Designing a Patient-Centered Clinical Workflow to Assess Cyberbully Experiences of Youths in the U.S. Healthcare System

Abstract

Cyberbullying or online harassment is often defined as when someone repeatedly and intentionally harasses, mistreats, or makes fun of others aiming to scare, anger or shame them using electronic devices [296]. Youths experiencing cyberbullying report higher levels of anxiety and depression, mental distress, suicide thoughts, and substance abuse than their non-bullied peers [360, 605, 261, 354]. Even though bullying is associated with significant health problems, to date, very little youth anti-bullying efforts are initiated and directed in clinical settings. There is presently no standardized procedure or workflow across health systems for systematically assessing cyberbullying or other equally dangerous online activities among vulnerable groups like children or adolescents [599].

Therefore, I developed a series of research projects to link digital indicators of cyberbullying or online harassment to clinical practices by advocating design considerations for a patient-centered clinical assessment and workflow that addresses patients’ needs and expectations to ensure quality care. Through this dissertation, I aim to answer these high-level research questions:

RQ1. How does the presence of severe online harassment on online platforms contribute to negative experiences and risky behaviors within vulnerable populations?

RQ2. How efficient is the current mechanism of screening these risky online negative experiences and behaviors, specifically related to cyberbully, within at-risk populations like adolescent in clinical settings?

RQ3. How might evidence of activities and negative harassing experiences on online platforms best be integrated into electronic health records during clinical treatment?

I first explore how harassment is presented within different social media platforms from diverse contexts and cultural norms (study 1,2, and 3); next, by analyzing actual patient data, I address current limitations in the screening process in clinical settings that fail to efficiently address core aspect of cyberbullying and their consequences within adolescent patients (study 4 and 5); finally, connecting all my findings, I recommend specific design guidelines for a refined screening tool and structured processes for implementation and integration of the screened data into patients’ electronic health records (EHRs) for better patient assessment and treatment outcomes around cyberbully within adolescent patients (study 6).