Exploring the discourses around microdosing psychedelics within the r/microdosing online community

In the present contribution, we examine the practice of microdosing psychedelics (microdosing) through textual analysis of the content produced by a dedicated online community, the r/microdosing subreddit. We collected a comprehensive dataset of publicly available submissions from this community and used structural topic modelling to identify and analyse the prevalent topics within the discussions. Through our analysis, we identified 16 distinct topics that mapped into clinical, human enhancement, as well as self-medication narratives. Notably, we found that the majority of discussions revolved around "how to" topics, supporting our argument that such online communities serve as essential information hubs, facilitating the dissemination of practical knowledge related to microdosing practices among the general population. The identified impact of the Covid-19 pandemic on the prevalence of discussion topics suggests that individuals within the online community may perceive microdosing primarily as a means of self-medication during times of heightened stress and uncertainty. Our findings contribute to the field of health sociology and psychedelic research by shedding light on the sociocultural factors influencing healthcare practices, including the role of online communities in facilitating processes of self-medicalization and self-medication.

Health Professionals' Use of Online Communities for Interprofessional Peer Education

Online communities in health care are well established as technologies for facilitating interactions between patients with common conditions and communication between patients and health professionals. Less well known is how health professionals use these platforms to connect with their peers, particularly for interprofessional education or support. We present early results from our exploratory international mixed methods (survey and interview) study of health professionals' experience of engaging with online communities for interprofessional peer education. Our results show that health professionals had relatively high levels of confidence engaging with multiple platforms. They used the platforms to formally and informally share evidence-based content, engage in collegial debate and connect with international colleagues. Health professionals are keen to engage with online communities for education and are aware of how these sites' functionality can promote engagement with interdisciplinary peers.

Buffering against exposure to mental health misinformation in online communities on Facebook: the interplay of depression literacy and expert moderation

BACKGROUND

The proliferation of health misinformation on social media is a growing public health concern. Online communities for mental health (OCMHs) are also considered an outlet for exposure to misinformation. This study explored the impact of the self-reported volume of exposure to mental health misinformation in misinformation agreement and the moderating effects of depression literacy and type of OCMHs participation (expert vs. peer-led).

METHODS

Participants (n = 403) were recruited in Italian-speaking OCMHs on Facebook. We conducted regression analyses using PROCESS macro (moderated moderation, Model 3). Measures included: the Depression Literacy Questionnaire (Griffiths et al., 2004), the self-reported misinformation exposure in the OCMHs (3 items), and misinformation agreement with the exposure items (3 items). Whether participants were members of expert or peer-led OCMHs was also investigated.

RESULTS

The final model explained the 12% variance in the agreement. There was a positive and significant relationship between misinformation exposure and misinformation agreement (β = 0.3221, p < .001), a significant two-way interaction between misinformation exposure and depression literacy (β = - 0.2179, p = .0014 ), and between self-reported misinformation exposure and type of OCMH (β = - 0.2322, p = .0254), such that at higher levels of depression literacy and in case of participation to expert-led OCMHs, the relationship misinformation exposure-misinformation agreement was weaker. Finally, a three-way interaction was found (β = 0.2497, p = .0144) that showed that depression literacy moderated the positive relationship between misinformation exposure and misinformation agreement such that the more misinformation participants were exposed to, the more they agreed with it unless they had higher levels of depression literacy; this, however, occurred only if they participated in peer-led groups.

CONCLUSIONS

Results provide evidence that the more members reported being exposed to mental health misinformation, the more they tended to agree with it, however this was only visible when participants had lower depression literacy and were participating in peer-led OCMHs. Results of this study suggest that both internal factors (i.e., high depression literacy) and external factors (the type of online community individuals were participating in) can buffer the negative effects of misinformation exposure. It also suggests that increasing depression literacy and expert community moderation could curb the negative consequences of misinformation exposure related to mental health. Results will guide interventions to mitigate the effects of misinformation in OCMHs, including encouraging health professionals in their administration and implementing health education programs.

"Your struggles are valid, you are worthy of help and you deserve to recover": narratives of recovery from orthorexia nervosa

PURPOSE

Limited research has examined recovery processes and conceptualisations of recovery within orthorexia nervosa (ON). This study harnessed Instagram data to examine how people who self-identify with ON use the hashtag #OrthorexiaRecovery and how recovery is represented within this online space.

METHODS

500 textual posts containing #OrthorexiaRecovery were extracted from Instagram. Co-occurring hashtags were analysed descriptively to determine whether this online space is specific to ON, and textual data were analysed using reflexive thematic analysis.

RESULTS

The hashtag analysis indicated that #OrthorexiaRecovery is being used within a wider context of eating disorder recovery and awareness, but also provides deep insights into experiences of recovery from ON. The thematic analysis generated five themes: the invisibility of orthorexia; a turbulent and continuous process; finding food freedom; from compulsive exercise to intuitive movement; a community of support. Our findings suggest that people with self-reported ON experience recovery as a continuous process and the current invisibility of ON within diagnostic criteria and wider society impedes recovery. While working towards recovery, users aimed to be free from diet culture, become more attuned to their bodies, and develop more adaptive relationships with food and fitness. Users noted a general lack of support for people with ON and so used this online space to create a supportive community, though some content was potentially triggering.

CONCLUSION

Our findings highlight the importance of increased recognition of ON and the potential value of targeting societal norms and harnessing social identity resources within therapeutic interventions for ON.

Support amid uncertainty: Long COVID illness experiences and the role of online communities

Long COVID is characterized by persistent and debilitating long-term symptoms from COVID-19. Many persons with Long COVID began gathering in online communities during the early phases of the pandemic to share their illness experiences. This qualitative interview study explored the subjective experiences of 20 persons with Long COVID recruited from five online communities. Their understandings of illness and associated implications for social relationships with family and friends, healthcare professionals, and online community members were explored. Three themes were identified from our analysis, including (1) complex and unpredictable illness experienced amid an evolving understanding of the pandemic; (2) frustration, dismissal, and gaslighting in healthcare interactions; and (3) validation and support from online communities. These findings highlight the significant uncertainty that persons with Long COVID navigated, the features of their often dismaying healthcare experiences, and the ways in which online communities aided them in understanding their illness.

A HOPE Online Community Peer Support Intervention for Help Seeking: A Randomized Controlled Trial

OBJECTIVE

A 6-week study was conducted to test the effectiveness of the Harnessing Online Peer Education (HOPE) intervention on anxiety, help seeking (requests for electronic resources [e-resources] on anxiety reduction), and online engagement.

METHODS

Three hundred participants with moderate to severe anxiety (i.e., seven-item Generalized Anxiety Disorder scale [GAD-7] scores ≥10) were randomly assigned to social media (i.e., Facebook) groups with or without peer leaders. The study was conducted from April 5 to May 17, 2020. GAD-7 scores, e-resource requests, and online engagement were measured at baseline and at weeks 2, 4, and 6.

RESULTS

GAD-7 scores improved in both intervention and control groups, with no difference between conditions. Participants in the intervention group were more likely than those in the control group to request e-resources (OR=10.27, 95% CI=4.52-23.35) and engage online (OR=2.84, 95% CI=1.70-4.76).

CONCLUSIONS

The HOPE intervention effectively promoted mental health help-seeking behavior and online engagement.

The distribution of fake Australian vaccine digital certificates on an alt-tech platform

This paper provides the first exploration of the online distribution of fake Australian COVID-19 vaccine certificates. Drawing on a collection of 2589 posts between five distributors and their community members on the alt-tech platform Gab, this study gathers key insights into the mechanics of illicit vaccine certificate distribution. The qualitative findings in this research demonstrate the various motivations and binding ideologies that underpinned this illicit distribution (e.g. anti-vaccine and anti-surveillance motivations); the unique cybercultural aspects of this online illicit network (e.g. 'crowdsourcing' the creation of fake vaccine passes); and how the online community was used to share information on the risks of engaging in this illicit service, setting the appropriate contexts of using fake vaccine passes, and the evasion of guardians in offline settings. Implications for future research in cybercrime, illicit networks, and organised crime in digital spaces are discussed.

Investigating toxicity changes of cross-community redditors from 2 billion posts and comments

This research investigates changes in online behavior of users who publish in multiple communities on Reddit by measuring their toxicity at two levels. With the aid of crowdsourcing, we built a labeled dataset of 10,083 Reddit comments, then used the dataset to train and fine-tune a Bidirectional Encoder Representations from Transformers (BERT) neural network model. The model predicted the toxicity levels of 87,376,912 posts from 577,835 users and 2,205,581,786 comments from 890,913 users on Reddit over 16 years, from 2005 to 2020. This study utilized the toxicity levels of user content to identify toxicity changes by the user within the same community, across multiple communities, and over time. As for the toxicity detection performance, the BERT model achieved a 91.27% classification accuracy and an area under the receiver operating characteristic curve (AUC) score of 0.963 and outperformed several baseline machine learning and neural network models. The user behavior toxicity analysis showed that 16.11% of users publish toxic posts, and 13.28% of users publish toxic comments. However, results showed that 30.68% of users publishing posts and 81.67% of users publishing comments exhibit changes in their toxicity across different communities, indicating that users adapt their behavior to the communities' norms. Furthermore, time series analysis with the Granger causality test of the volume of links and toxicity in user content showed that toxic comments are Granger caused by links in comments.

Online Conversations About Abuse: Responses to IPV Survivors from Support Communities

Purpose

Intimate partner violence (IPV) impacts the lives of millions, damaging survivors and families. Many survivors are unsure how to get help, and have limited access to resources. In recent years, those affected by IPV have turned online for answers, support, and to share their experiences. This study examined the online dialogue between survivors of violence and those who respond to their posts.

Method

Data consisted of 451 responses to IPV survivors on the website Reddit in a domestic violence subgroup. Responses were analyzed using a combination of grounded theory coding techniques with content analysis tools to generate categories and subcategories.

Results

Three main categories emerged from the data, including support, sharing experiences, and sharing information. The subcategories included specific types of help, advice, understanding, and were overwhelmingly positive in their tone and content.

Conclusions

Findings suggest that online forums may help bridge the gap between survivors and resources. Professionals who work with IPV or create policies can use these findings to understand how to help survivors find support. This may include encouraging survivors to connect with informal supports such as family and friends, or access formal support such as hotlines, therapy, or legal counsel. The findings also suggest that more research is needed to understand what types of questions survivors of violence have, and what outcomes result from online support.

Opportunities to expand access to mental health services: A case for the role of online peer support communities

This study investigated whether with disruptions in care due to the COVID-19 pandemic, persons who self-identified as living with a mental health condition increased their usage of an online peer support community. We also explored whether study participants who self-reported usage of online peer support communities were interested in using these communities to connect with evidence-based interventions and mental health services. This study employed a cross-sectional online survey design. The survey was disseminated by the Inspire online peer support community and Mental Health America through various social media channels. Descriptive and inferential analyses were conducted to summarize participant demographics, investigate patterns of use of online peer support communities, and interest in accessing additional programs through these platforms. There were 369 survey respondents, with a mean age of 49 (SD = 15.6), of which 77% were female. Most respondents self-reported having depression (34%), post-traumatic stress disorder (25%), and anxiety-related conditions (20%). The number of respondents who reported accessing online peer support platforms multiple times a day appeared to double after March 2020. We also found an overall positive association between frequency of community use and self-reported benefit to mental health. Approximately 81% of respondents expressed interest in accessing mental health services via an online peer support community. Persons who self-report living with mental health conditions and who engage in online peer support communities expressed interest in accessing evidence-based interventions via these online platforms. Participants were most interested in services related to enhancing coping mechanisms and skills, enabling overall wellbeing, and accessing therapy.

The #orthorexia community on Instagram

PURPOSE

This mixed-methods study delved into the relationship between orthorexia nervosa (ON) and Instagram.

METHODS

Two quantitative data sources were used: content analysis of pictures using #orthorexia (n = 3027), and an online questionnaire investigating the experience of ON and the use of Instagram of people sharing ON-related content on Instagram (n = 185). Following, interviews (n = 9) were conducted with people posting ON-related content on Instagram and self-identifying as having (had) ON.

RESULTS

People who share ON-related content on Instagram were found to be primarily young women (questionnaire = 95.2% females, mean age 26.2 years; interviews = 100% females, mean age 28.4 years), who were found to be heavy social media users and favor Instagram over other platforms. Questionnaire respondents agreed in defining ON as an obsession with a diet considered healthy, with bio-psycho-social negative consequences, though those who self-identified as having (had) ON were more likely to point out the negative impairments of ON. Interviewees deemed Instagram partially responsible for the development of ON. Instead, they agreed that Instagram encourages problem realization. Content analysis showed that ON is encoded in pictures of 'food', 'people', 'text' and 'other.' Interviewees revealed that they started posting to recover, share information, help others, and they felt inspired to post by other accounts. A sense of belonging to the #orthorexia community emerged, where people share values and ideals, and seek validation from others.

CONCLUSION

Conversations around #orthorexia on Instagram generate supportive communities aiding recovery. Individuals use Instagram for helping others and themselves recovering from ON. Understanding how people help each other, manage their health, cope with symptoms, and undertake recovery can inform the implementation of therapeutic interventions for ON.

LEVEL OF EVIDENCE

Level III, evidence obtained from well-designed cohort or case-control analytic studies.

Loneliness and psychological distress before and during the COVID-19 pandemic: Relationships with social media identity bubbles

Impacts of the COVID-19 pandemic on well-being and mental health are a concern worldwide. This article is based on two longitudinal studies that investigated the role of social media use in loneliness and psychological distress before and during the COVID-19 pandemic. Study 1 utilized nationally representative 3-point longitudinal data (n = 735) collected in 2017–2020 on the Finnish population. Study 2 utilized 5-point longitudinal data (n = 840) collected in 2019–2021 representing the Finnish working population. We analyzed the data using multilevel mixed-effects regression analysis. A longitudinal analysis of Study 1 showed that perceived loneliness did not increase among the Finnish population during the COVID-19 pandemic. Stronger involvement in social media identity bubbles predicted lower loneliness during the pandemic. Study 2 results showed that since the outbreak of the pandemic, psychological distress has increased among lonely individuals but not among the general working population. Involvement in social media identity bubbles predicted generally lower psychological distress during the COVID-19 pandemic, but it did not buffer against higher psychological distress among lonely individuals. The findings suggest that perceived loneliness is a risk factor for prolonged negative mental health effects of the pandemic. Social media identity bubbles can offer meaningful social resources during times of social distancing but cannot protect against higher psychological distress among those who perceive themselves as often lonely.

ProAna Worlds: Affectivity and Echo Chambers Online

Anorexia Nervosa (AN) is an eating disorder characterised by self-starvation. Accounts of AN typically frame the disorder in individualistic terms: e.g., genetic predisposition, perceptual disturbances of body size and shape, experiential bodily disturbances. Without disputing the role these factors may play in developing AN, we instead draw attention to the way disordered eating practices in AN are actively supported by others. Specifically, we consider how Pro-Anorexia (ProAna) websites-which provide support and solidarity, tips, motivational content, a sense of community, and understanding to individuals with AN-help drive and maintain AN practices. We use C. Thi Nguyen's work on epistemic "echo chambers", along with Maria Lugones' work on "worlds" and "ease", to explore the dynamics of these processes. Adopting this broader temporal and intersubjective perspective, we argue, not only helps to further illuminate the experiential character of AN but also has important clinical and therapeutic significance.

Life Satisfaction and Online-Gambling Communities: A Cross-National Study of Gambling Activities Among Young Finnish, American, South Korean and Spanish People

Gambling is a potential hazard to life satisfaction, yet peer relationships online might buffer this risk. This study analyzed the ways problem gambling is associated with life satisfaction as well as the extent to which the use of online-gambling community participation and, alternatively, offline belonging affect this association. A web-based survey was conducted among people aged 15–25 in Finland (n = 1,200), the United States (n = 1,212), South Korea (n = 1,192), and Spain (n = 1,212). The main variables included life satisfaction, problem gambling measured by the South Oaks Gambling Screen, online-gambling community participation, and offline belonging. Controls included compulsive internet use, hazardous drinking, psychological distress, income, age, and gender. Linear regression models were employed with country interactions. Results showed problem gambling had a negative relationship with life satisfaction, but the association was explained by control variables. Online-gambling community participation had a positive relationship with life satisfaction, especially among pathological gamblers who had poor offline relationships. Country comparisons revealed that the direct effect of excessive gambling and the compensating effect of online-gambling communities were most prominent in Finland.

Digital affordances: how entrepreneurs access support in online communities during the COVID-19 pandemic

COVID-19 has caused significant and unforeseen problems for entrepreneurs. While entrepreneurs would normally seek social support to help deal with these issues, due to social distancing, physical networks are often not available. Consequently, entrepreneurs must turn to alternative support sources, such as online communities, raising the question of how support is created in such spaces. Drawing on an affordance perspective, we investigate how entrepreneurs interact with online communities and base our qualitative analysis on conversation data (76,365 posts) from an online community of entrepreneurs on Reddit during the COVID-19 pandemic. Our findings draw out four affordances that online communities offer to entrepreneurs (resolving problems, reframing problems, reflecting on situations, refocusing thinking and efforts), resulting in a framework of entrepreneurial support creation in online communities. Thus, our study contributes to debates around (1) entrepreneurs' support during COVID-19 and (2) digital affordances in the entrepreneurship context.

Long Covid - The illness narratives

Callard and Perego depict long Covid as the first illness to be defined by patients who came together on social media. Responding to their call to address why patients were so effective in making long Covid visible and igniting action to improve its care, we use narrative inquiry - a field of research that investigates the place and power of stories and storytelling. We analyse a large dataset of narrative interviews and focus groups with 114 people with long Covid (45 of whom were healthcare professionals) from the United Kingdom, drawing on socio-narratology (Frank), therapeutic emplotment (Mattingly) and polyphonia (Bakhtin). We describe how storytelling devices including chronology, metaphor, characterisation, suspense and imagination were used to create persuasive accounts of a strange and frightening new condition that was beset with setbacks and overlooked or dismissed by health professionals. The most unique feature of long Covid narratives (in most but not all cases) was the absence, for various pandemic-related reasons, of a professional witness to them. Instead of sharing their narratives in therapeutic dialogue with their own clinician, people struggled with a fragmented inner monologue before finding an empathetic audience and other resonant narratives in the online community. Individually, the stories seemed to make little sense. Collectively, they provided a rich description of the diverse manifestations of a grave new illness, a shared account of rejection by the healthcare system, and a powerful call for action to fix the broken story. Evolving from individual narrative postings to collective narrative drama, long Covid communities challenged the prevailing model of Covid-19 as a short-lived respiratory illness which invariably delivers a classic triad of symptoms; undertook and published peer-reviewed research to substantiate its diverse and protracted manifestations; and gained positions as experts by experience on guideline development groups and policy taskforces.

Entrepreneurial learning in online communities

Abstract

New digital technologies possess the potential to transform entrepreneurial processes, such as how entrepreneurs pursue opportunities and access funding and how they learn. How entrepreneurs learn may be transformed as digital technologies provide new spaces for learning, such as online communities. Online communities can gather thousands of participants and provide entrepreneurs with new opportunities for learning that are not limited by time, space, or social class. Yet, we know little about how entrepreneurs take advantage of the new digital opportunities of learning. To remedy this, we studied a large online community of entrepreneurs on Reddit (r/startups), where we qualitatively analyzed the top-voted 100 threads from 2018 to 2019 (10,277 comments in total). By drawing on coactive vicarious learning, a theory that describes how learning is socially constructed through discursive interactions, we outline how entrepreneurial learning is socially constructed through conversations, which are taking place in different micro-learning contexts. Through identifying distinct entrepreneurial learning conversations, we build new theory on entrepreneurial learning in online communities. Our theorizing contributes to (1) the growing research on how entrepreneurial learning is socially constructed in communities, (2) the current debate on knowledge creation in online communities, and (3) the knowledge on how coactive vicarious learning unfolds in communities.

Plain English Summary

When entrepreneurs go online to learn, new research shows how online communities provide entrepreneurs with diverse learning spaces for developing ideas, learning new skills, and coping with the uncertainties of being an entrepreneur. Entrepreneurs increasingly use social media for doing business, but can they also use it to learn about doing business? In this article, we investigate this question by studying an online community of entrepreneurs on Reddit called r/startups, in which entrepreneurs exchange experiences and help each other with questions and issues. We show that entrepreneurial learning is taking place in five forms of learning conversations, which are situated in four learning contexts that differ from each other, from a classroom with a student-teacher dynamic, a collab space where entrepreneurs collect ideas and develop new skills and knowledge, a club context in which they challenge each other, and a care context in which they can bring their fears and uncertainties. Our findings show how entrepreneurship practitioners can make use of online communities, encouraging teaching and policy to pay more attention to how entrepreneurs work digitally.

Nerve transfer surgery in spinal cord injury: online information sharing

Background

Nerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community.

Methods

Data were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included ‘spinal cord injury’ and ‘SCI’ and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for ‘nerve’, ‘transfer’, ‘nerve transfer’, and ‘nerve surgery’. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation.

Results

The search yielded 99 groups; 35 met the inclusion criteria (average size = 2007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%).

Conclusion

Social media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies.

Analysis of associations between emotions and activities of drug users and their addiction recovery tendencies from social media posts using structural equation modeling

Background

Addiction to drugs and alcohol constitutes one of the significant factors underlying the decline in life expectancy in the US. Several context-specific reasons influence drug use and recovery. In particular emotional distress, physical pain, relationships, and self-development efforts are known to be some of the factors associated with addiction recovery. Unfortunately, many of these factors are not directly observable and quantifying, and assessing their impact can be difficult. Based on social media posts of users engaged in substance use and recovery on the forum Reddit, we employed two psycholinguistic tools, Linguistic Inquiry and Word Count and Empath and activities of substance users on various Reddit sub-forums to analyze behavior underlining addiction recovery and relapse. We then employed a statistical analysis technique called structural equation modeling to assess the effects of these latent factors on recovery and relapse.

Results

We found that both emotional distress and physical pain significantly influence addiction recovery behavior. Self-development activities and social relationships of the substance users were also found to enable recovery. Furthermore, within the context of self-development activities, those that were related to influencing the mental and physical well-being of substance users were found to be positively associated with addiction recovery. We also determined that lack of social activities and physical exercise can enable a relapse. Moreover, geography, especially life in rural areas, appears to have a greater correlation with addiction relapse.

Conclusions

The paper describes how observable variables can be extracted from social media and then be used to model important latent constructs that impact addiction recovery and relapse. We also report factors that impact self-induced addiction recovery and relapse. To the best of our knowledge, this paper represents the first use of structural equation modeling of social media data with the goal of analyzing factors influencing addiction recovery.

Investigating the healthcare pathway through patients' experience and profiles: implications for breast cancer healthcare providers

Background

Healthcare systems are facing many changes. Particularly, patients are more engaged in the care process. The medical perspective of the process is insufficient to provide patients with high quality care and service personalisation. This research presents an attempt to complete this medical perspective through an experiential perspective, especially for chronic diseases such as cancer. We investigated patients’ experiences and profiles to reach a deeper understanding of their needs and expectations when they confront the disease.

The objectives of this research were to model the key stages underling the patient pathway and to identify the challenging touch points of the interactions between patients and healthcare providers. Bringing together findings of patient experience, pathway, and profiles would help all the stakeholders involved to develop better practices for the healthcare process.

Methods

A qualitative observational nethnography on a French specialized forum for breast cancer patients “les Impatientes” was conducted. A total of 967 reviews were collected over a complete year period from all over France. Thematic and lexicometric content analysis were performed according to the experience dimensions, the pathway stages and touch points, as well as the patients’ profiles.

Results

Data analysis shows that the healthcare pathway experienced by the patients is built around three stages. The discovery stage is closely related to the emotional dimension regarding the patient and physician relationship. The examination stage is characterized by a more technical and informational needs for the types of treatments. The follow-up and survivorship stage illustrates the patients’ need to assess the treatments’ effectiveness and the quality of the follow-up. Moreover, three profiles of patients were identified. The newcomers, the altruists and the autonomous are characterized by different attitudes depending on the stage of the healthcare pathway they were living.

Conclusions

Our research presents an original modelling of the patient pathway and profiles beyond the medical process. It gives practical tracks to improve the healthcare pathway. Patients expect healthcare providers to integrate and strengthen several challenging touch points in order to create satisfactory patient experiences and high quality service.

Is the American College of Surgeons Online Communities a safe and useful venue to ask for surgical advice?

BACKGROUND

Many surgeons rely on the American College of Surgeons (ACS) Community Forums for advice on managing complex patients. Our objective was to assess the safety and usefulness of advice provided on the most popular surgical forum.

METHODS

Overall, 120 consecutive, deidentified clinical threads were extracted from the General Surgery community in reverse chronological order. Three groups of three surgeons (mixed academic and community perspectives) evaluated the 120 threads for unsafe or dangerous posts. Positive and negative controls for safe and unsafe answers were included in 20 threads, and reviewers were blinded to their presence. Reviewers were free to access all online and professional resources.

RESULTS

There were 855 unique responses (median 7, 2-15 responses per thread) to the 120 clinical threads/scenarios. The review teams correctly identified all positive and negative controls for safety. While 58(43.3%) of threads contained unsafe advice, the majority (33, 56.9%) were corrected. Reviewers felt that a there was a standard of care response for 62/120 of the threads of which 50 (80.6%) were provided by the responses. Of the 855 responses, 107 (12.5%) were considered unsafe/dangerous.

CONCLUSION

The ACS Community Forums are generally a safe and useful resource for surgeons seeking advice for challenging cases. While unsafe or dangerous advice is not uncommon, other surgeons typically correct it. When utilizing the forums, advice should be taken as a congregate, and any single recommendation should be approached with healthy skepticism. However, social media such as the ACS Forums is self-regulating and can be an appropriate method for surgeons to communicate challenging problems.

Frequently asked questions about dabbing concentrates in online cannabis community discussion forums

BACKGROUND

"Dabbing" involves vaporizing a "dab" of cannabis concentrate on a heated "nail," passing the vapour through a water-pipe rig or portable pen device, and inhaling the vapour. While some cannabis industry media claims that this process is cleaner, safer, and more effective for getting high, medical and public health sources raise concerns about residual solvents and pesticides, unexpectedly intense effects, and rapid increases in tolerance. The aim of this study is to characterize the content of questions about dabbing posed in cannabis and dabbing-specific forums on the Reddit social media platform, as well as comment responses to these questions.

METHODS

We conducted a content analysis of one year (2017) of information-seeking user-generated posts to three Reddit online cannabis community discussion forums ("subreddits") that contained the terms "dab" and "question." We also examined post engagement and the types and sentiment of information exchanged in the comment responses.

RESULTS

Across 193 dabbing question posts, the most frequently asked question content was about types and logistical use of devices and related equipment (38%) and comparisons of cannabis products (32%), followed by questions about the step-by-step process of getting high (18%), legal issues (17%), and health concerns (13%). Nearly every post had a response (98%), with a median 5 comments per post and few negative (i.e. hostile, condescending, or trolling) comments (4%). Source of advice or information was stated in about a quarter (26%) of comment responses, with the overwhelming majority of this information (89%) coming from disclosures of personal experience vs. web or commercial sources.

CONCLUSION

People seeking advice online about dabbing inquired most often about logistics of use, but less often about health, tolerance, and legal risks. These findings may be used to inform public health efforts and health practitioner education as cannabis becomes increasingly legal and accessible.

Excessive Gambling and Online Gambling Communities

The Internet provides an accessible context for online gambling and gambling-related online communities, such as discussion forums for gamblers. These communities may be particularly attractive to young gamblers who are active Internet users. The aim of this study was to examine the use of gambling-related online communities and their relevance to excessive gambling among 15-25-year-old Finnish Internet users (N = 1200). Excessive gambling was assessed by using the South Oaks Gambling Screen. Respondents were asked in a survey about their use of various kinds of gambling-related online communities, and sociodemographic and behavioral factors were adjusted. The results of the study revealed that over half (54.33%) of respondents who had visited gambling-related online communities were either at-risk gamblers or probable pathological gamblers. Discussion in these communities was mainly based on sharing gambling tips and experiences, and very few respondents said that they related to gambling problems and recovery. In three different regression models, visiting gambling-related online communities was a significant predictor for excessive gambling (with 95% confidence level) even after adjusting confounding factors. The association of visiting such sites was even stronger among probable pathological gamblers than among at-risk gamblers. Health professionals working with young people should be aware of the role of online communities in terms of development and persistence of excessive gambling. Monitoring the use of online gambling communities as well as utilizing recovery-oriented support both offline and online would be important in preventing further problems. Gambling platforms should also include warnings about excessive gambling and provide links to helpful sources.

The "Real World"? Effects of Online Communication about Prostate Cancer on Offline Communication

INTRODUCTION

Online peer-to-peer social support programs are based on the premise that support from others who have been through a similar experience can help reduce the negative impacts of disease. Such support programs are increasingly found online, but how these conversations translate into real world interactions about health concerns is currently not well understood.

METHODS

Grounded in social network theory, this formative study explored how participants in an online prostate cancer community comprised of patients and their families translate their online conversations into offline ones. A survey was designed and fielded, and received 157 complete responses.

RESULTS

Results support prior research findings that these offline conversations are primarily information-oriented (n = 105) and extend them by the finding that members of online prostate cancer social support communities do, in fact, share information obtained online with others offline (n = 103). Family members appear to be primary receivers of this information (n = 121) while health care providers are not, which may impact treatment and care.

CONCLUSIONS

The opportunity to tie more concretely online messages with offline conversations is of critical importance and interest. Recommendations are presented for future research.

Understanding emerging forms of cannabis use through an online cannabis community: An analysis of relative post volume and subjective highness ratings

BACKGROUND

Legalization of medical and recreational cannabis has coincided with an increase in novel forms of cannabis use and a burgeoning cannabis product industry. This research seeks to understand the occurrence of discussions about these emerging and traditional forms of use in an online social media discussion forum.

METHODS

We analyzed posts to a cannabis-specific forum on the Reddit social media platform posted from January 2010-December 2016. For each of various keywords describing smoking, vaping, edibles, dabbing, and butane hash oil (BHO) concentrate use, we analyzed (1) relative prevalence of posts mentioning these cannabis forms of use; (2) user-reported subjective ratings of "highness" on a scale of 1-10; (3) the ten most common words mentioned in posts; and (4) the frequency of adverse health effect terms.

RESULTS

Form of use was mentioned in approximately 17.7% of 2.26 million posts; smoking was the most commonly mentioned form of cannabis use. From 2010-2016, relative post volume increased significantly for posts mentioning dabbing (3.63/1000 additional posts per year, p < .001), butane hash oil terms (3.16/1000, p < .001), and edible terms (2.84/1000, p = .002). Mean subjective highness was significantly greater for posts mentioning dabbing (mean = 7.8, p < .001), butane hash oil terms (mean = 7.5, p < .001), and edible terms (mean = 7.2, p < .001) but not significantly different for vaping (mean = 6.7, p = .19), when compared to smoking (mean = 6.8).

CONCLUSIONS

Despite limitations in representativeness, findings indicate a significant increase in online discussion of emerging cannabis forms of use over time and greater subjective effects of dabbing, butane hash oil, and edible use.

Health care access and quality for persons with disability: Patient and provider recommendations

BACKGROUND

Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD.

OBJECTIVE

We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community.

METHODS

In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life^® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology.

RESULTS

Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform.

CONCLUSIONS

Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement.

Online community management as social network design: testing for the signature of management activities in online communities

Online communities are used across several fields of human activities, as environments for large-scale collaboration. Most successful ones employ professionals, sometimes called "community managers" or "moderators", for tasks including onboarding new participants, mediating conflict, and policing unwanted behaviour. Network scientists routinely model interaction across participants in online communities as social networks. We interpret the activity of community managers as (social) network design: they take action oriented at shaping the network of interactions in a way conducive to their community's goals. It follows that, if such action is successful, we should be able to detect its signature in the network itself. Growing networks where links are allocated by a preferential attachment mechanism are known to converge to networks displaying a power law degree distribution. Growth and preferential attachment are both reasonable first-approximation assumptions to describe interaction networks in online communities. Our main hypothesis is that managed online communities are characterised by in-degree distributions that deviate from the power law form; such deviation constitutes the signature of successful community management. Our secondary hypothesis is that said deviation happens in a predictable way, once community management practices are accounted for. If true, these hypotheses would give us a simple test for the effectiveness of community management practices. We investigate the issue using (1) empirical data on three small online communities and (2) a computer model that simulates a widely used community management activity called onboarding. We find that onboarding produces in-degree distributions that systematically deviate from power law behaviour for low-values of the in-degree; we then explore the implications and possible applications of the finding.

Leveraging medical taxonomies to improve knowledge management within online communities of practice: The knowledge maps system

BACKGROUND AND OBJECTIVE

Online communities of practice contain a wealth of information, stored in the free text of shared communications between community members. The Knowledge Maps (KMaps) system is designed to facilitate Knowledge Translation in online communities through multi-level analyses of the shared messages of these communications.

METHODS

Using state-of-the-art semantic mapping technologies (Metamap) the contents of the messages shared within an online community are mapped to terms from the MeSH medical lexicon, providing a multi-level topic-specific summary of the knowledge being shared within the community. Using the inherent hierarchical structure of the lexicon important insights can be found within the community.

RESULTS

The KMaps system was applied to two medical mailing lists, the PPML (archives from 2009-02 to 2013-02) and SURGINET (archives from 2012-01 to 2013-04), identifying 27,924 and 50,597 medical terms respectively. KMaps identified content areas where both communities found interest, specifically around Diseases, 22% and 24% of the total terms, while also identifying field-specific areas that were more popular: SURGINET expressed an interest in Anatomy (14% vs 4%) while the PPML was more interested in Drugs (19% vs 9%). At the level of the individual KMaps identified 6 PPML users and 9 SURGINET users that had noticeably more contributions to the community than their peers, and investigated their personal areas of interest.

CONCLUSION

The KMaps system provides valuable insights into the structure of both communities, identifying topics of interest/shared content areas and defining content-profiles for individual community members. The system provides a valuable addition to the online KT process.

Advantages and limitations of online communities of patients for research on health products

The way patients and their caregivers share information on various online platforms about health topics and their own experiential knowledge presents new potential environments for research, particularly as concerns health products. The information provided individually and voluntarily by patients who are members of these online communities is a new resource for identifying and understanding precisely how health products are used, assessing their effectiveness, quantifying potential adverse effects in real-life situations, detecting subtle signs that are significant for experts in pharmacovigilance and addiction studies, and developing new assessment tools to help form new working hypotheses. How patients freely express their experiences and feelings and the reality of what they share also opens the way for societal research into health products, a field that is still under-explored. Well-established regulations govern research into health products, which uses resources and methodologies that have changed little over the years. However, the development of online communities of patients presents new possibilities in this field. The challenge we face today is defining their place among traditional research techniques. This place cannot be accepted by all stakeholders unless we first establish a firm understanding of the advantages, limitations, and constraints of these communities. The round table on this topic endeavoured to: explore these issues and develop a better understanding of the phenomenon and the different varieties of online communities and networks for patients; identify possible advantages, special features, and methodological, regulatory, and ethical limitations that researchers currently face; and finally, to put forward the first recommendations in this growing field of research.

Liking and hyperlinking: Community detection in online child sexual exploitation networks

The online sexual exploitation of children is facilitated by websites that form virtual communities, via hyperlinks, to distribute images, videos, and other material. However, how these communities form, are structured, and evolve over time is unknown. Collected using a custom-designed webcrawler, we begin from known child sexual exploitation (CE) seed websites and follow hyperlinks to connected, related, websites. Using a repeated measure design we analyze 10 networks of 300 + websites each - over 4.8 million unique webpages in total, over a period of 60 weeks. Community detection techniques reveal that CE-related networks were dominated by two large communities hosting varied material -not necessarily matching the seed website. Community stability, over 60 weeks, varied across networks. Reciprocity in hyperlinking between community members was substantially higher than within the full network, however, websites were not more likely to connect to homogeneous-content websites.

Women's experiences of menopause in an online MS cohort: A case series

BACKGROUND

Many women with multiple sclerosis (MS) are postmenopausal. Previously reported findings from an online MS cohort suggested that earlier, surgical menopause may be associated with higher patient-reported MS severity scores.

OBJECTIVE

To explore experiences of menopause in a series of MS women responding to a reproductive survey from an online research platform, PatientsLikeMe (PLM).

METHODS

The free-text responses from a detailed reproductive history survey deployed to PLM members were analyzed using grounded theory approach.

RESULTS

Of the 208 free text responses, 127 responses related to menopause. Five themes emerged: (1) perimenopausal onset of MS symptoms, (2) overlap of MS and menopausal symptoms, (3) MS exacerbations and pseudo-exacerbations triggered by hot flashes, (4) escalation of disease course after menopause, including increasing fatigue, cognitive disturbance, and other symptoms; and (5) effect of HRT on MS symptoms. Some women reported no effects of menopause or HRT.

CONCLUSION

Given an aging population and a median age of individuals currently living with MS very close to menopausal age in many cohorts, there is a pressing need to understand the impact of menopause on MS course. Qualitative responses in this study illustrated several specific themes that require quantitative testing in clinic-based cohorts.

Health care experiences and perceptions among people with and without disabilities

BACKGROUND

Little is known about health care experiences among people with and without disabilities.

OBJECTIVE

We sought to explore perceptions of people with and without disabilities related to their health care experiences.

METHODS

Nineteen persons with and without disabilities participated in one of four focus groups. Focus groups were conducted in the physical world in Milwaukee, WI and in the virtual world in Second Life(®) with Virtual Ability, a well-established community designed by and for people with a wide range of disabilities. A grounded theory methodology was employed to analyze focus group data. Inclusion of physical and virtual world focus groups enabled people with a wide range of disabilities to participate.

RESULTS

While some participants described instances of receiving good care, many discussed numerous barriers. The main themes that emerged in focus groups among both persons with and without disabilities related to their health care experiences including poor coordination among providers; difficulties with insurance, finances, transportation and facilities; short duration of visits with physicians; inadequate information provision; feelings of being diminished and deflated; and self-advocacy as a tool. Transportation was a major concern for persons with disabilities influencing mobility. Persons with disabilities described particularly poignant experiences wherein they felt invisible or were viewed as incompetent.

CONCLUSIONS

Both persons with and without disabilities experienced challenges in obtaining high quality health care. However, persons with disabilities experienced specific challenges often related to their type of disability. Participants stressed the need for improving health care coordination and the importance of self-advocacy.

Hanging by a thread: exploring the features of nonresponse in an online young adult cancer survivorship support community

PURPOSE

Finding helpful information can be challenging for young adult (YA) cancer survivors; thus, it is critical to examine features of online posts that successfully solicit responses and assess how these differ from posts that do not solicit responses.

METHODS

Using posts from an online YA cancer support community, we analyzed initial posts that did and did not receive replies utilizing Linguistic Inquiry Word Count (LIWC).

RESULTS

Independent t tests revealed significant differences between the sets of posts regarding content, emotions, cognitive processes, pronoun use, and linguistic complexity. More specifically, posts with replies contained fewer words per sentence, had more first-person pronouns, had more expressions of negative emotions, and contained more present tense and past tense verbs.

CONCLUSIONS

The findings of this study can help improve peer-exchanged support in online communities so that YA cancer survivors can more effectively receive digital support. This research also provides communication researchers, health educators, and care providers a lens for understanding the YA cancer survivorship experience.

IMPLICATIONS FOR CANCER SURVIVORS

This research helps survivors be strategic in how they use online forums to seek advice and support. More complete understanding of what kinds of prompts produce responses allows those in need to craft messages in ways that are most likely to elicit support from fellow cancer survivors. These implications for message design extend beyond blogging and can be applicable for text message and email exchanges between cancer patients and their care providers.

Patients report worse MS symptoms after menopause: findings from an online cohort

BACKGROUND

Many women with multiple sclerosis (MS) are postmenopausal, yet the impact of menopause on MS symptoms is unknown.

OBJECTIVE

To investigate patient-reported impact of menopause in a large online research platform, PatientsLikeMe (PLM).

METHODS

A detailed reproductive history survey was deployed to PLM members, and responses were linked to PLM׳s prospectively collected patient-reported severity score (MS Rating Scale, MSRS). The MSRS has previously shown good correlation with physician-derived EDSS scores.

RESULTS

Of the 513 respondents, 55% were postmenopausal; 54% of these reported induced menopause. Median age at natural menopause was 51. Surgical menopause occurred at an earlier age (p<0.001) and was associated with more hormone replacement therapy use (p=0.02) than natural menopause. Postmenopausal status, surgical menopause, and earlier age at menopause were all associated with worse MSRS scores (p≤0.01) in regressions adjusting for age, disease type and duration.

CONCLUSION

Postmenopausal patients in this study reported worse MS disease severity. Further, this study highlights a utility for online research platforms, which allow for rapid generation of hypotheses that then require validation in clinical settings.

Perceived healthcare provider reactions to patient and caregiver use of online health communities

OBJECTIVE

Many Internet users seek health information through online health communities (OHCs) and other social media. Yet few studies assess how individuals use peer-generated health information, and many healthcare providers (HCPs) believe OHCs interfere with patient-provider relationships. This study explored how individuals use OHC content in clinical discussions and how HCPs react to it.

METHODS

We conducted in-person and virtual focus groups with patients/caregivers who visited OHCs (n=89). A trained moderator asked about reasons for membership, sharing OHC content with providers, HCP reactions, and preferred roles for HCPs. Two researchers independently coded verbatim transcripts (NVivo 9.2) and conducted thematic response analysis.

RESULTS

Participants described OHCs as supplementing information from HCPs, whom they perceived as too busy for detailed discussions. Almost all participants shared OHC content with HCPs, although only half cited OHCs as the source. Most HCPs reacted negatively to OHC content, making participants feel disempowered. Despite these reactions, participants continued to use OHCs, and most desired HCP feedback on the accuracy of OHC content.

CONCLUSIONS

Individuals do not use OHCs to circumvent HCPs but instead to gather more in-depth information.

PRACTICE IMPLICATIONS

HCPs should discuss OHC content with patients to help them avoid misinformation and make more informed decisions.

What is the role of online support from the perspective of facilitators of face-to-face support groups? A multi-method study of the use of breast cancer online communities

OBJECTIVE

To explore the role of online communities from the perspective of breast cancer survivors who are facilitators of face-to-face support groups.

METHODS

Seventy-three attendees (73% response rate) of a Canadian support group-training program completed a questionnaire examining when and why they used online communities. A purposive sample of 12 respondents was interviewed on how they used them in comparison to traditional supportive care. Survey responses were analyzed using descriptive statistics, and interview transcripts using a descriptive interpretive approach.

RESULTS

Online communities were used by 31.5%, mostly during treatment (73.9%), daily or weekly (91.3%), primarily for information (91.3%) and symptom management (69.6%) and less for emotional support (47.8%). Reasons for non-use were lack of need (48.0%), self-efficacy (30.0%), trust (24.0%), and awareness (20.0%). Respondents used online communities to address unmet needs during periods of stress and uncertainty. A multi-theory framework helps to explain the conditions influencing their use.

CONCLUSION

Online communities have the potential to fill gaps in supportive care by addressing the unmet needs of a subgroup of breast cancer survivors. Further research is required among typical cancer survivors.

PRACTICE IMPLICATIONS

Online communities could play an important role as a supplemental resource for a sub-group of breast cancer survivors.

What Makes Users Rate (Share, Tag, Edit…)? Predicting Patterns of Participation in Online Communities

Administrators of online communities face the crucial issue of understanding and developing their user communities. Will new users become committed members? What types of roles are particular individuals most likely to take on? We report on a study that investigates these questions. We administered a survey (based on standard psychological instruments) to nearly 4000 new users of the MovieLens film recommendation community from October 2009 to March 2010 and logged their usage history on MovieLens. We found that general volunteer motivations, pro-social behavioral history, and community-specific motivations predicted both the amount of use and specific types of activities users engaged in after joining the community. These findings have implications for the design and management of online communities.