Membership and boundary maintenance on an online self-harm forum

"I thought that crying was weakness": a thematic analysis of emotional experience in an online self-harm forum

OBJECTIVE

This study aimed to investigate the emotional experiences and beliefs of individuals who engage in self-harm by analyzing data from an online self-harm forum. Emphasis was placed on understanding how these individuals describe and evaluate their emotions (emotion beliefs) and the role these beliefs play in their emotion regulation and self-harming behaviors.

METHOD

A total of 119 posts from a self-harm discussion board on the forum were analyzed. Thematic analysis, following a critical realist perspective, was employed to identify and interpret recurring patterns in how posters articulated their emotion beliefs.

RESULTS

Four themes were created during analysis: "My emotions are too much," "Self-harm as control or controlled by self-harm," "Suppression is better than expression," and "Self-harm helps me escape my emotional pain." Posters described experiencing overwhelming, uncontrollable, and unacceptable emotions, resulting in a desire to suppress or escape them through self-harm.

CONCLUSIONS

Individuals struggling with self-harm hold negative beliefs about their emotions, which intensify emotional experiences and contribute to feelings of shame and guilt. The findings highlight the necessity of interventions targeting these negative emotion-related beliefs to foster alternative emotional regulation strategies and reduce reliance on self-harm, as well as the importance of increased education on these emotional beliefs for those who support them, in order to reduce stigma. Furthermore, the study emphasizes the potential of online forums in gaining valuable insights into sensitive behaviors.

"You Are By No Means Alone": A Netnographic Study of Self-Care Support in an Online Community for Older Adults

Online peer-to-peer communities provide environments in which people with similar health concerns can interact and exchange information that can support self-care of long-term conditions. However, current theories have not adequately accounted for how self-care support is enacted in online communities. We conducted an observational netnography to identify and analyze posts in a publicly accessible online community (discussion forum boards) designed for older people. A Straussian grounded theory approach was used to examine 659 posts in health-related message boards. Self-care support involved the construction of three interrelated identities: (1) the support seeking self, in which members described problems and requested information; (2) the empathizing self, in which they described similar experiences and offered support; and (3) the influencing self, in which they provided information or advice. Online communities appear to be an important source of peer support and information and may be a cost-effective approach to supplement standard care.

Effectiveness, acceptability and potential harms of peer support for self-harm in non-clinical settings: systematic review

BACKGROUND

Many people who have self-harmed prefer informal sources of support or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed or about the risks of peer support interventions in non-clinical settings.

AIMS

The aims of this review were to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated.

METHOD

We searched bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary-sector organisations providing one-to-one or group support, or via moderated online peer support forums.

RESULTS

Eight of the ten papers included focused on peer support that was delivered through online media. No study compared peer support with other treatments or a control group, so limited conclusions could be made about its effectiveness. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a sense of community, empowerment, and access to information and support. The most commonly perceived risk associated with peer support was the potential for triggering self-harm.

CONCLUSIONS

Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. Mitigations for potential risks include organisations using professional facilitators for groups, trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people while maintaining their own emotional health.

Investigating Self-injury Support Solicitations and Responses on a Mobile Peer Support Application

Online informal support networks may provide a critical source of support for young people who self-injure. While these platforms are often intended to mitigate digital harm, there is limited understanding of how individuals use peer support venues to seek self-injury related support and the specific contingencies of supportive exchanges. The present mixed-methods study was designed to explore the types of concerns members express on a mobile peer support application and the types of responses that they receive. Specifically, our aims were to (1) understand the prevalence of peer support types exchanged and (2) surface more nuanced themes within these categories of support. We also explore the relationship between support sought through posts and received through comments. Findings have important theoretical implications for understanding support seeking and provision through a mobile peer support app, which can help guide the design and optimization of peer-driven platforms for individuals who self-injure.

Identity and action: Help-seeking requests in calls to a victim support service

The nature of the link between identity and action is a fundamental question for social science. One focus in psychology is how actions like seeking help are implicated in matters of identity. This paper presents a discursive psychology study of identity and help in social interaction. Drawing on a corpus of nearly 400 recorded calls to a victim support helpline, I analysed how participants oriented to the link between identity and help. With attention to epistemic, deontic, and affective relations between participants, I analysed how identity was demonstrably relevant and procedurally consequential for building and interpreting help-seeking requests. Participants displayed an understanding that seeking help from Victim Support necessarily implicates identity. Callers' identities as victims or clients rendered their help-seeking accountable and invoked identities for call-takers as representatives of a support service. The findings show that identity and help are mutually constitutive. Seeking help constituted callers' identities as victims; and their identities as victims constituted their requests for help. I suggest that analysing identity and help in social interaction provides evidence for the mutually constitutive link between identity and action.

When do Online Audiences Amplify Benefits of Self-Disclosure? The Role of Shared Experience and Anticipated Interactivity

As individuals increasingly write about their distressing experiences online, it is important to understand how perceived online audiences influence the effects of self-disclosure. In an experiment, participants wrote about recent breakups for online audiences purportedly varying in 1) whether they shared recent breakup experiences and 2) their ability to leave comments. Participants perceiving audiences with shared experience showed more cognitive processing in their writing and reported increased post-traumatic growth at follow-up than participants perceiving general audiences. Those anticipating comments wrote less about emotions than those who did not. Mechanisms accounting for the benefits of shared experience warrant further investigation.

A systematic review exploring how young people use online forums for support around mental health issues

Background: Young people increasingly look towards the Internet for support. Online forums have been developed to provide mental health support, but they have received little attention in the research to date. Aims: To summarise the existing literature examining how individuals use online forums to obtain support for mental health difficulties. Methods: A systematic review of electronic databases was conducted to identify empirical literature in this area. The papers that met the inclusion criteria and satisfied quality assessment review were analysed for key themes. Results: Twenty-one papers were found. Three common themes in the papers were associated with opportunities of the technology: (1) Providing stand alone or complementary informal support, (2) Providing informational, emotional and infomotional support, and (3) Making use of the specific practical opportunities afforded by forum technology. A further three themes were associated with challenges: (1) Managing the expectations of forum users, (2) Ensuring service user safety, and (3) Navigating the technical challenges associated with forums. Conclusions: The paper highlights the potential for individuals to access dynamic and responsive support within online forums. Additionally, it reflects upon the major areas that mental health professionals need to be aware of when entering into this arena.

"They aren't all like that": Perceptions of clinical services, as told by self-harm online communities

Self-harm is a critical public health issue, with strikingly low rates of attendance to clinical services. By offering support, anonymity, and open discussions, online communities hold useful insights into the factors which influence help-seeking behavior. We explore the perceptions of clinical services in three self-harm online communities to understand which services are being used and why. Message threads from each community were extracted randomly until saturation, providing 513 messages across 60 threads. A thematic analysis was performed resulting in four key themes: access to appropriate services during an episode of self-harm, service preference, fears surrounding disclosure, and support.

A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown

Background

Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people.

Methods

We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis.

Results

Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified.

Conclusions

There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people appear to be increasingly using social media to communicate distress, particularly to peers. The focus should now be on how specific mediums’ (social media, video/image sharing) might be used in therapy and recovery. Clinicians working with young people who self-harm or have mental health issues should engage in discussion about internet use. This should be a standard item during assessment.

A protocol for this review was registered with the PROSPERO systematic review protocol registry: (http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42015019518).

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).

Unveiling self-harm behaviour: what can social media site Twitter tell us about self-harm? A qualitative exploration

AIMS AND OBJECTIVES

To report the findings from a unique analysis of naturally occurring data regarding self-harm behaviour generated through the global social media site, Twitter.

BACKGROUND

Self-harm behaviours are of global concern for health and social care practice. However, little is known about the experiences of those who harm and the attitudes of the general public towards such behaviours. A deeper, richer and more organic understanding of this is vital to informing global approaches to supporting individuals through treatment and recovery.

DESIGN

Exploratory, qualitative design.

METHODS

Three hundred and sixty-two Twitter messages were subject to inductive thematic analysis.

RESULTS

Five themes were identified: (1) celebrity influence, (2) self-harm is not a joke (with subthemes of you wouldn't laugh if you loved me and you think it's funny, I think it's cruel), (3) support for and from others, (4) eating disorders and self-harm and (5) videos and personal stories.

CONCLUSIONS

The findings indicate that self-harm behaviour continues to be largely misunderstood by the general public and is often the source of ridicule which may contribute to delays in accessing treatment. Whilst Twitter may also provide a source of valuable support for those who self-harm, the sense of community, relatedness and understanding generated by such support may contribute to normalising self-harm and perpetuating the behaviours.

RELEVANCE TO CLINICAL PRACTICE

Our understanding of the complexity of and aetiology and most effective treatment options for self-harm behaviours is still unclear. The findings demonstrate that there is a critical opportunity to conduct further qualitative research to better understand self-harm and to use these valuable and internationally relevant data to support the development of effective public education campaigns and personally tailored treatment options.

Stepping Back From Crisis Points: The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.

"You get to know the people and whether they're talking sense or not": Negotiating trust on health-related forums

The internet is increasingly being used as a source of health advice and information by individuals with long term conditions (LTCs). Specifically, online forums allow people to interact with others with similar conditions. However, it is not clear how online health information is assessed by those with LTCs. This study aims to address this gap by exploring how individuals with contested and uncontested LTCs utilise internet forums. Semi-structured interviews were conducted with 20 participants with ME/CFS and 21 participants with type 1 and 2 diabetes and analysed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. The findings indicate that the use of online forums was a complex and nuanced process and was influenced by a number of individual and illness-specific factors. Participants trusted those with similar experiences and perspectives as themselves, while also valuing conventional biomedical information and advice. By accessing support online, forum users were able to draw on a personalised form of support based on the lived experiences of their peers. However, the role of digital literacy in developing and maintaining online relationships must be acknowledged.

•

The use of online forums by individuals with LTCs is a complex and nuanced process.

•

Participants trust those with similar experiences and perspectives as themselves.

•

Users can access a personalised form of support based on the experiences of peers.

•

Role of digital literacy in developing online relationships must be acknowledged.

A Systematic Review of Social Media Use to Discuss and View Deliberate Self-Harm Acts

Objective

To conduct a systematic review of studies of social media platforms used by young people to discuss and view deliberate self-harm.

Study Design

11 electronic databases were searched from January 2000 to January 2012 for primary research; in June 2014 an updated search of Medline was conducted. Grey literature sources were also searched. Search results were screened by two reviewers. Data were extracted by one reviewer and verified by another. Methodological quality was assessed using the Mixed Methods Appraisal Tool.

Results

Due to heterogeneity in study objectives and outcomes, results were not pooled; a narrative analysis is presented. 26 studies were included. Most were conducted in Canada or the UK (30.8% each), used qualitative designs (42.3%), and evaluated discussion forums (73.1%). Participants were most often aged 19–21 years (69.2%), female (mean 68.6%), and 19.2% had a documented history of depression. The social media platforms evaluated were commonly supportive and provided a sense of community among users. Support included suggestions for formal treatment, advice on stopping self-harming behavior, and encouragement. Harms included normalizing and accepting self-harming behavior; discussion of motivation or triggers, concealment, suicidal ideation or plans; and live depictions of self-harm acts.

Conclusions

Although this evidence is limited by its descriptive nature, studies identify beneficial and detrimental effects for young people using social media to discuss and view deliberate self-harm. The connections users make online may be valuable to explore for therapeutic benefit. Prospective, longitudinal investigations are needed to identify short- and long-term potential harms associated with use.

Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data

BACKGROUND

Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood.

AIMS

To examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter.

METHOD

Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm.

RESULTS

Participants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle.

CONCLUSIONS

The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.

Producing, ratifying, and resisting support in an online support forum

Previous research examining online support forums has tended to focus either on evaluating their effectiveness while paying limited or no attention to the details of the interactions therein, or on features of their social organization, without regard to their effectiveness in fulfilling their stated purposes. In this article, we consider both the interactional features of a forum and participants’ treatment thereof as being effective (or otherwise), thus adopting a view of effectiveness grounded in participants’ proximate orientations and actions. Our analysis demonstrates some ways in which participants produce ratified displays of empathy in response to troubles expressed by another, as well as considering some designedly supportive actions that are treated by their recipients as unsupportive or antagonistic. Our findings indicate some structural features of such forums that facilitate the production of support, while suggesting that claims of knowledge tend to be treated as a basis of resistance to ostensibly supportive actions.

Self-Injury, Help-Seeking, and the Internet

Abstract. Background: Although increasing numbers of young people are seeking help online for self-injury, relatively little is known about their online help-seeking preferences. Aims: To investigate the perspectives of young people who self-injure regarding online services, with the aim of informing online service delivery. Method: A mixed-methods exploratory analysis regarding the perspectives of a subsample of young people who reported a history of self-injury and responded to questions regarding preferences for future online help-seeking (N = 457). The sample was identified as part of a larger study (N = 1,463) exploring self-injury and help-seeking. Results: Seven themes emerged in relation to preferences for future online help-seeking: information, guidance, reduced isolation, online culture, facilitation of help-seeking, access, and privacy. Direct contact with a professional via instant messaging was the most highly endorsed form of online support. Conclusion: Young people expressed clear preferences regarding online services for self-injury, supporting the importance of consumer consultation in development of online services.

"Please Know That You Are Not Alone with Your Pain": Responses to Newcomer Posts in an Online Grief Support Forum

In an effort to better understand how the Internet can provide support to bereaved individuals, this discourse analysis study examined the responses to 107 initial posts in an online grief support group to understand how newcomers' bids for group membership were taken up by current members. Discursive features included validation and empathy through second stories, constructing grief through descriptions, and accepting bids for membership through advice giving and invitations to return to the group. These features illustrate how grief and being a griever are constructed in an online context and how they deviate from the "normal" grief expectations in the offline world.

Configuring the caller in ambiguous encounters: volunteer handling of calls to Samaritans emotional support services

This paper discusses volunteer strategies for handling and assessing calls to Samaritans emotional support services for the suicidal and despairing. It presents findings from the qualitative components of a two-year mixed methods study based on an online caller survey, branch observations and interviews with volunteers and callers throughout the U.K. A thematic analysis of the qualitative data analysis was undertaken using the principle of constant comparison. Many calls fell beyond the primary remit of a crisis service, and called for rapid attribution and assessment. Uncertainty about identifying 'good' calls and recognizing those which were not caused difficulty, frustration and negative attribution towards some callers. This paper presents our analysis of volunteers' accounts of how they configure the caller in intrinsically uncertain and ambiguous encounters, and how such strategies relate to the formal principles of unconditional support and non-judgemental active listening espoused by the organization.

The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people

BACKGROUND

There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people.

METHODS

An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating.

RESULTS

Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to 'cyber-bully' peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm.

CONCLUSIONS

Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

Supportive interchanges and face-work as 'protective talk' in an online self-harm support forum

Within a context of concern about inappropriate advice-giving online, we examined how young people who self-harm behave online, and how professionals might engage with them. We use Discourse Analysis to focus on participant interactions (posts)from a forum's crisis/support rooms, and highlight the prevalence of disclaimers, hedges, questions and tags in the young people's online interactions. We use the concept of face-work as a framework to help understand interactions in the forum SharpTalk. The findings demonstrate the use of a range of mitigation devices, and suggest that the young people orientate to a 'protective' line in their supportive interactions. These findings echo Goffman's (1967) 'supportive interchanges' in that the young people's online interactions may help to preserve face, in an emotionally complex setting, whose vulnerable members also need 'protective'and sensitive support. Taking this 'line' may enable members to create a more open and trusting context for support, and to remain in a forum which they find both helpful and challenging. In light of concerns about online support, the findings provide a new perspective on online peer-support for young people who self-harm.

Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study

BACKGROUND

Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa.

AIM

We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice.

METHODS

We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction.

RESULTS

The young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators.

CONCLUSIONS

Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities.

A qualitative assessment of an online support community for ovarian cancer patients

Background:

A diagnosis of ovarian cancer can have detrimental effects on afflicted patients and their families. Therefore, it is important to understand the role online communities play in improving the quality of life of those affected by the disease.

Purpose:

The aim of this research study is to illustrate the role that online communities play in helping patients and their families to deal with ovarian cancer.

Methods:

Data were collected from an online ovarian cancer forum hosted by MedHelp.org in the form of transcripts of participant discussions. No identifying information about participants was collected. Grounded theory, a qualitative research method, was employed to develop a theory by analyzing the data. The aim of the analysis was to explore the role this forum played in ovarian cancer disease management.

Results:

Data analysis helped to determine participant roles and behaviors. The results suggested that an information seeker–information provider communication process existed among users of the forum observed. Participants in the online forum shared both technical and emotional knowledge and experience in order to achieve self-management of the disease while building trust and support.

Conclusions:

This study concluded that online discussion forums can play a crucial and indispensable role in dealing with diseases such as ovarian cancer, for which limited treatment options exist. Health educators can leverage online discussion forums to promote lifestyle choices and disseminate information about treatment and testing, while getting active feedback from the audience.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BACKGROUND

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

METHODS

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

RESULTS

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

CONCLUSIONS

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BACKGROUND

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

METHODS

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

RESULTS

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

CONCLUSIONS

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.