Effect of Recent Abortion Legislation on Twitter User Engagement, Sentiment, and Expressions of Trust in Clinicians and Privacy of Health Information: Content Analysis (Preprint)

Abstract

BACKGROUND The supreme court ruling in Dobbs v Jackson Women’s Health Organization overrules precedents established by Roe v Wade and Planned Parenthood v Casey and allows states to individually regulate access to abortion care services. While many states have passed laws to protect access to abortion services since the ruling, the ruling has also triggered the enforcement of existing laws and creation of new ones that ban or restrict abortion. In addition to denying patients to the full spectrum of reproductive health care, one major concern in the medical community is how the ruling will undermine trust in the patient-clinician relationship by influencing perceptions of the privacy of patient health information. OBJECTIVE To study the effect of recent abortion legislation on twitter user engagement, sentiment, and expressions of trust in clinicians and privacy of health information. METHODS We scraped tweets containing keywords of interest between Jan 1st 2020 – Oct 17th, 2022, to capture tweets posted before and after the supreme court decision. We the trained a Latent Dirichlet Allocation model to select tweets pertinent to the topic of interest and performed a sentiment analysis using a RoBERTa model and a causal impact time series analysis to examine engagement and sentiment. In addition, we used a Word2Vec model to study the terms of interest against a latent trust dimension to capture how expressions of trust for our terms of interest changed over time and used TFIDF to measure to volume of tweets before and after the decision with respect to negative and positive sentiment that map to our terms of interest. RESULTS Our study revealed 1) a transient increase in the number of daily users by 576.86% (95% CI: 545.34% - 607.92%), p < 0.001, tweeting about abortion, healthcare, and privacy of health information post decision; 2) a sustained and statistically significant decrease in the average daily sentiment on these topics by 19.81% (95% CI: 5-22.98%, -16.59%, p , 0.001 post decision ; 3) a decrease in the association of the latent dimension of trust across most clinician related and health information related terms of interest; 4) an increased frequency of tweets with these clinician related and health information related terms and concomitant negative sentiment in the post decision period. CONCLUSIONS The study suggests that the Dobbs ruling has consequences for health systems and reproductive healthcare that extend beyond denying patients access to the full spectrum of reproductive health services. The finding of a decrease in expression of trust in clinicians and health information-related terms provides evidence to support advocacy and initiatives that proactively address concerns of trust in health systems and services. CLINICALTRIAL N/A

The impact of abortion restrictions on American mental health

“…Since that time, the medical and academic communities have scrambled to understand the implications of these bans, with confusion emerging surrounding the conditions under which abortion remains permissible (3), giving rise to legal action (4,5). To date, received research indicates that these restrictions increase projected patient travel costs (6), change patterns of health information seeking (7), decrease trust in clinicians (8), contribute to excess mortality (9), and even alter firm recruitment strategies to cover out of state travel if an abortion is needed by an employee (10).…”