Visualizing YouTube Commenters' Conceptions of the US Health Care System: Semantic Network Analysis Method for Evidence-Based Policy Making.

backgroundThe challenge of extracting meaningful patterns from the overwhelming noise of social media to guide decision-makers remains largely unresolved.

objectiveThis study aimed to evaluate the application of a semantic network method for creating an interactive visualization of social media discourse surrounding the US health care system.

methodsBuilding upon bibliometric approaches to conducting health studies, we repurposed the VOSviewer software program to analyze 179,193 YouTube comments about the US health care system. Using the overlay-enhanced semantic network method, we mapped the contents and structure of the commentary evoked by 53 YouTube videos uploaded in 2014 to 2023 by right-wing, left-wing, and centrist media outlets. The videos included newscasts, full-length documentaries, political satire, and stand-up comedy. We analyzed term co-occurrence network clusters, contextualized with custom-built information layers called overlays, and performed tests of the semantic network's robustness, representativeness, structural relevance, semantic accuracy, and usefulness for decision support. We examined how the comments mentioning 4 health system design concepts-universal health care, Medicare for All, single payer, and socialized medicine-were distributed across the network terms.

resultsGrounded in the textual data, the macrolevel network representation unveiled complex discussions about illness and wellness; health services; ideology and society; the politics of health care agendas and reforms, market regulation, and health insurance; the health care workforce; dental care; and wait times. We observed thematic alignment between the network terms, extracted from YouTube comments, and the videos that elicited these comments. Discussions about illness and wellness persisted across time, as well as international comparisons of costs of ambulances, specialist care, prescriptions, and appointment wait times. The international comparisons were linked to commentaries with a higher concentration of British-spelled words, underscoring the global nature of the US health care discussion, which attracted domestic and global YouTube commenters. Shortages of nurses, nurse burnout, and their contributing factors (eg, shift work, nurse-to-patient staffing ratios, and corporate greed) were covered in comments with many likes. Comments about universal health care had much higher use of ideological terms than comments about single-payer health systems.

conclusionsYouTube users addressed issues of societal and policy relevance: social determinants of health, concerns for populations considered vulnerable, health equity, racism, health care quality, and access to essential health services. Versatile and applicable to health policy studies, the method presented and evaluated in our study supports evidence-based decision-making and contextualized understanding of diverse viewpoints. Interactive visualizations can help to uncover large-scale patterns and guide strategic use of analytical resources to perform qualitative research.