Visualizing YouTube Commenters’ Conceptions of the United States Healthcare System: A Semantic Network Method for Evidence-Based Policymaking (Preprint)

BACKGROUND The challenge of deriving meaningful patterns from social media cacophonies to inform decision makers remains insufficiently addressed. OBJECTIVE The purpose of this study was to test the application of a semantic network method to building an interactive visualization of social media discourse on the United States (U.S.) healthcare system METHODS Building upon bibliometric approaches to conducting health studies, we re-purposed a VOSviewer software program to analyze 179,193 YouTube posts about the U.S. healthcare system. Using the overlay-enhanced semantic network method, we mapped the contents and structure of the commentary evoked by 53 YouTube videos uploaded in 2014-2023 by the right, center, and left 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 semantic network’s robustness, representativeness, structural relevance, semantic accuracy, and decision support usefulness. We examined how the comments mentioning four health system design concepts – universal healthcare, Medicare for All, single-payer, and socialized medicine – were distributed across the network terms. RESULTS Grounded in actual text, the macro-level network representation unveiled complex discussions about illness and wellness; health services; ideology and society; the politics of healthcare agendas and reforms, market regulation, and health insurance; healthcare workforce; dental care; and wait times. We observed thematic alignment between the network terms, extracted from YouTube posts, and the videos that elicited these posts. Discussions about illness and wellness persistence across time, as well as international comparisons of costs of ambulances, specialist care, prescriptions, appointment wait times. The international comparisons were linked to commentaries with a higher concentration of British-spelled words, underscoring the global nature of the U.S. healthcare discussion which attracted domestic and global YouTube commenters. Shortage of nurses and nurse burnout, as well as factors contributing to it (e.g., shift work, nurse-to-patient staffing ratios, and corporate greed) were covered in comments with many likes. Posts about universal healthcare had much stronger ideological bearing than posts about single-payer health systems. CONCLUSIONS YouTube users addressed issues of societal and policy relevance: Social determinants of health, concerns for vulnerable populations, health equity, racism, healthcare 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.