Online Social Support Groups/Communities:

Implications of Theoretical and Empirical Findings for

Individuals Coping with Health Concerns

GLOBAL PERSPECTIVES ON HEALTH COMMUNICATION IN

THE AGE OF SOCIAL MEDIA
ISBN: 9781522537168
Release Date: February 2018

Liza Ngenye
George Mason University, USA

Kevin Wright
George Mason University, USA
ABSTRACT

Numerous studies over the past two decades suggest that people with a variety of health concerns

are increasingly turning to online networks for social support. This has led to the rise of online

support groups/communities for people facing health concerns. Researchers have found that these

groups/communities provide patients, disease survivors, and caregivers a number of advantages

and disadvantages in terms of mobilizing social support for their health-related concerns. This

chapter will examine these issues in greater detail as well as the theoretical and practical

implications of this body of research for patients who use online support communities to help cope

with and manage a variety of health issues. It will provide an overview of online social support

and health outcomes, discuss key processes and theoretical explanations for the efficacy of online

support communities for people facing health concerns, and the limitations of this body of research

as well as an agenda for future communication research on health-related online support

groups/communities.

Keywords: E-health, Online Social Support, Computer Mediated Communication.

INTRODUCTION

Numerous studies over the past two decades suggest that people with a variety of health

concerns are increasingly turning to online networks for social support. This has led to the rise of

online support groups/communities for people facing health concerns, growing from several

thousand support groups/communities in the late 1990’s to hundreds of thousands of

groups/communities by 2012 (Chou, Hunt, Beckjord, Moser, & Hesse, 2009; Fox, 2011; National

Cancer Institute, 2013; Wright & Bell, 2003). A survey conducted by the National Cancer Institute

(2012) indicated that almost 5% of all adult American Internet users—approximately 7.5 million

people—visited a health-related online support community during 2012. Another study found that

18 % of people had used the Internet in the last year to find information from a peer with similar

health concerns (Fox &Duggan, 2013).

Researchers have found that these groups/communities provide patients, disease survivors,

and caregivers a number of advantages (and some disadvantages) in terms of mobilizing social

support for their health-related concerns. Online health-related support groups/communities are

frequently used by individuals with rare health conditions/issues that are not well understood by

physicians, conditions/issues that are difficult for health care providers to explain in layperson

terms, or if members of one’s primary social network (i.e. friends and family members) have

limited knowledge of a person’s health condition (Campbell-Grossman et al., 2009; Tanis, 2008;

Tong et al., 2013). Due to these issues, many individuals report that they receive inadequate

informational support from their traditional social networks and health care providers; and they

appear to perceive online support groups/communities as a better alternative for receiving health

information (Wicks et al., 2010).

 Moreover, research in this area has found that online community members enjoy the ability

to draw upon the collective experience of other online participants who are dealing with a similar

health issue in ways that are not possible in the face-to-face world. For example, the Internet allows

people to access and interact with others in health-related online communities that cross

geographical and temporal boundaries (Rains & Wright, 2016). In addition, other participants

within these online communities appear to replace or extend traditional offline support networks

in terms of providing greater access to different forms of social support. Accessing support

providers online has the added benefit of finding people who are available in a larger, easier to

maintain, network of (often) geographically separated individuals compared to face-to-face

sources of social support (Ellison et al., 2007; Kim & Lee, 2011; Walther & Boyd, 2002). Online

support groups/communities can also help individuals facing health concerns during times of stress

and transition to access new networks of support, such as providing connections to others facing

the same or similar transitions and stressors (such as if a person moves to a small town where the

likelihood of meeting others living with a similar health condition is low).

In addition to convenience, online sources of social support can help individuals with

health problems overcome accessibility barriers and high service fees associated with other (more

traditional) sources of information and support, such as therapy (Barrera, 2000). The asynchronous

and mediated nature of online communication helps alleviate time and space barriers that exist for

support settings that require the simultaneous presence of conversational partners (Turner, Grube,

& Meyers, 2001). Online support groups/communities often offer people who are coping with

health problems higher quality health information and support for health behavior change than is

available among traditional, face-to-face sources of support (Wright & Miller, 2010).
 This chapter will examine each of these issues in greater detail as well as the theoretical

and practical implications of this body of research for patients who use online support communities

to help cope with and manage a variety of health issues. Specifically, it will review current

literature on communication issues related to social support within online support

groups/communities for individuals facing health concerns published within the health

communication literature. Toward that end, it will provide an overview of online social support

and health outcomes, and it will discuss key processes and theoretical explanations for the efficacy

of online support communities for people facing health concerns. Finally, the chapter provides an

overview of some of the limitations of this body of research as well as an agenda for future

communication research on health-related online support groups/communities.

Online Social Support and Health Outcomes

Social support refers to the emotional (e.g., empathy and encouragement), informational

(e.g., advice), or instrumental (e.g., financial and physical) resources provided by one’s social

networks that help her or him to cope with stressful events (Cohen, 2004). Studies across a number

of disciplines have reported the benefits of peer-to-peer social support groups (both in groups led

by peers and supervised by professionals) where individuals can interact with others who are

experiencing the same disease or similar health condition (Ussher, Kirsten, Butow, & Sandoval,

2006). Supportive communication with peers who share common health-related experiences may

decrease feelings of isolation and increase a sense of belonging (Cohen, Underwood, & Gottlieb,

2000; Ussher et al., 2006). Based on a shared identity and perceived similarity among peers,

individuals in peer support groups (both face-to-face and online) tend to perceive information

provided by peers as more credible (Campbell & Wright, 2002; Petosa & Smith, 2014) and
participants are more likely to engage in empathic communication (Helgeson & Gottlieb, 2000)

than in other contexts.

Social support plays an important role in one’s ability to cope with a range of stressors

from mundane everyday stressful situations to significant life events (Goldsmith, 2004; Uchino,

2004). Two general explanations have been offered for the effects of social support on well-being.

First, the direct-effects model posits that simply being involved in interpersonal relationships can

lead to physical and psychological benefits (Aneshensel & Stone, 1982; Thoits, 2011), even in the

absence of a specific stressor. Ties between individuals influence human health positively if they

satisfy the need to be socially and emotionally connected with others (Sorkin, Rook, & Lu, 2002).

Second, the buffering model suggests that social support serves to directly shield a person from a

stressor or positively alter one's appraisal of the stressor. For example, an individual may receive

advice to help him or her solve a problem or feedback to change his or her perceptions of its

severity. Researchers have linked the buffering model to positive health outcomes in terms of

morbidity and mortality (Berkman & Syme, 1979).

Studies have found that social support in online support communities buffers the harmful

physiological consequences of stress from breast cancer (Barak, Boniel-Nissim, & Suler, 2008).

For example, depressive symptoms such as feelings of isolation, hopelessness, anxiety, and a lack

of interest were found to be decreased in patients who received emotional support, such as empathy

and encouragement, from peers in a number of online support communities (Batenburg & Das,

2015). Individuals using health-related online support communities report higher quality of life

after participating in online communities (Lieberman & Goldstein, 2006). Moreover, the

information that is exchanged within online support communities appears to contribute to an

improvement in information competence (Han et al., 2012) and knowledge of disease and its
treatment among patients (Høybye et al., 2005; Owen et al., 2004), leading them to feel more in

control of their health situation.

The amount of time spent using online support communities has been shown to be

associated with users’ size and satisfaction with their online support network (Wright, 2000) as

well as decreased rates of depression over the course of a year among depression community

members (Houston, Cooper, & Ford, 2002; Wright et al., 2010). Participating in health-related

online support groups/communities has also been linked to other positive mental health outcomes

such as self-efficacy and optimism (Mo & Coulson, 2013). Online support is associated with online

support group participants’ perceived coping abilities (Seçkin, 2013). In general, studies have

shown a positive association between members’ well-being and support received from using online

groups/communities (Mo & Coulson, 2013; Oh, Ozkaya, & LaRose, 2014; Rains & Keating,

2011).

Researchers have also investigated the impact that online support groups/communities

have on how people cope with critical or chronic diseases (Eichhorn, 2008; Guo & Goh, 2014;

Johnston, Worrell, Di Gangi, & Wasko, 2013; Rodgers & Chen, 2005), how often people use the

online health communities looking for health information (Kummervold et al., 2008), which

sources of information are used in online health communities (Rodgers & Chen, 2005), which

factors contribute or obstruct the use of the online health communities when searching for health

information (Lemire, Paré, Sicotte, & Harvey, 2008), and how social support is requested and

offered on these sites (Mazzoni & Cicognani, 2014).

Benefits and Problems Associated with Seeking Support within Online Support

Groups/Communities

A growing number of studies have investigated the benefits of online support

groups/communities for people facing a variety of health concerns (See Green-Hamann, Campbell

Eichhorn, & Sherblom, 2011; Malik & Coulson, 2008; Rains, Peterson, & Wright, 2015; Rains &

Young, 2009; Wright & Bell, 2003). In terms of benefits, online support communities allow

individuals to discuss health-related topics with others who have been through similar experiences,

to support one another and talk about the unique difficulties associated with illness (Attard &

Coulson, 2012; Coulson, 2005). Online communities provide flexible access to social support at

any time of the day or night (Malik & Coulson, 2008), making it easy to fit support needs around

work, family, study or other commitments. However, the lack of physical proximity can make it

difficult to develop meaningful relationships and offer physical comfort, which may leave some

members feeling isolated in real life. Research examining computer-mediated communication

(CMC) support has largely focused on explaining why people choose to use CMC for exchanging

support (Tanis, 2008; Walther & Boyd, 2002; Wright, 2002) and identifying the types of support

messages shared online (Rains, Peterson, & Wright, 2015). Although less plentiful, there is also

evidence to suggest that support received or available in computer-mediated contexts can be a

valuable coping resource (Rains & Keating, 2011; Wright, 2000).

The sense of community an online support group creates for its members provides similar

health benefits to traditionally shared face-to-face social support in terms of important outcomes

like reduced stress and depression, faster recovery times, etc. (Rains & Young, 2009), but online

support offers the affordances of being able to transcend geography and temporality as well as

offer people greater ease in terms of communicating with a large network of potential support
providers (Bambina, 2007; Wright & Bell, 2003). Several studies have found that participation in

online support groups/communities is influenced by perceptions of the convenience, flexibility,

and relative anonymity of computer-mediated communication associated with these groups.

Online support groups/communities typically include greater accessibility (e.g., lack of time and

travel constraints), anonymity, and the ability to obtain information without having to personally

interact with others (Eichhorn, 2008; Green-Hamann, Campbell Eichhorn, & Sherblom, 2011;

Wright & Bell, 2003) compared to face-to-face forms of social support. Unlike face-to-face

support groups, online support venues offer participants access via computer and other Internet

accessible devices 24 hours a day and access to potential support providers all over the world

(Tanis, 2008; Wright & Bell, 2003). In addition, the anonymity of online groups/communities

appears to influence increased self-disclosure of one’s health issues to other group/community

members (Wright & Bell, 2003).

However, online support group members can also face a variety of challenges (van Uden-

Kraan et al., 2008), such as the quality and validity of information exchanged (Finn, 1999; Wright,

2002) and potential exposure to negative or self-destructive postings that may undermine the health

benefits of online support (Campbell & Wright, 2002; Wright & Bell, 2003). Moreover,

researchers have identified other negative aspects of online support communities that may

influence health outcomes, including flaming and delayed feedback in computer-mediated

interactions, short-term participation, and negative social comparisons (Wright, 2000; Wright &

Bell, 2003). More recent studies have identified online communities that actually support and

encourage unhealthy behaviors, such as anorexia, and substance abuse, and other health behaviors

(Custers & Van den Bulck, 2009; Davey, Schifano, Corazza, & Deluca, 2012).
Theoretical Explanations of Online Support Community Communication

Processes and Health Benefits for Participants

Similarity/social comparisons. Similarities between participants in online support

groups/ communities appear to increase the persuasiveness and influence of the messages that are

exchanged. For example, Wang, Walther, Pingree, and Hawkins (2008) showed that perceived

similarity of support group members influenced perceptions of their credibility and, in turn, the

evaluation of health information they provided. In addition, Wright (2000) and Campbell and

Wright (2002) found that similarity was a key perception that was associated with social support

satisfaction with support providers within health-related online support groups (which may be a

motivation to participate). Campbell et al. (2004), for example, claimed that “those who have

survived the disease have an understanding and first-hand experience of the disease and its

treatment that facilitates shared experiences” (p. 4). Similarly, Meyer, Coroiu, and Korner (2015)

found that patients can be ideal support providers because they have “authentic knowledge of what

it is like to live with the disease, and they are able to bring a unique perspective to the support

process. Moreover, disease survivors generally present better physical functioning and emotional

well-being than newly diagnosed patients (Baker, Denniston, Haffer, & Liberatos, 2009).

Survivors and long-term online community members may possess more resources to provide

informational and emotional support to other participants who are newly diagnosed or in the early

stages of a health problem (Cameron, Ashbury, & Iverson, 1997; Wright, 2000). More experienced

online community members can take a leading role in offering social support by providing

information and their experiences of coping (Meier, Lyons, Frydman, Forlenza, & Rimer, 2007;

Wright & Bell, 2003).

 Social comparison theory (Festinger, 1954) proposes that people use either upward or

downward comparison to cope with stressful events. Upward comparison includes seeking

affiliation with and information from those who are in a better condition, whereas downward

comparison refers to self-evaluation against others in a worse situation (Taylor & Lobel, 1989).

Buunk, Collins, Taylor, VanYperen, and Dakof (1990) later distinguished positive upward

comparison, in which individuals become optimistic to see others in a better situation (i.e., upward

identification), from negative upward comparison by which people become pessimistic to see

others in a better situation (i.e., upward contrast).

Studies have found that participants often glean information about the status of their health

issues through social comparisons that take place within supportive interactions in online support

groups/communities (Batenburg & Das, 2015; Vilhauer, 2009; Wright & Bell, 2003). Such social

comparison processes do not even require actual participation in the online group; rather,

individuals may engage in these practices passively by reading the posted group discussions. A

few studies have shown that (positive) upward comparison is related to the self-improvement of

cancer patients, such as developing coping strategies, finding hope, and learning useful

information (Taylor & Lobel, 1989). Furthermore, women with breast cancer tend to have a greater

desire for upward comparison, thereby seeking information and emotional support from better-

adjusted patients versus poorly adjusted patients (Stanton et al., 1999). Although the previous

literature on social comparison in cancer care has not specified the role of cancer survivors, given

a better understanding of cancer treatment and psychological adjustment of survivors (Baker et al.,

2009; Meyer et al., 2015), positive upward comparison may occur when newly diagnosed patients

receive social support from survivors, which in turn contributes to the psychological adjustment

of new patients. However, there are also several significant limitations of support community
participation from a social comparison perspective. The most common involves stress resulting

from hearing about difficulties experienced by other community members (Holbrey & Coulson,

2013; Malik & Coulson, 2008). Other drawbacks include social comparisons with others who are

improving (Malik & Coulson, 2008) and becoming negatively focused on one’s illness (Holbrey

& Coulson, 2013).

Strength of weak ties. Online support groups/communities are generally considered

networks of largely weak-tie relationships (Wright & Bell, 2003). Online groups can be beneficial

by offering connections to relevant peers (Scharer, 2005) and expanding access to resources and

social capital by gaining access to others’ online networks via the online support community

(Walther & Boyd, 2002; Wright & Miller, 2010). However, weak-tie networks can also come with

costs because members of online groups lack control over the quality, content, and validity of

presented information (Finn, 1999; Klemm et al., 2003; Wright, 2002). According to Colineau and

Paris (2010), people choose weak tie networks because of the members’ ability to understand their

experience and because of the emotional distance afforded by the online communication. Another

advantage of weak ties is that they tend to be more plentiful than strong ties, and they are more

likely to be different from the receiver and from one another. This means there is a greater

likelihood of being able to find an expert in a particular area in weak tie rather than strong tie

sources.

Members of weak tie networks may be more willing to talk about illness since these

individuals tend to be less emotionally attached to a person (Adelman, & Albretcht, 1987). Weak

tie network members are often able to provide more objective feedback about a problem since they

are less emotionally attached to a person with health problems than family and friends. According

to Goldsmith and Albrecht (2011), weaker ties tend to be perceived as helpful when a person is
coping with an issue that requires new information or skills (that may be limited within a close-

knit family or friendship social network). These features of weak ties can be beneficial to people

who are coping with health concerns that may be difficult to ameliorate in strong ties due to lack

of information and relational problems in close relationships (Winefield, 2006; Wright & Miller,

2010).

Several researchers have found weak tie network theory to be applicable to explaining why

some individuals prefer to obtain social support online (including online support

groups/communities) versus via traditional offline networks (Green-Hamman & Sherblom, 2014;

Wright & Rains, 2013; Wright, Rains, & Banas, 2010; Wright & Miller, 2010). When members of

traditional offline social networks have limited knowledge about a stressful situation, there is

evidence that individuals often turn to online sources of information and social support (Wright &

Miller, 2010) despite the fact that they may feel less close relationally to the people with whom

they interact online. Additionally, when online sources are able to offer specialized information

about a problem and/or may be in a better position to offer desired types of social support (such as

increased empathy and less judgment due to sharing similar problems).

Reduced stigma. Another important theoretical explanation for why online support

groups/community participation is associated with positive health outcomes is the group’s ability

to help individuals cope with the stigma that the larger culture attaches to many diseases and health

conditions (Ballantine & Stephenson, 2011; Faith, Thorburn, & Sinky, 2016; Lewis, Thomas,

Blood, Castle, Hyde, & Komesaroff, 2011; Rains, 2014; Wright & Rains, 2014). Health-related

stigma is a significant problem that many individuals facing health concerns have to deal with on

a daily basis (Herek & Glunt, 1988). It has been linked to reductions in the size of individuals’

support networks, problems discussing concerns with others, dissatisfaction with one’s support
network, reduced compliance with treatment recommendations, and increased health problems

(Vanable, Carey, Blair, & Littlewood, 2006). Stigmatized health issues have been linked to

increased stress and depression (Wolitski, Pals, Kidder, Courtenay-Quirk, & Holtgrave, 2008),

substance abuse, anxiety, and increased physical health problems (Duncan, Hart, Scoular, &

Bigrigg, 2001). Health-related stigma is also associated with reduced levels of self-esteem and

self-efficacy (Herek & Glunt, 1988). Researchers have found that people with stigmatized health

problems are drawn to online support groups/ communities because these groups/communities

help them to manage the stigma, leading them to feel less isolated and less judged by others (Lewis

et al., 2011; Rains, 2014; Wright & Miller, 2010; Wright & Rains, 2014).

Reduced cues/social information processing theory. One variable that makes

computer-mediated communication (CMC) unique is the reduction in social cues relative to face-

to-face interaction (Caplan & Turner, 2007; Rains & Young, 2009; Tanis, 2008; Walther & Parks,

2002; Wright & Bell, 2003). This reduction in social cues is particularly important given the setting

in which several popular forms of CMC are used for support. Although it is possible to routinely

communicate with well-known others (e.g., Turner et al., 2001), one-time interactions often take

place in online health-related communities and blogs among individuals who have never met and

will not interact in the future. Informal social support communities, for example, typically have

open membership in which an unlimited number of individuals can come and go as they please

(Rains & Young, 2009).

Computer-mediated communication (CMC) can be unique from face-to-face interaction in

several important ways (See Caplan & Turner, 2007; Tanis, 2008; Wright & Bell, 2003). For

example, many of the social cues available in face-to-face interaction (e.g., eye contact,

paralinguistic cues, etc.) are reduced or absent in online interaction. Walther and Parks (2002)
referred to the reduction in social cues as one of two structural aspects of social support that are

fundamentally altered by CMC. Even as communication technologies continue to evolve, the

reduction in social cues is likely to remain an important variable across different CMC modes. The

hyperpersonal communication model (Walther, 1996) is a popular theoretical framework that has

been applied to the context of online supportive communication (Caplan & Turner, 2007; Walther

& Boyd, 2002; Wright & Bell, 2003). This model outlines a process resulting in communication

that is “more socially desirable than we tend to experience in parallel [face-to-face] interactions’’

(Walther, 1996, p. 17). Two aspects of the hyperpersonal model are important in terms of

explaining the influence of using CMC on the outcomes of supportive interaction. The reduced

social cues associated with CMC create opportunities for selective self-presentation that may serve

to mitigate self-presentation concerns and allow individuals to give greater attention to message

construction (Walther & Boyd, 2002; Wright & Bell, 2003).

Support seekers report feeling less self-conscious and more comfortable sharing supportive

messages since health-related online communities are typically perceived as comfortable and non-

threatening environments in terms of forming and maintaining interpersonal relationships (Caplan

& Turner, 2007). This more comfortable communication environment appears to facilitate

individuals’ efforts to cope with their stressor and allow them to better manage their uncertainty

as well as feel less worry and greater self-efficacy relative to a face-to-face interaction. Features

of computer-mediated communication within online support communities may also lead support

seekers to construct idealized perceptions of support providers (Walther & Boyd, 2002; Wright &

Bell, 2003).

Idealized perceptions can be explained by the hyperpersonal model. According to Walther

(1996), the reduced number of available nonverbal cues in CMC increases message-editing
capabilities, and the temporal features of CMC allow communicators to be more selective and

strategic in their self-presentation, and engage in more intimate exchanges than people in face-to-

face situations. These features of computer-mediated communication appear to offer people more

interactional control over face-to-face communication, and they appear to influence perceptions of

the attractiveness of online relational partners. Walther, Slovacek, and Tidwell (2001) found that

individuals rated online interaction partners as more socially attractive and affectionate when a

photo was not present compared to those who did view a photo of the interaction partner. In

addition, dyads in computer-mediated settings also appear to self-disclose more than face-to-face

dyads (Tidwell & Walther, 2002). Given the nature of supportive interactions in which support

providers are attempting to be empathetic and offering encouragement and advice, receivers may

develop inflated perceptions of the degree to which providers are caring or knowledgeable. The

reduced social cues associated with CMC may ultimately result in receivers developing an

exaggerated sense of being supported by providers (Wright & Bell, 2003).

Similar to social information processing theory, the dual-process theory of supportive

message outcomes (Bodie & Burleson, 2008; Burleson, 2010) has been used to help understand

the implications of the reduced social cues in CMC during supportive interactions. An important

way that the reduced social cues in CMC may impact support processes is by increasing support

recipients’ attentional resources. Because they have less responsibility for managing nonverbal

behavior (e.g., eye contact) relative to face-to-face interaction, individuals using CMC may pay

greater attention to articulating their thoughts and feelings as well as the messages received from

a communication partner. This appears to allow for the construction of more thoughtful and

competent supportive messages.

 However, the reduced social cues in computer-mediated interaction have the potential to

undermine the benefits of supportive interactions. The cues-filtered-out perspective (Culnan &

Markus, 1987) is grounded in the idea that the reduction in social cues stemming from CMC

inhibits socio-emotional messages and the development of personal relationships (Kiesler, Siegel,

& McGuire, 1984). In the context of social support, the cues-filtered-out perspective suggests that

the reduction in social cues could serve to encourage more impersonal interactions (White &

Dorman, 2001) and make the process of exchanging support more difficult (Lewandowski,

Rosenberg, Parks, Siegel, 2011; Wright & Bell, 2003).

In terms of the influence of reduced cues in CMC and self-disclosure to others in online

support groups/communities, Wright (2000) found that older adults using SeniorNet (an early

online community for older adults) reported disclosing information about their health to

anonymous members of the online community that they were reluctant to discuss with family

members and friends in face-to-face settings. Anonymity led seniors using the community to feel

safer disclosing health information within the online group. Walther and Boyd (2002) found that

hyperpersonal interaction within online support groups/communities enhanced the attractiveness

of seeking support within this context. In particular, these researchers found that perceived social

distance from other participants facilitated perceptions of reduced risk in terms of disclosing

sensitive or stigmatized issues (including health concerns). Eysenbach (2003) drew upon social

information processing theory, and found that anonymity of virtual support communities was

particularly helpful in terms of facilitating the participation of men living with health concerns to

interact with others within these groups. Eysenbach (2003) argued that the reduced cues in this

environment were particularly helpful for men to obtain online support for health concerns since

they tend to be culturally and socially conditioned not to ask for help and support.
Agenda for Future Research in the Area of Online Support

Groups/Communities

Since online support groups/communities will likely continue to flourish and change in the

coming years, as newer technologies will likely transform the ways in which people with health

concerns connect and garner support from others online, it is important to examine some of the

limitations of the current literature in this area of research as well as opportunities to better

understand online support groups/communities, supportive communication processes within them,

and their relationship to important psychological and physical health outcomes. This section

presents a brief agenda for scholars who are interested in conducting research in this area.

Theories and methods in future research in this area need to take into account a more

comprehensive perspective of the influence of both types of social support on health outcomes,

including the main effects and interaction effects of online and offline sources of social support,

additional predictors of engaging in online support, mediated variables (i.e., the influence of

different computer-mediated channels and contexts), and key demographic and environmental

variables on health outcomes. There are many limitations of the existing research in this area that

need to be addressed in future work. While a number of theoretical frameworks have been utilized

in the study of online support and health outcomes, this area would benefit from the development

of new theories that shed light on features of online support that are unique from offline supportive

contexts. This section discusses some of the key limitations to the existing research as well as

fruitful areas of research and theory development within this area.

One of the first limitations of previous studies concerns the need to account for the

influence of overlapping sources of social support on key outcome variables, such as stress and
depression. For example, according to Haythornthwaite (2002), both online and off-line supportive

exchanges influence health outcomes. In short, it becomes difficult to separate online supportive

influences from off-line influences. Most individuals typically mix face-to-face contact with e-

mail, or searching the Internet for health information and then discussing it with people in their

face-to-face social network. Future research should assess the interaction of both online and face-

to-face support networks on key outcome variables such as satisfaction, well-being, stress,

depression, and physical health outcomes while also comparing differences between support from

these two networks in terms of how they uniquely contribute to these outcomes. Future research

in this area would benefit from the development of theories and methods that take into account a

more comprehensive perspective of the influence of social support on health outcomes, including

the main effects and interaction effects of online and off-line sources of social support, additional

predictors of engaging in online support, mediated variables (i.e., the influence of different

computer-mediated channels, contexts), and key demographic and environmental variables on

health outcomes.

Research is also needed to examine interaction(s) between face-to-face and online social

support networks as well as how new communication technologies are facilitating the intersection

of virtual and face-to-face interactions through media convergence (e.g., GPS chips and

applications that allow you to find key people in your support network in the face-to-face world).

For example, although research has examined the influence of mobile games on physical activity

levels (Fanning, Mullen, McAuley, 2012), few studies have specifically focused on the role of

social support on health outcomes within this context. More research is needed to better understand

a wider variety of health issues and the influence of multimodal communication (e.g., online
communication combined with face-to-face interaction) and mobile/online social support

processes on key health outcomes, such as stress, depression, and physical health.

As research studies on social support networks/relationships and health continue to

develop, more meta-analyses and meta-analytic reviews will be needed to assess the impact of

social networks/relationships on health across similar studies. Meta-analytic reviews have

contributed greatly to our understanding of newer areas, such as online support group network,

influences on health. For example, Rains and Young (2009) conducted a meta-analysis of 28

published online support group studies dealing with people coping with health concerns and found

that greater participation in their online support groups was related to increased perceived support,

reduced depression, increased quality of life, and increased self-efficacy in terms of managing

health problems. Meta-analytic can also help researchers identify key mechanisms that help to

explain or moderate the influence of online support networks on health outcomes.

More studies are needed to better understand complex cultural differences in how social

support networks influence is conceptualized, how social support communication processes may

differ, and cultural influences on health outcomes across a wide variety of cultural contexts. In

addition, more research is needed in the area of cross-cultural and international comparisons in

terms assessing the relationship between social network and interpersonal dyadic support on

important health outcomes (including regionally specific health issues) (Goldsmith & Albrecht,

2011). In addition, more research is need to better understand how online social support is used by

older adults and the challenges they may face in terms of accessing and using newer

communication technologies. While researchers have examined online support and health-related

technology for older adults (Wright, 2000; LeRouge et al., 2014), more research and interventions

are needed to design online support platforms and technologies for older adult populations.
Relatively little is known about how minority groups and other populations facing health

disparities use computer-mediated support groups. However, it appears that members of minority

groups engage in a variety of online social support activities, and individuals within these groups

may benefit from online support group/community interventions (Hong, Pena-Purcell, & Ory,

2012). For example, Fogel, Albert, Schnabel, Ann Ditkoff, and Neugut (2003) found that while

African Americans, Hispanics, and Asian Americans tend to use the Internet less than whites, their

Internet use was associated with greater ability to talk with someone about problems and to obtain

other types of social support. Weinert and Hill (2005) found that rural women (including a high

percentage of minorities) using an online support group intervention had lower levels of depression

and higher self-reported management of day-to-day chronic illness symptoms than a control group

of similar rural women living with chronic illness. Qualitative research and quantitative studies

can both make important contributions to the study of cultural influences on social support network

and health outcome processes (as well as to the larger area of social support and health research).

While quite a bit research in the area of social support groups/communities and health outcomes

has been conducted in a variety of countries around the world, most of the research has been

conducted in a relatively small number of countries in Europe and Asia (mainly China) (Deng et

al., 2010; Rao et al, 2012; Van Tilburg, 1998).

In recent years, smartphones have become the primary way people gain access to the

Internet and social media. New mobile applications have taken advantage of the media

convergence potential of smartphone (e.g., GPS combined with wireless Internet, video, etc.). At

the same time, we have witnessed the emergence of wearable electronic devices that track physical

activity (e.g., Fitbit). Both innovations have led to the burgeoning field of MHealth (Boulos et al.,

2014; Luxton et al., 2011). While much of this research has examined the impact of smartphones
on provider-patient communication, a number of researchers have examined the social support

potential of smartphones (Boulos et al., 2014). Although diet and exercise applications and devices

are currently the most widely used health-related features of smartphones (Boulos et al., 2014),

other applications are available for a variety of health issues, including alcohol addiction recovery

support, smoking cessation support, and support for mental health issues (Luxton et al., 2011;

Alvarez-Jimenez et al., 2014). These types of MHealth applications can allow researchers to access

available data from smartphones, including activity levels and diet information, which can be used

as important health outcome measures. Moreover, these applications also provide the names/online

contacts of online social network members with whom an individual shares his or her health

information via these applications.

CONCLUSION

The findings from the reviewed literature provide support for the idea that online support

groups/communities have health benefits for a variety of people facing health concerns. As online

support among members of these populations will likely continue in the future, researchers need

to continue gaining a better understanding of the nature of online support group/ community

processes and outcomes. While scholars have identified a number of theoretical frameworks that

help to explain key processes of online support groups/communities and their relationship to health

outcomes, new theoretical perspectives are needed to capture the complexity of this phenomenon.

Scholars should work on integrating overlapping concepts from the major theories discussed in

this article, and they should take into account the unique influences that computer-mediated

communication has on supportive relationships within these groups/communities.

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KEY TERMS AND DEFINITIONS

Asynchronous/ Computer Mediated Communication/CMC: information sent and received

through computer, internet or other forms of media.

Emotional Support: the sharing of emotions to assist one during health-related challenges, such

as empathy and encouragement.

Informational Support: the sharing of information to assist one during health-related challenges,

such as advice and referrals.

Instrumental Support/Resources: the sharing of financial or physical resources to assist one

during health-related challenges, such as transportation or donations.

Online Community/Network: social networks that primarily engage through online platforms

such as social media.

Online Support Community/Network: social networks that engage to provide informational and

emotional support for various health-related challenges.

Social Support: the emotional, informational, or instrumental resources provided by one’s social

networks that help one to cope with stressful events.

Social Network: members of one’s primary social environment such as friends and family.