title: The family journey-to-diagnosis with systemic juvenile idiopathic arthritis: a cross-sectional study of the changing social media presence.
abstract: BACKGROUND
  Children with systemic juvenile idiopathic arthritis (SJIA) often encounter a delay between symptom onset and disease diagnosis, partly due to the broad differential of fever and lack of symptom recognition by providers. Families often seek multiple medical opinions and post on social media about their frustrations. This linguistic analysis observed the changing language patterns and social media posting behaviors of parents in the time leading to, during, and after SJIA diagnosis.
  
  
  METHODS
  Public social media sites were manually reviewed by a linguistic team to evaluate posts about SJIA from US-based parents.
  
  
  RESULTS
  A total of 3,979 posts between July 2001 and January 2015 were reviewed from 108 sites. Pre-SJIA diagnosis parents sought answers and shared status updates on social media, focusing primarily on the following three site types: alternative/natural lifestyle forums (39%), Facebook (27%), and disease-specific forums (17%). Posts during early prediagnosis phases were characterized by expressive language showing confidence in health care providers and trust in parental instincts. At later prediagnosis stages, parents continued to use social media, but the posts demonstrated increased frustration with delays in diagnosis and gaps in communication with providers. More objective symptom descriptions and a greatly reduced child-centered emotional focus were observed as parents shifted into caregiving roles. Once the diagnosis of SJIA was confirmed, parents used straightforward, less expressive language, and Facebook (47%) to make "announcement" posts and increased their use of SJIA websites (30%). With treatment initiation, the posts demonstrated a slow return of expressive language and an increased parental understanding of the "new normal".
  
  
  CONCLUSIONS
  Parents use different language styles, frames of reference, and websites before and after SJIA diagnosis. Gaps in parent-provider communication, especially before diagnosis, and their new roles as caregivers lead to parental use of social media to express frustration with the health care process. Providers should tailor their discussions with parents to address these issues.
authors.affiliation: Division of Pediatric Rheumatology, Immunology and Infectious Diseases, University of Florida, Gainesville, FL, USA.
authors.forename: Renee F
authors.initials: RF
authors.lastname: Modica
authors.affiliation: Immunology and Dermatology Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, USA.
authors.forename: Kathleen Graham
authors.initials: KG
authors.lastname: Lomax
authors.affiliation: Treato, Princeton, NJ, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Batzel
authors.affiliation: Treato, Princeton, NJ, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Shapardanis
authors.affiliation: Treato, Princeton, NJ, USA.
authors.forename: Kimberly Compton
authors.initials: KC
authors.lastname: Katzer
authors.affiliation: Division of Pediatric Rheumatology, Immunology and Infectious Diseases, University of Florida, Gainesville, FL, USA.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Elder
keywords: diagnostic process; language frames; linguistics; social media; systemic juvenile idiopathic arthritis