{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:06:32Z","timestamp":1790021192677,"version":"4.0.1"},"reference-count":40,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since 2011, T\u00fcrkiye has become the primary destination for Syrian refugees. Although health care is a fundamental human right, public discourse surrounding refugee health services can influence policy and social cohesion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of our study was to examine 14 years of health-related discourse in T\u00fcrkiye regarding Syrian refugees on platform X (formerly Twitter) to identify evolving patterns in sentiment, stance, and key grievances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From a dataset of 4.5 million tweets (2009-2022), 116,172 health-related posts were identified. We used a fine-tuned Turkish Bidirectional Encoder Representations from Transformers (BERT)\u2013based large language model to perform multitask classification for sentiment, stance, and health topics. Tweets were categorized into 5 domains: provision of health care services, financing and coverage, human resources, public health and disease prevention, and access to medications and pharmaceutical services. Lift scores and heatmaps were used to analyze the relationship between keywords and public attitudes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The fine-tuned Turkish BERT model achieved high classification performance, with a weighted\n                      <jats:italic>F<\/jats:italic>\n                      <jats:sub>1<\/jats:sub>\n                      -score of 0.814 for sentiment and 0.757 for stance detection. Public discourse shifted from neutral or positive tones in 2011 to increasingly negative tones over time. By 2021, negative sentiment reached 79.9% (13,148\/16,456), and the anti-refugee stance peaked at 78.3% (12,882\/16,456). Prominent topics evolved from provision of health care services (38\/80, 47.5% in 2011) to public health and disease prevention (9428\/16,456, 57.3% in 2021) and human resources (13,969\/40,368, 34.6% in 2022). High lift scores revealed that an anti-refugee stance was strongly associated with keywords such as \u201cappointment,\u201d \u201cvaccine,\u201d and \u201cfree.\u201d\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a marked and consistent rise in anti-refugee sentiment within Turkish digital health discourse, often fueled by misinformation and perceived systemic strain. Public health authorities should prioritize evidence-based communication strategies to counter digital polarization and ensure the legibility of health policies to the host population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/93227","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:45:08Z","timestamp":1784043908000},"page":"e93227-e93227","source":"Crossref","is-referenced-by-count":0,"title":["Health Discourse Regarding Syrian Refugees in T\u00fcrkiye on X (Formerly Twitter): Longitudinal Sentiment and Stance Analysis"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8984-9673","authenticated-orcid":false,"given":"\u00d6mer","family":"Ata\u00e7","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7110-2894","authenticated-orcid":false,"given":"Abdul Basit","family":"Adeel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3557-6304","authenticated-orcid":false,"given":"Ibrahim Enes","family":"Ata\u00e7","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"R1","unstructured":"14th anniversary of Syrian revolution | Nearly 657,000 persons killed since the onset of the revolution in March 2011. 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URL: https:\/\/globalcompactrefugees.org\/good-practices\/migrant-health-centers [Accessed 7-09-2026]"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.596071","article-title":"Social media and attitude change: information booming promote or resist persuasion?","volume":"12","author":"Wang","journal-title":"Front Psychol"},{"key":"R5","unstructured":"Wardle C Derakhshan H . Information disorder: toward an interdisciplinary framework for research and policy making (2017). Council of Europe; 2017. URL: https:\/\/edoc.coe.int\/en\/media\/7495-information-disorder-toward-an-interdisciplinary-framework-for-research-and-policy-making.html [Accessed 07-09-2026]"},{"key":"R6","unstructured":"We are social 2024: global ve T\u00fcrkiye verileriyle dijital d\u00fcnya [Article in Turkish]. Clicks\u2019us Digital. 2024. URL: https:\/\/www.clicksus.com\/we-are-social-2024-global-ve-turkiye-raporu-ozeti [Accessed 25-01-2026]"},{"key":"R7","doi-asserted-by":"crossref","unstructured":"Liu B . Sentiment Analysis and Opinion Mining. Springer; 2012. [doi: 10.1007\/978-3-031-02145-9]","DOI":"10.1007\/978-3-031-02145-9"},{"issue":"1-2","key":"R8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1561\/1500000011","article-title":"Opinion mining and sentiment analysis","volume":"2","author":"Pang","journal-title":"Found Trends Inf Retr"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1017\/pan.2022.10","article-title":"Sentiment is not stance: target-aware opinion classification for political text analysis","volume":"31","author":"Bestvater","journal-title":"Polit Anal"},{"key":"R10","doi-asserted-by":"crossref","unstructured":"Mohammad S Kiritchenko S Sobhani P Zhu X Cherry C . SemEval-2016 task 6: detecting stance in tweets. In: Proceedings of the 10th International Workshop on Semantic Evaluation (SemEval-2016). Association for Computational Linguistics; 2016:31-41. [doi: 10.18653\/v1\/S16-1003]","DOI":"10.18653\/v1\/S16-1003"},{"key":"R11","unstructured":"Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. World Health Organization; 2010. 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URL: https:\/\/research.ku.edu.tr\/wp-content\/uploads\/2025\/12\/Mirekoc_Bibliographies_on_Syrian_Refugees_in_Turkey_30.07.2018-WEB.pdf [Accessed 06-12-2025]"},{"issue":"30","key":"R26","first-page":"265","volume":"12","author":"Yavuz","journal-title":"MKUJSS"},{"issue":"5","key":"R27","doi-asserted-by":"publisher","first-page":"583","DOI":"10.5455\/pmb.1-1344684524","article-title":"Epidemics of infectious diseases in disasters and control measures of them","volume":"12","author":"\u00c7ali\u015fkan","journal-title":"TAF Prev Med Bull"},{"issue":"1","key":"R28","first-page":"55","volume":"9","author":"Karada\u011f","journal-title":"TAF Prev Med Bull"},{"key":"R29","unstructured":"Toksabay B . The health right of refugees in Turkey [Master's thesis]. Middle East Technical University; 2010. 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