Breast Cancer Survivors' Contribution to Psychosocial Adjustment of Newly Diagnosed Breast Cancer Patients in a Computer-Mediated Social Support Group

Connected and supported: a scoping review of how online communities provide social support for breast cancer survivors

PURPOSE

To (i) assess how and to what extent online communities are used among breast cancer survivors (BCS) as a source of social support, (ii) describe the kind of support BCS access through online communities, and (iii) explore how these communities foster social support for BCS that promotes well-being and reduces the challenges of survivorship.

METHODS

We conducted a scoping review. A professional librarian performed a comprehensive search in multiple databases from January 2010 to May 2023. The review process adhered to the Johana Briggs Institute's method guidelines and the PRISMA-ScR reporting system.

RESULTS

Fifteen studies were included. Participants used social media, cancer support communities, message boards, or websites for information and emotional support. Qualitative findings resulted in four themes: to reassure; to empower; to promote equity, diversity, and inclusion; and to demonstrate for BCS the drawbacks of online support.

CONCLUSIONS

We underscore that a variety of internet websites and social media platforms are valuable for and appreciated by BCS, especially as a source of social support and human connectedness. Our study raises the existing gap in cultural/ethnic representation in this field and shows that institutional and organizational efforts are needed to address gaps in information regarding access to social support for multiethnic BCS women.

IMPLICATIONS FOR CANCER SURVIVORS

This data synthesis will empower the BCS community by sharing how they can strengthen and support their peers and community via their participation in online communities that connect and support cancer survivors in healthcare spaces.

Using Machine Learning of Online Expression to Explain Recovery Trajectories: Content Analytic Approach to Studying a Substance Use Disorder Forum

BACKGROUND

Smartphone-based apps are increasingly used to prevent relapse among those with substance use disorders (SUDs). These systems collect a wealth of data from participants, including the content of messages exchanged in peer-to-peer support forums. How individuals self-disclose and exchange social support in these forums may provide insight into their recovery course, but a manual review of a large corpus of text by human coders is inefficient.

OBJECTIVE

The study sought to evaluate the feasibility of applying supervised machine learning (ML) to perform large-scale content analysis of an online peer-to-peer discussion forum. Machine-coded data were also used to understand how communication styles relate to writers' substance use and well-being outcomes.

METHODS

Data were collected from a smartphone app that connects patients with SUDs to online peer support via a discussion forum. Overall, 268 adult patients with SUD diagnoses were recruited from 3 federally qualified health centers in the United States beginning in 2014. Two waves of survey data were collected to measure demographic characteristics and study outcomes: at baseline (before accessing the app) and after 6 months of using the app. Messages were downloaded from the peer-to-peer forum and subjected to manual content analysis. These data were used to train supervised ML algorithms using features extracted from the Linguistic Inquiry and Word Count (LIWC) system to automatically identify the types of expression relevant to peer-to-peer support. Regression analyses examined how each expression type was associated with recovery outcomes.

RESULTS

Our manual content analysis identified 7 expression types relevant to the recovery process (emotional support, informational support, negative affect, change talk, insightful disclosure, gratitude, and universality disclosure). Over 6 months of app use, 86.2% (231/268) of participants posted on the app's support forum. Of these participants, 93.5% (216/231) posted at least 1 message in the content categories of interest, generating 10,503 messages. Supervised ML algorithms were trained on the hand-coded data, achieving F1-scores ranging from 0.57 to 0.85. Regression analyses revealed that a greater proportion of the messages giving emotional support to peers was related to reduced substance use. For self-disclosure, a greater proportion of the messages expressing universality was related to improved quality of life, whereas a greater proportion of the negative affect expressions was negatively related to quality of life and mood.

CONCLUSIONS

This study highlights a method of natural language processing with potential to provide real-time insights into peer-to-peer communication dynamics. First, we found that our ML approach allowed for large-scale content coding while retaining moderate-to-high levels of accuracy. Second, individuals' expression styles were associated with recovery outcomes. The expression types of emotional support, universality disclosure, and negative affect were significantly related to recovery outcomes, and attending to these dynamics may be important for appropriate intervention.

Social relationships and their associations with affective symptoms of women with breast cancer: A scoping review

BACKGROUND

Problems in affective and cognitive functioning are among the most common concurrent symptoms that breast cancer patients report. Social relationships may provide some explanations of the clinical variability in affective-cognitive symptoms. Evidence suggests that social relationships (functional and structural aspects) can be associated with patients' affective-cognitive symptoms; however, such an association has not been well studied in the context of breast cancer.

PURPOSE

The purpose of this scoping review was to address the following question: What social relationships are associated with affective-cognitive symptoms of women with breast cancer?

METHODS

This scoping review used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published by February 2022 were searched using four databases: MEDLINE (PubMed), Embase (Elsevier), PsycINFO (EBSCOhost), and Web of Science (Clarivate). All retrieved citations were independently screened and eligibility for inclusion was determined by study team members. Extracted data included research aims, design, sample, type and measures of social relationships (functional and structural), and the association between social relationships and affective-cognitive symptoms.

RESULTS

A total of 70 studies were included. Affective symptoms were positively associated with social support, family functioning, quality of relationships, social networks, and social integration, whereas the negative association was found with social constraints.

CONCLUSION

Our findings suggest positive social relationships may mitigate affective symptoms of women with breast cancer. Thus, health care providers need to educate patients about the importance of building solid social relationships and encourage them to participate in a supportive network of friends and family members.

Peer Mentors for People with Advanced Cancer: Lessons Learnt from Recruiting and Training Peer Mentors for a Feasibility Randomized Controlled Trial

Peer mentors may offer distinctive forms of support to people with advanced cancer. Whilst peer mentor programmes are known, little is understood about recruiting and training peer mentors to support those with advanced cancer. The purpose of this study is to determine the feasibility of recruiting and training peer mentors for a novel peer mentor intervention to promote well-being in people with advanced cancer. Feasibility study testing proactive introduction to a trained peer mentor for 12 weeks in the context of a randomized controlled two-arm trial and nested qualitative process evaluation was used. Peer mentors have/had cancer, recruited via an open call. Two-day training included a new bespoke module on coping with cancer. Descriptive recruitment and training data were captured, supplemented by qualitative interviews, analysed thematically. Forty-eight people expressed interest, mostly female (69%), with breast cancer (32%), and recruited via social media (49%). Twelve people completed training, with attrition often due to availability or mentors' own health; many had advanced cancer themselves. They wanted to 'give something back', but also formed supportive bonds with fellow mentors. It is feasible to recruit and train people with lived experience of cancer to be peer mentors, but those with particular characteristics may predominate. Broad social media based recruitment may have merit in widening the pool of potential peer mentors.

Moderating effect of people-oriented public health services on depression among people under mandatory social isolation during the COVID-19 pandemic: a cross-sectional study in China

BACKGROUND

Public health measures, such as social isolation, are vital to control the spread of the coronavirus disease 2019 (COVID-19), but such measures may increase the risk of depression. Thus, this study examines the influencing and moderating factors of depressive symptoms among individuals subjected to mandatory social isolation.

METHODS

An online cross-sectional survey was conducted to collect data from people under mandatory home or centralized social isolation in Shenzhen, China, from February 28 to March 6, 2020. The perceived risk of infection with COVID-19, perceived tone of media coverage, perceived quality of people-oriented public health services, and their depressive symptoms were assessed. Three rounds of stepwise multiple regression were performed to examine the moderating effects after controlling various variables, such as demographics, duration and venue of mandatory social isolation, infection and isolation status of family, time spent on COVID-related news, and online social support.

RESULTS

Among the 340 participants, 57.6% were men, the average age was 35.5 years old (SD = 8.37), and 55.6% held a bachelor's degree or above. Individuals subjected to mandatory social isolation generally reported low levels of depressive symptoms. Perceived susceptibility to infection was relatively low, whereas perceived tone of media coverage was mainly positive. In terms of perceived quality of public health services, 12 (3.5%), 103 (30.3%), and 225 (66.2%) participants reported low, medium, and high quality of people-oriented services, respectively. Perceived susceptibility was positively associated with depression, whereas perceived tone of media coverage was negatively associated. The quality of people-centered public health services moderated the association between perceived risk and depressive symptoms and between perceived tone of media coverage and depressive symptoms.

CONCLUSIONS

This study revealed the depressive symptoms among individuals subjected to mandatory social isolation during the COVID-19 pandemic and highlighted that frontline public health workers play a critical role in protecting public mental health.

From Network Positions to Language Use: Understanding the Effects of Brokerage and Closure Structures from a Linguistic Perspective

We investigated cancer survivors' interactions on an online breast cancer support forum, focusing on how the network structures of brokerage and closure relate to the types of support received and to the language used in posts. Data came through the extraction of 1,443 forum members' online networks. Automated linguistic analysis was carried out on the 27,248 threads these survivors made and the 336,151 replies they received. Survivors' brokerage and closure levels were positively correlated with the use of positive affective words in their posts, a linguistic marker of well-being. Different network positions fostered different types of support in the community. Specifically, people bridging unconnected users (the broker role) were more likely to receive informational support whereas people in closely knit groups (the closure role) were more likely to receive emotional support. Theoretical, methodological, and practical implications are examined.

Online Support Seeking and Breast Cancer Patients: Changes in Support Seeking Behavior following Diagnosis and Transition off Cancer Therapy

Transitions in breast cancer care are associated with significant increases in stress and anxiety, and this stress can negatively impact mental and physical health. Social support has been shown to alleviate such distress, but whether, how, and how often social support is accessed through existing support networks is unclear. Our study examines changes in social media use following breast cancer diagnosis and treatment, using hand-coded longitudinal data from 30 breast cancer survivors' Facebook pages for the 6 months surrounding cancer diagnosis and for the 6 months surrounding transition off cancer therapy. Results revealed that following diagnosis, there was a significant increase in posting behavior and self-disclosure. However, this increase in posts did not correspond to an increase in support requests. In addition, while participants' primary support requests were for resources, support provided tended to be lower-cost emotional support. Finally, temporal maps indicated that participants started off increasing their engagement but withdrew over time. Our findings suggest that Facebook offered participants a platform for continued social engagement and self-disclosure - but showed several indications that support was principally low-effort, limited quality, and ill-fitting.

How Cancer Patients Benefit from Support Networks Offline and Online: Extending the Model of Structural-to-Functional Support

Although social support is an indispensable resource for coping with illness, the connections among the structural properties of one's support network, received social support from offline and online network members, and well-being are not well understood. This study aims to extend the model of structural-to-functional support by distinguishing offline from online support networks and identifying different pathways through which these two networks contribute to patients' emotional well-being. Using data from 386 cancer patients, the results revealed that offline and online support networks were associated with patients' emotional well-being via different types of received support. Specifically, offline support network size was negatively associated with their emotional well-being via informational support received offline. Online support network size was positively associated with their emotional well-being via emotional support received online.

Feasibility and Acceptability of an Interactive Cancer-Communication Video Program Using African American Breast Cancer Survivor Stories

To examine the feasibility and acceptability of an interactive video program of African American breast cancer survivor stories, we explored story reactions among African American women with newly diagnosed breast cancer and associations between patient factors and intervention use. During a randomized controlled trial, patients in the intervention arm completed a baseline/pre-intervention interview, received the video intervention, and completed a post-intervention 1-month follow-up interview. Additional video exposures and post-exposure interviews occurred at 6- and 12-month follow-ups. Multivariable linear mixed-effects models examined interview and clinical data in association with changes in minutes and actions using the program. After Exposure1, 104 of 108 patients allocated to the intervention reported moderate-to-high levels of positive emotional reactions to stories and identification with storytellers. Exposure1 mean usage was high (139 minutes) but declined over time (p <.0001). Patients receiving surgery plus radiation logged about 50 more minutes and actions over 12-month follow-up than patients receiving surgery only (p <.05); patients reporting greater trust in storytellers logged 18.6 fewer actions over time (p =.04). Patients' topical interests evolved, with patients watching more follow-up care and survivorship videos at Exposure3. The intervention was feasible and evaluated favorably. New videos might satisfy patients' changing interests.

Online social support among breast cancer patients: longitudinal changes to Facebook use following breast cancer diagnosis and transition off therapy

PURPOSE

Active social engagement, both on and offline, is widely recognized as an important buffer against the negative effects of cancer-related stress. Nevertheless, studies show that social stigma can lead to a decrease in available social support following cancer diagnosis. This study examines whether Facebook friends provide continuous, health-promoting social support to breast cancer patients following transitions in care.

METHODS

To examine support provided to breast cancer patients, we hand-coded 21,291 status updates and wall posts with respect to both post content and support exchange. We then use descriptive statistics, pairwise t tests, and temporal maps to show whether posts received more likes, comments, or unique commenters following breast cancer diagnosis and the post content that was most likely to garner positive responses from Facebook friends.

RESULTS

Results showed an initial increase across all three support metrics (likes, comments, and unique commenters) after cancer diagnosis but that all three metrics decrease steadily over time. Results also revealed significant decreases in the average number of comments and number of commenters following transition off cancer treatment.

CONCLUSIONS

Taken together, our results reveal that while support is available through Facebook, support may be sporadic, characterized by limited engagement and low cost. There is also limited support available through Facebook to weather the stress of transition off cancer treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Facebook is an important feature in people's lives, particularly among the demographic most impacted by breast cancer. Our results suggest that social media can be useful in accessing support but should be used with caution.

Attracting Users to Online Health Communities: Analysis of LungCancer.net's Facebook Advertisement Campaign Data

BACKGROUND

With growing numbers of adults turning to the internet to get answers for health-related questions, online communities provide platforms with participatory networks to deliver health information and social support. However, to optimize the benefits of these online communities, these platforms must market effectively to attract new members and promote community growth.

OBJECTIVE

The aim of this study was to assess the engagement results of Facebook advertisements designed to increase membership in the LungCancer.net online community.

METHODS

In the fall of 2017, a series of 5 weeklong Facebook advertisement campaigns were launched targeting adults over the age of 18 years with an interest in lung cancer to increase opt ins to the LungCancer.net community (ie, the number of people who provided their email to join the site).

RESULTS

The advertisements released during this campaign had a sum reach of 91,835 people, and 863 new members opted into the LungCancer.net community by providing their email address. Females aged 55 to 64 years were the largest population reached by the campaign (31,401/91,835; 34.29%), whereas females aged 65 and older were the largest population who opted into the LungCancer.net community (307/863; 35.57%). A total of US $1742 was invested in the Facebook campaigns, and 863 people opted into LungCancer.net, resulting in a cost of US $2.02 per new member.

CONCLUSIONS

This research demonstrates the feasibility of using Facebook advertising to promote and grow online health communities. More research is needed to compare the effectiveness of various advertising approaches. Public health professionals should consider Facebook campaigns to effectively connect intended audiences to health information and support.

Codifying Online Social Support for Breast Cancer Patients: Retrospective Qualitative Assessment

BACKGROUND

Social media has emerged as the epicenter for exchanging health-related information, resources, and emotional support. However, despite recognized benefits of social media for advancing health-promoting support exchange, researchers have struggled to differentiate between the different ways social support occurs and is expressed through social media.

OBJECTIVE

The objective of this study was to develop a fuller understanding of social support exchange by examining the ways in which breast cancer patients discuss their health needs and reach out for support on Facebook and to develop a coding schema that can be useful to other social media researchers.

METHODS

We conducted a retrospective qualitative assessment of text-based social support exchanges through Facebook among 30 breast cancer survivors. Facebook wall data were systematically scraped, organized, coded, and characterized by whether and which types of support were exchanged. Research questions focused on how often participants posted related to cancer, how often cancer patients reached out for support, and the relative frequency of informational, instrumental, or socioemotional support requests broadcast by patients on the site.

RESULTS

A novel ground-up coding schema applied to unwieldy Facebook data successfully identified social support exchange in two critical transitions in cancer treatment: diagnosis and transition off cancer therapy. Explanatory coding, design, and analysis processes led to a novel coding schema informed by 100,000 lines of data, an a priori literature review, and observed online social support exchanges. A final coding schema permits a compelling analysis of support exchange as a type of peer community, where members act proactively to buffer stress effects associated with negative health experiences. The coding schema framed operational definitions of what support meant and the forms each type of support could take in social media spaces.

CONCLUSIONS

Given the importance of social media in social interaction, support exchange, and health promotion, our findings provide insight and clarity for researchers into the different forms informational, resource, and emotional support may take in Web-based social environments. Findings support broader continuity for evaluating computer-mediated support exchange.

Social Media Intervention Design: Applying an Affordances Framework

Social media interventions are a growing area of internet research, particularly for adolescent health. Researchers developing social media intervention approaches face the task of selecting a social media platform for their intervention. In this paper, we present the theoretical framework of affordances to help guide social media platform selection for intervention research. Affordances are a concept often used in fields associated with design and by those systematically studying the impact of a design of an object. Thus, the affordances approach is often used by those considering the impact of information technology and the design of social media platforms. Affordances are often described as properties of artifacts that can be recognized by users and contribute to their function or items that present an action possibility. We describe common affordances that can be applied to intervention design as well as current evidence and an intervention case example for each affordance. A scientific approach for the selection of the appropriate social media platform for a given intervention is an important research priority to advance the field of internet research.