Differences in intrapersonal and interactional empowerment between lurkers and posters in health-related online support communities

Uncovering the relationship between community participation and socio-political control among the migrant population

Prior research on psychological empowerment has found that community participation is associated with socio-political control, which takes place when people perceive control in their socio-political contexts. However, the process by which this relationship occurs remains an understudied area for migrants. This study aims to: (a) analyze the differences in socio-political control, critical thinking, and ethnic identity according to membership in migrant community-based organizations; and (b) propose a predictive model of socio-political control. A total of 239 first-generation migrants living in northern Italy completed a questionnaire (48.4% belonged to a migrant community-based organization). Members were found to have higher levels than nonmembers in all the variables. A moderated mediation model was proposed, whereby ethnic identity was a mediator between community participation and socio-political control, and critical thinking was a negative moderator between ethnic identity and socio-political control. Practical implications for enhancing socio-political control among migrants in receiving societies are discussed.

"We the BE": An educational mobile health application for children and families affected by bladder exstrophy-epispadias-cloacal exstrophy complex

GOALS

Despite the proliferation of over 45 000 smartphone mobile health applications (MHAs), as far as we know, there is no MHA for those living with rare diseases such as Bladder Exstrophy-Epispadias-Cloacal Exstrophy complex (BEEC). We hypothesized that an MHA could provide similar "on-demand" information and connectivity within health communities for patients with BEEC as they do for more common diseases. Thus, our primary goal was to create an MHA for patients and families affected by BEEC to provide them with important information about the condition and a format for them to connect with other affected patients and families. A secondary goal was to develop an adaptable MHA template for other rare diseases in the future.

METHODS

We began our app development by examining existing common-disease MHAs for thematic structure. We conducted an extensive literature search of PubMed and Google scholar for MHA development and existing MHAs related to BEEC, utilizing these search terms: mobile health applications, rare diseases, bladder exstrophy, and online health communities. Our app development team began with our clinical multidisciplinary team of pediatric urologists; a child psychiatrist; a patient/family mental health therapist; and a certified nurse practitioner. We hired a website engineer and a production team. All clinical members have extensive experience caring for children and families affected by BEEC. Additionally, clinical team members compiled lists of themes deemed relevant from these reviews and themes gleaned from their clinical experience that appear with some frequency or urgency and from the myriad of themes discussed within the literature for MHAs.

RESULTS

We found no existing rare disease MHAs in the literature or our search of app stores online. However, we derived basic app categories from existing MHA formats and the thematic content of all sources reviewed. These categories aligned with the groupings of our lists of clinical themes. Thus, we could subsume diverse themes within a broad categorical format: for example, child development (as "Psychological Development" in the app) or various clinical care options (as "Treatment"). This app structure became nine sections, as shown in. This format allows diverse information to be retrieved efficiently from broader categories. This app is being offered to affected families, healthcare providers, and individuals unrelated to where care is offered.

CONCLUSION

"We the BE" is the first MHA developed for a rare disease, BEEC. It has been published in a downloadable format for the general public at no cost. Further research is required to determine its efficacy for the BEEC community members; preliminary, unsolicited feedback from multiple users has been positive.

Understanding the Antecedents and Effects of mHealth App Use in Pandemics: A Sequential Mixed-Method Investigation

Pandemics such as COVID-19 pose serious threats to public health and disrupt the established systems for obtaining healthcare services. Mobile health (mHealth) apps serve the general public as a potential method for coping with these exogenous challenges. However, prior research has rarely discussed the antecedents and effects of mHealth apps and their use as a coping method during pandemics. Based on the technology acceptance model, empowerment theory, and event theory, we developed a research model to examine the antecedents (technology characteristics and event strength) and effects (psychological empowerment) of mHealth apps and their use. We tested this research model through a sequential mixed-method investigation. First, a quantitative study based on 402 Chinese mHealth users who used the apps during the COVID-19 pandemic was conducted to validate the theoretical model. A follow-up qualitative study of 191 online articles and reviews on mHealth during the COVID-19 pandemic was conducted to cross-validate the results and explain the unsupported findings of the quantitative study. The results show that (1) the mHealth app characteristics (perceived usefulness and perceived ease of use) positively affect mHealth app use; (2) mHealth app use positively affects the psychological empowerment of mHealth users; and (3) the characteristics of pandemic events (event criticality and event disruption) have positive moderating effects on the relationship between mHealth app characteristics and mHealth app use. This study explains the role of mHealth apps in the COVID-19 pandemic on the micro-level, which has implications for the ways in which mHealth apps are used in response to public pandemics.

The Role of EFL/ESL Teachers' Psychological Empowerment and Optimism on Their Job Commitment

Research has approved that teaching is a complex profession involving many cognitive, social, cultural, and psycho-emotional factors. To perform efficiently, teachers must be psycho-emotionally powerful and ready to cope with the existing challenges and complications of teaching a second/foreign language. This demands attempts to be made to psychologically empower the teachers to form positive outlooks about their profession and practices. Despite the criticality of psychological empowerment (PE), few studies in L2 contexts have dealt with it. Against this gap, the present article aimed to theoretically analyze the interaction among teachers' PE, optimism, and commitment. In so doing, the definitions, models, components, typologies, and empirical studies related to these constructs were presented. Finally, practical implications of this line of research for EFL/ESL teachers, teacher trainers, and researchers are provided to raise their awareness of psycho-emotional factors involved L2 education.

Pregnant women's coping strategies, participation roles and social support in the online community during the COVID-19

Pregnant women are experiencing enormous physical changes and suffering pregnancy-related losses, which may lead to depression symptoms during pregnancy. Given that the onslaught of COVID-19 had exacerbated pregnant women's anxiety because of disruptions in antenatal care and concerns regarding safe delivery, it is worth exploring how they obtain social support to cope with stress during COVID-19. Although many works have explored the impact of coping resources that people have on coping strategies, few studies have been done on the relationship between people's coping strategies and their acquisition of coping resources such as social support. To fill this gap, based on the stress and coping theory (SCT) and social penetration theory (SPT), this study investigates the impacts of pregnant women's different coping strategies on the acquisition of social support and the moderating role of the adverse impacts of COVID-19 and their online participation roles (support providers vs. support seekers) using the data of 814 pregnant women's online behavior from a parenting community in China1. Our study indicates that both women's superficial level disclosure and personal level disclosure positively affect online social support received. Moreover, self-disclosure about the adverse impacts of COVID-19 negatively moderates the relationship between personal level disclosure and social support received. Participation role positively moderates the relationship between personal level disclosure and social support received, but negatively moderates the relationship between superficial level disclosure and social support received. This paper makes theoretical contributions to the literature of SCT, SPT and the literature about social support in online communities.

Online social support and collective empowerment: Serial mediation effect on self-efficacy among mothers of children with type 1 diabetes

AIM

To identify a serial multiple mediation effect of social support in online health communities and collective empowerment on the relationship between diabetes-related burden (DRB) and self-efficacy, among mothers using a continuous glucose monitoring device for children with type 1 diabetes (T1D).

DESIGN

A secondary analysis, cross-sectional, descriptive study.

METHODS

Data were obtained from 198 mothers of children with T1D via a web survey, from August to September 2020. Measures used were the Collective Empowerment in the Online Health Community Scale, a modified version of the Multidimensional Scale of Perceived Social Support, Problem Areas in Diabetes Survey-Parent Revised version and a modified version of the Maternal Self-efficacy for Diabetes Management Scale. Data were analysed using SPSS 25.0, and PROCESS MACRO for SPSS v3.5.

RESULTS

A serial multiple mediation model was used. The indirect effects of both social support in online health communities and collective empowerment were identified in the relationship between DRB and diabetes self-efficacy (DSE). However, there was no indirect effect of social support in online health communities on these relationships.

CONCLUSION

These findings suggest that online social support alone has a limited role in chronic disease management self-efficacy. Collective empowerment should be a strategic component in intervention development using online health communities to strengthen DSE in mothers of children with T1D.

IMPACT

This study provides novel insights into the functional mechanism of online health communities for T1D. Peer mentor coaching by parents of children with T1D effectively helps other children's parents with its recent diagnosis. The findings recognize a need for strategies enhancing collective empowerment among parents of children with T1D. Along with peer coaching, these strategies should strengthen knowledge of resources and methods to impact social change as well as resource mobilization for collective actions.

The Impact of Health Information Privacy Concerns on Engagement and Payment Behaviors in Online Health Communities

Online health communities (OHCs) have enjoyed increasing popularity in recent years, especially in the context of the COVID-19 pandemic. However, several concerns have been raised regarding the privacy of users’ personal information in OHCs. Considering that OHCs are a type of data-sharing or data-driven platform, it is crucial to determine whether users’ health information privacy concerns influence their behaviors in OHCs. Thus, by conducting a survey, this study explores the impact of users’ health information privacy concerns on their engagement and payment behavior (Paid) in OHCs. The empirical results show that users’ concerns about health information privacy reduce their Paid in OHCs by negatively influencing their OHC engagement. Further analysis reveals that if users have higher benefit appraisals (i.e., perceived informational and emotional support from OHCs) and lower threat appraisals (i.e., perceived severity and vulnerability of information disclosure from OHCs), the negative effect of health information privacy concerns on users’ OHC engagement will decrease.

Extracting Additional Influences From Physician Profiles With Topic Modeling: Impact on Ratings and Page Views in Online Healthcare Communities

How physicians can get better ratings and more page views in online healthcare communities is an important issue. Based on 38,457 physicians' profiles from a popular online healthcare community in China, we used Latent Dirichlet Allocation model, which is a common topic model, to analyze the non-English text to obtain more doctor's latent characteristics. We found five of the most frequently mentioned topics. In addition to the first topic (doctor's academic rank and practice name), “research ability,” “foreign experience,” “committee position,” and “clinical experience” were included as unstructured descriptions in the doctor's profile. Inferences about physician ratings and page views could be improved if these themes were set as characteristics of physicians. Specifically, in our findings, Physicians' mentions of their “research ability” and “foreign experience” had a significant positive impact on physician ratings. Surprisingly, physicians mentioning more “clinical experience” had a significant negative impact on physician ratings. Moreover, while descriptions about “foreign experience” and “committee position” had a significant positive impact on page views, physician mentions of “research ability” had a significant negative impact on page views. These results provide new insights into the ways in which online healthcare community managers or physicians create their personal online profiles.

A Newly Developed Online Peer Support Community for Depression (Depression Connect): Qualitative Study

Background

Internet support groups enable users to provide peer support by exchanging knowledge about and experiences in coping with their illness. Several studies exploring the benefits of internet support groups for depression have found positive effects on recovery-oriented values, including empowerment. However, to date, little attention has been paid to user narratives.

Objective

This study aims to capture the user perspective on an online peer support community for depression with a focus on the modes of user engagement and the benefits users derive from participation in the forum.

Methods

In this qualitative study, we conducted 15 semistructured interviews with users of Depression Connect, a newly developed online peer support community for individuals with depression. Combining a concept-driven and a data-driven approach, we aimed to gain insight into what users value in our Depression Connect platform and whether and how the platform promotes empowerment. We performed a thematic analysis to explore the merits and demerits reported by users by using theoretical concepts widely used in internet support group research. In the subsequent data-driven analysis, we sought to understand the relationship between different styles of user engagement and the participants’ experiences with the use of Depression Connect. Data analysis consisted of open, axial, and selective coding. To include as diverse perspectives as possible, we opted for purposive sampling. To verify and validate the (interim) results, we included negative cases and performed member checks.

Results

We found participation in Depression Connect contributes to a sense of belonging, emotional growth, self-efficacy, and empowerment. “Getting too caught up” was the most frequently reported negative aspect of using Depression Connect. The deployment and development of three participation styles (ie, reading, posting, and responding) affected the perceived benefits of Depression Connect use differentially, where the latter style was central to enhancing empowerment. “Being of value to others” boosted the users’ belief in their personal strength. Finally, Depression Connect was predominantly used to supplement offline support and care for depression, and it mainly served as a safe environment where members could freely reflect on their coping mechanisms for depression and exchange and practice coping strategies.

Conclusions

Our findings shed new light on user engagement processes on which internet support groups rely. The online community primarily served as a virtual meeting place to practice (social) skills for deployment in the offline world. It also allowed the members to learn from each other’s knowledge and experiences and explore newly gained insights and coping skills.

Online Communities as a Driver for Patient Empowerment: Systematic Review

BACKGROUND

The use of online resources has changed how people manage health care processes. Patients seek information about health conditions, guidance in treatment, and support from peers online, complementary to traditional health care trajectories. Online communities have the potential to contribute to the quality of care by increasing patient empowerment; however, there is a gap in research regarding in what way online communities contribute to patient empowerment.

OBJECTIVE

We synthesized research regarding how online communities contribute to patient empowerment to address the research question "In what ways can participation in online communities support patient empowerment?" by studying how patient empowerment is operationalized in different studies. The definition of patient empowerment used in this paper is enablement for people to develop mastery over actions and control over decisions that influence their lives. The mastery is both through processes and outcomes of the development.

METHODS

A systematic review was conducted by searching in the following databases: Scopus, ACM Digital Library, EBSCO (CINAHL and MEDLINE), PubMed, and Web of Science. In total, there were 1187 papers after excluding duplicates, and through selection processes using an analytical framework with definitions of patient empowerment and related concepts, 33 peer-reviewed papers were included.

RESULTS

Findings indicated that online communities support patient empowerment both as a process and as outcomes of these processes. Additionally, it was seen as a complement to traditional health care and encouragement for health care professionals to have a more positive attitude toward patients' usage. There was a mix between deductive (19/33, 58%), inductive (11/33, 33%), and a mixed approach (3/33, 9%) of studying patient empowerment in various forms. The online communities in most papers (21/33, 64%) were well-established and represented patients' initiatives.

CONCLUSIONS

There is a need to include professionals' perspectives regarding how health care can embrace patient empowerment through online communities. This systematic review's main contribution is the proposal of a new framework and conceptualization of how patient empowerment in online communities can be understood from different hierarchical levels.

Predicting Quality of Life among Mothers in an Online Health Community for Children with Type 1 Diabetes

Quality of life of parents of children with chronic disease is important for disease self-management. This study aimed to identify predictors of quality of life among mothers of children with type 1 diabetes. A cross-sectional study was conducted. A total of 208 mothers of children with type 1 diabetes were recruited from an online health community. Online health community collective empowerment and social support, diabetes self-efficacy, diabetes-related burden, and quality of life were measured. A multiple regression analysis was conducted to determine predictive factors for quality of life. Multiple regression analysis showed that diabetes-related burden and the child’s age were predictors of quality of life, and total variance explained by the model was 64.1% using two factors. In mothers of younger children, it is important to reduce the diabetes-related burden. Factors that increase the diabetes-related burden should be identified, and strategies to reduce the diabetes-related burden must be established.

Collective Empowerment in Online Health Communities: Scale Development and Empirical Validation

Background

The role of online health communities (OHCs) in patient empowerment is growing and has been increasingly studied in recent years. Research has focused primarily on individualistic conception of patients’ empowerment, with much less attention paid to the role of OHCs in the development of patients’ collective empowerment. Although OHCs have immense potential for empowerment that goes beyond the individual, the concept and scale of collective empowerment in OHCs have not yet been developed or validated.

Objective

This study aimed to develop an instrument for measuring collective empowerment in online health communities (CE-OHC) and to test its quality by investigating its factorial structure, reliability, construct validity, and predictive validity.

Methods

The CE-OHC scale was developed according to a strict methodology for developing valid and reliable scales. An initial set of 20 items was first tested in the pilot study conducted in 2016 using a sample of 280 registered users of Slovenia’s largest OHC. A refined version with 11 items was tested in the main study conducted in 2018 on a random sample of 30,000 registered users of the same OHC. The final sample comprised 784 users. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factorial structure, discriminant validity, and convergent validity of the scale. Cronbach alpha coefficient was used to determine the CE-OHC scale’s internal consistency. To establish the predictive validity, ordinary least squares regression was performed to test the role of CE-OHC in users’ civic participation.

Results

The EFA resulted in a two-factor solution, and the two factors—knowledge of resources and resource mobilization for collective action—together explain 63.8% of the variance. The second-order CFA demonstrated a good fit to the data (root mean square error of approximation=0.07) and the scale had a good internal consistency (alpha=.86). Although evidence of the scale’s convergent validity was partially provided, discriminant validity of the scale remained unconfirmed. Overall, CE-OHC was confirmed to be a predictor of users’ civic participation, but the influence was somewhat weak and inconsistent across two subscales.

Conclusions

The proposed CE-OHC scale is a reliable and relatively valid instrument and serves as a good baseline to advance the measurement of collective empowerment in OHC contexts. This is the first scale developed for this purpose, and future research should focus on the development of a clear nomological network of the collective empowerment construct in relation to the OHC settings.

Patient Continued Use of Online Health Care Communities: Web Mining of Patient-Doctor Communication

BACKGROUND

In practice, online health communities have passed the adoption stage and reached the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in health care are capable of switching between different communities to maximize their online health community activities. Online health communities employ doctors to answer patient questions, and high quality online health communities are more likely to be acknowledged by patients. Therefore, the factors that motivate patients to maintain ongoing relationships with online health communities must be addressed. However, this has received limited scholarly attention.

OBJECTIVE

The purpose of this study was to identify the factors that drive patients to continue their use of online health communities where doctor-patient communication occurs. This was achieved by integrating the information system success model with online health community features.

METHODS

A Web spider was used to download and extract data from one of the most authoritative Chinese online health communities in which communication occurs between doctors and patients. The time span analyzed in this study was from January 2017 to March 2017. A sample of 469 valid anonymous patients with 9667 posts was obtained (the equivalent of 469 respondents in survey research). A combination of Web mining and structural equation modeling was then conducted to test the research hypotheses.

RESULTS

The results show that the research framework for integrating the information system success model and online health community features contributes to our understanding of the factors that drive patients' relationships with online health communities. The primary findings are as follows: (1) perceived usefulness is found to be significantly determined by three exogenous variables (ie, social support, information quality, and service quality; R²=0.88). These variables explain 87.6% of the variance in perceived usefulness of online health communities; (2) similarly, patient satisfaction was found to be significantly determined by the three variables listed above (R²=0.69). These variables explain 69.3% of the variance seen in patient satisfaction; (3) continuance use (dependent variable) is significantly influenced by perceived usefulness and patient satisfaction (R²=0.93). That is, the combined effects of perceived usefulness and patient satisfaction explain 93.4% of the variance seen in continuance use; and (4) unexpectedly, individual literacy had no influence on perceived usefulness and satisfaction of patients using online health communities.

CONCLUSIONS

First, this study contributes to the existing literature on the continuance use of online health communities using an empirical approach. Second, an appropriate metric was developed to assess constructs related to the proposed research model. Additionally, a Web spider enabled us to acquire objective data relatively easily and frequently, thereby overcoming a major limitation of survey techniques.

Do online health communities enhance patient-physician relationship? An assessment of the impact of social support and patient empowerment

The diffusion of the Web 2.0 has made it possible for patients to exchange on online health communities, defined as computer-mediated communities dedicated to health topics, wherein members can build relationships with other members. It is now acknowledged that online health communities provide users not only with medical information but also with social support with no time or geographical boundaries. However, in spite of their considerable interest, there is still a paucity of research as to how online health communities alter the patient-physician relationship. This research aims at filling this gap and examines how online health communities, while providing users with computer-mediated social support and empowerment, impact the patient-physician relationship. Six hypotheses are proposed and tested. A survey was developed and 328 responses were collected from online patient groups in Canada in 2016. The data were analysed using structural equation modelling. All but one hypothesis are validated. The results show that user computer-mediated social support positively influences user empowerment and participation during the consultation, which in turn determines user commitment to the relationship with the physician. Importantly and contrary to our expectations, user empowerment is found to be significantly but negatively related to user commitment with the physician.

Ill Literates or Illiterates? Investigating the eHealth Literacy of Users of Online Health Communities

Background

Electronic health (eHealth) literacy is an important skill that allows patients to navigate intelligibly through the vast, often misleading Web-based world. Although eHealth literacy has been investigated in general and specific demographic populations, it has not yet been analyzed on users of online health communities (OHCs). Evidence shows that OHCs are important Web 2.0 applications for patients for managing their health, but at the same time, warnings have been expressed regarding the quality and relevance of shared information. No studies exist that investigate levels of eHealth literacy among users of OHCs and differences in eHealth literacy between different types of users.

Objective

The study aimed to investigate eHealth literacy across different types of users of OHCs based on a revised and extended eHealth literacy scale (eHEALS).

Methods

The study was based on a cross-sectional Web survey on a simple random sample of 15,000 registered users of the most popular general OHC in Slovenia. The final sample comprised 644 users of the studied OHC. An extended eHEALS (eHEALS-E) was tested with factor analytical procedures, whereas user types were identified with a hierarchical clustering algorithm. The research question was analyzed with analysis of variance (ANOVA) procedure and pairwise comparison tests.

Results

Factor analysis of the revised and extended eHEALS revealed six dimensions: awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information, and being smart on the Net. The factor solution demonstrates a good fit to the data (root mean square error of approximation [RMSEA]=.059). The most developed dimension of eHEALS-E is awareness of different Internet sources (mean=3.98, standard deviation [SD]=0.61), whereas the least developed is understanding information (mean=3.11, SD=0.75). Clustering resulted in four user types: active help-seekers (48.3%, 311/644), lurkers (31.8%, 205/644), core relational users (16.9%, 109/644), and low-engaged users (3%, 19/644). Analysis of the research question showed statistically significant differences among user types across all six dimensions of eHEALS-E. Most notably, core relational users performed worse than lurkers on the validating information dimension (P=.01) and worse than active help-seekers on the being smart on the Net dimension (P=.05). Active help-seekers have the highest scores in all dimensions of the eHEALS-E, whereas low-engaged users have statistically significantly lower scores on all dimensions of the eHEALS-E in comparison with the other groups.

Conclusions

Those who are looking for advice and support in OHCs by making queries are well equipped with eHealth literacy skills to filter potential misinformation and detect bad advice. However, core relational users (who produce the most content in OHCs) have less-developed skills for cross-validating the information obtained and navigating successfully through the perils of the online world. Site managers should monitor their activity to avoid the spread of misinformation that might lead to unhealthy practices.

Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment

Background

Substantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs.

Objective

The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician’s paternalism.

Method

An email list–based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses.

Results

The mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=−.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=−.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=−.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=−.17, P=.01).

Conclusions

Social processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians.

Exploring the benefits and challenges of health professionals' participation in online health communities: Emergence of (dis)empowerment processes and outcomes

BACKGROUND

Various online applications and service has led to the development of online health communities (OHCs), which in addition to the peer-to-peer communication offer patients and other users also interaction with health professionals. While the benefits and challenges of patients and other users' participation in OHCs have been extensively studied, a thorough examination of how health professionals as moderators (i.e., those who provide clinical expertise to patients and other users in OHCs) experience participation in OHCs is lacking.

OBJECTIVE

The aim of this study is to explore the main benefits and challenges of health professional moderators' participation in the OHCs.

METHODS

The study undertakes an exploratory qualitative study, with in-depth semi-structured interviews with health professional moderators (n=7) participating in the largest OHC in Slovenia, Med.Over.Net. The data was analysed using inductive thematic analysis approach and principles of grounded theory.

RESULTS

Four themes of health professional moderators' experiences were identified: (a) benefits of addressing OHC users' health-related needs, (b) challenges of addressing OHC users' health-related needs, (c) health professional moderators' benefits, and (d) health professional moderators' challenges.

CONCLUSIONS

This small study demonstrates that health professional participating in OHCs as moderators perceive themselves as facilitators of patients and other OHC's users empowering processes and outcomes, in which OHC's users improve their health literacy, develop skills, expand their social support, and gain other important resources necessary when dealing with health-related issues. Health professional moderator's role, however, also involves several duties, responsibilities and limitations that are often experienced as difficulties in providing patients and other users with adequate counselling and online medical service. OHCs also represent an important terrain for personal and professional empowerment of health professional moderators, although the presence of disempowering processes also needs to be noted.

Frequent Surfing on Social Health Networks is Associated With Increased Knowledge and Patient Health Activation

Background

The advent of the Internet has driven a technological revolution that has changed our lives. As part of this phenomenon, social networks have attained a prominent role in health care. A variety of medical services is provided over the Internet, including home monitoring, interactive communications between the patient and service providers, and social support, among others. This study emphasizes some of the practical implications of Web-based health social networks for patients and for health care systems.

Objective

The objective of this study was to assess how participation in a social network among individuals with a chronic condition contributed to patient activation, based on the Patient Activation Measure (PAM).

Methods

A prospective, cross-sectional survey with a retrospective component was conducted. Data were collected from Camoni, a Hebrew-language Web-based social health network, participants in the diabetes mellitus, pain, hypertension, and depression/anxiety forums, during November 2012 to 2013. Experienced users (enrolled at least 6 months) and newly enrolled received similar versions of the same questionnaire including sociodemographics and PAM.

Results

Among 686 participants, 154 of 337 experienced and 123 of 349 newly enrolled completed the questionnaire. Positive correlations (P<.05) were found between frequency and duration of site visits and patient activation, social relationships, and chronic disease knowledge. Men surfed longer than women (χ²₃=10.104, P<.05). Experienced users with diabetes surfed more than those with other illnesses and had significantly higher PAM scores (mean, M=69.3, standard deviation, SD=19.1, PAM level 4; Z=−4.197, P<.001) than new users (M=62.8, SD=18.7, PAM level 3). Disease knowledge directly predicted PAM for all users (β=.26 and .21, respectively). Frequency and duration of social health network use were correlated with increased knowledge about a chronic disease. Experienced surfers had higher PAM than newly enrolled, suggesting that continued site use may contribute to increased activation.

Conclusions

Web-based social health networks offer an opportunity to expand patient knowledge and increase involvement in personal health, thereby increasing patient activation. Further studies are needed to examine these changes on other aspects of chronic illnesses such as quality of life and costs.