Virtual voices: social support and stigma in postnatal mental illness Internet forums

Exploring experiences and needs of perinatal women in digital healthcare: A meta-ethnography of qualitative evidence

OBJECTIVE

The aim of this review is to identify, appraise, and synthesize the available qualitative evidence on the experiences and needs of perinatal women by using digital technologies in healthcare.

METHODS

This review was consolidated following the eMERGe meta-ethnography reporting guidance. We conducted a comprehensive search in eight databases from inception to 12 October 2021. Published and unpublished qualitative and mixed-method studies published in English were included. The methodological quality was assessed using the critical appraisal skill program checklist. A meta-ethnographic synthesis was used according to Noblit and Hare's seven-step iterative process.

RESULTS

A total of 3,843 articles were retrieved, and 27 qualitative studies pertaining to 3,775 perinatal women from 13 countries across different ethnicities were included. Four overarching themes emerged for the aspect of experiences: (1) normalization of experience, (2) attainment of valuable knowledge, (3) empowerment and self-confidence boosting, and (4) beneficial features of digital platforms. For the aspect of needs, the derived themes included the following: (1) necessity of credible resources, (2) importance of personalization, (3) concern about cybersecurity, and (4) urging additional support. Our line-of-argument for interpreting the perinatal women's experiences can offer a much greater engagement in digital healthcare, while the findings on the perinatal women's needs can add value for improving the design of digital healthcare in the future.

CONCLUSION

This review offers a deeper understanding of the perinatal women's experiences and needs when using digital technologies in healthcare. Our findings provide meaningful recommendations for clinical practice and future research.

Learners' viewpoints on the possibilities and limitations imposed by social contexts on online group-based participatory interventions to address violence

Intimate partner violence (IPV) is a global public health concern amongst young people. Consequently, prevention efforts in the form of participatory interventions have been implemented, mainly in face-to-face settings. However, in recent years, there has been a growing interest to deliver participatory IPV prevention interventions online, and this has been exacerbated by COVID-19 imposed limitations. There remain concerns, however, about the impact social contexts may have on transformative communication in participatory interventions online. We conducted semi-structured interviews with 18 learners (14-19 years) from Eastern Cape province, South Africa, to understand the possibilities and limitations that social contexts impose on online participatory IPV prevention interventions. Access to devices, reliable internet, and privacy in homes provided opportunities for online IPV prevention interventions, while limited privacy, safety, concentration, and familiarity with some apps online challenged young people's interest in online IPV prevention interventions. We also found that young people's greatest concern was around achieving trust, privacy and safety online. More evidence is needed on how trust, privacy, and safety, supportive of transformative communication, can be achieved online. Further, young people are active and strategic in their engagements online and their potential to generate creative relevant solutions to address these challenges is highlighted.

Understanding the use of heart failure online health forums: a qualitative study

AIMS

Heart failure is a major public health challenge and is described as an epidemic. Many people resort to the internet as a source of health information and online health forums have become an increasingly common way to obtain information and support regarding health-related issues. This study aims to explore what information people concerned about heart failure seek from online health forums, and how this shapes decision-making, trust, and interactions with healthcare professionals.

METHODS AND RESULTS

Widely available internet search engines (Google, Yahoo, and Bing) were used to identify online health forums, accessed by people seeking information on heart failure. Comments posted between 2016 and 2019 were screened, downloaded, and analysed thematically. Normalization Process Theory provided the underlying conceptual lens to inform analysis. Ten online health forums were identified, and 204 individual posts analysed. Three themes were identified [(information and support needs; online diagnosis; and relationship with healthcare professionals (HCPs)]. The most common purpose for using online health forums was to plug information/knowledge gaps surrounding diagnosis or treatments (e.g. discussion of results, medication/health insurance queries). They were used as a tool to aid decision-making regarding, (i) whether to seek further medical attention and (ii) lifestyle choices, medications, and other advice surrounding concerns. Negative experiences with HCPs were discussed, and sometimes online health forums appeared to promote distrust with HCPs.

CONCLUSION

Online health forums offer a supportive platform and help fill key informational gaps. However, online forums may amplify distrust with HCPs.

Analysis of Online Peripartum Depression Communities: Application of Multilabel Text Classification Techniques to Inform Digitally-Mediated Prevention and Management

Peripartum depression (PPD) is a significant public health problem, yet many women who experience PPD do not receive adequate treatment. In many cases, this is due to social stigmas surrounding PPD that prevent women from disclosing their symptoms to their providers. Examples of these are fear of being labeled a “bad mother,” or having misinformed expectations regarding motherhood. Online forums dedicated to PPD can provide a practical setting where women can better manage their mental health in the peripartum period. Data from such forums can be systematically analyzed to understand the technology and information needs of women experiencing PPD. However, deeper insights are needed on how best to translate information derived from online forum data into digital health features. In this study, we aim to adapt a digital health development framework, Digilego, toward translation of our results from social media analysis to inform digital features of a mobile intervention that promotes PPD prevention and self-management. The first step in our adaption was to conduct a user need analysis through semi-automated analysis of peer interactions in two highly popular PPD online forums: What to Expect and BabyCenter. This included the development of a machine learning pipeline that allowed us to automatically classify user post content according to major communication themes that manifested in the forums. This was followed by mapping the results of our user needs analysis to existing behavior change and engagement optimization models. Our analysis has revealed major themes being discussed by users of these online forums- family and friends, medications, symptom disclosure, breastfeeding, and social support in the peripartum period. Our results indicate that Random Forest was the best performing model in automatic text classification of user posts, when compared to Support Vector Machine, and Logistic Regression models. Computerized text analysis revealed that posts had an average length of 94 words, and had a balance between positive and negative emotions. Our Digilego-powered theory mapping also indicated that digital platforms dedicated to PPD prevention and management should contain features ranging from educational content on practical aspects of the peripartum period to inclusion of collaborative care processes that support shared decision making, as well as forum moderation strategies to address issues with cyberbullying.

Risk factors associated with experienced stigma among people diagnosed with mental ill-health: a cross-sectional study

PURPOSE

to examine the relationship between religiosity, social support, trauma, quality of life and experienced stigma of mental illness amongst a population diagnosed with mental ill-health.

METHODS

A cross-sectional survey of day service users in Northern Ireland (n = 295) covering a range of issues including religiosity, social support, quality of life and prior experience of trauma. Stigma was measured using a recognised stigma scale. We used multinomial logistic regression to examine risk factors associated with experienced stigma.

RESULTS

Univariate analysis showed significant associations between stigma and age, number of friends, social support, quality of life and prior experience of trauma. Age, quality of life, and trauma remained independently associated with stigma in a multivariate logistic regression model (x2(12) = 98.40, p < 0.001).

CONCLUSION

Younger people, those with less social support, prior experience of trauma and with poorer quality of life are at increased risk of experiencing stigma related to their diagnosis of mental illness. The findings provide further understanding of stigma and are useful for those overseeing programmes to improve access to mental health treatment.

What YouTube narratives reveal about online support, counseling entrance, and how Black Americans manage depression symptomatology

This manuscript explores the depression disease management of Black Americans (N = 50) who post their experiences on YouTube. The narratives garnered five themes: (1) personal and national histories as a barrier to treatment and contributor to depression, (2) utilizing the social network as informal counseling and as the catalyst for formal counseling, (3) long-term undiagnosed depression management and mismanagement, (4) advocating to destigmatize and treat depression, and (5) positive experiences initiating and engaging in treatment. Novel findings include how participants discuss narratives in third person, the importance of the Youtube community, and advocacy to destigmatize and treat depression.

Online Peer Support and Well-being of Mothers and Children: Systematic Scoping Review

BACKGROUND

Online peer support groups are common and can be an effective tool for mothers with young children. The purpose of this review is to examine the types of support that online-based peer groups establish as well as its health effects to mothers and their children.

METHODS

Systematic scoping review. Systematic review of existing literature was conducted using Pubmed, Cinahl, Medline, Cochrane and Ichushi (Japanese language) database in December 2019.

RESULTS

Based on the inclusion and exclusion criteria, total of 1,475 articles were extracted by initial search. After the review of titles, abstracts and full texts, total of 21 articles met the inclusion criteria. The types of support mothers received were mainly informational and emotional support. Mothers also felt a sense of connection and community. Some health effects of online-based peer support group were seen in the area of mothers' mental well-being. Minimal effects were seen in behavioral modification for child nutrition and breastfeeding.

CONCLUSION

Due to the limited evidence in interventional studies, the effects of online-based peer support groups were inconclusive. Further studies with rigorous research designs would be helpful in future research.

Perspectives of partners of mothers who experience mental distress in the postnatal period: A systematic review and qualitative evidence synthesis

OBJECTIVE

To offer insight and understanding on the perspectives of the partners of mothers who experience postnatal mental distress.

BACKGROUND

Partners have an important role in identifying postnatal mental distress, supporting the mother, and encouraging help-seeking behaviours that may help reduce the associated long-term consequences on the mother and baby.

DESIGN

A qualitative evidence synthesis.

DATA SOURCES

Medline, CINAHL, EMBASE, Maternity and Infant Care, PsycINFO and Scopus were searched from their foundation to May 2017 and updated again in April 2019.

REVIEW METHODS

A total of 2928 studies were retrieved. Studies were screened for inclusion and included studies were assessed for methodological quality using the Critical Appraisal Skills Programme quality assessment tool. Study characteristics and findings were extracted and analysed using thematic synthesis methods.

RESULTS

Twenty-five studies between 1998 and 2018, involving 270 partners from seven countries were included. Four main themes and nine associated subthemes were identified. These main themes were Knowledge, Relationships, Personal Impact and Disclosure.

CONCLUSIONS

This qualitative evidence synthesis provides clear, nonbiased findings on the perceptions of partners of mothers who experience postnatal mental distress. Partners lacked knowledge on how to identify postnatal mental distress and how to access help. The distress impacted on their relationship with the mother and baby, their health and raised questions about disclosure.

RELEVANCE

The findings from this synthesis will contribute to the development of responsive care for families when a mother experiences postnatal mental distress.

A meta-synthesis of women's experiences of online forums for maternal mental illness and stigma

Perinatal mental illness affects 15% of women; however, only half of these women access treatment. Some women with untreated perinatal mental illness may continue to suffer with mental illness after the perinatal period. Evidence suggests that one barrier to accessing treatment is stigma. Forums may provide an acceptable place for women to converse about the stigmatised symptoms of maternal mental illness. Reducing stigma may increase treatment uptake. This study aimed to review and synthesise the qualitative research on maternal mental illness forums and stigma so that stigma can be addressed and treatment improved. A meta-synthesis was conducted to describe and interpret qualitative studies regarding forum use and maternal mental illness stigma. A systematic search of seven electronic databases and Google Scholar was performed. Additional references were collected through screening references of the identified studies. Five studies were identified that reported women's experiences of online forums for maternal mental illness and stigma. The synthesis identified four key themes: (1) a safe place to talk; (2) virtual support; (3) stigma and identity; and (4) repair of the mother identity. Stigma maybe reduced by forum discourse that reconceptualises what is to be a "good mother" and separates stigma and maternal identity. This synthesis provides a novel and more detailed framework for the stigma of maternal mental illness and forum use. This suggests forums may enable women to explore their dual identity and repair their maternal identity, and this may reduce stigma. Healthcare providers could discuss forum use with their clients.

Internet use for family carers of people with intellectual disabilities: A literature review and thematic synthesis

Being a family carer can be rewarding but can also lead to mental and physical exhaustion as well as feelings of social exclusion and isolation. Research has shown that the use of the Internet and online forums can provide an immediate place to find information and reassurance and that forum use can be an empathetic place to share experiences and seek emotional support. This article details a systematic literature search of research on carers of people with intellectual disabilities and/or autism using the Internet. A thematic synthesis of the resulting papers identified that online forums give carers a sense of agency by providing a place to go for informational support that may not be elsewhere. Carers also enjoyed the safe community of solidarity and emotional support that online forums provide. An important finding is the lack of published papers in this area with the inclusion of just eight papers.

Social Connection and Online Engagement: Insights From Interviews With Users of a Mental Health Online Forum

BACKGROUND

Over the past 2 decades, online forums for mental health support have emerged as an important tool for improving mental health and well-being. There has been important research that analyzes the content of forum posts, studies on how and why individuals engage with forums, and how extensively forums are used. However, we still lack insights into key questions on how they are experienced from the perspective of their users, especially those in rural and remote settings.

OBJECTIVE

The aim of our study was to investigate the dynamics, benefits, and challenges of a generalized peer-to-peer mental health online forum from a user perspective; in particular, to better explore and understand user perspectives on connection, engagement, and support offered in such forums; information and advice they gained; and what issues they encountered. We studied experiences of the forums from the perspective of both people with lived experience of mental illness and people who care for people with mental illness.

METHODS

To understand the experience of forum users, we devised a qualitative study utilizing semistructured interviews with 17 participants (12 women and 5 men). Data were transcribed, and a thematic analysis was undertaken.

RESULTS

The study identified 3 key themes: participants experienced considerable social and geographical isolation, which the forums helped to address; participants sought out the forums to find a social connection that was lacking in their everyday lives; and participants used the forums to both find and provide information and practical advice.

CONCLUSIONS

The study suggests that online peer support provides a critical, ongoing role in providing social connection for people with a lived experience of mental ill-health and their carers, especially for those living in rural and remote areas. Forums may offer a way for individuals to develop their own understanding of recovery through reflecting on the recovery experiences and peer support shown by others and individuals enacting peer support themselves. Key to the success of this online forum was the availability of appropriate moderation, professional support, and advice.

The Use of Online Health Forums by Patients With Chronic Cough: Qualitative Study

Background

Online health discussion forums are used by different patient groups for sharing advice and information. Chronic cough is a common problem, and people with chronic cough use online health forums alongside formal medical therapies.

Objective

The objective of this study was to assess how chronic cough sufferers use online health forums, including the treatment advice they share with one another and the possible clinical uses of online forums in chronic cough.

Methods

Three open-access health forums were searched for threads related to chronic cough. Identified threads were screened against inclusion and exclusion criteria adapted from the British Thoracic Society (BTS) Guidelines related to chronic cough diagnosis. Included data were subjected to qualitative thematic analysis. All study data were cross-validated by a second author and discrepancies were resolved.

Results

In total, 96 threads were included in the analysis, consisting of posts by 223 forum users. Three main themes were identified: the effect of chronic cough on the lives of patients, the treatment advice shared between users, and the provision of support within forums.

Conclusions

Chronic cough symptoms had impacts on multiple aspects of patients’ health and well-being. To try and combat these issues, forum users suggested a variety of treatments to one another, ranging from mainstream traditional therapies to odd alternative remedies. The provision of support and empathy were also prominent themes in discussion threads. Online forums themselves may provide increasing benefit to users through the addition of a moderator.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model

BACKGROUND

Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure.

OBJECTIVE

This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers.

METHODS

A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information.

RESULTS

There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety.

CONCLUSIONS

Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and moderated online forums that facilitate expression of perinatal mental illness stigma and promote disclosure to health care providers.