Exploratory study: Health promotion through Wikipedia outreach and educational activities

doi:10.21203/rs.3.rs-3568640/v1

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Research Article

Exploratory study: Health promotion through Wikipedia outreach and educational activities

https://doi.org/10.21203/rs.3.rs-3568640/v1

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published 30 Sep, 2024

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Background

Several health institutions developed strategies to improve health content on Wikimedia platforms, given their unparalleled reach. The objective of this study was to compare an online a volunteer-based Wikimedia outreach campaign and Wikipedia university course assignments in terms of the reach of the contributions and evaluate the extent of the students' input.

Methods

In 2022, researchers from seven Brazilian universities and a Canadian university, in coordination with the National Institute for Occupational Safety and Health, the World Health Organization, the Ronin Institute, and Wiki Movimento Brasil, received a grant from the State of São Paulo (Brazil) that supported the 1) coordination of improvements in hearing and healthcare content through educational programs using Wikimedia platforms and 2) participation in the global campaign Wiki4WorldHearingDay2023. We examined the feasibility and the implementation of the two strategies and compared the contributions from those enrolled in educational activities versus volunteer activities from Wikipedia editors to a global campaign.

Results

The strategy was demonstrated to be feasible. It increased the availability of quality plain language information on hearing conditions and hearing care. By May 1, 2023, Wiki4WorldHearingDay2023, 145 participants (78 from educational programs) had contributed 167,000 words, 259 + references and 140 images to 322 Wikipedia articles (283 existing and 39 new ones), which were viewed by 16.5 million readers. Contributions occurred in 6 languages. Edits in Portuguese, mainly by those involved in educational programs, led the number of articles (226 or 70.2%) that were expanded or created during the 5-month tracking period.

Conclusions

The crowdsourcing of expertise and knowledge is relevant for public health. This study’s approach can be applied in other contexts. In addition to the coordination with educational programs, the elements that contributed to the success of these initiatives include an impact topic, international collaborations, the connection with a robust local Wikimedia affiliate, and the use of a technical infrastructure that gives us metrics and coordination mechanisms. The partnerships, the dissemination of the work in several platforms, the participation of multidisciplinary teams, and the availability of resources through institutional support and funding were additional elements that contributed to the success of these initiatives.

Science communication

hearing loss

hearing health

educational programs

Wikimedia

misinformation

Hearing loss can be a seriously disabling condition due to the integral role of hearing in human communication. Hearing-impaired individuals often avoid situations in which communication is difficult, rather than risking a misunderstanding and potentially embarrassing mistakes. This tendency leads to isolation, difficulties at school and work, and possibly adverse psychological consequences. Persons with hearing loss are more prone to falls and accidents as a result of impaired speech perception or an inability to hear audible warnings. Addressing hearing loss has been shown to be an important modifying factor toward reducing rates of cognitive decline in populations. Greater awareness and improved health services are needed for the prevention of these hearing disorders (1, 2).

In 2021, the World Health Organization published its first World Report on Hearing, following a resolution from the World Health Assembly of 2017, highlighting not only the individual but also societal costs of hearing loss (1, 2). Globally, unaddressed hearing loss was estimated to cost nearly 1 trillion international dollars in 2020, an amount expected to rise unless public health advances are implemented (3). The World Report on Hearing (2) also contrasts the availability and access to ear and hearing care across the world (2). As an example, outside high-income countries, it was estimated that only 17% of people who need hearing aids have access to them (4). There is evidence of a gap of several years between the first signs of hearing difficulties and the search for care (5, 6). There are many reasons for the gap in ear and hearing care across countries, one of them being the lack of accurate and understandable information (7–9). Across countries, the promotion of public health is hindered by the lack of available and accessible information on health conditions and services, a challenge clearly demonstrated for hearing health (9–12).

The abundance of communication channels and the overload of misinformation make it challenging for the public to locate timely, accessible, science-based health information in credible public spaces. Wikipedia is recognized for advancing public health and is one of the most accessed health information sources (13–16). It can be used to deliver information quickly and effectively to broad, established, and relevant audiences. Initiatives dedicated to expanding and improving Wikipedia content are also gaining scholarly recognition due to the increasing number of educational programs that incorporate Wikipedia writing assignments. (17). In addition, there is a growing number peer-reviewed articles on studies that used Wikimedia platforms and datasets in health research, given the accessibility and transparency they provide (see Wikipedia: Academic studies of health information on Wikipedia - Wikipedia) (18).

Leading health organizations noted that science-based information on health conditions, therapies, and events (epidemics or disasters) can be missing/underdeveloped on Wikipedia. Some, including Cochrane(19), Cancer Research UK(20), and the CDC's National Institute for Occupational Safety and Health(21), developed strategies to integrate content on Wikipedia and evaluate readership/community response. Their efforts align with Open Science principles and other efforts to increase and expedite the reach and accessibility of health information to the public.

The objective of this exploratory study was to evaluate a strategy to maximize the availability of focused content on hearing health in Wikimedia’s public digital knowledge archives. The evaluation included examining the feasibility and factors that contribute to the implementation of a health communication strategy involving education and outreach activities and included multiple partners.

This exploratory study was designed to evaluate the feasibility and contributions of two initiatives to increase the availability of quality plain language health information on hearing conditions and hearing care. These initiatives consisted of the 1) coordination of improvements of Wikipedia content in hearing and healthcare through educational programs using Wikimedia platforms and 2) participation in the global outreach program Wiki4WorldHearingDay2023(22). We also compared the contribution to the global program from those enrolled in educational activities versus volunteer activities from Wikipedia editors. The project activities are some of those included in a larger Wikimedia campaign: Hearing health 2022–2024 (23).

Participating institutions and coordination

In 2022, a research consortium composed of professors from seven Brazilian universities (Universidade de São Paulo, Universidade Federal de Santa Catarina; Universidade Federal do Rio Grande do Norte; Universidade Federal de Sergipe; Faculdade Cásper Líbero; Universidade de São Caetano do Sul and Universidade Tuiuti do Paraná), the University of Montreal, Canada, researchers from the Ronin Institute, USA, University of Virginia, USA, the National Institute for Occupational Safety and Health, of the Center for Disease Control and Prevention, USA, the Ear and Hearing Care Office of the World Health Organization, Switzerland, and Wiki Movimento Brasil (a Wikimedia national affiliate), received grant 2021/06902-2 from the Call for Proposals for Internet Strategic Research (24) from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo). The grant has several aims and activities. In this study we are only reporting the results of two of the aims (cited above). Seventy-eight students who were enrolled in educational activities (either coursework or learning extension programs) between July 2022 and April 2023 were invited to join Wiki4WorldHearingDay2023. Figure 1 displays a timeline of the activities of this research consortium included in this exploratory study.

>>> Insert Fig. 1 about here <<<

Figure 1. Timeline of activities, activity type and number of contributors to the outreach campaign Wiki4WorldHearingDay 2023.

[Legend to be place below Fig. 1]: WHO = World Health Organization; NIOSH = National Institute for Occupational Safety and Health; > indicates settings where some of the participants developed content as a group, and only one of the group members published the new content using a single Wikipedia account identifier.

The courses from the six different participating university programs (five undergraduate and one graduate) are identified in Table 1.

Table 1

Educational activities in which students contributed to Wiki4WorldHearingDay2023 between November 2022 and April 2023.
Educational Programs from which participated in Wiki4WorldHearingDay2023
Université de Montréal (discipline) ● Promotion and prevention in audiology I and II (Promotion et prévention en audiologie)
Universidade de São Paulo (disciplines) ● Audiological Theory and Diagnosis II (Teoria e Diagnóstico Audiológico II) ● Audiological Theory and Diagnosis III- Pediatrics (Teoria e Diagnóstico Audiológico III – Infantil) ● Educational Audiology and Hearing Rehabilitation I (Audiologia Educacional e Reabilitação Auditiva I)
Universidade Federal de Santa Catarina ● Advanced Topics in Speech Pathology-Language and Audiology Therapy in Primary Health Care (Tópicos Avançados em Fonoaudiologia na Atenção Primária à Saúde) (discipline) ● Hearing health - Wikipedia as a learning tool in health disciplines (Saúde auditiva - Wikipédia como ferramenta de aprendizagem em saúde) (extension activity) ● Module XII – The Therapeutic Process I – Therapy of Hearing Disorders (Módulo XII – O Processo Terapêutico I – Terapia das Alterações da Audição) (discipline)
Universidade Tuiuti do Paraná (extension activity) ● Work, Health and Society Study Group (Núcleo de estudos- Trabalho Saúde e Sociedade)
Universidade Federal de Sergipe, (extension activity) ● Hearing health - Wikipedia as a learning tool in health disciplines (Saúde auditiva: Wikipédia como ferramenta de aprendizagem em saúde)
Universidade Federal do Rio Grande do Norte (discipline) ● Hearing Development, Assessment, and Intervention (Desenvolvimento, Avaliação e Intervenção em Audição)
Sources: Campaign: Hearing health 2022–2024 (Articles) (25) / Projeto Saúde Auditiva (26)

>>> Insert Table 1 about here <<<

The coordination of the educational activities in Brazil was performed by the principal investigator (L.J., Universidade de São Paulo), while coordination for the global campaign was performed by the first author (T.M., National Institute for Occupational Safety and Health). The coordination and management of the activities are described in a public-facing platform on the Portuguese Wikiversity (Wikiversidade, Projeto Saúde Auditiva)(26). Wikiversity is a Wikimedia Foundation project that supports learning communities, their learning materials, and resulting activities.

Participants

Educational activities

For the duration of the 2-year project (April 2022- March 2024), 159 students from 11 speech pathology and audiology courses at 8 universities were assigned to expand and/or improve Wikipedia articles related to hearing, hearing health services, hearing testing, and hearing preventive and treatment interventions as part of their coursework. Of these, 78 students participated in the Wiki4WorldHearingDay2023 effort and were included in this exploratory study (see Fig. 1). To our knowledge, the remaining 67 Wiki4WorldHearingDay2023 participants were volunteer contributors not associated with any formal educational program. Forty of them were volunteers who participated in short (2-to-3-hour training events); the remaining 20 were independent volunteer editors not associated with this study. These numbers are likely to be undercounts, as some edits were performed by a group of individuals using a single Wikipedia account identifier.

Training

A formal training process was developed and implemented throughout the duration of the courses (which ranged from 3 to 12 months). The extent of their edits and participation were used to evaluate the viability of the approach. Instructors reviewed student edits before they were published. As an external quality indicator, we examined whether Wikipedia, through their process of public review, accepted (kept) their edits.

In Brazil, training was offered by experienced Wikipedia writers and editors who used educational materials and tutorials developed by the local Wikimedia affiliate Wiki Movimento Brasil (27) and from the training library of the Wikipedia Education Foundation(28). In Canada, the instructor used the Wiki Edu platform and dashboard, and in-person training was provided by an expert from the local Wikimedia affiliate Wikimedia Canada. The Wikipedia training covered the theoretical framework of the platform; hands-on guidance showed the processes for editing, translating, and developing content. In addition, the Wikipedia Crowdsourcing Group from the University of São Paulo held online workshops and technical support training sessions throughout the effort.

The main objective of the training was to show the students how to discover associated content gaps in Wikipedia, to locate and evaluate sources for their verifiability and to improve the content on the platform. Activities involving Wikipedia included (1) locating and evaluating specific content on the intersection of audiology and hearing care; (2) discussing scientific evidence in these topic areas; (3) engaging in the health education process; and (4) introducing students to a public-directed scientific writing experience.

All courses utilized the Wikipedia-specific “My Sandbox” page, which is a tool offered by Wikipedia that allows students to practice drafting edits in a nonindexed namespace prior to making life changes to Wikipedia. In addition to providing a low-stakes environment to practice editing, instructors reviewed their edits while they were in “My Sandbox.”

Students had the option to work in groups or individually in 2 of the courses. In 3 extension activities and in 3 courses, students were expected to complete assignments independently; in 2 courses, students were expected to develop content in groups. In all courses, students could select the article to edit based on the course topic and/or from an instructor-provided list, and when they declined deciding, instructors assigned them with a specific topic.

Wiki4WorldHearingDay2023 activities

The National Institute for Occupational Safety and Health (NIOSH) has participated in the annual World Hearing Day activities (29) organized by the Office of Ear and Hearing Care of the World Health Organization (WHO) since the campaigns were launched in 2015. In 2023, the theme of the campaign was “Ear and hearing care for all! Let’s make it a reality.” NIOSH coordinated with the WHO on an initiative to improve Wikipedia content related to hearing, hearing health services, hearing testing, and preventive and rehabilitative interventions. The Wiki4WorldHearingDay2023 campaign (22) provided a platform (translated into seven languages) and tutorials to guide participants in creating/editing Wikipedia content and allowed anyone with access to a computer and the internet to participate in the campaign. This initiative was informed and motivated by the success of two earlier efforts, Wiki4WorldHearingDay2019 and Wiki4YearOfSound2020 (30–33).

Short-duration training events

The Wiki4WorldHearingDay2023 campaign launched on November 18, 2022, with a hybrid workshop at the World Health Organization headquarters in Geneva, attended by approximately 22 participants. Presentations covered the need for a multifaceted approach to improving hearing-related content on Wikipedia and an overview of health knowledge in the Wikimedia ecosystem, including a list of existing Wikipedia articles pertaining to hearing. (34) The WHO streamed and recorded the event, then archived the recording (35). Participants were from several countries ─ including Chile, Zambia, England, India, Austria, Brazil, Uganda, Australia, Italy, and Georgia. Toward promoting participation in Wiki4WorkdHearingDay2023, four other training courses took place on how to create effective Wikipedia content. One 4-hour in-person training occurred at NIOSH in the US, offered by the first author and NIOSH’s Wikimedian-in-Residence and included 10 participants, and their contributions were only counted in the dashboard of Wiki4WorldHearingDay. They included edits to Wikipedia in English, Spanish and Chinese. The other in-person training took place at a conference in Brazil (for which results were also counted and combined with the main dashboard)(36). Approximately 50 of the conference attendees participated and counted with the support of Wiki Movimento Brasil and 9 experienced volunteer editors. Two shorter online trainings also took place (for the Global Coalition of Parents of Children who are Deaf or Hard of Hearing (37) for which results were also counted separately and later combined with the main dashboard) and one at NIOSH (part of the main dashboard). The Wiki4WorldHearingDay2023 effort officially closed on March 23, 2023, at an audiology conference in Florianópolis, Brazil (for which results were also counted separately and later combined with the main dashboard).

Because Wikipedia tracks contributions by account and because multiple people may have shared a computer and account at the event, we have limited information on whether volunteer Wiki4WorldHearingDay2023 participants (other than those involved in education activities) worked in groups or as individuals. The authors reviewed edited articles for eligibility to be included and tracked by the outreach dashboard based on their association with the theme of the campaign.

Tracking of contributions

We used Wikimedia’s Program and Events Dashboard(38), a web tool that assists in the management of wiki programs, activities, and events. This web application was adapted from a dashboard created for educational purposes by the Wiki Education Foundation. The platform reports the evolution of interventions and provides statistical parameters that can be used for evaluation. The parameters include the number of page views, number of characters added, number of references added, number of media files incorporated, and indicators of quality of the entry provided by automated tools that use metrics such as readability, amount of information, number of citations/references, syntax, compliance with editing policies and other official website policies. The authors set up an event page and used many communication channels (partners’ newsletters, emails, social media channels) to invite anyone with a Wikimedia account to register as a participant in Wiki4WorldHearingDay2023(22). After registering, participants' contributions to Wikipedia began to be tracked. Observers can view outcomes for programs in which they are not participants. The dashboard is used by schools of all age levels, universities, edit-a-thons, writing contests and outreach campaigns. We used it to track the progress of both the educational and campaign activities(23). Note that this link includes other activities not examined by the present study.

Wiki4WorldHearingDay2023: quantitative assessment

Activities from the Wiki4WorldHearingDay2023 were tracked from November 17, 2022, through May 1st, 2023 - available in Outreach Wikipedia Edit-a-thon4World Hearing Day 2023(39). Overall, the results indicated that 167,000 words were contributed to 322 (283 existing and 39 new) Wikipedia articles, and 140 media files were uploaded to the open access repository Wikimedia Commons. These expanded (edited) and new articles received more than 16.5 million views during the 5-month tracking period.

For this study, edits on topics closely related to hearing and hearing care were divided into the following categories: hearing conditions, anatomical sites, audiological tests, treatments and rehabilitation, health care, risk factors, prevention, musicians’ health, and hearing conditions in film. Wikipedia's content was also expanded on topics that were not only directly related, but also one step removed from target topics, and we kept tracking of those topics. The article that attracted the most views was ChatGPT (12,254,560), a significant outlier, which we excluded from the present analysis. Content and citations on the challenges and opportunities in the uses of ChatGPT for health services and health communication were added to the ChatGPT Wikipedia article. The tracking of unrelated topics was disabled by the first author (T.M.). Contributions occurred in several languages: English, Portuguese, French, Spanish, Chinese, and German.

Table 2

Number of articles edited, number of edits and words added during Wiki4WorldHearingDay2023, by language.
Language	# of articles edited	total edits	# of articles created	# of words added
English	60	120	2	7280
Spanish	10	19	1	4900
Portuguese	195	575	31	103124
French	9	139	0	29600
German	3	4	0	185
Chinese	6	9	5	13500
Total	283	866	39	1585891

Source: Outreach Wikipedia Edit-a-thon 4 World Hearing Day 2023. (39)

Reach and extent of edits from the intersection between Wiki4WorldHearingDay2023 and educational activities

Many detailed metrics are available through Wikimedia’s Program and Events Dashboard. Given the aims of the current study, we report the number of views of the edited articles, the extent of the edits (number of words added), and whether the contributions remained in Wikipedia (deemed acceptable by Wikipedia's public review process). Another informative metric in these efforts is the number of references added to an article. We decided against analyzing the number of references because the tool currently is unable to track these are not available for edits done to Wikipedia in languages other than English.

The default setting of the tool sets tracking of the number of views to 30 days after the end of the activity to capture the reach of edits that took place at the last period of the event. Caution is needed when interpreting the visualization results. This metric includes the visualization by participants while editing an article. Articles edited and tracked early in the activity have longer tracking periods than those edited on the activity’s last day. However, it provides information on the level of interest from readers across topics.

Instructors and students selected articles for development or expansion based on the subject matter of the class and considering their relevance in the context of each discipline. They also examined related Wikipedia categories (identified at the bottom of each Wikipedia article), such as audiology, acoustics, anatomy, health care, and universal health care.

In addition to the number of views, the extent of edits, captured as the number of words, was the other metric we selected to report, despite its limitations. While all actions can be reviewed in the outreach dashboard(39) and in particular edits by article, by editor in the Articles tab, option “Assessment tools” we selected to report the top five most viewed articles and the top five articles that were more extensively edited, by thematic subcategory (accessed on September 14, 2023). We considered this to be sufficient for the analysis of the strategy results. The resulting number may express the efforts from a single individual or a group (see Table 2). Of the 283 edited Wikipedia articles, 281 were accepted and remained in Wikipedia.

Table 3 displays the five most viewed articles during the Wiki4WorldHearingDay2023, by subtopic and five articles, that received the most extensive edits, by subtopic.

Table 3

Wiki4WorldHearingDay2023: Five most viewed articles and five articles that received most extensive edits, by subtopic. Articles were edited at different times during the campaign, so the tracking duration for each edit was different.
Top five most viewed articles by Topic area/articles	Number of views	Number of words added	Top five articles by the extent of edits by Topic area/articles	Number of words added	Number of views
Hearing Conditions -Total	1298848	876	Hearing Conditions -Total	30669	5625
Tinnitus	463185	545	Trouble du traitement auditif (fr)*	17293	3164
Meniere’s disease	469956	36	Pérdida auditiva ocupacional (sp)	3795	1211
Cauliflower ear	187849	7	Doenças infectocontagiosas e audição (pt)*	3684	264
Cholesteatoma	93457	288	Hearing loss (zh)	3057	0
Auditory processing disorder	84401	0 ( ∓ 3)	Perda auditiva induzida por ruído (pt)*	2840	986
Anatomical Sites - Total	238584	72	Anatomical Sites - Total	7109	14096
Middle ear	55635	25	Aparelho vestibular (pt)*	1899	7095
Cochlea	62816	11	Système auditif (fr)*	1760	1742
Inner ear	46278	9	Nervo vestibulococlear (pt)*	1498	3577
Ear canal	43640	9	Sistema auditivo periférico (pt)*	1372	534
Organ of Corti	30215	18	Órgão de Corti (pt)*	580	1148
Audiological Tests-Total	39500	1992	Audiological Tests-Total	11790	5584
Auditory brainstem response	12122	4	Mascaramento em audiometria (pt)*	2912	1728
Tympanometry	12810	9	Medida da imitância acústica (pt)*	2842	401
Timpanometria (pt)*	7898	2	Testes acumétricos (deleted-pt)*	2163	0
Audiometria (pt)*	2092	1904	Émission oto-acoustique (fr)*	1969	1363
Electrocochleography	4578	73	Audiometria (pt)*	1904	2092
Treatment/rehabilitation- Total	318134	155	Treatment/rehabilitation- Total	1587	101485
Sign language	216947	4	Leitura labial (pt)*	387	820
Hearing aid	86969	21	Tuba auditiva (pt)*	122	3198
Tinnitus retraining therapy	10289	8	Hearing aid	21	86969
Aparelho de amplificação sonora individual (pt)	731	0	Tinnitus retraining therapy	8	10289
Tuba auditiva (pt)*	3198	122	Habilitação e reabilitação auditiva (pt)*	1049	209
Health Care- Total	268029	772	Health Care- Total	739	192180
Universal health care	87729	46	Primary health care	277	59009
Primary health care	59009	277	Global health	201	14480
COVID-19 vaccine	77851	82	Sistema Único de Saúde (pt)*	166	28960
Sistema Único de Saúde (pt)*	28960	166	Saúde do trabalhador (pt)*	49	2002
Global health	14480	201	Universal health care	46	87729
Risk factors- Total	287888	146	Risk factors- Total	13913	4243
COVID-19 vaccine	256913	82	Envenenamento por organofosforado (pt)	12589	400
Poluição sonora (pt)*	4546	14	Ruído ambiental (pt)*	951	477
Pollution sonore (fr)*	5524	14	Efeitos da poluição sonora na saúde (pt)*	39	763
Ruído (es)*	19307	14	Ototoxicidade (pt)*	312	1005
Ototoxicite (fr)*	1598	22	Ototoxicite (fr)*	22	1598
Prevention -Total	50585	461	Prevention -Total	2174	11815
Ear plug	23407	9	Escuta Segura (pt)	776	380
Health promotion	15518	69	Safe listening	614	3206
Hearing protection device	6668	53	Dia Mundial da Audição (pt)*	346	266
Lei do silêncio (pt)	3783	10	World Hearing Day	320	1209
World Hearing Day	1209	320	Construction site safety	118	6754
Music- Total	21316	2434	Music- Total	2434	21316
Diplacusis	14268	235	Riscos auditivos em músicos (pt)*	561	317
Safe listening	3206	614	Health problems of musicians	248	3145
Health problems of musicians	3145	248	Diplacusis	235	14268
Riscos auditivos em músicos (pt)*	317	561	Escuta segura (pt)	776	380
Escuta segura (pt)	380	776	Safe listening	614	3206
Hearing Conditions in Film- Total	923631	16	Hearing Conditions in Film- Total	16	923631
CODA	583354	5	CODA	5	583354
Sound of metal	205384	5	Sound of metal	5	205384
Children of a lesser God	102103	3	Children of a lesser God	3	102103
List of films featuring deaf and hard of hearing	32790	3	List of films featuring deaf and hard of hearing	3	32790
Abbreviations: (pt = Portuguese, fr = French, es = Spanish, zh = Chinese, NA = not available). Asterisks indicate content developed as part of a classroom activity. Italics indicate articles that were both among most viewed and among those that were more extensively edited.
For the elaboration of this Table and, consequently, the ranking of the Articles, edits to sandbox users and articles only remotely associated with these themes were excluded. Articles were edited at different times during the campaign, so the tracking duration for each edit was different. Source: Outreach Wikipedia Edit-a-thon 4 World Hearing Day 2023. (39)

>> Please insert Table 3 here<<

With a few exceptions, Table 3 shows that the most viewed articles were not among the most edited ones. The subtopic “Hearing conditions” registered the highest number of views (1,298,848), followed closely by those in the category “Hearing conditions in Film” (923,631). The articles that received the most extensive edits were Auditory processing disorder (in French “Trouble du traitement auditif”) with 17,293 words added and Organophosphate poisoning (in Portuguese “Envenenamento por organofosforado”), with 12,589 words added.

An extensive body of knowledge exists on a wide range of health outcomes; however, studies from public health settings suggest that evidence-based practices are not disseminated effectively (40–42). More specifically, we lack data demonstrating that available evidence from the scientific literature is coming to and influencing prevention programs and interventions or reaching the ultimate beneficiary (43). Wikipedia has been considered an important resource for healthcare information in different contexts, as it is able to reach the public, patients, students, and professionals looking for health-related information online (15, 44, 45).

NIOSH was one of the first US federal agencies to collaborate with the Wikimedia organizations, which developed into a multicomponent strategy.(21) One of these components involves partnering with education programs for the assignment of Wikipedia editing tasks to students. Another component involves organizing events of all sizes to expand and improve Wikipedia content in specific areas. NIOSH, in collaboration with the WHO and several other institutions, organized the global online events Wiki4WorldHearingDay2019 and Wiki4YearOfSound2020, and Wiki4WorldHearingDay2023 (focus of the present study) to improve the Wikipedia content related to acoustics, hearing, hearing health services, hearing testing, preventive and treatment interventions(30, 31). The participation of those enrolled in education activities had a large impact on the extent of contributions completed during the data collection period of this study.

The objectives of the present study were to examine the feasibility and factors that contributed to the implementation of two strategies for science communication using Wikimedia platforms. We compared the contribution to the global campaign from those enrolled in educational activities versus volunteer activities from Wikipedia editors. We reported the number of views of the edited articles, the extent of the edits (number of words added), and whether the contributions remained in Wikipedia (deemed acceptable by Wikipedia's public review process). The approach taken was feasible, and its components (outreach efforts and educational activities) were mutually beneficial. The lessons learned from this analysis can guide the development of similar future activities across different disciplines.

Wiki4WorldHearingDay2023: quantitative assessment

Editing Wikipedia was a new type of activity for more than half of the participants of Wiki4WorldHearingDay2023; nonetheless only two of the 39 new articles developed were deleted in the scrutiny of Wikipedia’s public review process.(39) This is an indicator of the success of the effort.

Despite its limitations, the number of article views is a metric often reported when Wikipedia efforts are studied (44, 46–48). Perhaps due to initial skepticism toward Wikipedia content, the motivation behind reporting this metric was to demonstrate how widely health pages are read by the public, as well as physicians and medical students (45). In addition, information on the level of interest in a topic by both editors and the public is valuable for researchers, health care practitioners, and health communication professionals in planning and prioritizing research and communication efforts.

The 145 participants (78 from educational programs) of Wiki4WorldHearingDay2023 (39) contributed 155,000 words, 258 + references and 140 images to 283 existing and 39 new Wikipedia articles (Outreach Dashboard accessed on September 14, 2023). Given our objectives, we considered sufficient to report the results of the top 5 most visited articles on topics closely related to hearing and hearing care in the following 9 categories: hearing conditions, anatomical sites, audiological tests, treatments and rehabilitation, health care, risk factors, prevention, music, and media coverage of hearing and deafness through films. Wikipedia's content was also expanded on topics that were one-step removed from target topics but were not included in our analysis; edits to unrelated topics were not tracked.

The limitations from the number of views metric arise from not being able to exclude the number of views an article receives in the process of it being edited. More significant perhaps is that the period of tracking can be very different in events of long duration. Articles edited and tracked early in the event have longer tracking periods than those edited on the event last day. This is not an issue for short duration events, such as the Vaccine Safety Virtual Wikipedia Edit-a-ton (49).

Intersection between Wiki4WorldHearingDay2023 and educational activities

Contributions occurred in 6 languages. Students who were enrolled in this study’s educational activities edited in Portuguese and French contributed the bulk of the new content (70.2%). Edits in other languages were from volunteers who we assumed were not tasked to edit Wikipedia as part of an educational activity.

Wikipedia exists in more than 323 official language editions that meet the eligibility requisites established by the Wikimedia Foundation(50). The content of each Wikipedia edition is independent of the others, but equivalent Wikipedia articles in different languages can be linked via interlanguage links. Wikidata (a collaborative, multilingual, and machine-readable database) is used by various language-editions of Wikipedia to ensure consistency of content across the platform.

Knowledge equity and health promotion

As part of the Wikimedia Foundation Strategy Process, a goal was identified to establish a fair and quality representation of knowledge and peoples or “knowledge equity” across the different platforms in the Wikimedia movement(51). Notwithstanding the editorial freedom that editors enjoy across platforms, there are various community initiatives attempting to coordinate efforts to address various gaps and inconsistencies in content between different languages (52, 53). We argue that outreach efforts such as those described in the present study contribute to the knowledge equity goal.

In addition, the significance of this effort is magnified by its focus, given the need to increase available and accessible information on hearing health conditions and services, particularly directed to low- and middle-income countries. Expanding the availability of content in Portuguese Wikipedia can prove beneficial not only to populations in Brazil but also to other Portuguese-speaking countries or regions (Portugal, Cape Verde, Angola, Mozambique, Guinea-Bissau, São Tomé and Príncipe, East Timor, Equatorial Guinea, Goa and Macau).

Comparisons with previous studies

Previous similar efforts included Wiki4WorldHearingDay2019 and Wiki4YearOfSound2020 online programs(47). These efforts had different durations than the ones included in the present study. Wiki4WorldHearingDay2019 lasted 2 months, while Wiki4YearOfSound2020 lasted 12 months. The Brazilian student participants were involved in an extension activity for which they did not receive a grade or formal credits. Nevertheless, the group edited 37 articles, which attracted more than 220,000 views during the set tracking period. Students were responsible for 60% of the Portuguese-language edits during the Wiki4WorldHearingDay2019 campaign and more than 90% of the Portuguese-language edits during the first half of the Wiki4YearOfSound2020 campaign. Moreover, the quality indexes for pages either created or edited were improved in all situations by registering an increase rate ranging from 33–100%(47). These results are similar to those we report here (from a coursework activity to be graded and a volunteer activity from extension activities), despite the different duration of the events and differences in the type of student participation from the previous study (who were exclusively from an extension activity). The participation of students in extension activities for which they did not receive a grade suggests that the act of sharing knowledge by writing for a larger audience on a publicly accessible platform was enough to motivate participation. While the campaign greatly benefited from the participation of those who were involved in the educational programs, faculty and students reported that, in turn, their participation in Wiki4WorldHearingDay programs provided them with context, inspired them toward the work, and gave them a sense of inclusion and representation.

Informal feedback from students and instructors who participated in the present study indicated appreciation for the opportunity to improve their digital literacy and science communication skills, as well as the opportunity to combat misinformation. Instructors also communicated that writing for Wikipedia offers a unique opportunity for students to interact with interlocutors outside the academic-professional universe who are interested in the common content. They added that the topic of public health relevance, an international articulation, the connection with a robust local Wikimedia affiliate, the use of a social-technical infrastructure that gives anyone metrics and coordination mechanisms were the elements that contributed to the success of these initiatives. In other words, while educational activities greatly increased the accomplishments of outreach efforts such as Wiki4WorldHearingDay2023, in turn, being part of a global activity increased the participants’ motivation students to engage in this coursework assignment.

More formal documentation of the reactions from students who participated in education programs that include Wikipedia activities is available from previous studies (48, 54–60). A study on the perspectives from health profession educators on teaching with Wikipedia reported that two themes summarize the benefits of teaching with Wikipedia: “1) that it provides a meaningful instructional alternative while helping society and developing learners’ information literacy” and “2) that Wikipedia supports learners’ careers and professional identity formation” (61). Identified challenges included extent of effort and time, restrictive Wikipedia sourcing guidelines, and difficult interactions with stakeholders(61). For information on the Wikimedia Foundation’s educational efforts, see Wikimedia Communities and Education (62).

Information gained by number of views versus extent of edits

We reported the extent of the edits completed (in number of words added). Only in a few cases the most viewed articles were those that received more extensive edits. Previous observations indicated that expanding and improving Wikipedia articles is associated with an increase in the number of views (15, 16, 30). Students, particularly when new to Wikipedia editing, are often encouraged to contribute to articles that have received a low-quality classification (information usually available for any Wikipedia article).

Our findings also made two different perspectives and motivations explicit. The views suggest that in the scope of our activities (hearing health), the motivation behind the number of views among the population at large is greater for specific hearing conditions, general information on health care, treatments, and popular portrayals of those in film. This information is valuable for those who work in health communication. From the instructors’ and students’ perspective, it was more important to select articles for development or expansion based on the subject matter of the class. Nevertheless, both results (small improvements to articles that attract a large number of edits or more extensive edits to articles not yet attracting a large number of views) contribute to our ultimate objective of increasing the availability of quality plain language health information on hearing conditions and hearing care.

Our experiences in this project can be applied in other contexts. Our approach is flexible enough to be adapted in a context-specific way for other topics, institutions, and countries. Instructors are not expected to become Wikipedia experts to incorporate Wikipedia activities in the coursework. A total of 141 Wikimedia groups exist and support people around the world to collect and develop educational content under a free license or in the public domain and to disseminate it effectively and globally(63). The Wikipedia and Education User Group is another source of support, including volunteer members, training materials and tools.(64) In the US and Canada, instructors can use support from Wiki Edu (65).

Study limitations and recommendations for future actions

While this study satisfactorily met its goals, there were limitations in our approach. The limitations associated with the metric selected for this study were discussed earlier and are inherent to Wikimedia’s Program and Events Dashboard.(38) Some of them are associated with the tracking of activities in Wikipedia in languages other than English. By the time of publication of this article, the number of references added during editing of Wikipedia articles, an important metric, is only tracked by the English Wikipedia. This and other weaknesses are in queue to be corrected in the near future.

Another limitation pertains to the different periods for tracking the number of views for editing efforts of long duration. Programs associated with an outreach campaign can address this limitation by shortening its duration. For educational activities, instructors are encouraged to consider asking students to move their edits from the sandbox to Wikipedia’s main space on the same date. Also, if organizers/instructors limited the themes to be edited or preselected specific articles to be expanded or created would make the activity easier to manage and deliver results more closely aligned to their objectives.

We did not include a separate analysis of the contributions from volunteer participants who were not part of formal educational activities, as it was not part of the objective of this study. Those who attended training events provided meaningful contributions in several languages (English, Portuguese, Spanish and Chinese). For future studies, we recommend comparing the extent and quality of contribution by volunteers who participated in training events and those who did not.

In addition we did not track or compare contributions by individuals versus the contributions of groups. We suggest studies to determine the effectiveness of each method (individual work with collaborative editing). We also encourage the collection of anonymous data for student feedback.

While a quality evaluation of the contributed content would allow us to further interpret the data from this effort, such analysis would be challenging given the scale of our dataset, and it was outside the scope of the study. However, we are aware that Wikimedia offers tools to facilitate evaluation from of this perspective.

While our study demonstrated the feasibility of the approach, it was only feasible after five years of experimenting with different strategies, building of partnerships, an international articulation, the connection with a robust local Wikimedia affiliate and financial support through a grant.

The number of views during our effort confirm Wikipedia to be a prominent source of online health information, meriting consideration in health communication and health promotion strategies. Wikipedia metrics allow researchers to learn what health topics are attracting public interest. The two outreach initiatives described in this study satisfactorily met the goals of this study while increasing the availability of quality plain language health information on hearing conditions and hearing care in several languages. Access to health information can help with decisions to seek care and improve outcomes.

Wikipedia can make a meaningful contribution to improving health literacy in the general population and the working population globally. In addition to increasing the availability and accessibility of science and health content, participants in Wikipedia activities develop academic and digital literacies by learning about sourcing and citing and writing to a new media (encyclopedic)(66). Participants exercise distinguishing reliable content from misinformation and improve their collaborative skills, particularly online (59).

Finally, the activities described here are aligned with the principles of open science as defined by UNESCO in 2022 (67). These principles aim to open the processes of scientific knowledge creation, evaluation, and communication to society, making multilingual scientific knowledge openly available, accessible, and reusable. They support the right of everyone to share in scientific advancement and its benefits (Article 27.1 of the Universal Declaration of Human Rights).(68)

Ethical considerations

Ethical review and approval are not often required for the analysis of student class assignments, we applied and were granted ethical approval by the Committee of Ethics in Research (Comitê de Ética em Pesquisa) of the Universidade de São Paulo (CEP-USP #6.004.006). Students signed an informed consent form before participation. All other volunteers who participated in Wiki4WorldHearingDay2023 were not asked to do so.

Consent for publication

All data and logs are available publicly in Wikimedia sites and can be searched via nonproprietary software maintained by WMF. According to the Wikimedia Privacy Policy, users are not needed to disclose any personal information while registering their accounts on the platform, including regarding their usernames, which do not need to reflect their real names. (69)

Availability of data and materials

The datasets generated and analyzed during the current study are publicly available at:

Campaign: Hearing health 2022-2024 (23)

Outreach Wikipedia Edit-a-thon 4 World Hearing Day 2023 (39)

Projeto Saúde Auditiva (26)

Competing interests

The authors declare that they have no competing interests.

Funding

This work was partially funded by a Grant 2021/06902-2 by FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo (Call for Strategic Research on the uses of the Internet for Research). (70) The Wikimedia Foundation provided Rapid Fund grant G-RF-2301-11773 for the training event at a Brazilian conference.

Authors' contributions

TCM, LCBJ, FZ, SC and JAP conceptualized the scope of the study, the study design and were responsible for implementing the study. All authors participated in data acquisition. TM, AJSA, PCC, HGCM contributed to the analysis and interpretation of data. The first draft of the manuscript was written by TCM, AJSA, PCC, HGCM, AAPM. JAP, DM, LR and LCBJ contributed feedback to previous versions of the manuscript. All authors approved the final manuscript.

Acknowledgments

We greatly appreciate the support and guidance provided by Amanda Jurno, Felipe Lima, Lucas Belo (Wiki Movimento Brasil), Ha-Loan Phan (Wikimedia Canada), James Heilman (WikiProject Medicine), John Sadowski (US National Institute for Occupational Safety and Health), Erika Barioni Mantello (Universidade Federal do Rio Grande do Norte, Brazil), Hannalice Gottschalk Cavalcanti (Universidade Federal da Paraíba, Brazil), Helaine Blumenthal and Brianda Felix (Wiki Edu). David Byrne, Tania Carreon-Valencia and Chuck Kardous (retired) from the National Institute for Occupational Safety and Health reviewed the final version of the manuscript. We thank all who volunteered their time and effort in this science communication effort.

Disclaimer The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC).

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No competing interests reported.

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Exploratory study: Health promotion through Wikipedia outreach and educational activities

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Abstract

Background

Methods

Results

Conclusions

Figures

Introduction

Methods

Participating institutions and coordination

Participants

Educational activities

Training

Wiki4WorldHearingDay2023 activities

Short-duration training events

Tracking of contributions

Results

Wiki4WorldHearingDay2023: quantitative assessment

Reach and extent of edits from the intersection between Wiki4WorldHearingDay2023 and educational activities

Discussion

Wiki4WorldHearingDay2023: quantitative assessment

Intersection between Wiki4WorldHearingDay2023 and educational activities

Knowledge equity and health promotion

Comparisons with previous studies

Information gained by number of views versus extent of edits

Study limitations and recommendations for future actions

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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