Using content and network analysis to understand the social support exchange patterns and user behaviors of an online smoking cessation intervention program

Online health community for change: Analysis of self-disclosure and social networks of users with depression

Background

A key research question with theoretical and practical implications is to investigate the various conditions by which social network sites (SNS) may either enhance or interfere with mental well-being, given the omnipresence of SNS and their dual effects on well-being.

Method/process

We study SNS’ effects on well-being by accounting for users’ personal (i.e., self-disclosure) and situational (i.e., social networks) attributes, using a mixed design of content analysis and social network analysis.

Result/conclusion

We compare users’ within-person changes in self-disclosure and social networks in two phases (over half a year), drawing on Weibo Depression SuperTalk, an online community for depression, and find: ① Several network attributes strengthen social support, including network connectivity, global efficiency, degree centralization, hubs of communities, and reciprocal interactions. ② Users’ self-disclosure attributes reflect positive changes in mental well-being and increased attachment to the community. ③ Correlations exist between users’ topological and self-disclosure attributes. ④ A Poisson regression model extracts self-disclosure attributes that may affect users’ received social support, including the writing length, number of active days, informal words, adverbs, negative emotion words, biological process words, and first-person singular forms.

Innovation

We combine social network analysis with content analysis, highlighting the need to understand SNS’ effects on well-being by accounting for users’ self-disclosure (content) and communication partners (social networks).

Implication/contribution

Authentic user data helps to avoid recall bias commonly found in self-reported data. A longitudinal within-person analysis of SNS’ effects on well-being is helpful for policymakers in public health intervention, community managers for group organizations, and users in online community engagement.

Assessment of Social Support and Quitting Smoking in an Online Community Forum: Study Involving Content Analysis

Background

A key factor in successfully reducing and quitting smoking, as well as preventing smoking relapse is access to and engagement with social support. Recent technological advances have made it possible for smokers to access social support via online community forums. While community forums associated with smoking cessation interventions are now common practice, there is a gap in understanding how and when the different types of social support identified by Cutrona and Suhr (1992) (emotional, esteem, informational, tangible, and network) are exchanged on such forums. Community forums that entail “superusers” (a key marker of a successful forum), like QuitNow, are ripe for exploring and leveraging promising social support exchanges on these platforms.

Objective

The purpose of this study was to characterize the posts made on the QuitNow community forum at different stages in the quit journey, and determine when and how the social support constructs are present within the posts.

Methods

A total of 506 posts (including original and response posts) were collected. Using conventional content analysis, the original posts were coded inductively to generate categories and subcategories, and the responses were coded deductively according to the 5 types of social support. Data were analyzed using Microsoft Excel software.

Results

Overall, individuals were most heavily engaged on the forum during the first month of quitting, which then tapered off in the subsequent months. In relation to the original posts, the majority of them fit into the categories of sharing quit successes, quit struggles, updates, quit strategies, and desires to quit. Asking for advice and describing smoke-free benefits were the least represented categories. In relation to the responses, encouragement (emotional), compliment (esteem), and suggestion/advice (informational) consistently remained the most prominent types of support throughout all quit stages. Companionship (network) maintained a steady downward trajectory over time.

Conclusions

The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation.

Exploring features of social support in a Chinese online smoking cessation community: A multidimensional content analysis of user interaction data

Due to the rapid development of information technology, an increasing number of smokers choose online smoking cessation communities to interact with other individuals to help themselves quit smoking. Though it is well known that social support plays a key role in the process of smoking cessation, the features of social support that one can get from online smoking cessation communities remain unclear. We collected user interaction data from the largest Chinese online smoking cessation community, the quit smoking forum of Baidu Tieba. We selected 2758 replies from 29 active repliers and 408 correlated posts as our data set. Multidimensional content analysis is carried out from three aspects: posting scenarios, user quitting behavior stages, and types of social support. This article also explores the co-occurrence relationships of different types of social support by social network analysis. Results showed that users receive different compositions of social support in various posting scenarios and behavior stages. In most cases, emotional support is the most typical support the community provides. The community will provide more informational support when needed. Besides, informational support, especially personal experience and perceptual knowledge, has more diverse combination patterns with other types of social support. "Gratitude-Mutual assistance" and "Encouragement-Mutual assistance" are the most frequent co-occurrence relationships. The online smoking cessation community brings people who quit smoking together, and users provide rich types of social support for each other. Users can effectively obtain expected social support in different posting scenarios and smoking cessation stages. Smoking cessation projects should be designed to promote user communication and interaction, which positively affects achieving users' smoking cessation goals.

The Exchange of Informational Support in Online Health Communities at the Onset of the COVID-19 Pandemic: Content Analysis

Background

Online health communities (OHCs) provide social support for ongoing health-related problems. COVID-19, the disease caused by SARS-CoV-2, has been an acute and substantial stressor worldwide. The disease and its impact, especially in the beginning phases, left many people with questions about the nature, treatment, and prevention of COVID-19. Unlike typical chronic ailments discussed on OHCs, which are more established, COVID-19, at least at the onset of the pandemic, is distinct in that it lacks a consensus of clinical diagnosis and an existing community foundation.

Objective

The study aims to investigate a newly formed OHC for COVID-19 to determine the topics and types of information exchange as well as the sources of information this community referenced during the early phases of the COVID-19 pandemic in the United States.

Methods

A total of 357 posts from a COVID-19 OHC on the MedHelp platform were annotated according to an open-coding process. Participants’ engagement patterns, topics of posts, and sources of information were quantified.

Results

Participants who offered informational support had a significantly higher percentage of responding more than once than those seeking information (P<.001). Among the information-seeking topics, symptoms and public health practice and psychological impacts were the most frequently discussed, with 26% (17/65) and 15% (10/65) of posts, respectively. Most informational support was expressed through feedback/opinion (181/220, 82.3%). Additionally, the most frequently referenced source of information was news outlets/websites, at 55% (11/20). Governmental websites were referenced less frequently.

Conclusions

The trends of this community could be useful in prioritizing public health responses to address the most common questions asked by the public during crisis communication and in identifying which venue of communication is most effective in reaching a public audience during such times.

A Relational Approach to the Design for Peer Support

Peer-support services enhance mental wellbeing and increase the knowledge and capabilities of self-help groups in various settings. To ensure that these services foster peer-support relationships as intended, it is necessary to design and assess them from a relational perspective. This study presents a relational framework for peer-support design and its application to two existing peer-support services for solitary seniors in Seoul and Ulsan. The framework aims to support the analysis and conception of peer-support services. It incorporates network analysis and codesigning to understand multi-faceted peer-support relationships and to develop strategies for creating relational values, respectively. Case studies used observation and interviews to understand the multi-faceted issue of social support. Relational data for fourteen solitary seniors were collected and analyzed in terms of the qualities, quantities, and structure of peer-support relationships. Analysis results demonstrate an increased level of perceived peer support through relationship forming, as well as the factors that suppress peer-support building such as network fragmentation and the discrepancy of needs. Analysis results were fed into codesigning interventions with stakeholders. Based on these findings, we discuss the preconditions for building peer-support relationships and outline the relational approach to the design for peer support in a wider context.

Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts

Background

The current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women’s efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes.

Objective

This study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers.

Methods

A total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns.

Results

The majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC.

Conclusions

OHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse.

Predicting User Posting Activities in Online Health Communities with Deep Learning

Online health communities (OHCs) represent a great source of social support for patients and their caregivers. Better predictions of user activities in OHCs can help improve user engagement and retention, which are important to manage and sustain a successful OHC. This article proposes a general framework to predict OHC user posting activities. Deep learning methods are adopted to learn from users’ temporal trajectories in both the volumes and content of posts published over time. Experiments based on data from a popular OHC for cancer survivors demonstrate that the proposed approach can improve the performance of user activity predictions. In addition, several topics of users’ posts are found to have strong impact on predicting users’ activities in the OHC.

Attraction, selection, and attrition in online health communities: Initial conversations and their association with subsequent activity levels

BACKGROUND

The effectiveness of online health communities (OHCs) for improving outcomes for health care consumers, health professionals, and health services has already been well investigated. However, research on determinants of OHC users' activity levels, what is associated with attrition or attraction to these communities, and the impacts of initial posts is limited.

OBJECTIVES

We sought to explore topic exchanges in OHCs and determine how users' initial posts and community reactions to them are associated with their subsequent activity levels. We also aimed to extend the theory of Attraction-Selection-Attrition for Online Communities (OCASA) to this area.

METHODS

We examined exchanges in a major Australian OHC for cancer patients, analyzing about 2500 messages posted over 2009-18. We developed a novel annotation scheme to examine new members' initial posts and the community's reactions to them.

RESULTS

The annotation scheme includes five themes: informational support provision, emotional support provision, requests for help, self-reflection & disclosures, and conversational cues. Initial conversations were associated with future activity levels in terms of active posting versus non-active engagement in the community. We found that most OHC members disclosed personal reflections to bond with the community, and many actively posted to the community solely to provide informational and emotional support to others.

CONCLUSION

Our work extends OCASA theory to bond-based contexts, presents a new annotation scheme for OHC support topics, and makes an important contribution to knowledge about the relationship between users' activity levels and their initial posts. The findings help managers and owners understand how members use OHCs and how to encourage active participation. They also suggest how to attract new members and minimize attrition among existing members.

HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention

HIV and sexuality stigma impede HIV prevention and care efforts. HealthMpowerment.org (HMP) is an interactive mobile phone- and web-based HIV prevention and care intervention for young Black men who have sex with men (YBMSM; ages 18-30) in the United States. HMP included three forums where participants could share their experiences. In this study, we explored whether engaging in stigma-related discussions was associated with changes in YBMSM's stigma-related scores throughout the trial. YBMSM (ages 18-30; N = 238) participating in HMP completed surveys at baseline, and 3 and 6 month follow-ups that included a series of scales focused on HIV and sexuality (internalized homophobia; sexual prejudice) stigma. Sixty-two participants contributed to the forums (1497 posts). We coded instances where YBMSM's conversations were stigma related (915 posts, 61.1%), including discussions of anticipated (74/915, 8.1%), experienced (125/915, 13.7%), internalized (410/915, 44.8%), and/or challenged (639/915, 69.8%) stigma regarding sexuality and HIV. Using a mixed methods approach, we examined whether changes in YBMSM's stigma scores were associated with stigma-related discussions within the forum. We controlled for age, HIV status, income, and educational attainment in these multivariable models. YBMSM who discussed experiencing HIV stigma in the forums reported decreases in perceived HIV stigma over time (b = - 0.37, p ≤ 0.05). YBMSM whose forum posts indicated anticipated HIV stigma reported increases in HIV stigma over time (b = 0.46, p ≤ 0.01). Participants who challenged sexuality-related stigma in forums had lower internalized homophobia (b = - 0.68, p ≤ 0.01) at baseline. YBMSM whose discussions focused on experiencing sexuality-related stigma reported increases in internalized homophobia (b = 0.39, p ≤ 0.01) and sexual prejudice (b = 0.87, p ≤ 0.05) over time. Developing strategies to combat stigma remains a key priority. HMP created an online space where YBMSM could discuss HIV and sexuality stigma. Although a limited number of HMP participants authored the majority of these forum discussions, the discussions were associated with changes in the sample's stigma scores over time. Online interventions (e.g., social media, apps) should consider the inclusion of forums to address stigma and test the efficacy of forums to improve YBMSM's HIV prevention and care continuum outcomes.

Use of social network analysis in the development, dissemination, implementation, and sustainability of health behavior interventions for adults: A systematic review

Interest in conceptualizing, measuring, and applying social network analysis (SNA) in public health has grown tremendously in recent years. While these studies have broadened our understanding of the role that social networks play in health, there has been less research that has investigated the application of SNA to inform health-related interventions. This systematic review aimed to capture the current applied use of SNA in the development, dissemination, implementation, and sustainability of health behavior interventions for adults. We identified 52 articles published between 2004 and 2016. A wide variety of study settings were identified, most commonly in the US context and most often related to sexual health and HIV prevention. We found that 38% of articles explicitly applied SNA to inform some aspect of interventions. Use of SNA to inform intervention development (as opposed to dissemination, implementation, or sustainability) was most common. The majority of articles represented in this review (n = 39) were quantitative studies, and 13 articles included a qualitative component. Partial networks were most represented across articles, and over 100 different networks measures were assessed. The most commonly described measures were network density, size, and degree centrality. Finally, very few articles defined SNA and not all articles using SNA were theoretically-informed. Given the nascent and heterogeneous state of the literature in this area, this is an important time for the field to coalesce on terminology, measures, and theoretical frameworks. We highlight areas for researchers to advance work on the application of SNA in the design, dissemination, implementation and sustainability of behavioral interventions.

Consumer health information seeking in social media: a literature review

OBJECTIVE

The objective of this literature review was to summarise current research regarding how consumers seek health-related information from social media. Primarily, we hope to reveal characteristics of existing studies investigating the health topics that consumers have discussed in social media, ascertaining the roles social media have played in consumers' information-seeking processes and discussing the potential benefits and concerns of accessing consumer health information in social media.

METHODS

The Web of Science Core Collection database was searched for existing literature on consumer health information seeking in social media. The search returned 214 articles, of which 21 met the eligibility criteria following review of full-text documents.

CONCLUSION

Between 2011 and 2016, twenty-one studies published explored various topics related to consumer information seeking in social media. These ranged from online discussions on specific diseases (e.g. diabetes) to public health concerns (e.g. pesticide residues). Consumers' information needs vary depending on the health issues of interest. Benefits of health seeking on social media, in addition to filling a need for health information, include the social and emotional support health consumers gain from peer-to-peer interactions. These benefits, however, are tempered by concerns of information quality and authority and lead to decreased consumer engagement.

User recommendation in healthcare social media by assessing user similarity in heterogeneous network

OBJECTIVE

The rapid growth of online health social websites has captured a vast amount of healthcare information and made the information easy to access for health consumers. E-patients often use these social websites for informational and emotional support. However, health consumers could be easily overwhelmed by the overloaded information. Healthcare information searching can be very difficult for consumers, not to mention most of them are not skilled information searcher. In this work, we investigate the approaches for measuring user similarity in online health social websites. By recommending similar users to consumers, we can help them to seek informational and emotional support in a more efficient way.

METHODS

We propose to represent the healthcare social media data as a heterogeneous healthcare information network and introduce the local and global structural approaches for measuring user similarity in a heterogeneous network. We compare the proposed structural approaches with the content-based approach.

RESULTS

Experiments were conducted on a dataset collected from a popular online health social website, and the results showed that content-based approach performed better for inactive users, while structural approaches performed better for active users. Moreover, global structural approach outperformed local structural approach for all user groups. In addition, we conducted experiments on local and global structural approaches using different weight schemas for the edges in the network. Leverage performed the best for both local and global approaches. Finally, we integrated different approaches and demonstrated that hybrid method yielded better performance than the individual approach.

CONCLUSION

The results indicate that content-based methods can effectively capture the similarity of inactive users who usually have focused interests, while structural methods can achieve better performance when rich structural information is available. Local structural approach only considers direct connections between nodes in the network, while global structural approach takes the indirect connections into account. Therefore, the global similarity approach can deal with sparse networks and capture the implicit similarity between two users. Different approaches may capture different aspects of the similarity relationship between two users. When we combine different methods together, we could achieve a better performance than using each individual method.

You Get What You Give: Understanding Reply Reciprocity and Social Capital in Online Health Support Forums

Adopting a social network analysis approach, the present study examined social capital and network dynamics of online support seeking and support provision in a depression forum. We constructed a depression forum network by mapping out all of the users and the reply ties among them. The findings showed a consistently reciprocal pattern between users' replies sent to others and replies received from others. Forum users' bridging social capital was positively associated with the source diversity of their received replies and negatively associated with the average length of their received replies. Furthermore, forum users' bonding social capital was positively associated with the average length of their received replies and negatively associated with the source diversity of their received replies.

The influence of health-specific social network site use on the psychological well-being of cancer-affected people

OBJECTIVE

We aimed to explore and examine how and in what ways the use of social network sites (SNSs) can improve health outcomes, specifically better psychological well-being, for cancer-affected people.

METHODS

Qualitative semi-structured interviews were conducted with users of the Ovarian Cancer Australia Facebook page (OCA Facebook), the exemplar SNS used in this study. Twenty-five women affected by ovarian cancer who were users of OCA Facebook were interviewed. A multi-theory perspective was employed to interpret the data.

RESULTS

Most of the study participants used OCA Facebook daily. Some users were passive and only observed created content, while other users actively posted content and communicated with other members. Analysis showed that the use of this SNS enhanced social support for users, improved the users' experiences of social connectedness, and helped users learn and develop social presence, which ultimately improved their psychological well-being.

DISCUSSION

The strong theoretical underpinning of our research and empirically derived results led to a new understanding of the capacity of SNSs to improve psychological well-being. Our study provides evidence showing how the integration of these tools into existing health services can enhance patients' psychological well-being. This study also contributes to the body of knowledge on the implications of SNS use for improving the psychological well-being of cancer-affected people.

CONCLUSION

This research assessed the relationship between the use of SNSs, specifically OCA Facebook, and the psychological well-being of cancer-affected people. The study confirmed that using OCA Facebook can improve psychological well-being by demonstrating the potential value of SNSs as a support service in the healthcare industry.