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      Examining BRCA Previvors’ Social Media Content Creation as a Form of Self and Community Care: Qualitative Interview Study

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          Abstract

          Background

          Genetic testing has become a common way of identifying a woman’s risk of developing hereditary breast and ovarian cancer; however, not all medical providers have the necessary information to support patients interested in genetic testing, nor do they always have the proper information for patients once they have been diagnosed. Therefore, many “previvors”—the name given to those who have tested positive for the BRCA genetic mutation—have taken to social media to inform others about the importance of genetic testing and explain to them how to understand their test results. Historically, those desiring to speak about their medical issues online have sought out structured support groups or chat rooms; however, many previvors today are instead posting on their own personal social media accounts and creating more niche communities.

          Objective

          This study aimed to examine why BRCA previvors are sharing content on their personal social media accounts and how posting online in this way serves a purpose for their larger community.

          Methods

          A total of 16 semistructured interviews were conducted with individuals who posted about their experience being diagnosed with the BRCA genetic mutation and their subsequent treatment on their personal social media accounts, specifically for followers interested in their medical journey. The interviews were recorded, transcribed, and coded by an experienced qualitative researcher and a graduate student using inductive techniques, and a reflexive thematic analysis was applied to the transcripts.

          Results

          The results suggest BRCA previvors want to control the narrative around their personalized medical experiences rather than participating in existing groups or chat rooms. Controlling their own story, rather than adding to existing narratives, gives previvors a sense of control. It also allows them to set boundaries around the types of experiences they have online when sharing their medical journey. Finally, previvors said they feel they are serving the larger BRCA community by each sharing their individual journeys, to hopefully avoid stereotyping and homogenizing the experience of patients with BRCA genetic mutations.

          Conclusions

          Research with the objective of understanding the experiences of BRCA previvors should include exploring how and why they talk about their journeys, especially due to the lack of knowledge BRCA previvors say many of their medical providers have. We suggest further research should examine how other patients with the BRCA genetic mutation, especially racial and ethnic minority patients, are navigating their own content creation, especially considering content moderation policies that social media platforms are continuing to implement that directly impact users’ ability to share about their medical experiences.

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          Most cited references30

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            What can “thematic analysis” offer health and wellbeing researchers?

            The field of health and wellbeing scholarship has a strong tradition of qualitative research—and rightly so. Qualitative research offers rich and compelling insights into the real worlds, experiences, and perspectives of patients and health care professionals in ways that are completely different to, but also sometimes complimentary to, the knowledge we can obtain through quantitative methods. There is a strong tradition of the use of grounded theory within the field—right from its very origins studying dying in hospital (Glaser & Strauss, 1965)—and this covers the epistemological spectrum from more positivist forms (Glaser, 1992, 1978) through to the constructivist approaches developed by Charmaz (2006) in, for instance, her compelling study of the loss of self in chronic illness (Charmaz, 1983). Similarly, narrative approaches (Riessman, 2007) have been used to provide rich and detailed accounts of the social formations shaping subjective experiences of health and well-being (e.g., Riessman, 2000). Phenomenological and hermeneutic approaches, including the more recently developed interpretative phenomenological analysis (Smith, Flowers, & Larkin, 2009), are similarly regularly used in health and wellbeing research, and they suit it well, oriented as they are to the experiential and interpretative realities of the participants themselves (e.g., Smith & Osborn, 2007). Thematic analysis (TA) has a less coherent developmental history. It appeared as a “method” in the 1970s but was often variably and inconsistently used. Good specification and guidelines were laid out by Boyatzis (1998) in a key text focused around “coding and theme development” that moved away from the embrace of grounded theory. But “thematic analysis” as a named, claimed, and widely used approach really “took off” within the social and health sciences following the publication of our paper Using thematic analysis in psychology in 2006 (Braun & Clarke, 2006; see also Braun & Clarke, 2012, 2013; Braun, Clarke, & Rance, 2014; Braun, Clarke, & Terry, 2014; Clarke & Braun, 2014a, 2014b). The “in psychology” part of the title has been widely disregarded, and the paper is used extensively across a multitude of disciplines, many of which often include a health focus. As tends to be the case when analytic approaches “mature,” different variations of TA have appeared: ours offer a theoretically flexible approach; others (e.g., Boyatzis, 1998; Guest, MacQueen, & Namey, 2012; Joffe, 2011) locate TA implicitly or explicitly within more realist/post-positivist paradigms. They do so through, for instance, advocating the development of coding frames, which facilitate the generation of measures like inter-rater reliability, a concept we find problematic in relation to qualitative research (see Braun & Clarke, 2013). Part of this difference results from the broad framework within which qualitative research is conducted: a “Big Q” qualitative framework, or a “small q” more traditional, positivist/quantitative framework (see Kidder & Fine, 1987). Qualitative health and wellbeing researchers will be researching across these research traditions—making TA a method well-suited to the varying needs and requirements of a wide variety of research projects. Despite the widespread uptake of TA as a formalised method within the qualitative analysis canon, and within health and wellbeing research, we often get emails from researchers saying they have been queried about the validity of TA as a method, or as a method suitable for their particular research project. For instance, we get emails from doctoral students or potential doctoral students, who have been told that “TA isn't sophisticated enough for a doctoral project” or emails from researchers who have been told that TA is only a descriptive or positivist method that requires no interpretative analysis. We get emails from people asking how to respond to reviewer queries on articles submitted for publication, where the validity of TA has been raised. We get so many emails, that we've created a website with answers to many of the questions we get: www.psych.auckland.ac.nz/thematicanalysis. The queries or critiques often reveal a lack of understanding about the potential of TA, and also about the variability and flexibility of the method. They often seem to assume a realist, descriptive method, and a method that lacks nuance, subtlety, or interpretative depth. This is incorrect. TA can be used in a realist or descriptive way, but it is not limited to that. The version of TA we've developed provides a robust, systematic framework for coding qualitative data, and for then using that coding to identify patterns across the dataset in relation to the research question. The questions of what level patterns are sought at, and what interpretations are made of those patterns, are left to the researcher. This is because the techniques are separate from the theoretical orientation of the research. TA can be done poorly, or it can be done within theoretical frameworks you might disagree with, but those are not reasons to reject the whole approach outright. TA offers a really useful qualitative approach for those doing more applied research, which some health research is, or when doing research that steps outside of academia, such as into the policy or practice arenas. TA offers a toolkit for researchers who want to do robust and even sophisticated analyses of qualitative data, but yet focus and present them in a way which is readily accessible to those who aren't part of academic communities. And, as a comparatively easy to learn qualitative analytic approach, without deep theoretical commitments, it works well for research teams where some are more and some are less qualitatively experienced. Ultimately, choice of analytic approach will depend on a cluster of factors, including what topic the research explores, what the research question is, who conducts the research, what their research experience is, who makes up the intended audience(s) of the research, the theoretical location(s) of the research, the research context, and many others. Some of these are somewhat fluid, some are more fixed. Ultimately, we advocate for an approach to qualitative research which is deliberative, reflective, and thorough. TA provides a tool that can serve these purposes well, but it doesn't serve every purpose. It can be used widely for health and wellbeing research, but it also needs to be used wisely. Virginia Braun School of Psychology, The University of AucklandPrivate Bag 92019, Auckland Mail Centre 1142Auckland, New ZealandEmail: v.braun@auckland.ac.nz Victoria Clarke Department of Health and Social Sciences, University of the West of EnglandBristol BS16 1QY, UK
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              Thematic analysis

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                2025
                3 March 2025
                : 27
                : e67794
                Affiliations
                [1 ] Advertising & Public Relations College of Communication Arts and Sciences Michigan State University East Lansing United States
                [2 ] Department of Communication University of Utah Salt Lake City, UT United States
                [3 ] Department of Communication Huntsman Cancer Institute University of Utah Salt Lake City, UT United States
                Author notes
                Corresponding Author: Mariah L Wellman mwellman@ 123456msu.edu
                Author information
                https://orcid.org/0000-0001-5089-7379
                https://orcid.org/0009-0008-2076-7168
                https://orcid.org/0000-0001-7498-0599
                https://orcid.org/0000-0003-2668-9080
                Article
                v27i1e67794
                10.2196/67794
                11914846
                40053732
                3c61ce8a-38b3-4773-af88-386d4e4dc259
                ©Mariah L Wellman, Camilla M Owens, Avery E Holton, Kimberly A Kaphingst. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.03.2025.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 21 October 2024
                : 29 November 2024
                : 7 January 2025
                : 7 February 2025
                Categories
                Original Paper
                Original Paper

                Medicine
                brca,breast cancer,genetic testing,social media,breast cancer gene,content creation,self care,community care,qualitative interview,qualitative,interview,previvors,cancer previvors,genetic mutations,online,content,interviews,thematic analysis

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