Stroke Experiences in Weblogs: A Feasibility Study of Sex Differences

BACKGROUND Research on cerebral stroke symptoms using hospital records has reported that women experience more nontraditional symptoms of stroke (eg, mental status change, pain) than men do. This is an important issue because nontraditional symptoms may delay the decision to get medical assistance and increase the difficulty of correct diagnosis. In the present study, we investigate sex differences in the stroke experience as described in stories on weblogs. OBJECTIVE The goal of this study was to investigate the feasibility of using the Internet as a source of data for basic research on stroke experiences. METHODS Stroke experiences described in blogs were identified by using StoryUpgrade, a program that searches blog posts using a fictional prototype story. In this study, the prototype story was a description of a stroke experience. Retrieved stories coded by the researchers as relevant were used to update the search query and retrieve more stories using relevance feedback. Stories were coded for first- or third-person narrator, traditional and nontraditional patient symptoms, type of stroke, patient sex and age, delay before seeking medical assistance, and delay at hospital and in treatment. RESULTS There were 191 relevant stroke stories of which 174 stories reported symptoms (52.3% female and 47.7% male patients). There were no sex differences for each traditional or nontraditional stroke symptom by chi-square analysis (all Ps>.05). Type of narrator, however, affected report of traditional and nontraditional symptoms. Female first-person narrators (ie, the patient) were more likely to report mental status change (56.3%, 27/48) than male first-person narrators (36.4%, 16/44), a marginally significant effect by logistic regression (P=.056), whereas reports of third-person narrators did not differ for women (27.9%, 12/43) and men (28.2%, 11/39) patients. There were more reports of at least 1 nontraditional symptom in the 92 first-person reports (44.6%, 41/92) than in the 82 third-person reports (25.6%, 21/82, P=.006). Ischemic or hemorrhagic stroke was reported in 67 and 29 stories, respectively. Nontraditional symptoms varied with stroke type with 1 or more nontraditional symptoms reported for 79.3% (23/29) of hemorrhagic stroke patients and 53.7% (36/67) of ischemic stroke patients (P=.001). CONCLUSIONS The results replicate previous findings based on hospital interview data supporting the reliability of findings from weblogs. New findings include the effect of first- versus third-person narrator on sex differences in the report of nontraditional symptoms. This result suggests that narrator is an important variable to be examined in future studies. A fragmentary data problem limits some conclusions because important information, such as age, was not consistently reported. Age trends strengthen the feasibility of using the Internet for stroke research because older adults have significantly increased their Internet use in recent years.