The Exchange of Social Support on Online Bariatric Surgery Discussion Forums: A Mixed-Methods Content Analysis

Support sought and offered online for miscarriage: content analysis of a Facebook miscarriage support group

OBJECTIVE

Responses to miscarriage can vary, with many, but not all, people describing inadequate support, feelings of isolation and significant psychological distress. Limited knowledge exists about the support that people seek and offer online following miscarriage. We aimed to explore how people impacted by miscarriage use an online Facebook support group to seek and offer support.

METHODS AND MEASURES

We employed directed content analysis to examine 270 opening posts and 3,484 responding comments within an 'open' Facebook support group for miscarriage. Opening posts and responding comments were coded into five social support categories using an existing support framework.

RESULTS

Informational Support, particularly medical information or advice, was the most commonly sought support in opening posts, followed by Emotional Support, where people expressed their grief-related feelings. In responding comments, Emotional Support and Informational Support were predominantly offered.

CONCLUSION

While not a substitute for appropriate medical care, people impacted by miscarriage seek and offer support online. Health professionals should be aware of this behaviour and discuss potential benefits and risks of online support with patients. A social support framework may usefully guide health professionals in identifying patients' support needs and in knowing how to support patients.

Trauma Isn't One Size Fits All: How Online Support Communities Point to Different Diagnostic Criteria for C-PTSD and PTSD

Reddit has provided rich data on mental health discourse. The present study uses 40,335 online posts from Reddit communities to investigate how language can contribute to the understanding of PTSD and C-PTSD. The results showed distinct language patterns in the use of first-person pronouns, cognitive processing, and emotion words, suggesting that they are separate disorders with different effects on survivors. Further, while some social media studies have differentiated submissions and comments, few have investigated the language changes between these contexts. Post-hoc results showed a clear distinction between two contexts across several linguistic markers. Discussion and future directions are explored.

Self-withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives

The objective of the study was to explore the experience of patients who self-withdrew from their scheduled bariatric surgery (BS) after completing the lengthy multidisciplinary assessment and optimization process, and to examine how these withdrawals affect healthcare providers (HCPs) in a Bariatric Centre of Excellence (BCoE). Interviews were conducted with patients who self-withdrew, within 1 month, from scheduled BS. Additionally, a focus group with HCPs from the same BCoE was completed. The data were analysed using an inductive, emergent thematic approach with open coding in NVivo 12, with comparative analysis to identify common themes between groups. Eleven patients and 14 HCPs participated. HCPs identified several behavioural and logistical red flags among patients who self-withdrew from scheduled BS. Patients and HCPs felt the decision was appropriate, owing to a patient's lack of mental preparedness for change, social supports, or fears of postoperative complications. HCPs reported frustration and described negative impacts on clinic efficiency. Additional mental health resources for patients contemplating self-withdrawal, such as peer support, were suggested. In conclusion, a patient's decision to self-withdraw from a scheduled BS is often sudden, definite, and associated with anxiety, fear of surgical risks and post-operative complications. Additional mental health resources at a BCoE may be beneficial to support patients at risk of self-withdrawal from scheduled BS.

Participating in Bariatric Support Groups: the Effects on Self-management Changes

BACKGROUND

This study focused on changes in self-management as the main outcome of participation in bariatric psychoeducational support groups. We assessed the contribution of changes in cognitive and emotional variables to improved self-management among 155 participants.

METHOD

Data for this longitudinal study were collected at the beginning (time 1) and at the end (time 2) of the support groups' 10-session program. The structured questionnaire included self-management (the Bariatric Surgery Self-Management Behaviors Questionnaire), cognitive variables (eating self-efficacy, eating awareness, weight control motivation), and emotional variables (positive and negative affect, emotional eating), as well as background variables.

RESULTS

Significant improvements in self-management and in eating self-efficacy, eating awareness, and emotional eating were found at time 2. The hierarchical regression model showed that the improvements in eating self-efficacy, and in positive and negative affect, contributed significantly to improved self-management. Additionally, a modification effect of negative affect was found.

CONCLUSION

We conclude that participation in psychoeducational bariatric support groups is beneficial to improving one's self-management.

Lived Experiences of Unwed Single Mothers: Exploring the Relationship between Structural Violence and Agency in the Context of Chinese Reproductive Health Discourse

China's family planning policy prioritizes the state and has historically silenced the voices of women in their own reproductive discourse. Unwed single Chinese mothers are in particular penalized and remain invisible in the national reproductive health discourse that promotes childbirth only within the institution of marriage. Drawing on Giddens' theoretical framework of structure-agency, thirty in-depth interviews were conducted to understand the lived experiences of Chinese unwed single mothers. Specifically, this study explored the ways in which structural violence is communicatively enacted in the interactions within institutions such as police station, family planning office and health care system; and interpersonal relationships such as family and neighbors that silence the voices of the unwed single mothers. Further the study also explored the ways in which the women enact their agency to navigate these macro and micro level constrains and limitations. The findings revealed that the women's experience of structural violence is often a manifestation of the state-controlled sexuality discourse in the social institutions and interpersonal relationships, and highlighted the women's agency enactment through employing various communicative behaviors to manage these day-to-day struggles.

Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review

BACKGROUND

Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients.

OBJECTIVE

This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support.

METHODS

A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data.

RESULTS

A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality-based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery.

CONCLUSIONS

These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.

Evaluating the Communication of Online Social Support: A Mixed-Methods Analysis of Structure and Content

Social support in online self-help groups has been found to benefit participants with emotional instability or mental illness. Many studies have employed content analysis to reveal categories of social support, claiming the prevalence of emotional and informational support can aid support seekers. In the studies, optimal matching theory is used to explain the helpfulness of these types of support. This article argues that content analysis is unpersuasive in its claim that support seekers benefit from social support; participants' communicative behaviors should also be considered to evaluate the potential advantages and drawbacks of such groups. Drawing on a mixed-method approach of conversation analysis and content analysis, this study investigates the sequential structure and content of social support in communication in six online self-help groups for anxiety and depression (OSGADs). The main findings show that optimal matching theory may not be suitable for elucidating how support seekers receive help due to the immediate provision of social support and little interaction otherwise. In addition, results identify expressed understanding/empathy and advice as prominent support categories in OSGADs, with most thread openers requesting support indirectly.

Peer Support Groups for Weight Loss

Purpose of Review

Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs.

Recent Findings

Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats.

Summary

Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.

Digital Support for Patients Undergoing Bariatric Surgery: Narrative Review of the Roles and Challenges of Online Forums

Background

The internet has become an important medium within health care, giving patients the opportunity to search for information, guidance, and support to manage their health and well-being needs. Online forums and internet-based platforms appear to have changed the way many patients undergoing bariatric surgery view and engage with their health, before and after weight loss surgery. Given that significant health improvements result from sustained weight loss, ensuring patient adherence to recommended preoperative and postoperative guidance is critical for bariatric surgery success. In a patient cohort with high information needs preoperatively, and notoriously high attrition rates postoperatively, online forums may present an underutilized method of support.

Objective

The aim of this study was to conduct a narrative review focusing on the developing roles that online forums can play for patients with bariatric conditions preoperatively and postoperatively.

Methods

A literature search was conducted in October-November 2019 across 5 electronic databases: Scopus, EMBASE, PsycINFO, CINAHL, and MEDLINE. Qualitative or mixed methods studies were included if they evaluated patients undergoing bariatric surgery (or bariatric surgery health care professionals) engaging with, using, or analyzing online discussion forums or social media platforms. Using thematic analysis, themes were developed from coding patterns within the data to identify the roles and challenges of online forums for patients undergoing bariatric surgery.

Results

A total of 8 studies were included in this review, with 5 themes emerging around (1) managing expectations of a new life; (2) decision making and signposting; (3) supporting information seeking; (4) facilitating connectedness: peer-to-peer social and emotional support; and (5) enabling accessibility and connectivity with health care professionals.

Conclusions

Online forums could offer one solution to improving postoperative success by supporting and motivating patients. Future research should consider how best to design and moderate online forums for maximal effectiveness and the sharing of accurate information. The surgical multidisciplinary team may consider recommendations of online peer-support networks to complement care for patients throughout their surgical journey.

Application and effectiveness of eHealth strategies for metabolic and bariatric surgery patients: A systematic review

OBJECTIVE

To date the application of eHealth strategies among adults and adolescents undergoing metabolic and bariatric surgery (MBS) has not been systematically reviewed. This study comprehensively examines eHealth intervention studies among MBS patients within the RE-AIM framework to assess reach, effectiveness, adoption, implementation and maintenance of these efforts.

METHODS

A search was conducted using PubMed, EMBASE, CINAHL, PsycNET and SCOPUS of original research relating to eHealth strategies for MBS patients published in peer-reviewed journals and revealed 38 published articles between 2011 and 2019.

RESULTS

Studies varied widely in terms of design (qualitative to randomized controlled trials) and eHealth delivery method (telemedicine to blog post content) with a balance of pre- or post-MBS use. No studies included adolescents and very few reported (1) a conceptual framework to support study design/outcomes; and (2) race/ethnicity composition.

CONCLUSIONS

Although some studies report that eHealth strategies/interventions are effective in producing post-MBS weight loss and other positive health outcomes, most are pilot studies or have study design limitations. There is an opportunity for development of (1) tailored eHealth interventions to support pre- and post-MBS sustained behavior change and improved outcomes; and (2) rigorous studies that employ robust conceptual frameworks so dissemination and implementation efforts can be mapped to construct-driven outcomes.

Exploring How People Affected by Methamphetamine Exchange Social Support Through Online Interactions on Facebook: Content Analysis

BACKGROUND

Methamphetamine is an illicit and addictive psychostimulant that remains to be a significant cause of economic burden in Australia. Social media is increasingly being used by nongovernment organizations and health services to encourage the growth of social support networks among people with health-related issues. Several studies have investigated the utility of social media in providing social support to groups of people with health-related issues. However, limited research exists that explores how people who have been directly or indirectly affected by methamphetamine use social media for social support.

OBJECTIVE

This study aimed to determine the types of social support being sought and provided by people affected by methamphetamine when interacting with others on a Facebook page.

METHODS

A total of 14,777 posts were collected from a Facebook page and transferred into an Excel document for content analysis. The posts were manually coded into categories of social support using an adapted version of Cutrona and Suhr's Social Support Behavior Code. Posts could be coded into more than one category. Saturation was reached at 2000 posts, which were used to draw inferences.

RESULTS

Emotional support was the most offered support type, with 42.05% (841/2000) of posts providing this form of support. This is followed by esteem support, which was provided in 40.40% (808/2000) of posts. Overall, 24.20% (484/2000) of posts offered informational support. Network support and tangible support were the least offered support types, with 2.25% (45/2000) and 1.70% (34/2000) of posts offering these types of support, respectively.

CONCLUSIONS

This study suggests that online social support groups can be effective in challenging stigma by encouraging people affected by methamphetamine to connect with each other and talk about their struggles. This in turn represents an important step toward successful rehabilitation.

'The only chance of a normal weight life': A qualitative analysis of online forum discussions about bariatric surgery

Background

The only effective weight loss treatment for severe obesity is bariatric surgery, with Roux-en-Y gastric bypass being the most common method. Patients often have unrealistic expectations of surgery and expect a “miracle cure” even though the procedure requires major lifelong lifestyle changes. Most patients access information about the procedure online, and come into contact with others who have had the surgery.

Objective

The objective of this study was to describe shared values, feelings, and thoughts among visitors to a web-based forum for those undergoing bariatric surgery.

Methods

In this cross-sectional observation study using qualitative contents analysis, the material consisted of an online discussion forum thread about bariatric surgery, with 498 posts. These were saved in a document, read and re-read. Through coding of meaningful units of text, themes were established.

Results

Four themes were constructed during data analysis: a) A new life—anticipating dramatic changes of body and mind; b) Negotiating the system and playing the waiting game; c) A means to an end—managing the pre-operative diet; and d) Managing the attitudes of others. Posters described the process of bariatric surgery as a journey, riddled with roadblocks, setbacks and trials, but also with joy and expectations of a new life.

Conclusion

Professionals who encounter this group should be aware of their need for support throughout the process, and investigate the possibility of both pre- and postoperative support groups, either online or face-to-face. The results also show that the posters on the forum had very high, and often unrealistic, expectations on how the surgery would change their lives. It is important for those who encounter this group before surgery to be aware of this tendency and to take measures to ensure that patients undergo the surgery with realistic expectations.