The Therapeutic Potential of the Internet: Exploring Self-Help Processes in an Internet Forum for Young People With Inflammatory Bowel Disease

Peer Support for Chronic Pain in Online Health Communities: Quantitative Study on the Dynamics of Social Interactions in a Chronic Pain Forum

BACKGROUND

Peer support for chronic pain is increasingly taking place on social media via social networking communities. Several theories on the development and maintenance of chronic pain highlight how rumination, catastrophizing, and negative social interactions can contribute to poor health outcomes. However, little is known regarding the role web-based health discussions play in the development of negative versus positive health attitudes relevant to chronic pain.

OBJECTIVE

This study aims to investigate how participation in online peer-to-peer support communities influenced pain expressions by examining how the sentiment of user language evolved in response to peer interactions.

METHODS

We collected the comment histories of 199 randomly sampled Reddit (Reddit, Inc) users who were active in a popular peer-to-peer chronic pain support community over 10 years. A total of 2 separate natural language processing methods were compared to calculate the sentiment of user comments on the forum (N=73,876). We then modeled the trajectories of users' language sentiment using mixed-effects growth curve modeling and measured the degree to which users affectively synchronized with their peers using bivariate wavelet analysis.

RESULTS

In comparison to a shuffled baseline, we found evidence that users entrained their language sentiment to match the language of community members they interacted with (t198=4.02; P<.001; Cohen d=0.40). This synchrony was most apparent in low-frequency sentiment changes unfolding over hundreds of interactions as opposed to reactionary changes occurring from comment to comment (F2,198=17.70; P<.001). We also observed a significant trend in sentiment across all users (β=-.02; P=.003), with users increasingly using more negative language as they continued to interact with the community. Notably, there was a significant interaction between affective synchrony and community tenure (β=.02; P=.02), such that greater affective synchrony was associated with negative sentiment trajectories among short-term users and positive sentiment trajectories among long-term users.

CONCLUSIONS

Our results are consistent with the social communication model of pain, which describes how social interactions can influence the expression of pain symptoms. The difference in long-term versus short-term affective synchrony observed between community members suggests a process of emotional coregulation and social learning. Participating in health discussions on Reddit appears to be associated with both negative and positive changes in sentiment depending on how individual users interacted with their peers. Thus, in addition to characterizing the sentiment dynamics existing within online chronic pain communities, our work provides insight into the potential benefits and drawbacks of relying on support communities organized on social media platforms.

The Helpfulness of Web-Based Mental Health and Well-being Forums for Providing Peer Support for Young People: Cross-sectional Exploration

BACKGROUND

Young people are increasingly seeking out web-based support for their mental health and well-being. Peer support forums are popular with this age group, with young individuals valuing the fact that the forums are available 24/7, providing a safe and anonymous space for exploration. Currently, little systematic evaluation of the helpfulness of such forums in providing support has been conducted.

OBJECTIVE

This study examined the helpfulness of the support offered within web-based mental health and well-being peer support forums for young people. It specifically investigated the self-reported user ratings of helpfulness reported through the completion of a developing experience measure. The ratings will be used to consider further development of the measure and reflect upon the overall helpfulness of the forums as indicated by the reported scores.

METHODS

The study used routinely collected practice-based outcome data from web-based mental health forums for young people. These forums are hosted by the UK-based web-based therapy and support service, Kooth. A cross-sectional design was used to explore-using a range of inferential statistical measures-the outcomes reported by those accessing the forums using a Peer Online Community Experience Measure (POCEM). To consider the helpfulness in general, 23,443 POCEMs completed in 2020 were used. A second data set of 17,137 completed POCEMs from the same year was used to consider whether various engagement indicators had an impact upon the helpfulness rating.

RESULTS

Female users aged between 11 and 16 years predominantly completed the POCEM. This is in keeping with the majority of those using the service. In total, 74.6% (8240/11,045) of the scores on the POCEM indicated that the individuals found the posts helpful. An ANOVA indicated that male users were more likely to report obtaining intrapersonal support, whereas female users obtained interpersonal support. Furthermore, the POCEM scores reflected the internal consistency of the measure and provided an insight into the way that young people made use of the peer support resource; for instance, posts that were rated more helpful were correlated with spending longer time reading them, and the topics discussed varied throughout the day with more mental health issues being discussed later at night.

CONCLUSIONS

The results seem to demonstrate that, overall, the young people involved in this study found web-based peer support helpful. They indicate that peer support can provide an important strand of care within a supportive mental health ecosystem, particularly during time periods when in-person support is typically closed. However, limitations were noted, suggesting that caution is needed when interpreting the results of this study. Although such services are incredibly well used, they have received little research attention to date. As such, further investigation into what constitutes helpful and unhelpful peer support is needed.

Inflammatory Bowel Disease Self-Management: Exploring Adolescent Use of an Online Instagram Support Community

The purpose of this qualitative study was to explore the challenges adolescents with inflammatory bowel disease (IBD) experience with disease self-management as expressed in an online Instagram social support community. Public Instagram posts between January and December 2019 were manually collected from an online IBD support community. To focus on adolescent self-management needs, only posts from Instagram users who (1) indicated they had inflammatory bowel disease, (2) were 13-24 years old, or were in middle school, high school, or college were collected. Using thematic analysis, authors independently coded and identified emerging themes about self-management. Of 2,700 Instagram posts assessed for eligibility, 83 posts met inclusion criteria. Six major themes about inflammatory bowel disease self-management emerged: Desire for Normalcy, Dietary Changes, Education and Career, Healthcare System, Relationships With Others, and Symptoms and Complications. As the first thematic analysis of Instagram posts in an online inflammatory bowel disease community, results provide a crucial perspective of the concerns of adolescents with inflammatory bowel disease. Self-management challenges were wide-ranging and complex, underscoring the importance of IBD self-management in the adolescent population. Nurses should take a holistic approach to assess self-management challenges and tailor care to the specific needs of adolescents living with inflammatory bowel disease.

Mental health-related communication in a virtual community: text mining analysis of a digital exchange platform during the Covid-19 pandemic

BACKGROUND

Virtual communities played an important role in mental health and well-being during the Covid-19 pandemic by providing access to others and thereby preventing loneliness. The pandemic has accelerated the urge for digital solutions for people with pre-existing mental health problems. So far, it remains unclear how the people concerned communicate with each other and benefit from peer-to-peer support on a moderated digital platform.

OBJECTIVE

The aim of the project was to identify and describe the communication patterns and verbal expression of users on the inCLOUsiv platform during the first lockdown in 2020.

METHODS

Discussions in forums and live chats on inCLOUsiv were analysed using text mining, which included frequency, correlation, n-gram and sentiment analyses.

RESULTS

The communication behaviour of users on inCLOUsiv was benevolent and supportive; and 72% of the identified sentiments were positive. Users addressed the topics of 'corona', 'anxiety' and 'crisis' and shared coping strategies.

CONCLUSIONS

The benevolent interaction between users on inCLOUsiv is in line with other virtual communities for Covid-19 and the potential for peer-to-peer support. Users can benefit from each other's experiences and support each other. Virtual communities can be used as an adjuvant to existing therapy, particularly in times of reduced access to local health services.

Social media in inflammatory bowel disease: the patient and physician perspective

PURPOSE OF REVIEW

Social media use by patients with inflammatory bowel disease (IBD) and their respective providers continues to increase, promoting disease awareness and scholarship. In this review article, we summarize the current literature regarding social media use and IBD, discuss both the patient and physician perspective, and provide guidance to avoid commonly encountered pitfalls.

RECENT FINDINGS

Patients and providers commonly rely on social media to share medical information, advocate for improved IBD care, and to network and collaborate on common research interests. This shift from more traditional formats of education and networking continues to grow exponentially, and even more rapidly so during the COVID-19 pandemic.

SUMMARY

Social media use in the IBD community will continue to grow and lead to further innovation. Providers should be aware of social media as a valuable tool for their patients and themselves.

Online forum users' views and experiences of managing irritable bowel syndrome: a qualitative analysis of discussion content

Background

Irritable bowel syndrome (IBS) is common and often negatively affects quality of life. Patients frequently perceive medical interventions as inadequate and seek support from other sources, including online discussion forums.

Aim

To explore online discussion forum topics posted by people with IBS.

Design & setting

A qualitative study exploring three UK-based online discussion forums.

Method

A scoping review identified UK-based discussion forums with high activity and frequent use, which did not require a password/registration to view posts (two IBS-specific and one general health forum). Internal search functions were used to identify and export relevant discussion threads relating to managing IBS. Inductive thematic analysis of exported discussions was undertaken.

Results

Analysis identified two main overarching themes from 122 relevant discussion threads: 1) sharing information and practical advice about lifestyle changes; and 2) receiving emotional support. The most prevalent topics were lifestyle changes, including diet, using oral preparations (for example, supplements or probiotics), and physical activity. Dietary changes were usually considered positive, and most hopeful for potentially alleviating symptoms. Emotional support was also regularly offered with expressions of empathy, kindness, and gratitude, and a sense of users feeling less alone. Some discussions raised concern around potentially inappropriate symptomatic reassurance, and negative or conflicting advice.

Conclusion

Online forums seem, generally, to be a positive experience for those posting, but include potential risks of misinformation. Most posts focus on symptomatic relief through lifestyle change and/or emotional support. Clinicians could gain a better understanding of patients’ ideas, concerns, and expectations of IBS diagnosis and management by asking about patient-acquired online forum information.

Early morbidities following paediatric cardiac surgery: a mixed-methods study

Background

Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%.

Objectives

We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback.

Design and setting

Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres.

Participants

The participants were children aged < 17 years.

Methods

We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups.

Results

Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity).

Limitations

Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in.

Conclusions

Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement.

Future work

National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment.

Funding

This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 30. See the NIHR Journals Library website for further project information.

Parental understanding of our communication of morbidity associated with paediatric cardiac surgery: a qualitative study

BACKGROUND

Following paediatric cardiac surgery, quality of life may be significantly impacted by morbidities associated with cardiac surgery. Parental understanding of the potential for postoperative morbidity is important for informed decision making. As part of a broader research study, we aimed to elicit parental understanding and experience of the communication of morbidities following their child's cardiac surgery, using traditional focus groups together with an online forum.

METHODS

The Children's Heart Federation set up and moderated a closed, anonymous online discussion group via their Facebook page, focusing on complications, information needs and methods of providing families with information. Additionally, we ran three focus groups with parents/carers, moderated by an experienced independent professional. Focus groups were recorded and transcribed and a single transcript was generated from the online forum. All transcripts were thematically analysed.

RESULTS

All data were collected in 2014. The forum ran over 3 months in 2014 and involved 72 participants. Focus groups involved 13 participants. Three broad themes were identified: (1) clinicians' use of language, (2) feeling unprepared for complications and (3) information needs of families.

CONCLUSIONS

Clinicians' language is often misunderstood, with wide variability in the way morbidities are described, and between differing teams looking after the same child. Information may not be easily absorbed or retained by families, who often felt unprepared for morbidities that arose after their child's heart surgery. Here, we propose key principles of good communication tailored to the individual receiving it.

The invisible paradox of inflammatory bowel disease: An analysis of men's blogs

Inflammatory bowel disease is associated with stigmatising symptoms. Online support platforms eschew stigma, thus may appeal more to men who avoid traditional forms of health support. Using a critical realist netnographic approach and inductive thematic analysis, this study examined six blogs written by UK-based men to explore how inflammatory bowel disease was narrated. Three subthemes and one overarching theme - The (in)visible paradox of IBD - were developed. Findings suggest private aspects of inflammatory bowel disease risk experiential erasure, whereas public aspects lack control. Blogging facilitates the regaining of control, leading to important support connections and a re-imagining of the male inflammatory bowel disease body.

Are there also negative effects of social support? A qualitative study of patients with inflammatory bowel disease

OBJECTIVE

Social support is considered an important resource in coping with chronic conditions. By conducting a series of interviews with people who suffer from inflammatory bowel disease (IBD), we received the impression that social support in face-to-face or online communication could also be a source of stress and strain. The aim of our study was to better understand and describe possible negative effects of social support.

DESIGN

This is a secondary analysis of narrative interviews. The interviewees were selected using a maximum-variation sampling approach. Grounded theory and the 'OSOP' (one sheet of paper) method were applied to categorise those parts of the interviews that touched on the negative effects of social support.

SETTING

The open-end interview collection took place throughout Germany from September 2011 to June 2012. Most of the participants were interviewed in their homes, some in the Department of General Practice in Göttingen.

PARTICIPANTS

42 patients with IBD.

RESULTS

Two interrelated categories emerged: (1) unwanted confrontation and (2) undesirable reactions. The interviewees perceived social support as negative, especially if they felt overwhelmed and/or if they had not asked for it. Consequently, some of our interview partners developed strategies to prevent coming into social contact with others or stopped talking entirely about their disease.

CONCLUSION

While social support is usually conceptualised and perceived as a positive resource in chronic disease, it sometimes turns into a negative experience and may end in social isolation and deteriorate health. This process also happens in online support groups and increases anxiety when exchanging with other people on the internet. Before motivating ill people to seek contact with others, they should know about the negative effects of social support.

Use of Social Media for Health-Related Tasks by Adolescents With Inflammatory Bowel Disease: A Step in the Pathway of Transition

BACKGROUND

Social media is commonly used among the adolescent and young adult population, including those with chronic diseases. For adults, these platforms have been shown to be a major source of health information. Our aims were to explore how youth with inflammatory bowel disease (IBD) use social media for (1) disease information gathering, (2) provider communication, (3) sense of belonging to the IBD community, (4) self-expression around IBD, and (5) disease management/monitoring.

METHODS

An anonymous and voluntary survey was administered to IBD patients age 12 to 25 years at a single center over 4 months.

RESULTS

Of 218 patients approached, there were 109 respondents. The mean age of the cohort (SD) was 18 (2.9) years, 65% were male, and 82% had Crohn's disease. Almost all patients accessed the Internet daily, but only 17% reported looking up information about IBD "always" or "often." Less than half (47%) turned to medical websites (WebMD or Crohn's and Colitis Foundation) for information. A small number (16%) connected with other IBD patients. Patients' preferred communication with provider was by e-mail (88%) compared with a phone call to the office (67%) or hospital website/patient portal (52%). Few patients used mobile applications to monitor symptoms (2%) or for medication reminders (9%), although there was professed interest.

CONCLUSIONS

Adolescents and young adults with IBD are less likely than adults to use social media for health-related activities. They prefer e-mail rather than oral communication between visits, and privacy seems to be less of a concern. Targeted education and skill building may be helpful for this transitioning population.

Online stroke forum as source of data for qualitative research: insights from a comparison with patients' interviews

OBJECTIVE

To determine the appropriateness of an online forum compared with face-to-face interviews as a source of data for qualitative research on adherence to secondary prevention medications after stroke.

DESIGN

A comparison of attributes of two data sources, interviews and a forum, using realistic evaluation; a comparison of themes around adherence according to the Perceptions and Practicalities Approach (PAPA) framework.

SETTING

Interviews were conducted in UK GP practices in 2013 and 2014; online posts were written by UK stroke survivors and family members taking part in the online forum of the Stroke Association between 2004 and 2011.

PARTICIPANTS

42 interview participants: 28 stroke survivors (age range 61-92 years) and 14 caregivers (85% spouses). 84 online forum participants: 49 stroke survivors (age range 32-72 years) and 33 caregivers (60% sons/daughters).

RESULTS

10 attributes were identified within the two data sources and categorised under three domains (context, mechanisms and outcomes). Participants' characteristics of forum users were often missing. Most forum participants had experienced a stroke within the previous 12 months, while interviewees had done so 1-5 years previously.All interview themes could be matched with corresponding themes from the forum. The forum yielded three additional themes: influence of bad press on taking statins, criticisms of clinicians' prescribing practices and caregiver burden in assisting with medications and being advocates for survivors with healthcare professionals.

CONCLUSIONS

An online forum is an appropriate source of data for qualitative research on patients' and caregivers' issues with adherence to secondary prevention stroke medications and may offer additional insights compared with interviews, which can be attributed to differences in the approach to data collection.

Internet Forums for Suicide Bereavement

Abstract. Background: Bereavement by suicide is associated with a number of consequences including poor mental health outcomes and increased suicide risk. Despite this, the bereaved by suicide may be reluctant to seek help from friends, family, and professionals. Internet forums and social networking sites are a popular avenue of support for the bereaved, but to date there is a lack of research into their use and efficacy. Aims: To survey users of suicide bereavement Internet forums and Facebook groups regarding their help-seeking behaviors, use of forums, and perceived benefits and limitations of such use. Method: This study employed a cross-sectional design in which users of suicide bereavement Internet forums and Facebook groups completed an anonymous online survey. Results: Participants were 222 users of suicide bereavement Internet forums. Most participants (93.2%) had sought face-to-face help from sources other than Internet forums, but were more likely to seek help in the near future from informal rather than formal sources. Forums were perceived as highly beneficial and there were few limitations. Limitations: The generalizability of these results to other internet forums may be limited. Additionally, we were not able to examine differences between forums in terms of quality or user-reported efficacy. Finally, the data reflects the subjective views of forum users, which may differ from the views of moderators or experts. Conclusion: Internet forums, including Facebook groups, appear to be a useful adjunct to face-to-face help-seeking for supporting those who have been bereaved by suicide.

Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support

BACKGROUND

The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world.

OBJECTIVE

The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2).

METHODS

Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset.

RESULTS

The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do.

CONCLUSIONS

This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective).

The use of an online support group for neuromuscular disorders: a thematic analysis of message postings

PURPOSE

People affected by neuromuscular disorders can experience adverse psychosocial consequences and difficulties accessing information and support. Online support groups provide new opportunities for peer support. The aim of this study was to understand how contributors used the message board function of a newly available neuromuscular disorders online support group.

METHODS

Message postings (n = 1951) from the first five months of the message board of a newly formed online support group for neuromuscular disorders hosted by a charitable organization were analyzed using inductive thematic analysis.

RESULTS

Members created a sense of community through disclosing personal information, connecting with people with similar illness experiences or interests, welcoming others and sharing aspirations for the development of a resourceful community. Experiences, emotional reactions and support were shared in relation to: delayed diagnosis; symptom interpretation; illness management and progression; the isolating impact of rare disorders; and the influence of social and political factors on illness experiences.

CONCLUSIONS

This study provided a novel insight into individuals' experiences of accessing a newly available online support group for rare conditions hosted by a charitable organization. The findings highlight how the online support group provided an important peer support environment for members to connect with others, exchange information and support and engender discussion on political and social issues unique to living with often-rare neuromuscular disorders. Online support groups may therefore provide an important and easily accessible support outlet for people with neuromuscular disorders as well as a platform for empowering members to raise awareness about the impact of living with these conditions. Further research is needed to examine member motivations for using such groups and any effects of participation in greater detail. Implications for rehabilitation Online support groups may provide a unique forum for information sharing and peer support between people affected by often rare, neuromuscular conditions. Rehabilitation professionals may wish to signpost those affected by neuromuscular disorders to such groups. An advantage is that these groups are freely available and can be accessed from anywhere and at any time. Members may be able to learn about the diagnosis and symptom experiences of others, discuss coping strategies, validate illness experiences and discuss social and political issues relating to living with these conditions. Further research is needed before researchers and clinicians can fully understand participants' motivations for, and experiences of, using such groups and any potential psychosocial benefits.

Social Media Use by Transplant Recipients for Support and Healing

Transplant recipients use a diverse support network that now includes transplant-related social media support groups. The purpose of this study is to explore the use of social media sites by transplant recipients as a potential source of support and healing and the usefulness of Internet postings as a source of rich qualitative data. A qualitative descriptive design was used for the study. A total of 126 retrospective postings from 58 participants were analyzed as they existed on this open publically available Web site over a 20-month period from the selected discussion threads. Two major themes emerged from the data: sharing overwhelming gratitude and finding sanctuary. Sharing overwhelming gratitude was expressed in emotional postings about feelings and letters to donor families. Finding sanctuary described the recipients' perception of the online community as a safe and nonjudgmental environment to discuss sensitive issues and feelings. This study adds to what is known about the unique psychological and emotional needs of transplant recipients. Transplant-related support Web sites offer the opportunity to learn what matters most to transplant recipients and identify gaps in care related to calls for nursing.

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.

Patterns of Engagement With Inflammatory Bowel Disease Online Support Groups: Comparing Posters and Lurkers

Little is known about the varying patterns of member engagement within inflammatory bowel disease online support groups. The aim of the study was, therefore, to compare posters and lurkers (i.e., those who read messages but choose not to post) in terms of engagement and motives for accessing online groups as well as to explore reasons why lurkers do not make an active contribution through posting messages. The findings revealed that those who posted messages visited groups more often and spent longer periods of time accessing them. However, there was no difference between posters and lurkers in terms of length of time as a group member. Furthermore, posters were more inclined to access online support groups to both seek and provide emotional, informational, and experiential support. Finally, four main reasons were described by lurkers for not posting messages and these focused on personal factors, illness severity, being helpful, and new member. For those healthcare professionals or patient volunteers who are involved in supporting inflammatory bowel disease online support groups, there are a number of practical strategies arising from these results which can be implemented to help integrate and encourage active participation by all members.

Communication at an online infertility expert forum: provider responses to patients' emotional and informational cues

Online patient-provider communication has become increasingly popular in fertility care. However, it is not known to what extent patients express cues or concerns and how providers respond. In this study, we investigated cues and responses that occur in online patient-provider communication at an infertility-specific expert forum. We extracted 106 threads from the multidisciplinary expert forum of two Dutch IVF clinics. We performed the following analyses: (1) thematic analysis of patients' questions; and (2) rating patients' emotional and informational cues and subsequent professionals' responses using an adaptation of the validated Medical Interview Aural Rating Scale. Frequencies of themes, frequencies of cues and responses, and sequences (what cue is followed by what response) were extracted. Sixty-five infertile patients and 19 providers participated. The most common themes included medication and lifestyle. Patients gave more informational than emotional cues (106 versus 64). Responses to informational cues were mostly adequate (61%). The most common response to emotional cues was empathic acknowledgment (72%). Results indicate that an online expert forum could have a positive effect on patient outcomes, which should guide future research. Offering infertile patients an expert forum to communicate with providers can be a promising supplement to usual care in both providing information and addressing patients' concerns.

Blogging as a viable research methodology for young people with arthritis: a qualitative study

Background

The development of services that are responsive to the needs of users is a health policy priority. Finding ways of engaging young people in research to gain insights into their particular experiences, perspectives, and needs is vital but challenging. These data are critical to improving services in ways that meet the needs of young people.

Objective

Our aim was to evaluate Web-based blogging as a viable method for understanding the daily experiences and condition management strategies of young people with juvenile arthritis.

Methods

To meet the objectives of the study, a qualitative approach was required to gather information on the experiences and perspectives of young people regarding the management of their condition and its daily impact. In collaboration with a group of young people with arthritis, a custom website was developed. This website provided the opportunity for young people (aged 11-19) with arthritis from a United Kingdom pediatric hospital to contribute blogs. It was designed so that young people were free to write about whatever was important to them, but the site also included some structure and prompts to facilitate the writing of blogs. Qualitative analytical procedures were employed, supported by NVivo software.

Results

Engagement in the study by young people was variable in terms of their participation rates, frequency of website visits, and the length of their blogs. Young people used the site in different ways, some responding to the website categories and prompts that the team created, while others used it as a diary to record their experiences and thoughts. In line with principles of qualitative inquiry, the data collection was participant-led. Young people were in control of what, how much, and how often they wrote. However, some young people expressed difficulty regarding knowing what they should blog about. For a number of reasons, discussed here, the blogs may also not be fully reflective of experiences and perspectives of the participants. However, the data obtained provided insights into young people’s experiences of living with arthritis and their use of medicines in the context of their daily lives.

Conclusions

Web-based research with young people presents opportunities and challenges for researchers. Web-based blogging methodology has the potential to give young people and parents the space and empowerment to express their own ideas and concerns. However, this project suggests that it might not be the best way to engage a large diverse group of young people and might most effectively be combined with other approaches. Despite these limitations, the study provided valuable data about the experience and impact of living with a long-term condition from the perspectives of young people with arthritis.

"A gift wrapped in barbed wire" positive and negative life changes after being diagnosed with inflammatory bowel disease

PURPOSE

A growing interest in posttraumatic growth among individuals who have experienced a traumatic event has given rise to measures such as the Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun, 1996). However, such measures may not fully represent all dimensions of change among individuals diagnosed with a chronic disease and fail to highlight the negative changes that may also occur. This study explores the positive and negative changes patients with inflammatory bowel disease (IBD) have experienced since diagnosis.

METHODS

Three hundred and seventy-eight IBD patients provided answers to the qualitative question "Could you please describe the (positive/negative) effect(s) IBD has had on your life?" A grounded theory approach using NVivo was performed on participants' responses.

RESULTS

Nearly 73 % of participants reported their disease positively affected their life in some way, and five themes related to positive changes emerged from the analysis: Interpersonal Relations, Personal Growth, Valuing Life, New Life Paths, and Spiritual Growth. However, almost 80 % of participants also reported their disease negatively affected their lives, with three themes emerging from the analysis: Freedom Restrictions, Psychological Side Effects, and Social Isolation.

CONCLUSIONS

Our results support previous findings but also reveal that some dimensions related to the positive changes following adversity are not adequately assessed by the PTGI (e.g., appraising existing friendships, openness to try different forms of treatment or therapies, and psychological preparedness). The implications of these findings for future measurement and research of posttraumatic growth with IBD patients are discussed.

Utilization and efficacy of internet-based eHealth technology in gastroenterology: a systematic review

OBJECTIVE

While there have been several reviews exploring the outcomes of various eHealth studies, none have been gastroenterology-specific. This paper aims to evaluate the research conducted within gastroenterology which utilizes internet-based eHealth technology to promote physical and psychological well-being.

MATERIAL AND METHODS

A systematic literature review of internet-based eHealth interventions involving gastroenterological cohorts was conducted. Searched databases included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on eHealth interventions (both to manage mental health problems and somatic symptoms) in gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or studies using only email as primary eHealth method, and studies in language other than English.

RESULTS

A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically oriented intervention (additional two provided follow-up analyses exploring the original published data) and eight studies evaluated disease management programs for patients with either irritable bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth interventions were associated with significant reductions in bowel symptoms and improvement in quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease management was shown to generally improve QoL, adherence, knowledge about the disease, and reduce healthcare costs in IBD, although the studies were associated with various methodological problems, and thus, this observation should be confirmed in well-designed interventional studies.

CONCLUSIONS

Based on the evidence to date, eHealth internet-based technology is a promising tool that can be utilized to both promote and enhance gastrointestinal disease management and mental health.