divide the comments into units of analysis (sentences, n=2,166) and manually coded them into predefined and pilot-tested thematic categories. These categories were derived from the model "Seeking Health-Related Information Online". The frequencies of the categories, word clouds, and cluster analyses were generated using WordStat software.
Ethics
This study was deemed exempt from approval by the Council of Ethics in Human Research of Bauru School of Dentistry, University of São Paulo. The exemption was granted because federal regulations do not apply to research using publicly available data that does not involve human subjects. It is noteworthy that while the user data is publicly accessible, it has been anonymized to ensure confidentiality prior to its inclusion in the data repository.
Inclusion and exclusion criteria
To be included in this analysis, the comments must meet all the following criteria: i) the comment must be published in Portuguese; ii) the comment must be related to the use of amber necklace for preventing teething symptoms; and iii) the comment must contain text expressing Facebook users\' beliefs, experiences, impressions, knowledge, or interests related to amber necklaces. Conversely, the comments did not provide substantial content for the analysis, and duplicates were subsequently excluded from consideration.
Selection of comments
Given the impracticality of manually evaluating all available content, a sample of 1,000 comments was selected based on criteria established in a previous study13. This sample is deemed representative for elucidating the interests of media users. One investigator (OSJ) assessed 3,284 comments from 23 posts with the highest number of total interactions observed in a primary study, which was conducted to evaluate the interaction of Facebook users with amber necklace-related content between August 2016 and August 2021.
In order to reach the number of comments, it was planned to collect 50 comments from each of the 20 posts with the highest number of interactions, totalizing 1,000 posts. Both the posts and comments were presented in order of relevance, as determined by Facebook. If a post had fewer than the required number of comments (fewer than 50 comments), only the comments that met the inclusion criteria were collected, and additional posts were accessed until the final sample size was reached. Comments consisting only of emojis, like "
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