JMIR Publications

ABSTRACT

Background:

Women remain underrepresented in radiation-based cardiovascular procedures, and occupational radiation concerns are a leading career deterrent. How these concerns surface in everyday professional discourse, particularly in China, is poorly documented.

Objective:

We aimed to compare radiation-related discourse by author gender among cardiovascular interventional professionals on Xiaohongshu (RedNote), China's largest female-dominant social platform, and to characterize themes that are rarely captured by workforce surveys.

Methods:

In October 2026, we collected public Xiaohongshu posts through systematic keyword searches (59 query groups in 3 iterative waves) and full sampling of 12 key opinion leader accounts, yielding 2,300 deduplicated posts and 27,881 comments with nested replies. Posts were coded for author role, 9 radiation-related themes, and affective valence (cost, neutral, empowerment) using rule-based pre-screening followed by human-supervised large language model (LLM)-assisted adjudication, with full-text review of all practitioner-authored posts. Author gender was ascertained from platform profile fields with in-text self-presentation as fallback. Proportions were compared with χ² tests, with author-level analysis to address clustering.

Results:

Of 2,300 posts, 1,027 were authored by health care practitioners (405 female, 376 male, 246 unknown gender; 576 unique authors). Cost-valence discourse was twice as prevalent among women as among men (21.5% vs 10.6%; χ²₁=16.84; P<.001) and persisted at author level (32.9% vs 20.1%; P=.007). Among posts explicitly addressing radiation, cost content was expressed in 35.8% of female-authored versus 21.6% of male-authored posts (P=.07). Fertility and pregnancy concerns (10.4% vs 1.1%; P<.001) and gendered workplace culture (9.1% vs 0.8%; P<.001) were almost exclusively female-authored and spanned all career stages, from specialty selection to pregnancy and return to the table. Empowerment content was nonsignificantly more common among women (14.3% vs 10.4%; P=.09). Comment-layer analysis (341 retained comments) added partner fertility anxiety, pregnancy-related scheduling penalties, operator health effects, and gatekeeping voiced mainly by women (10 of 15 known-gender comments). Posts by patients and family members were predominantly female-authored (86.7% of 255 known-gender authors).

Conclusions:

On China's largest female-dominant social platform, female cardiovascular interventional professionals described the costs of occupational radiation at twice the rate of male peers, while also producing more empowerment content. The fertility-radiation conflict was voiced already at the specialty-selection stage and extended to operators' partners and patients, identifying actionable targets for protection, staffing, and counseling.