Analysis of the supportive care needs of the parents of preterm children in South Korea using big data text-mining: Topic modeling

Article information

Child Health Nurs Res. 2021;27(1):34-42

Publication date (electronic) : 2021 January 31

doi : https://doi.org/10.4094/chnr.2021.27.1.34

Ji Hyeon Park¹, Hanna Lee¹, Haeryun Cho²

¹Graduate Student, Department of Nursing, Wonkwang University, Iksan, Korea

²Associate Professor, Department of Nursing, Wonkwang University, Iksan, Korea

Corresponding author: Haeryun Cho, https://orcid.org/0000-0001-7366-9774, Department of Nursing, Wonkwang University, 460 Iksn-daero, Iksan 54538, Korea, TEL +82-63-850-6020, FAX +82-63-850-6060, E-MAIL chr@wku.ac.k

Received 2020 October 30; Revised 2020 December 11; Accepted 2020 December 21.

Abstract

INTRODUCTION

Worldwide, the proportion of premature births (under 37 weeks of gestation) is approximately 10%[1]. In South Korea, the proportion of premature infants has more than doubled from 3.8% in 2000 to 8.1% in 2019 [2]. Meanwhile, the survival rate of premature infants is steadily increasing with advances in medical technology and the implementation of active policies related to the neonatal intensive care unit (NICU) [3]. According to University of Utah Health, the survival rate for infants born at 24 weeks is approximately 50%, but 80%~90% for infants born at 28 weeks and 95% at 32 weeks [4]. In South Korea in 2019, the survival rate was 87.9% for infants born with a body weight under 1,500 g and 72.8% for those under 1,000 g [2].

As the survival rate of premature infants improves, the interest in the field has shifted from medical care to parenting at home after NICU discharge and the proper growth and development of premature children [3,5]. Even if premature infants are safely discharged, they are at a high risk of complications, such as health problems or developmental disabilities [6,7].

Parents of infants born prematurely are exposed to various crisis situations while coping with the possible health problems and developmental disabilities of their children [8]. They also experience more and longer post-traumatic and parenting stress than the parents of full-term infants [9,10] and encounter anxiety, depression, and conflict [8,11]. They may be unprepared for their parental roles or may exhibit inappropriate parenting behaviors, such as overprotection [11,12].

Parental responses are the major factor influencing the neurodevelopment, cognitive development, and behavioral development of children born as premature infants [13]. Parents experiencing high parenting stress have impaired mental health, inappropriate relationships with their children, and poor parenting quality [5,14]. Therefore, the need for interventions that can support the parents of preterm children has emerged [5,8,12].

The term “big data” refers to the vast amount of data generated online, which would be difficult to analyze using existing data processing technologies [15]. Currently, online social network services (SNSs) are used for communication by a large number of people, and they can be used to grasp various viewpoints comprehensively because of the amount of data that is accumulated [16]. In particular, South Korea has the highest internet penetration rate in the world, and more than 50% of newspaper users use online platforms [15,16]. Big data analysis using text data of online news and SNSs has been attracting attention as a useful analytical method to explore the flow of people’s perception, times, and society [15,16]. Topic modeling is an analytical method that can find hidden topics in a large amount of text data [15]. Moreover, research using surveys and interviews is limited in terms of identifying population-scale phenomena owing to the selection of participants. By contrast, the analysis of big data, including online newspapers and SNSs, can reflect the experiences of the population [15].

Interest in the growth, development, and parenting of preterm children has been increasing. Related research is being conducted worldwide; some examples include a meta-analysis of the parenting behavior of parents of preterm children [12], qualitative studies on the care experience of preterm children [8,11], a systematic literature review of the relationship between parenting style and preterm infant development [13], and research on the stress of parenting preterm children [5,9,17]. These studies have reported that support is required for the parents of preterm children, but have been limited to investigations of the relationships between parenting aspects and child development. In other words, research aiming to understand the types of support required by the parents of preterm children is insufficient.

Research on the experiences of parents of preterm children after their discharge from the NICU is insufficient owing to the limited accessibility to such parents. However, analyzing the experiences of parents of preterm children using online big data is expected to produce results that reflect the actual phenomena because there are no restrictions on participation. Online news can be regarded as a public concern because it contains information that attracts attention related to real life through interactions with people living at the same time [18]. Therefore, this study was conducted to identify the types of support requests made by the parents of preterm children by using text data from online newspaper articles and SNS posts on a portal site. The specific purpose of the present study was 1) to collect big data using text mining to analyze keywords and 2) to derive the supportive care needs of parents of preterm children by using topic modeling.

METHODS

3. Study Process and Data Analysis

This study was conducted in the following order: keyword selection, data collection, morpheme analysis, keyword analysis, and topic modeling (Figure 1).

Figure 1

Study process and data analysis. *Yirundung-yi is native Korean as premature infant; LDA, latent dirichlet allocation; SNS, social network service; TF-IDF, term frequency inverse document frequency.

1) Keyword selection

The keywords selected were “premature infant” or “yirundung-yi”. Officially, the term “premature infant” is used, but the National Institute of the Korean Language created a new term, “yirundung-yi”, in 2006. “Yirundung-yi” is a native Korean word that denotes that a baby was born earlier than full term [20], and it is commonly used in online newspaper articles and SNSs.

2) Data collection

Data were collected through Textom (Textom, the IMC, South Korea), a big data analysis software that can collect, clean, and process matrix data in a web environment. It was chosen for this study because it can collect and analyze data from various channels, including portal sites [15,16]. The settings for the data collection were as follows: 1) text in Korean; 2) keywords of “yirundung-yi” and “premature infant”; 3) full text; 4) post start date was January 1, 2019; 5) post end date was December 31, 2019; 6) the collection channel was an online newspaper article and web community on Naver; and 7) duplicate uniform resource locators (URLs) were removed.

The title, URL, and text of the collected data were saved as an Excel file with a size of 1.2 MB. The titles and texts of the collected data were checked by the researchers, and unrelated data and duplicate content were deleted. In total, 1,247 online newspaper articles were collected, from which 628 texts were analyzed after excluding 583 duplicate and 36 unrelated articles. In total, 1,976 SNS posts were collected; there were 10 unrelated posts and no duplicate data, resulting in 1,966 texts for analysis. The final text size was 627 KB.

3) Morpheme analysis

Morphological analysis was performed with nouns and adjectives using the MeCab-ko analyzer. Unlike Espresso K, MeCab-ko has the advantage of classifying vocabulary by referring to a dictionary regardless of space [21]. However, as compound nouns are extracted as simple nouns, and synonyms and similar words cannot be distinguished, the meaning of the text was not clear. Thus, through an N-gram depicting the degree of concentration of the keywords, complex nouns were created again from the refined data. Subsequently, a user dictionary was used to refine words with the same or similar meaning and words that did not have a meaning in the refined data. The user dictionary refers to a function in which the words to be changed are constructed as a dictionary when it is necessary to refine data for similar or identical subjects repeatedly, and these words are collectively changed into corrected words designated in the morpheme analysis process [21]. Therefore, a synonym dictionary was constructed for words with agreed-upon meanings, and words with similar meanings were constructed as a thesaurus dictionary using Textom’s user word dictionary. Words such as “because of”, “etc.”, “related”, and “and” do not have relevant meanings in this context; therefore, they were treated as stop words. The final refined data were saved as a .txt file, and the encoding was set to UTF-8, saved, and then uploaded to Textom.

4) Keyword analysis

In this study, the term frequency-inverse document frequency (TF-IDF) value was applied to extract important keywords, as it represents the frequency and weight of specific words in the document [22]. From the collected data, the top 50 keywords were extracted by applying the TF-IDF weight to each data point. In addition, the keywords were analyzed with the keywords of data collection: “yirundung-yi” and “premature infant”. A word cloud is the most representative text mining technique for visualizing keywords [23]. In this study, the size was expressed as large, medium, and small according to the frequency of a word’s appearance in the data. The colors were set as blue, green, and gray, in descending order of importance of appearance in the data.

5) Topic analysis

For topic modeling, the latent dirichlet allocation (LDA) model was used in this study. The LDA method assumes that a document is a collection of topics, each of which is a set of keywords, and it probabilistically infers the topics latent in the document [24]. In the LDA method, the researcher determines the number of topics that are considered well-categorized [21]. In this study, the number of topics was determined to be four, which demonstrated the clearest distance and boundary between the topics. The researchers reviewed the keywords and texts that composed the four topics that were derived and named them in a way that clearly expressed their meaning.

RESULTS

1. Keyword Analysis

The top 50 keywords based on their TF-IDF values are shown in Table 1. Three word clouds for the combined data (online newspaper articles and SNS data), online newspaper article data, and SNS data are presented in Figure 2. The word cloud of online newspaper articles revealed that “premature infant” was the most important term, as its representation in the cloud was larger than that of “yirundung-yi”, indicating that the official medical term was primarily used in online newspaper articles. In the word cloud of SNS data, “yirundung-yi” was found to have higher importance than “premature infant”, and other words related to parenting were found to be the main words.

Table 1

Top 50 Keywords (N=9,782)

Figure 2

Word clouds. (A) Total. (B) News articles. (C) Social network service.

DISCUSSION

This study analyzed a vast amount of text from online newspaper articles and SNS posts to understand the supportive care needs reported by parents raising preterm children. Four topics were identified through the data analysis.

The first topic was parents’ vague fear of caring for their child, starting when NICU discharge was imminent. First-time parents generally experienced stress and anxiety about caring for their children [5]. In particular, previous studies have reported that the parents of premature infants are generally less prepared for parenting than the parents of full-term infants [11]. Furthermore, the parents of premature infants experience more stress than the parents of full-term infants [9,25]. Parent education [26], skin-to-skin contact through kangaroo care [27], and massages [28] are among the interventions that have been implemented in NICUs to enhance parent-child attachment, reduce parental stress, and strengthen parental confidence. However, in this study, it was found that parents exhibited an uncertain and vague reaction to caring for their children. Although NICU discharge education is being implemented, in reality, parents seek advice on how to handle their children using SNS, which indicates that the education provided at the NICU was ineffective. Therefore, it is necessary to develop effective educational methods and content that can improve parents’ confidence to raise their children at home after discharge from the NICU.

The second topic encompassed the real-world difficulties of parenting preterm children. Compared to the first topic, which represented an abstract future difficulty, this topic included specific parenting difficulties. According to a study by Lee and Koh [29], the parents of infants lacked the ability to meet their own parenting expectations. In addition, according to a study by Jeong and Kim [30] that analyzed the parental education of parents of infants, the most frequently encountered type of parental education dealt with child development; however, parents wanted education related to actual parenting behaviors, including interacting with their child, solving health problems, and proper eating habits. Consistent with previous studies, the results of this study revealed that keywords related to practical care for infants, such as “formula”, “diapers” and “childcare products” appeared, rather than content specific to preterm children. Therefore, the demands of parents who care for their children after discharge from the NICU relate to real-world parenting behaviors. Furthermore, previous studies have reported that similar issues caused stress when parenting premature and full-term infants [5,10,17]. In other words, it is necessary to educate the parents of preterm children about general parenting behaviors and to provide interventions that can improve overall parenting competence. In addition, to effectively deliver necessary information to parents caring for infants after being discharged from the NICU, it is necessary to develop educational material that is as accessible as SNSs as a way to find information.

The third topic involved concerns about the growth and development of preterm children. The results of a qualitative study by Kim [8], which analyzed parenting experience with infants born prematurely, indicated that vague anxiety was the parents’ main reaction and was caused by a lack of certainty about the normal growth and development of their children. This is consistent with the results of this study. Furthermore, Whittingham et al. [11] also reported that the parents of prematurely born infants lacked assurance that their children would develop appropriately. Parents obtain information on growth and development problems that may occur in premature infants through SNSs or online communities [5,8,10]. If parents have a limited ability to interpret information and apply it under the circumstances of caring for a child born as a premature baby, the information related to growth and development provided by health non-professionals may cause excessive anxiety. Therefore, to provide assurance regarding premature children’s growth and development, health professionals need to help parents through individual child growth and development interventions, in addition to the use of self-help groups, such as SNSs, by parents of preterm children.

The final identified topic was parental anxiety about possible future health complications in preterm children. Parents of preterm infants are aware of the potential medical problems of their children and seek information [11]. A study by Kim [8] reported that parents of premature infants were anxious to prevent infection, diseases, or complications from worsening after discharge, which is similar to the results of this study. Therefore, it is necessary to provide multidisciplinary interventions for the parents of preterm children, including a neonatal health care professional, a developmental expert, and an expert who can provide medical interventions.

In the word cloud, it was found that the keywords “premature infant” and “yirundung-yi” were similar in size in the online newspaper articles, whereas “yirundung-yi” was larger in the SNS posts where parents’ writings were reflected. This result means that for parents, the term “yirundung-yi”, which is a pure Korean word, is a more practical term than the technical term “premature infant”. Therefore, when providing intervention for the parents of preterm infants, the use of the term “yirundung-yi” rather than the medical term “premature infant” may be a more useful strategy.

As research on raising premature children discharged from the NICU is just beginning, this study is significant in that an analysis was conducted using big data with the goal of understanding the supportive care needs of parents raising preterm children. The significance of this study lies in its ability to identify parents’ needs meaningfully because it analyzed 2,594 texts using text mining and LDA topic modeling to extract topics embedded in online documents used by these parents. In addition, as the data were collected using various channels, namely online newspaper articles and SNSs, the research results derived in this study are reliable.

However, a methodological limitation is that the subjectivity of the researcher may have been reflected in the process of refining the keywords. Furthermore, slang, abbreviations, and new words were not completely reflected in the refined keywords. In addition, the results of this study should be interpreted considering the fact that they did not reflect the needs of parents who do not use SNSs.

CONCLUSION

The supportive care needs of parents of preterm children were identified in this study and can be summarized as follows: 1) uncertainty in caring for their infants, 2) real-world difficulties in raising their children, 3) concerns about appropriate growth and development, and 4) anxiety about potential medical problems of their children. Reflecting these needs, the following interventions are needed. It is necessary to develop and apply effective education that increases the confidence of parents in caring for their children at home when NICU discharge is imminent. For interventions after NICU discharge, parenting methods specific to premature infants are important; however, information on parenting methods in general should also be included. In addition, it is necessary for a team composed of multidisciplinary experts, such as doctors, nurses, development experts, and occupational therapists, to provide support for the individual growth and development of preterm children and help manage complications of prematurity. Finally, it is suggested that various media such as SNS, internet, and mobile platforms be used to increase the accessibility of information for parents.

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