Empathic exchanges in online cancer support groups: distinguishing message expression and reception effects

Public sense of dental implants on social media: A cross-sectional study based on text analysis of comments

OBJECTIVES

To investigate the most discussed topics and possible new interests in dental implants among the public, as well as the public sentiments toward dental implants through topic and sentiment analysis of online comments.

METHODS

Comments of the top 100 most viewed dental implant-related YouTube videos were studied. The comments were analyzed by topic analysis (LDA topic model, Word co-occurrence analysis) and sentiment analysis. The basic information of videos was collected and classified. Video quality was evaluated by GQS criteria and 9-point usefulness scoring system. Statistical analyses were performed using Kruskal-Wallis test, Mann-Whitney U-tests, and Spearman correlation analysis.

RESULTS

74 videos with 61,618 comments were considered eligible in this study. Most videos targeted the public with high viewing and comments, but the theme was single and the quality was low. From topic analysis, the most discussed topics in the comments were procedure, cost, feelings associated with prognosis, and expectations. Multidisciplinary approaches in implant dentistry were frequently discussed. From sentiment analysis, the public mainly expressed positive sentiment through comments. In detail, the public had positive feelings about aesthetics and health, negative feelings about pain, and neutral feelings about cost.

CONCLUSION

The hot topics of public concern were procedure, cost, feelings associated with prognosis, and expectations. Intriguingly, multidisciplinary approaches in implant dentistry have emerged as a new hot subtopic within the topic "procedure". Based on the sentiment analysis of the comments, the general sentiment expressed by the public toward dental implants was predominantly positive.

CLINICAL SIGNIFICANCE

Text mining can extract data from social media to explore public interest in dentistry. Clinicians should convey reasonable expectations and understanding about dental implants, especially addressing the most public-concerned topics (procedure, cost, feelings, and expectations), and provide patients with well-grounded multidisciplinary treatment plans to meet the growing public demand.

Previvorship Posting: Why Breast Cancer Previvors Share Their Stories on Social Media

Research on previvors, individuals with a genetic predisposition to develop hereditary breast and ovarian cancer but who have not yet been diagnosed with breast or other cancers, examines online information gathering and community support to alleviate uncertainty. However, research exploring online content published by previvors themselves is limited. We examined content published to Instagram and TikTok to explore how breast cancer previvors discussed their lived experience which included, but was not limited to, genetic testing, diagnosis with a BRCA1/2 pathogenic (i.e. risk-increasing) variant, the decision to undergo preventative measures like surgery and/or reconstruction, and how they cope after diagnosis and surgical procedures. In the findings, we explicate how many previvors feel a responsibility to share their authentic experience on social media in order to help others and mitigate their own feelings of uncertainty. This study offers a snapshot of how women are sharing breast cancer previvorship and building social connections with each other online.

Social processes of participatory engagement effects: A longitudinal examination with a sample of young women in the United States

Participatory interventions enable active user engagement, but research is needed to examine the longitudinal mechanisms through which engagement may generate outcomes. This study investigated the social processes following a web-based participatory media literacy intervention. In this program, young women were asked to create a digital counter message against the media content that promotes risk behavior. The effects of the message production were assessed at an immediate post-test and three- and six-month follow-ups. Message production increased collective efficacy at immediate post-test, which then stimulated the sharing of self-generated messages and interpersonal conversation at three-month follow-up. These sharing behaviors, in turn, led to critical media use and negative attitude toward risk behavior at six months. Collective efficacy and sharing behavior sequentially mediated the effects of message production on outcomes. Theoretical and pragmatic implications are discussed.

Compassionate Technology: A Systematic Scoping Review of Compassion as Foundation for Blended and Digital Mental Health Interventions (Preprint)

BACKGROUND

An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by clients and more accessible and economically viable care. However, digital mental health interventions (DMHIs) have not been widely implemented in daily practice. Developing and evaluating DMHIs around important mental health care values, such as compassion, could be key for a better integration of technology in the mental health care context.

OBJECTIVE

This systematic scoping review explored the literature for previous instances where technology for mental health care has been linked to compassion or empathy to investigate how DMHIs can support compassion in mental health care.

METHODS

Searches were conducted in the PsycINFO, PubMed, Scopus, and Web of Science databases, and screening by 2 reviewers resulted in 33 included articles. From these articles, we extracted the following data: technology types, goals, target groups, and roles of the technologies in the intervention; study designs; outcome measures; and the extent to which the technologies met a 5-step proposed definition of compassion.

RESULTS

We found 3 main ways in which technology can contribute to compassion in mental health care: by showing compassion to people, by enhancing self-compassion in people, or by facilitating compassion between people. However, none of the included technologies met all 5 elements of compassion nor were they evaluated in terms of compassion.

CONCLUSIONS

We discuss the potential of compassionate technology, its challenges, and the need to evaluate technology for mental health care on compassion. Our findings could contribute to the development of compassionate technology, in which elements of compassion are explicitly embedded in its design, use, and evaluation.

Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

Background

Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging.

Objective

The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree.

Methods

A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome.

Results

Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications.

Conclusions

To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort.

Trial Registration

ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196

International Registered Report Identifier (IRRID)

PRR1-10.2196/37522

Intraindividual, Dyadic, and Network Communication in a Digital Health Intervention: Distinguishing Message Exposure from Message Production

Communicating within digital health interventions involves a range of behaviors that may contribute to the management of chronic illnesses in different ways. This study examines whether communication within a smartphone-based application for addiction recovery produces distinct effects depending on 1) the "level" of communication, defined as intraindividual communication (e.g., journal entries to oneself); dyadic communication (e.g., private messaging to other individuals); or network communication (e.g., discussion forum posts to all group members), and 2) whether individuals produce or are exposed to messages. We operationalize these communication levels and behaviors based on system use logs as the number of clicks dedicated to each activity and assess how each category of system use relates to changes in group bonding and substance use after 6 months with the mobile intervention. Our findings show that (1) intraindividual exposure to one's own past posts marginally predicts decreased drug use; (2) dyadic production predicts greater perceived bonding; while dyadic exposure marginally predicts reduced drug use; (3) network production predicts decreased risky drinking. Implications for digital health interventions are discussed.

Exploring the Role of Social Support in Promoting Patient Participation in Health Care among Women with Breast Cancer

Scholars have adopted Street's (2003) ecological model of communication in medical encounters to investigate the factors promoting patient participation in health care. However, factors demonstrated in the ecological model were bounded in the context of medical care primarily focusing on health care providers and patients. Social factors, such as patients' relationships and supportive communication with others outside the context of health care remain relatively unexplored. To expand the purview of our understanding of factors that influence patient participation, this research integrated social support literature into the research on physician-patient communication and proposed a model which described a process through which social support can enhance patient participation in health care. The data analyzed in this study were a part of two larger clinical trials in which 661 women with breast cancer were recruited from three cancer institutions in the United States. The results from structural equation modeling analysis from cross-sectional and longitudinal data provided strong evidence for the hypotheses predicting that perceived social support was positively associated with health information competence, which in turn fully mediated the association between social support and patient participation in health care. Theoretical and practical implications are discussed.

The Exploration of How Social Media Cultivate College Student Smokers: Theorizing Valence of Communication, Impression Management, and Perceived Risks and Benefits of Smoking in the O1-S-R1-O2-R2 Model

The purpose of this study is to build a theoretical framework to account for how social media lead college students to smoke. Arguing critical concepts, such as valence of communication, impression management, perceived risks and benefits, this study develops the O 1 -S-R 1 -O 2 -R 2 model. For this, we test a separated model for smokers and nonsmokers. For smokers, the effect of exposure to pro-smoking content on smoking behavior is mediated by an impression of smokers, a favorable expression about smoking, and perceived benefits. And, the effect of exposure to anti-smoking content on smoking behavior is mediated by an unfavorable expression about smoking and perceived risks. However, such mediation processes cannot be observed for nonsmokers; namely, the effect of exposure to pro-smoking content on smoking intention is only mediated by a favorable expression about smoking. Considering the separated path models for smokers and nonsmokers, theoretical and practical implications are suggested for future study. Methodological limitations are discussed as well.

A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

Background

Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives.

Objective

This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures.

Methods

In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes.

Results

Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021.

Conclusions

With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications.

Trial Registration

ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735.

International Registered Report Identifier (IRRID)

DERR1-10.2196/25175

Effects of Web-Based Social Connectedness on Older Adults' Depressive Symptoms: A Two-Wave Cross-Lagged Panel Study

Background

Depressive symptoms are the most prevalent mental health concern among older adults (possibly heightened during the COVID-19 pandemic), which raises questions about how such symptoms can be lowered in this population. Existing research shows that offline social connectedness is a protective factor against depression in older adults; however, it is unknown whether web-based social connectedness can have similar effects.

Objective

This study investigates whether social connectedness on a support website protects older adults against depressive symptoms over the course of a year, above and beyond the protective effect of offline social connectedness. The secondary aim is to determine whether older adults with increased depressive symptoms are more likely to engage in social connectedness on this website. Thus, we examine depressive symptoms as both an outcome and predictor of web-based social connectedness to fully understand the chain of causality among these variables. Finally, we compare web-based social connectedness with offline social connectedness in their ability to lower depressive symptoms among older adults.

Methods

A total of 197 adults aged 65 years or older were given access to a social support website, where they were able to communicate with each other via a discussion forum for a year. Participants’ social connectedness on the web-based platform, conceptualized as message production and consumption, was measured using behavioral log data as the number of messages participants wrote and read, respectively, during the first 6 months (t₁) and the following 6 months (t₂) of the study. Participants self-reported their offline social connectedness as the number of people in their support networks, and they reported their depressive symptoms using the Patient Health Questionnaire-8 both at baseline (t₁) and at 12-month follow-up (t₂). To ascertain the flow of causality between these variables, we employed a cross-lagged panel design, in which all variables were measured at t₁ and t₂.

Results

After controlling for the effect of offline support networks at t₁, web-based message consumption at t₁ decreased older adults’ depressive symptoms at t₂ (β=−.11; P=.02), but web-based message production at t₁ did not impact t₂ depressive symptoms (β=.12; P=.34). Web-based message consumption had a larger effect (β=−.11; P=.02) than offline support networks (β=−.08; P=.03) in reducing older adults’ depressive symptoms over time. Higher baseline depressive symptoms did not predict increased web-based message consumption (β=.12; P=.36) or production (β=.02; P=.43) over time.

Conclusions

The more messages older adults read on the web-based forum for the first 6 months of the study, the less depressed they felt at the 1-year follow-up, above and beyond the availability of offline support networks at baseline. This pinpoints the substantial potential of web-based communication to combat depressive symptoms in this vulnerable population.

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-015-0713-2

From Risk Butterflies to Citizens Engaged in Risk Prevention in the Zika Virus Crisis: Focusing on Personal, Societal and Global Risk Perceptions

This study investigates how posting information about the Zika virus on social media, and receiving information about Zika through the same platforms, are associated with personal, societal and global risk perceptions, and whether different types of risk perceptions are related to information seeking and preventive behavior intentions. A survey of U.S. participants (N = 958) revealed that posting information on social media is positively associated with personal and societal risk perceptions but not with global risk perceptions. Receiving information through social media, however, is positively associated with personal, societal and global risk perceptions. Personal and societal risk perceptions are associated with high information seeking intentions, which in turn leads to preventive behavioral intentions. The results suggest that so-called risk butterflies-those who frequently post information on social media-relate the health crisis to themselves and to their communities, and that these are important motivations for information-seeking and risk preventive behavior.

A smartphone-based support group for alcoholism: Effects of giving and receiving emotional support on coping self-efficacy and risky drinking

The purpose of this study was to investigate the nature and effects of exchanging emotional support via a smartphone-based support group for patients with alcohol dependence. Of the 349 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol dependence, 153 patients participated in the discussion group within the Addiction-Comprehensive Health Enhancement Support System, a smartphone application aimed at reducing relapse. This was developed to prevent problem drinking by offering individuals in recovery for alcohol dependence automated 24/7 recovery support services and frequent assessment of their symptom status as part of their addiction care. The results showed that receiving emotional support from health care providers improved coping self-efficacy. Giving emotional support and receiving emotional support from health care providers acted as a buffer, protecting patients from the harmful effects of emotional distress on risky drinking. Clinicians and researchers should use the features of smartphone-based support groups to reach out to alcoholic patients in need and encourage them to participate in the exchange of emotional support with others.

How Risk Communication via Facebook and Twitter Shapes Behavioral Intentions: The Case of Fine Dust Pollution in South Korea

Despite the importance of social network sites (SNSs) in addressing emerging public health risks, there is still a relative lack of studies examining the effects of risk communication via SNSs on risk perceptions and preventive behaviors. Based on message expression‒ and reception‒effects paradigms, this study aims to explore how expressing and receiving risk information shape preventive behavioral intentions via risk perceptions. Given the differential nature and functionality of SNSs, the present investigation also examines whether expressing and receiving risk information via two different types of SNSs-Facebook and Twitter-have different effects on risk perceptions and behavioral intentions. Analyzing survey data from 1,152 South Korean adults in the context of fine dust hazards, this study found that expressing and receiving risk information not only affected risk perceptions but also directly or indirectly influenced preventive behavioral intentions. In addition, the effects of expressing and receiving risk information were differentiated between SNS platforms, specifically Facebook and Twitter.

A Longitudinal Investigation of Empathic Exchanges in Online Cancer Support Groups: Message Reception and Expression Effects on Patients' Psychosocial Health Outcomes

Recent studies have devoted attention to the effects of both expression and reception in communication process. However, there remain both theoretical and methodological complexities concerning whether and under what condition message expression and reception play significant but different roles in explaining various psychosocial health outcomes. Relying on theoretical insights from the social support literature and methodological innovations offered by computational social science, this study aims to examine the effects of empathic exchanges on cancer patient's short- and long-term psychosocial health outcomes. Our findings suggest that both empathy expression and reception are crucial to attaining benefits for cancer patients, each predicting differential cognitive and affective health outcomes. Further, our finding supports the stress-buffering hypothesis such that empathy reception provides a beneficial effect for patients who experienced a higher degree of depression associated with their cancer diagnosis and follow-up treatments.

Emotional Self-Disclosure in Online Breast Cancer Support Groups: Examining Theme, Reciprocity, and Linguistic Style Matching

The present study investigated emotional self-disclosure (ESD) patterns and their effects in online support groups specific to different stages of breast cancer. Linguistic features of messages posted to an online breast cancer support group were analyzed. ESD was common, and was consistent across four stage forums. Emotional talk was linked to a variety of themes, but most prominently in the context of discussions about social connections rather than health or death. Linguistic style matching mediated the relationship between ESD in posts and reciprocal ESD in comments, suggesting a key role for mutual understanding and engagement between posters and commenters. Implications for health communication theory and practice were discussed.

Seeing Others Receive Support Online: Effects of Self-Disclosure and Similarity on Perceived Similarity and Health Behavior Intention

Participation in online support groups leads to improved health. While viewing others' interactions is one of the major activities in online support groups and lurkers comprise the majority of online support group participants, the literature on how participants benefit from viewing others' posts and comments is sparse. Building upon the Social Penetration Theory and the narrative persuasion process, this study focused on two key features of online support groups, self-disclosure and similarity. It tested their direct effects on viewers' perceived similarity with the poster and indirect effects on viewers' behavior intention through three mediators: perceived similarity, identification, and perceived support availability. A 2 (similarity vs. dissimilarity) by 3 (factual vs. cognitive vs. emotional self-disclosure) online experiment involving 280 overweight adult participants was conducted. Findings showed similarity of health status led to increased level of perceived similarity and moderated the effects of self-disclosure. Self-disclosure and similarity increased dieting intention through increasing perceived similarity, identification, and perceived support availability. This study provides experimental evidence suggesting viewers can benefit from online support groups through a narrative persuasion process.

Sharing and Empathy in Digital Spaces: Qualitative Study of Online Health Forums for Breast Cancer and Motor Neuron Disease (Amyotrophic Lateral Sclerosis)

BACKGROUND

The availability of an increasing number of online health forums has altered the experience of living with a health condition, as more people are now able to connect and support one another. Empathy is an important component of peer-to-peer support, although little is known about how empathy develops and operates within online health forums.

OBJECTIVE

The aim of this paper is to explore how empathy develops and operates within two online health forums for differing health conditions: breast cancer and motor neuron disease (MND), also known as amyotrophic lateral sclerosis.

METHODS

This qualitative study analyzed data from two sources: interviews with forum users and downloaded forum posts. Data were collected from two online health forums provided by UK charities: Breast Cancer Care and the Motor Neurone Disease Association. We analyzed 84 threads from the breast cancer forum and 52 from the MND forum. Threads were purposively sampled to reflect varied experiences (eg, illness stages, topics of conversation, and user characteristics). Semistructured interviews were conducted with 14 Breast Cancer Care forum users and five users of the MND forum. All datasets were analyzed thematically using Braun and Clarke's six-phase approach and combined to triangulate the analysis.

RESULTS

We found that empathy develops and operates through shared experiences and connections. The development of empathy begins outside the forum with experiences of illness onset and diagnosis, creating emotional and informational needs. Users came to the forum and found their experiences and needs were shared and understood by others, setting the empathetic tone and supportive ethos of the forum. The forum was viewed as both a useful and meaningful space in which they could share experiences, information, and emotions, and receive empathetic support within a supportive and warm atmosphere. Empathy operated through connections formed within this humane space based on similarity, relationships, and shared feelings. Users felt a need to connect to users who they felt were like themselves (eg, people sharing the same specific diagnosis). They formed relationships with other users. They connected based on the emotional understanding of ill health. Within these connections, empathic communication flourished.

CONCLUSIONS

Empathy develops and operates within shared experiences and connections, enabled by structural possibilities provided by the forums giving users the opportunity and means to interact within public, restricted, and more private spaces, as well as within groups and in one-to-one exchanges. The atmosphere and feeling of both sites and perceived audiences were important facilitators of empathy, with users sharing a perception of virtual communities of caring and supportive people. Our findings are of value to organizations hosting health forums and to health professionals signposting patients to additional sources of support.

Analysis of Content Shared in Online Cancer Communities: Systematic Review

Background

The content that cancer patients and their relatives (ie, posters) share in online cancer communities has been researched in various ways. In the past decade, researchers have used automated analysis methods in addition to manual coding methods. Patients, providers, researchers, and health care professionals can learn from experienced patients, provided that their experience is findable.

Objective

The aim of this study was to systematically review all relevant literature that analyzes user-generated content shared within online cancer communities. We reviewed the quality of available research and the kind of content that posters share with each other on the internet.

Methods

A computerized literature search was performed via PubMed (MEDLINE), PsycINFO (5 and 4 stars), Cochrane Central Register of Controlled Trials, and ScienceDirect. The last search was conducted in July 2017. Papers were selected if they included the following terms: (cancer patient) and (support group or health communities) and (online or internet). We selected 27 papers and then subjected them to a 14-item quality checklist independently scored by 2 investigators.

Results

The methodological quality of the selected studies varied: 16 were of high quality and 11 were of adequate quality. Of those 27 studies, 15 were manually coded, 7 automated, and 5 used a combination of methods. The best results can be seen in the papers that combined both analytical methods. The number of analyzed posts ranged from 200 to 1,500,000; the number of analyzed posters ranged from 75 to 90,000. The studies analyzing large numbers of posts mainly related to breast cancer, whereas those analyzing small numbers were related to other types of cancers. A total of 12 studies involved some or entirely automatic analysis of the user-generated content. All the authors referred to two main content categories: informational support and emotional support. In all, 15 studies reported only on the content, 6 studies explicitly reported on content and social aspects, and 6 studies focused on emotional changes.

Conclusions

In the future, increasing amounts of user-generated content will become available on the internet. The results of content analysis, especially of the larger studies, give detailed insights into patients’ concerns and worries, which can then be used to improve cancer care. To make the results of such analyses as usable as possible, automatic content analysis methods will need to be improved through interdisciplinary collaboration.

Social Media Campaign Effects: Moderating Role of Social Capital in an Anti-Smoking Campaign

This study examined the effects of an anti-smoking campaign that employs a crowdsourcing method with a social networking service. Drawing upon social capital scholarship and the expression effect research paradigm in eHealth systems, the study also investigated the roles of social trust and community life satisfaction in the social media campaign that has a specific geographical boundary. To that end, we conducted an experiment using a two-group pretest-posttest design. We randomly assigned 201 participants to two conditions: "campaign message reception only" as a control group and "message reception and expression" as a treatment group in which participants fully engaged in the campaign process by sharing their own campaign ideas with other participants. Findings revealed that social trust and community life satisfaction interacted with the treatment condition to positively affect persuasive intentions, but in distinct ways. Social trust moderated the effect of the message reception and interaction condition on participants' willingness to encourage community members to stop smoking. In contrast, community life satisfaction moderated the effect of the treatment condition on encouraging others to comply with the community's anti-smoking policy. These results provide theoretical and practical implications related to the roles of social capital in geographically defined social media campaigns.

Online cancer communities as informatics intervention for social support: conceptualization, characterization, and impact

Objectives: The Internet and social media are revolutionizing how social support is exchanged and perceived, making online health communities (OHCs) one of the most exciting research areas in health informatics. This paper aims to provide a framework for organizing research of OHCs and help identify questions to explore for future informatics research. Based on the framework, we conceptualize OHCs from a social support standpoint and identify variables of interest in characterizing community members. For the sake of this tutorial, we focus our review on online cancer communities.

Target audience: The primary target audience is informaticists interested in understanding ways to characterize OHCs, their members, and the impact of participation, and in creating tools to facilitate outcome research of OHCs. OHC designers and moderators are also among the target audience for this tutorial.

Scope: The tutorial provides an informatics point of view of online cancer communities, with social support as their leading element. We conceptualize OHCs according to 3 major variables: type of support, source of support, and setting in which the support is exchanged. We summarize current research and synthesize the findings for 2 primary research questions on online cancer communities: (1) the impact of using online social support on an individual's health, and (2) the characteristics of the community, its members, and their interactions. We discuss ways in which future research in informatics in social support and OHCs can ultimately benefit patients.

Engagement of young adult cancer survivors within a Facebook-based physical activity intervention

Few studies have examined how young adult cancer survivors use online social media. The objective of this study was to characterize Facebook engagement by young adult cancer survivors in the context of a physical activity (PA) intervention program. Young adult cancer survivors participated in one of two Facebook groups as part of a 12-week randomized trial of a PA intervention (FITNET) compared to a self-help comparison (SC) condition. A moderator actively prompted group discussions in the FITNET Facebook group, while social interaction was unprompted in the SC group. We examined factors related to engagement, differences in engagement by group format and types of Facebook posts, and the relationship between Facebook engagement and PA outcomes. There were no group differences in the number of Facebook comments posted over 12 weeks (FITNET, 153 vs. SC, 188 p = 0.85) or the proportion of participants that reported engaging within Facebook group discussions at least 1-2 days/week. The proportion of participants that made any posts decreased over time in both groups. SC participants were more likely than FITNET participants to agree that group discussions caused them to become physically active (p = 0.040) and that group members were supportive (p = 0.028). Participant-initiated posts elicited significantly more comments and likes than moderator-initiated posts. Responses posted on Facebook were significantly associated with light PA at 12 weeks (β = 11.77, t(85) = 1.996, p = 0.049) across groups. Engagement within Facebook groups was variable and may be associated with PA among young adult cancer survivors. Future research should explore how to promote sustained engagement in online social networks. ClinicalTrials.gov identifier: NCT01349153.

How Cancer Patients Use and Benefit from an Interactive Cancer Communication System

Despite the mounting evidence of efficacy of eHealth interventions, their mechanisms of action remain unknown. The current study analyzed patient log data as each patient engaged in an eHealth system called the Comprehensive Health Enhancement Support System (CHESS) and reports on how patients engage with different combinations of eHealth services over time. Newly diagnosed breast cancer patients (N = 443) were given access for 6 months to one of four different configurations of CHESS: (1) Information, (2) Information and Support, (3) Information, Support, and Coaching (Full CHESS), and (4) Full CHESS and Mentor. Besides a baseline survey, three follow-up posttests were administered. Action log data on how patients engaged with the CHESS were also collected and merged with surveys to examine how patients benefit during the cancer experience. The findings suggest that usage patterns were not competitive, implying that cancer patients' access to more complex tools generates more use with their time spreading out over the diverse services. Despite overall decline in usage rates, it was less severe in Full CHESS and Mentor condition, suggesting that communication functions drive long-term engagement with the system. Notably, the strongest relation between use and cancer information competence appeared late in the follow-up period.

The Impact of Participation in Online Cancer Communities on Patient Reported Outcomes: Systematic Review

Background

In recent years, the question of how patients’ participating in online communities affects various patient reported outcomes (PROs) has been investigated in several ways.

Objectives

This study aimed to systematically review all relevant literature identified using key search terms, with regard to, first, changes in PROs for cancer patients who participate in online communities and, second, the characteristics of patients who report such effects.

Methods

A computerized search of the literature via PubMed (MEDLINE), PsycINFO (5 and 4 stars), Cochrane Central Register of Controlled Trials, and ScienceDirect was performed. Last search was conducted in June 2017. Studies with the following terms were included: (cancer patient) and (support group or health communities) and (online or Internet). A total of 21 studies were included and independently assessed by 2 investigators using an 11-item quality checklist.

Results

The methodological quality of the selected studies varied: 12 were of high quality, eight were of adequate quality, and only one was of low quality. Most of the respondents were women (about 80%), most with breast cancer; their mean age was 50 years. The patients who were active in online support groups were mostly younger and more highly educated than the nonusers. The investigated PROs included general well-being (ie, mood and health), anxiety, depression, quality of life, posttraumatic growth, and cancer-related concerns. Only marginal effects—that is, PRO improvements—were found; in most cases they were insignificant, and in some cases they were contradictory.

Conclusions

The main shortcoming of this kind of study is the lack of methodological instruments for reliable measurements. Furthermore, some patients who participate in online communities or interact with peers via Internet do not expect to measure changes in their PROs. If cancer survivors want to meet other survivors and share information or get support, online communities can be a trustworthy and reliable platform to facilitate opportunities or possibilities to make this happen.

Using smartphones to decrease substance use via self-monitoring and recovery support: study protocol for a randomized control trial

Background

Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs).

Methods/design

The target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors.

Discussion

This project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible.

Trial registration

ClinicalTrials.gov, ID: NCT02132481. Registered on 5 May 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2096-z) contains supplementary material, which is available to authorized users.

Social media for breast cancer survivors: a literature review

PURPOSE

Social media may offer support to individuals who are navigating the complex and challenging experience of cancer. A growing body of literature has been published over the last decade exploring the ways cancer survivors utilize social media. This study aims to provide a systematic synthesis of the current literature in order to inform cancer health communication practice and cancer survivorship research.

METHODS

Using PRISMA guidelines, four electronic databases were searched to retrieve publications on breast cancer and social media published between 2005 and 2015. The final sample included 98 publications (13 commentaries and reviews, 47 descriptive studies, and 38 intervention studies). Intervention studies were assessed for key features and outcome measures. Studies utilizing content analysis were further evaluated qualitatively.

RESULTS

Online support groups were the most commonly studied platform, followed by interactive message boards and web forums. Limited research focuses on non-Caucasian populations. Psychosocial well-being was the most commonly measured outcome of interest. While social media engagement was assessed, few standardized measures were identified. Content analyses of social media interactions were prevalent, though few articles linked content to health outcomes.

CONCLUSIONS

The current literature highlights the impact and potential utility of social media for breast cancer survivors. Future studies should consider connecting social media engagement and content to psychosocial, behavioral, and physical health outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Online groups and communities may improve the well-being of breast cancer survivors by providing opportunities to engage with wider social networks, connect with others navigating similar cancer experiences, and obtain cancer-related information. Researchers should consider the potential role of social media in addressing the unmet needs of breast cancer survivors, and particularly the implications for clinical and public health practice.

Expression and Reception: An Analytic Method for Assessing Message Production and Consumption in CMC

This article presents an innovative methodology to study computer-mediated communication (CMC), which allows analysis of the multi-layered effects of online expression and reception. The methodology is demonstrated by combining the following three data sets collected from a widely tested eHealth system, the Comprehensive Health Enhancement Support System (CHESS): 1) a flexible and precise computer-aided content analysis; 2) a record of individual message posting and reading; and 3) longitudinal survey data. Further, this article discusses how the resulting data can be applied to online social network analysis and demonstrates how to construct two distinct types of online social networks - open and targeted communication networks - for different types of content embedded in social networks.

Factors Contributing to Dropping-out in an Online Health Community: Static and Longitudinal Analyses

Dropping-out, which refers to when an individual abandons an intervention, is common in Internet-based studies as well as in online health communities. Community facilitators and health researchers are interested in this phenomenon because it usually indicates dissatisfaction towards the community and/or its failure to deliver expected benefits. In this study, we propose a method to identify dropout members from a large public online breast cancer community. We then study quantitatively what longitudinal factors of participation are correlated with dropping-out. Our experimental results suggest that dropout members discuss diagnosis- and treatment-related topics more than other topics. Furthermore, in the time before withdrawing from the community, dropout members tend to initiate more discussions but do not receive adequate response from the other members. We also discuss implications of our results and challenges in dropout-member identification. This study contributes to further understanding community participation and opens up a number of future research questions.

"The Church of Online Support": Examining the Use of Blogs Among Family Caregivers of Persons With Dementia

Many individuals, including dementia caregivers, use blogs to share their experiences. These blogs contain rich narratives representing an untapped resource for understanding the psychosocial impact of caring for a person with dementia at the family level. The present study used blogs written by caregivers of persons with dementia to explore how these individuals leveraged this medium as part of the caregiving experience. Blogs written by self-identified informal caregivers of persons with dementia were identified using a systematic search method, and data were analyzed using a qualitative thematic analysis. Four themes emerged from the narratives: social support through communication and engagement, information gathering and seeking, reminiscing and legacy building, and altruism. By understanding the ways in which individuals providing care for persons with dementia use social media as part of the caregiving experience, family nurses can develop interventions and services aimed at improving caregiver burden and quality of life.

Self-Determination Theory and Computer-Mediated Support: Modeling Effects on Breast Cancer Patient's Quality-of-Life

A breast cancer diagnosis typically results in dramatic and negative effects on an individual's quality of life. Web-based interactive support systems such as the Comprehensive Health Enhancement Support System (CHESS) offer one avenue for mitigating these negative effects. While evidence supports the efficacy of such systems, evaluations typically fail to provide a true test of the theorized model of effects, treating self-determination theory's constructs of competence, relatedness, and autonomy as outcomes rather than mediators. Using path analysis, this study tests the nature of the proposed mediated relationship between system engagement and quality-of-life indicators utilizing data collected from women (N = 90) who participated in the treatment condition of a CHESS randomized controlled trial. Findings support a latent model, indicating that system effects are mediated through an intertwined measure of autonomy, competence, and relatedness.

Predicting Retweeting Behavior on Breast Cancer Social Networks: Network and Content Characteristics

This study explored how social media, especially Twitter, serves as a viable place for communicating about cancer. Using a 2-step analytic method that combined social network analysis and computer-aided content analysis, this study investigated (a) how different types of network structures explain retweeting behavior and (b) which types of tweets are retweeted and why some messages generate more interaction among users. The analysis revealed that messages written by users who had a higher number of followers, a higher level of personal influence over the interaction, and closer relationships and similarities with other users were retweeted. In addition, a tweet with a higher level of positive emotion was more likely to be retweeted, whereas a tweet with a higher level of tentative words was less likely to be retweeted. These findings imply that Twitter can be an effective tool for the dissemination of health information. Theoretical and practical implications for psychosocial interventions for people with health concerns are discussed.

#Stupidcancer: Exploring a Typology of Social Support and the Role of Emotional Expression in a Social Media Community

Social network sites (SNSs) like Twitter continue to attract users, many of whom turn to these spaces for social support for serious illnesses like cancer. Building on literature that explored the functionality of online spaces for health-related social support, we propose a typology that situates this type of support in an SNS-based open cancer community based on the type (informational or emotional) and the direction (expression or reception) of support. A content analysis applied the typology to a 2-year span of Twitter messages using the popular hashtag "#stupidcancer." Given that emotions form the basis for much of human communication and behavior, including aspects of social support, this content analysis also examined the relationship between emotional expression and online social support in tweets about cancer. Furthermore, this study looked at the various ways in which Twitter allows for message sharing across a user's entire network (not just among the cancer community). This work thus begins to lay the conceptual and empirical groundwork for future research testing the effects of various types of social support in open, interactive online cancer communities.

Engagement with a social networking intervention for cancer-related distress

BACKGROUND

Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions.

PURPOSE

The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress.

METHODS

Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention.

RESULTS

Over 12 weeks, average total engagement was 7.3 h (sd = 11.7), and 42 % of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints.

CONCLUSIONS

For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts.

The Effects of Expressing Religious Support Online for Breast Cancer Patients

The growth of online support groups has led to an expression effects paradigm within the health communication literature. Although religious support expression is characterized as a typical subdimension of emotional support, we argue that in the context of a life-threatening illness, the inclusion of a religious component creates a unique communication process. Using data from an online group for women with breast cancer, we test a theoretical expression effects model. Results demonstrate that for breast cancer patients, religious support expression has distinct effects from general emotional support messages, which highlights the need to further theorize expression effects along these lines.

Eliciting and receiving online support: using computer-aided content analysis to examine the dynamics of online social support

Background

Although many people with serious diseases participate in online support communities, little research has investigated how participants elicit and provide social support on these sites.

Objective

The first goal was to propose and test a model of the dynamic process through which participants in online support communities elicit and provide emotional and informational support. The second was to demonstrate the value of computer coding of conversational data using machine learning techniques (1) by replicating results derived from human-coded data about how people elicit support and (2) by answering questions that are intractable with small samples of human-coded data, namely how exposure to different types of social support predicts continued participation in online support communities. The third was to provide a detailed description of these machine learning techniques to enable other researchers to perform large-scale data analysis in these communities.

Methods

Communication among approximately 90,000 registered users of an online cancer support community was analyzed. The corpus comprised 1,562,459 messages organized into 68,158 discussion threads. Amazon Mechanical Turk workers coded (1) 1000 thread-starting messages on 5 attributes (positive and negative emotional self-disclosure, positive and negative informational self-disclosure, questions) and (2) 1000 replies on emotional and informational support. Their judgments were used to train machine learning models that automatically estimated the amount of these 7 attributes in the messages. Across attributes, the average Pearson correlation between human-based judgments and computer-based judgments was .65.

Results

Part 1 used human-coded data to investigate relationships between (1) 4 kinds of self-disclosure and question asking in thread-starting posts and (2) the amount of emotional and informational support in the first reply. Self-disclosure about negative emotions (beta=.24, P<.001), negative events (beta=.25, P<.001), and positive events (beta=.10, P=.02) increased emotional support. However, asking questions depressed emotional support (beta=–.21, P<.001). In contrast, asking questions increased informational support (beta=.38, P<.001), whereas positive informational self-disclosure depressed it (beta=–.09, P=.003). Self-disclosure led to the perception of emotional needs, which elicited emotional support, whereas asking questions led to the perception of informational needs, which elicited informational support. Part 2 used machine-coded data to replicate these results. Part 3 analyzed the machine-coded data and showed that exposure to more emotional support predicted staying in the group longer 33% (hazard ratio=0.67, P<.001), whereas exposure to more informational support predicted leaving the group sooner (hazard ratio=1.05, P<.001).

Conclusions

Self-disclosure is effective in eliciting emotional support, whereas question asking is effective in eliciting informational support. Moreover, perceptions that people desire particular kinds of support influence the support they receive. Finally, the type of support people receive affects the likelihood of their staying in or leaving the group. These results demonstrate the utility of machine learning methods for investigating the dynamics of social support exchange in online support communities.

It's better to give than to receive: the role of social support, trust, and participation on health-related social networking sites

Nearly 60% of American adults and 80% of Internet users have sought health information online. Moreover, Internet users are no longer solely passive consumers of online health content; they are active producers as well. Social media, such as social networking sites, are increasingly being used as online venues for the exchange of health-related information and advice. However, little is known about how participation on health-related social networking sites affects users. Research has shown that women participate more on social networking sites and social networks are more influential among same-sex members. Therefore, this study examined how participation on a social networking site about pregnancy influenced members' health-related attitudes and behaviors. The authors surveyed 114 pregnant members of 8 popular pregnancy-related sites. Analyses revealed that time spent on the sites was less predictive of health-related outcomes than more qualitative assessments such as trust in the sites. Furthermore, providing support was associated with the most outcomes, including seeking more information from additional sources and following recommendations posted on the sites. The implications of these findings, as well as directions for future research, are discussed.

Does sustained participation in an online health community affect sentiment?

A large number of patients rely on online health communities to exchange information and psychosocial support with their peers. Examining participation in a community and its impact on members' behaviors and attitudes is one of the key open research questions in the field of study of online health communities. In this paper, we focus on a large public breast cancer community and conduct sentiment analysis on all its posts. We investigate the impact of different factors on post sentiment, such as time since joining the community, posting activity, age of members, and cancer stage of members. We find that there is a significant increase in sentiment of posts through time, with different patterns of sentiment trends for initial posts in threads and reply posts. Factors each play a role; for instance stage-IV members form a particular sub-community with patterns of sentiment and usage distinct from others members.

Cognitive and Affective Uses of a Thoracic Outlet Syndrome Facebook Support Group

There are currently many disease-specific groups on Facebook in which patients may take an active part (Greene, Choudhry, Kilabuk, & Shrank, 2011). Although uses and gratifications of patient-disease groups have begun to be identified for chronic diseases, rare diseases have been omitted, even though they collectively affect roughly 30 million people in the United States and 350 million people worldwide. This study is a content analysis of one Facebook rare disease patient group, the Thoracic Outlet Syndrome (TOS) Awareness group. All wall posts were recorded and content analyzed for cognitive and affective categories and subcategories between October 9, 2011 (date of site origin), and May 1, 2012. Analysis of cognitive needs indicated TOS patients used the site more to share information about their own TOS symptoms and journey with diagnosis than to seek information. Analysis of affective needs found patients were more likely to use the site to give support and encouragement to others than to express concerns and complaints. The complaints they did express were primarily related to their frustration with the general medical community's perceived inability to diagnose and understand their disease or to question a specific doctor's diagnosis/recommendation. Results point to needs specific to TOS patients that uses and gratifications research can help clarify.

The effects of expression: how providing emotional support online improves cancer patients' coping strategies

BACKGROUND

Emotional support has traditionally been conceived as something a breast cancer patient receives. However, this framework may obscure a more complex process, facilitated by the emerging social media environment, which includes the effects of composing and sending messages to others. Accordingly, this study explores the effects of expression and reception of emotional support messages in online groups and the importance of bonding as a mediator influencing the coping strategies of breast cancer patients.

METHODS

Data were collected as part of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of diagnosis of primary breast cancer or recurrence. Expression and reception of emotionally supportive messages were tracked and coded for 237 breast cancer patients. Analysis resulted from merging 1) computer-aided content analysis of discussion posts, 2) action log analysis of system use, and 3) longitudinal survey data.

RESULTS

As expected, perceived bonding was positively related to all four coping strategies (active coping: β = 0.251, P = .000; positive reframing: β = 0.288, P = .000; planning: β = 0.213, P = .006; humor: β = 0.159, P = .009). More importantly, expression (γ = 0.138, P = .027), but not reception (γ = -0.018, P = .741), of emotional support increases perceived bonding, which in turn mediates the effects on patients' positive coping strategies.

CONCLUSIONS

There is increasing importance for scholars to distinguish the effects of expression from reception to understand the processes involved in producing psychosocial benefits. This study shows that emotional support is more than something cancer patients receive; it is part of an active, complex process that can be facilitated by social media.

Emotional coping differences among breast cancer patients from an online support group: a cross-sectional study

Background

Due to mixed findings in research on the effect of online peer-to-peer support on psychological well-being, there is a need for studies explaining why and when online support communities are beneficial for cancer patients.

Objective

Previous studies have typically not taken into account individual coping differences, despite the fact that patients have different strategies to cope with cancer-related emotions. In the current study, it was predicted that the effects of online support group participation would partly depend on patients’ ability to cope with thoughts and emotions regarding the illness.

Methods

For this study, 184 Dutch breast cancer patients filled out a questionnaire assessing activity within a peer-led online support community, coping with emotions and thoughts regarding the illness (cognitive avoidance, emotional processing, and expression) and psychological well-being (depression, breast cancer-related concerns, and emotional well-being). Of these, 163 patients were visiting an online peer-led support community.

Results

Results showed interactions of the intensity of support group participation and coping style on psychological well-being. Specifically, we found an interaction of online activity and emotional expression on depression (beta=–.17, P=.030), a marginally significant interaction of online activity and emotional expression on emotional well-being (beta=.14, P=.089), and an interaction of online activity and cognitive avoidance on breast cancer–related concerns (beta=.15, P=.027). For patients who actively dealt with their emotions and thoughts, active online support group participation was positively related to psychological well-being. For patients high on avoidance of illness-related thoughts or low on emotional expression, active participation was negatively related to measures of well-being.

Conclusions

The current study revealed the role of individual differences in coping in online support group participation. Results suggest that breast cancer patients’ ability to cope with emotions and thoughts regarding the illness influence the relationship between online support group participation and psychological well-being.

Giving and Receiving Emotional Support Online: Communication Competence as a Moderator of Psychosocial Benefits for Women with Breast Cancer

This study examines the moderating role of emotional communication competence in the relationship between computer-mediated social support (CMSS) group participation, specifically giving and receiving emotional support, and psychological health outcomes. Data were collected as part of randomized clinical trials for women diagnosed with breast cancer within the last 2 months. Expression and reception of emotional support was assessed by tracking and coding the 18,064 messages that 236 patients posted and read in CMSS groups. The final data used in the analysis was created by merging (a) computer-aided content analysis of discussion posts, (b) action log data analysis of system usage, and (c) baseline and six-month surveys collected to assess change. Results of this study demonstrate that emotional communication competence moderates the effects of expression and reception of emotional support on psychological quality of life and breast cancer-related concerns in both desired and undesired ways. Giving and receiving emotional support in CMSS groups has positive effects on emotional well-being for breast cancer patients with higher emotional communication, while the same exchanges have detrimental impacts on emotional well-being for those with lower emotional communication competence. The theoretical and practical implications for future research are discussed.

Lurking as an active participation process: a longitudinal investigation of engagement with an online cancer support group

To better understand participation in computer-mediated social support (CMSS) groups for breast cancer patients, this study examines two overarching questions of (1) who are posters, lurkers, or nonusers and (2) what role do these different types of engagement play in explaining psychosocial health outcomes? This study incorporates the comprehensive model of information seeking and two competing models of social enhancement and social compensation, as well as the literature on lurking and posting behaviors in online groups to answer research questions. Our findings suggest that patterns of engagement in a CMSS group differed according to patients' sociodemographic characteristics and psychosocial factors. In addition, we found that lurkers had a higher level of perceived functional well-being than posters at 3 months post baseline. Theoretical and practical implications for effective online cancer support group campaigns are discussed.

Cancer talk on twitter: community structure and information sources in breast and prostate cancer social networks

This study suggests taking a social networks theoretical approach to predict and explain patterns of information exchange among Twitter prostate and breast cancer communities. The authors collected profiles and following relationship data about users who posted messages about either cancer over 1 composite week. Using social network analysis, the authors identified the main clusters of interconnected users and their most followed hubs (i.e., information sources sought). Findings suggest that users who populated the persistent-across-time core cancer communities created dense clusters, an indication of taking advantage of the technology to form relationships with one another in ways that traditional one-to-many communication technologies cannot support. The major information sources sought were very specific to the community health interest and were grassroots oriented (e.g., a blog about prostate cancer treatments). Accounts associated with health organizations and news media, despite their focus on health, did not play a role in these core health communities. Methodological and practical implications for researchers and health campaigners are discussed.

Narrating dementia: self and community in an online forum

In this article, I examine how individuals diagnosed with early-onset Alzheimer's disease use illness narratives to construct community. The ability to narrate is a fundamental component of the self. Using 354 posts by 32 members of an Internet forum, I argue that people with Alzheimer's, whose ability to narrate, and thus create a self, was compromised, nonetheless managed to tell stories of redemption out of which a salvaged self emerged. Narratives are essential for the construction of self, but as I show in this article, they are also essential for the construction of community. Forum members shared stories, gave advice, offered encouragement, and commiserated about their symptoms in ways that generated solidarity. Internet forums provide a venue for people with illnesses who are unable to leave the home to construct community.

It is out of my hands: how deferring control to God can decrease quality of life for breast cancer patients

OBJECTIVE

This paper seeks to contribute to the understanding of how and why religion affects psychosocial health outcomes. We propose a theoretical model predicting that when women with breast cancer defer control to God they will experience fewer breast cancer related concerns. Deferring control to God, however, should also reduce the likelihood that they take a proactive coping approach, which will be exacerbated by lowered breast cancer concerns. We therefore predict that this passive coping style will ultimately result in lower levels of quality of life.

METHODS

Data were collected as part of a randomized clinical trial funded by the National Cancer Institute. A total of 192 women with breast cancer participated in a computer-mediated social support group. Deferring control to God statements were captured by using computer-aided content analysis of discussion posts. Psychosocial outcomes were measured using longitudinal survey data. Analysis was performed using structural equation modeling.

RESULTS

The results of our analysis largely confirm our mediation model for which we find significant model fit. As predicted, deferring control to God leads to lower levels of breast cancer concerns but also to more passive coping styles. Ultimately, deferring control to God can lead to lower levels of quality of life.

CONCLUSIONS

Our study demonstrates how and why religious coping can lead to both positive and negative psychosocial health outcomes. Health care practitioners should encourage patients who are relying on religion to keep their end of the bargain and maintain an active coping style.

A medical oncologist's perspective on communication skills and burnout syndrome with psycho-oncological approach (to die with each patient one more time: the fate of the oncologists)

The increasing incidence of cancer is at the same time one of the leading causes of death all over the world. Many clinical studies show that the psychological disorders are more frequent in cancer patients than the normal population. That is the reason why "psycho-oncology" is getting popular each day. On the other hand, clinical studies about psychological status of the oncologists who are in contact with cancer patients ceaselessly and who are mostly responsible to give the "bad news" to the cancer patients are very limited. In fact, if the clinical studies which show that the frequency of depression and burnout syndrome are increasing among physicians are taken into consideration, one can say that psycho-oncology must cover all the medical personnel who are dealing with cancer patients. It is determined that the rate of depression and burnout syndrome is high among oncologists when referred to the literature. Several solutions are proposed for the psychological conditions of the oncologists and other related personnel who empathize with the patients and deliver "bad news" and also try to adopt ideal "patient-physician" communication model. The knowledge on the psychological conditions of oncology professionals and their behaviour and the results of the clinical studies on this subject will be discussed and the personal opinion will also be presented in this paper.

Predictors of the change in the expression of emotional support within an online breast cancer support group: a longitudinal study

OBJECTIVES

To explore how the expression of emotional support in an online breast cancer support group changes over time, and what factors predict this pattern of change.

METHODS

We conducted growth curve modeling with data collected from 192 participants in an online breast cancer support group within the Comprehensive Health Enhancement Support System (CHESS) during a 24-week intervention period.

RESULTS

Individual expression of emotional support tends to increase over time for the first 12 weeks of the intervention, but then decrease slightly with time after that. In addition, we found that age, living situation, comfort level with computer and the Internet, coping strategies were important factors in predicting the changing pattern of expressing emotional support.

CONCLUSIONS

Expressing emotional support changed in a quadratic trajectory, with a range of factors predicting the changing pattern of expression.

PRACTICAL IMPLICATIONS

These results can provide important information for e-health researchers and physicians in determining the benefits individuals can gain from participation in should CMSS groups as the purpose of cancer treatment.

How Patients Recovering From Alcoholism Use a Smartphone Intervention

OBJECTIVE: Mobile technology has the potential to radically improve addiction treatment and continuing care by offering emotional and instrumental support anywhere and just in time. This is particularly important in addiction because timing is critical to preventing relapse. Although most experts consider alcoholism to be a chronic disease, providers do not typically offer ongoing support for relapse prevention after patients complete treatment, even though a central characteristic of alcoholism and other addictive behaviors is their chronically relapsing nature. A-CHESS is a smartphone-based system for preventing relapse to heavy drinking among people leaving active alcohol dependence treatment. A-CHESS is designed to improve competence, social relatedness, and motivation, the three tenets of Self-Determination Theory. This paper reports on the relative impact and use of A-CHESS four months after patients entered the study and discusses implications of the results on treating addiction and chronic diseases generally. METHODS: A total of 349 individuals with alcohol dependence leaving residential treatment were randomly assigned to either receive A-CHESS+Treatment as Usual or Treatment as Usual (standard aftercare). Patients came from two treatment agencies, one in the Midwest and one in the Northeast. Patients assigned to A-CHESS received a smartphone for 8 months and were followed for 12. The authors analyzed use patterns during the first 4 months of use by those receiving A-CHESS. RESULTS: Participants used A-CHESS heavily and sustained their use over time. Ninety-four percent of A-CHESS participants used the application during the first week after residential treatment. At week 16, almost 80% continued to access A-CHESS. Participants with alcohol and drug-dependence showed higher levels of system use than those with alcohol dependence only. Participants with a mental health diagnosis had slightly lower levels of use at the end of the intervention period (week 16), although more than 70% still accessed the system. CONCLUSIONS: These findings illustrate that patients with alcohol dependence, alcohol and drug dependence, and mental health issues will use smartphone applications such as A-CHESS for ongoing support, resources and information, thus extending patient care if given the opportunity. Further analysis is needed to determine if sustained A-CHESS use improves outcomes.