blogging in infectious diseases 833
serve as educational tools, opportunities for reflection, information collators for emerging situations, and/or discussion forums around current controversies.8 Despite its potential utility, the exploration and analysis of the infectious diseases ‘blogosphere’ remains weak. In this article, we aim (1) to describe the existing landscape of
existing blogs for HCP in the field of infectious disease diagnosis, prevention, and treatment, (2) to assess their content through a quality criteria tool, (3) to analyze HCP interest in blogs, the impact of blogs on HCPs, and the influence of the blogger.
methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.9
Search Strategy
We conducted a systematic search for blogs in Google, Yahoo, Bing, and the blog aggregator “Searchblogspot.” The last search was run on October 6, 2015. Search terms (Online Appendix 1) covered (1) infectious diseases (endemic or emerging), (2) antimicrobial stewardship, (3) infection preven- tion and control, and (4)medical microbiology. In addition, the blogrolls (lists of related blogs or websites) of all selected blogs were scanned to identify any further relevant blogs.
Blog Selection
All blogs that focused exclusively on infectious diseases, infection prevention, treatments, and microbiology (ie, bacteriology, virology, parasitology, mycology) topics were considered. Blogs were eligible for analysis if they (1) focused on human medicine, (2) were written in English, and (3) included at least 1 new post in the 6 months prior to data collection for this study. Blogs on veterinary medicine, blogs with a clear commercial purpose, and blogs clearly targeted toward patients were excluded. We used a snowball sampling approach to identify infectious-
disease–related blogs from keyword searches in various search engines and blog aggregators.10 This approach is especially appropriate for studying blogs.11,12 We reviewed the top 200 search-engine results for all preselected keywords. This method has been previously described to yield the most frequently linked blogs as a proxy measure of its influence.11 From the blogrolls provided by these blogs, we identified additional blogs to consider for inclusion.
Data Collection
Architecture and content evaluation were undertaken for all blogs arising from theWeb search, with subsequent full content analysis and quality assessment of those blogs fulfilling the inclusion/exclusion criteria. Moreover, 2 authors (G.B. and R.T.) independently reviewed the blog architecture and content. Disagreements were resolved by a third person (L.M.).
A data extraction form was developed and validated using 10 randomly selected blogs. Data from the included blogs were recorded by 2 reviewers (G.B. and R.T.) and were then subjected to further critical appraisal during a narrative synthesis. Blog architecture. Data extraction aimed to quantify objective
measures of blogger characteristics and blog architecture. Demographic information (ie, blogger gender, country, occupation, and education) were extracted. Blogger age was extracted if available or was independently categorized in age groups (10-year ranges) by the 2 reviewers using available data. Blog architecturewas assessed using the 9 criteria listed in Table 1. Blog content. The contents of blogs and posts were explored
using 9 quantitative and qualitative criteria (Table 1). We identified topics by reading blog descriptions and posts, and we coded the primary purpose of each blog. The practical or research purpose of each blog was independently categorized by the 2 reviewers, and disagreements were resolved by discussion. Blog features included the frequency and regularity of posts during the month preceding data collection and the date of publication of the last post. The traffic rank of the blog was estimated using Alexa (
http://www.alexa.com/). A qualitative assessment was also performed for 4 criteria:
clear statement, overall presentation, level of analysis on post topics, and ease of reading. These variables were scored using a Likert scale varying from 1 for a poor evaluation to 5 for high- level evaluation. Agreement was reached if the 2 reviewers reported the same score or if the difference did not exceed 1 point. If the scores differed by >1 point, the third reviewer assessed the blog and an average of the 3 scores was taken. Finally, the field covered by the blogwas categorized according to the number of topics covered. The fieldwas considered narrow if it was constrained by geographic area or pathogen type or if it was only relevant to a small group of professionals. The fieldwas considered to have a mediumbreadth of focus if the blog related to a general field (eg, mycology or bioinformatics), and the field was considered broad if the information presented was generally relevant to HCPs or researchers in infectious diseases. Quality assessment tool. A tool was developed to evaluate
the quality of blog architecture and content, including 17 of the 19 criteria described above. A score was derived by attributing 1 point for each item present. Points for 7 items considered highly important were multiplied by a factor of 2 (see formula inOnline Appendix 2). The final score could range from0 to 72. This tool was compared with the previously published “Quality Checklists for Health Professions Blogs and Podcasts”13 in terms of acuity and comprehensiveness. Perception of bloggers and readers. Perceptions of bloggers
were qualitatively assessed using an online survey thatwas directly e-mailed to bloggers and included 10 open questions regarding their motivations, vision, and perceived impact of their blog for readers and themselves (Online Appendix 3). For readers, 10 questions were asked on their habits regarding blogs (eg, how often they comment/share and what they like about blogs) and preferences about blog topics and content. Readers were contacted either directly or indirectly through blogger posts, or
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