MATERIALS AND METHODS
Reddit was chosen as the social media platform of interest given its increase in popularity and limited data surrounding its content on the subject of psoriasis and psoriatic arthritis. The data was collected from a publicly accessible forum, so this study was exempt from institutional review board approval.7
Publicly accessible posts and comments uploaded between March 1, 2021, and July 31, 2021, within two subreddits (r/psoriasis and r/psoriaticarthritis) were reviewed, and posts in English pertaining to PsO or PsA and biologics were manually extracted. The following search terms were utilized: "biologic", "biologics", "Humira", "Tremfya", "Cosentyx", "Taltz", "Skyrizi", "Remicade", "Stelara", "Enbrel", "Cimzia", and "Ilumya". All posts were de-identified before collection. The text of the post, as well as the total engagement (the sum of upvotes and reply comments), was recorded. Posts were assigned a sentiment corresponding to a numerical value (positive=1, negative=-1,
neutral=0) and then classified into a first-order and second-order theme. Reviewers delineated the themes as posts were identified.
Five first-order themes (FOTs) were identified: general comments (general), access to medication (access), efficacy (efficacy), safety/side effects (safety), and how the medication is used (use). In this paper, we focus on the themes of general and efficacy. Within these two FOTs, 15 second-order themes (SOTs) were identified (Table 1).
Statistical analysis was performed using STATA 15.0 (StataCorp LP, College Station, TX). Frequencies, mean engagement scores, and mean sentiment scores were calculated for each FOT and SOT. One-way analysis of variance (ANOVA) tests were used to determine differences in the mean engagement scores and mean sentiment scores between themes. Chi-squared tests were utilized to determine significant differences between sentiment and engagement within the themes. Level of significance was set to P<0.05.
RESULTS
A total of 1141 posts were extracted from Reddit. Among these, 708 (61.8%) were identified under the FOTs of general and efficacy. 532 posts were classified under the theme of efficacy, and 176 posts were identified within the general theme. The frequencies of each second-order theme, as well as sentiment, are described in Table 1. Among posts regarding efficacy, 68.0%
