To gain an initial representative understanding of how media debate analyses have been used and are useful for bioethics, as well as which methodological approaches were used to different ends, we conducted a rapid scoping review of the literature. This review offers a systematic and resource-efficient overview of studies analysing health-related media debates [26], highlighting the different methodologies applied in the field. It provides a broad perspective of the study landscape, helping to illustrate our methodological and theoretical considerations. As such, the rapid scoping review serves as a foundation for identifying methodological requirements and challenges and to develop perspectives for methodologically founded investigations of media debates in bioethics. Given the conceptual focus of this paper, an in-depth examination of individual studies that other review methodologies provide is beyond this paper’s scope. Instead, the rapid scoping review efficiently captures the research objectives and the methodological approaches necessary to underline our conceptual arguments in this paper.
Methodology
We systematically searched relevant articles in PubMed, Web of Science (Core Collection), and Scopus (see Table 1 for search algorithms and Fig. 1 for the article selection process). We included English-language articles that used an established methodology (e.g., qualitative or quantitative content analysis, thematic analysis) to analyse the content of traditional mass media or social media on a health topic (broadly defined, including One Health, public health, health research, and medical education) with a reference to bioethics (regarding topic, affiliation of authors, scope of journal etc.). Following our above-introduced definition of media debates, we excluded analyses of fictional content (e.g., assessment of child TV programs), social media analyses focusing on private conversations (e.g., closed Facebook groups) and studies that analysed the content of advertisements. Non-English-language studies were also not included.
Flow chart illustrating the systematic publication selection process. Studies in languages other than English were excluded from this review
From the included publications, we collected the following data from titles, abstracts, and other publication meta-data: (1) research field of the periodical; (2) first author’s field of affiliation; (3) topic of the paper; (4) unit of analysis (e.g. social media posts, newspaper articles); (5) methodology to analyse media content (qualitative, quantitative, mixed methods, Machine Learning-based); (6) presence of data triangulation; and (7) the contribution to bioethics. No full-text analysis was conducted.
Interdisciplinary landscape
To assess the interdisciplinary landscape of the 191 included publications, we extracted information on topics, methodologies, and academic fields. Topics were identified by applying Philipp Mayring’s methodology of a summarizing content analysis, which includes a step-wise paraphrasing and abstraction of content [27]. The most frequent topics were public health-related, including infectious diseases (24.6% of articles, Fig. 2A), mental health (13.1%) as well as nutrition, obesity and diet (6.8%). Other frequent topics addressed technological innovation in healthcare, including new technologies & therapies (9.9%), reproductive health (7.9%), and genomics (6.8%). Further, topics addressing the health system, including stakeholder perspectives (9.4%), health research & research ethics (8.9%), as well as health policy & health care systems (8.4%) were addressed. Various other health topics were addressed, too. Figure 2B shows that most analyses were conducted based on debates in news media (61.3%). Figure 2C indicates the variety of academic fields represented in health-relevant media debate analyses. Medicine was the most-represented field, followed by the social sciences and bioethics. Moreover, 15.2% of the articles were published in interdisciplinary journals. Our rapid scoping review further shows that the number of relevant publications has steadily increased since 2008 (Fig. 2D).
Characteristics of media debate analysis publications about health. (A) Topics covered. (B) Arena of debate. (C) Academic fields represented. (D) Publications per year
Contribution to bioethical inquiries
Based on the considerations on the threefold significance of public media debate analyses for bioethics and initial findings from the rapid scoping review, we defined four categories of how media debate analyses have contributed to bioethical inquiries so far (Fig. 3). They show the different content-related potentials of the investigation of media debates in bioethics as well as their methodological range. While we conceptualized the first three categories as mutually exclusive, the fourth category (ethical evaluation of media debate) was sometimes coded in addition to one of the other categories. In the following, we will describe these categories by giving illustrative examples and emphasizing characteristics as identified through the rapid scoping review.
Categorization of media debate analyses regarding their contribution to bioethical inquiries
Description of empirical context
Around one in three included publications (n = 61, 31.9%) did not engage explicitly in any ethical rationale or discussion but provided descriptive information on the content of media debates. Methodologically, qualitative and quantitative approaches were similarly represented. Additionally, four articles in this category used Machine Learning-based text categorization methodologies. For example, Indra and colleagues analysed social media posts about obesity, physical activity, and diets in the context of healthy lifestyles [28]. They performed sentiment analysis and topic modelling on these posts to identify the tone of the debate and the topics covered as determined by word frequencies, combinations, and relative proximities.
As argued above, even though they are descriptive, such investigations may still be of relevance for bioethical inquiries: They can provide an empirical basis for further bioethical analyses, even if no such analysis is provided in the publication itself. A pertinent example is a quantitative content analysis by Zimmermann and colleagues about the content, evaluations, and stakeholder influence in newspaper coverage of predictive genetic testing in Switzerland and the United Kingdom [29]. Contrasting their findings with other studies in the field of science communication, they showed how the debate fostered a more active public engagement with the topic than previous science communication topics and how the debate was much less salient in German-speaking Switzerland as compared to the United Kingdom.
Description of ethical aspects
As a second category, we identified 52 publications (27.2%) which explicitly described ethical aspects of health topics while not engaging in any more in-depth investigation and evaluation of ethical aspects. For example, Zimmermann and colleagues analysed what ethical issues pertinent in scholarly debates about predictive genetic testing were reported on in British newspapers. They quantified what ethical issues were particularly salient in newspaper reporting, identified what ethical issues were underrepresented, and discussed what ethical issues the public should be more explicitly informed about and why [30]. This allowed a detailed description of how ethical aspects within a specific context were represented in a pertinent media debate. In this way, this example illustrates the above-outlined significance of media debate analysis through a reflection of morality.
Further, such descriptions of ethical aspects covered in media debates touch upon the societal relevance of media debate analyses. For example, Chandler and colleagues qualitatively analysed online comments in response to news articles reporting on a Canadian patient who had been in a vegetative state for several years and was reported to communicate via fMRI neuroimaging [31]. The findings illustrated important moral deliberations in the online comments, including the quality of life of this patient, the question of withdrawing life support and options of the patient consenting to this, and the accuracy of diagnosing brain death. In concluding that “[t]hese public perspectives are relevant to the obligations of clinicians, lawyers, and public policymakers to patients, families, and the public” [31], the authors refer to the practical and ethical significance of their analysis.
Methodologically, publications in this category mostly followed traditional methodologies of media content analyses, including quantitative content analysis (n = 21, 40.4%) and qualitative content analysis (n = 16, 30.8%, see Fig. 3).
Identification and evaluation of moral problems
More than a quarter of the reviewed publications (n = 51, 26.7%) identified and evaluated moral problems regarding health-related topics in addition to describing the content of media debates. Such publications employed more qualitative (24/51, 47.1%) than quantitative procedures (12/51, 23.5%). Some 12 publications in this category (23.5%) analysed other data sources in addition to media content. This seems plausible since qualitative approaches and data triangulation offer more possibilities to examine a topic in-depth, and, in this course, to identify and evaluate ethical problems. For example, Rosenberg and colleagues analysed qualitative semi-structured interviews in addition to expert comments in Finnish media to demonstrate the social impact of the orphan drug Nusinersen [32]. By combining these two analyses, they outlined competing attitudes and values and showed that these may be classified differently depending on the situation.
As an example of a qualitative content analysis, Ross Arguedas investigated the media coverage of orthorexia nervosa [33]. Applying inductive thematic analysis, the author identified different framings of orthorexia but also a heterogeneous assignment of responsibility depending on the explanation of the causes of the eating disorder. Further, exemplifying a quantitative content analysis, Zimmermann and colleagues investigated solidarity and personal responsibility as important normative reference points in newspaper coverage in Germany and German-speaking Switzerland [34]. Using quantitative content analysis, they identified different contexts and areas of application of these two concepts. Finding that the limits of solidarity were only rarely mentioned in newspaper coverage about COVID-19, they called for a more distinct consideration of these limits to sustain solidarity as a resource in further crises.
Ethical evaluation of media debates
Finally, around one in three included publications (n = 59, 30.9%) discussed and evaluated the media debate itself from a normative perspective. For example, they identified blind spots, shortcomings, and tendencies in the media debate by focusing on how the media and the debate were embedded in a broader social and societal context. Such publications thus identified moral problems that arise or are reinforced because of the media debate.
For example, Aspler and colleagues conducted a content analysis of 286 articles from Canadian newspapers to investigate how the fetal alcohol spectrum disorder is presented in the media debate [35]. Starting from inductive coding, they identified six major themes. In discussing these findings, they focused especially on exaggeration and misinterpretation in the debate and highlighted the risks of harmful stereotypical beliefs about indigenous people, confusion about health choices during pregnancy, and the unhelpful fueling of debates about sensitive issues surrounding women’s choices.
Some 32 of the 59 publications in this category (59.2%) were additionally assigned to other categories. For example, the above-mentioned study by Aspler and colleagues also aims to identify and evaluate moral problems [35]. This is not surprising since a certain thematic focus is usually necessary for a substantial ethical evaluation of the media debate.
In terms of methodology, the investigations in this category are diverse. Quantitative and qualitative approaches are equally spread. For example, Bosch and Wasserman chose a quantitative approach to analyse the tabloid media coverage of COVID-19 in South Africa [36]. Starting from the proposition that tabloid newspapers are often criticized for their sensation- and entertainment-orientated journalism, they investigated 1050 online news stories in the tabloid Daily Sun and found that the majority of the coverage was topic-oriented and neutral. Thus, using a quantitative approach to the evaluation of media debate, they show how the societal and practical significance of media debates can be addressed in media debate analyses.
The study of Patterson and colleagues applied both qualitative and quantitative content analysis to investigate how media coverage in the UK represented ‘binge’ drinking [37]. They found a “disproportionate focus on women’s ‘binge’ drinking” and discussed the potential effects of reinforcing harmful gender stereotypes. Furthermore, they formulated concrete suggestions on how media framing could be improved by a more comprehensive media engagement of public health advocates. Hence, this investigation is a very significant example illustrating how the societal and practical significance of media debates can be addressed in a field with different methodological approaches and different concrete research questions.