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Aims and method To explore what young people who self-harm think about online self-harm discussion forums. SharpTalk was set up to facilitate shared learning between health professionals and young people who self-harm.We extracted themes and illustrative statements from the online discussion and asked participants to rate statements. Results Of 77 young people who participated in the forum, 47 completed the questionnaire. They said they learned more about mental health issues from online discussion forums than from information sites, found it easier to talk about self-harm to strangers than to family or friends, and preferred to talk online than face-to-face or on the telephone. They valued the anonymity the forums provided and reported feeling more able to disclose and less likely to be judged online than in ‘real life’. Clinical implications Mental health professionals should be aware of the value of anonymous online discussion forums for some young people who self-harm, so that they can talk about them and assess their use with their patients.
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... A key finding was that Peer Navigators thought discussions online through text messages or voice notes enabled a sense of greater anonymity and thus supported shyer participants to be more open in discussions of sensitive topics. This anonymity was different to that described in online chat forums in high-income settings, where people do not know each other and use pseudonyms, and were more comfortable discussing sensitive topics as compared to face-to-face conversations (Jones et al., 2011;Prescott et al., 2017). Rather, the anonymity described by the peer navigators on WhatsApp conversation was potentially related to not seeing other people's immediate responses to any comment made by a participant (Colom, 2021). ...
... The potential for dialogical interventions to be delivered online, given the massive constraints for young men in rural South Africa in terms of poor network access, high costs and limited access to technology, suggests that simply transferring the methodology of face-to-face participatory interventions from physical to virtual spaces is unrealistic. This is in stark contrast to work and research in the global north, where participatory research and interventions are being developed and implemented (Hall et al., 2021;Jones et al., 2011;Nind et al., 2021). Despite the challenges for online interventions in rural South Africa, Peer Navigators had a sophisticated understanding of the opportunities and constraints presented using by using communications technologies and how these could be translated into online dialogical health communication. ...
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There is increasing interest in the potential to deliver participatory HIV and intimate partner violence (IPV) prevention interventions via digital platforms, though the majority of mHealth interventions have been didactic in approach. We undertook 10 in-depth interviews with male Peer Navigators (PNs) who had been extensively trained and working on a larger intervention promoting young people's sexual and reproductive rights, in rural KwaZulu-Natal. Interviews focused on their, and their peers', use of technology in their everyday lives. Data were transcribed and translated, and subjected to thematic analysis. PNs described structural barriers to the use of technology, including poor connectivity, high data costs, and erratic electricity. They primarily used Facebook and WhatsApp for communication and highlighted how reading messages asynchronously was important to overcome connectivity challenges. PNs shared how groups were primarily for information sharing, they also discussed ‘sensitive’ issues online. Privacy was a concern, especially for conversations, and there was recognition of how confidentiality could be breached. It was also felt that WhatsApp could potentially support greater openness in discussions. We reflect on the potential for online interventions to support dialogical health communication, highlighting how dialogical health communication may be enabled through information provision, the asynchronous communication enhancing the potential for reflection, and greater participation in discussion by those who are shyer. Despite this potential there remain important risks around privacy of discussions and how to implement these approaches online.
... 7 Many young people who self-harm prefer informal sources of support, 8 or support from those with lived experience available through voluntary-sector organisations 9 and online forums. 10 Peer support interventions are increasingly adopted worldwide within mental health services and third-sector organisations (voluntary organisations, community organisations and charities). 11 Although studies of peer support for mental health problems suggest that it is associated with positive effects on hope, recovery and quality of life, the effects on other outcomes such as symptoms, hospital admission and satisfaction are inconclusive. ...
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Background Many people who have self-harmed prefer informal sources of support or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed or about the risks of peer support interventions in non-clinical settings. Aims The aims of this review were to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated. Method We searched bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary-sector organisations providing one-to-one or group support, or via moderated online peer support forums. Results Eight of the ten papers included focused on peer support that was delivered through online media. No study compared peer support with other treatments or a control group, so limited conclusions could be made about its effectiveness. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a sense of community, empowerment, and access to information and support. The most commonly perceived risk associated with peer support was the potential for triggering self-harm. Conclusions Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. Mitigations for potential risks include organisations using professional facilitators for groups, trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people while maintaining their own emotional health.
... Previous research has illustrated key reasons for young people seeking out support in online communities are to feel less alone with their problems, find a space to talk with peers, and where they feel less likely to be judged 69 . The most frequently selected outcomes in POCEM for positive experiences in the community were 'Felt connection', 'Feel safe', and 'Not judged'. ...
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Online digital mental health communities can contribute to users’ mental health positively and negatively. Yet the measurement of outcomes and impact relating to digital mental health communities is difficult to capture. In this paper we demonstrate the development of an online experience measure for a specific children and young people’s community inside a digital mental health service. The development is informed by three phases: (i) item reduction through Estimate-Talk-Estimate modified Delphi methods, (ii) user testing with participatory action research and (iii) a pilot within the digital service community to explore its use. Rounds of experts talks help to reduce the items. User experience workshops helped to inform the usability and appearance, wording, and purpose of the measure. Finally, the pilot results highlight completion rates, difference in scores for age and community roles and a preference to ‘relate to others’; as a mechanism of support. Outcomes frequently selected in the measure show the importance of certain aspects of the community, such as safety, connection, and non-judgment previously highlighted in the literature. Self-reported helpfulness scales like this one could be used as indicators of meaningful engagement within the community and its content but further research is required to ascertain its acceptability and validity. Phased approaches involving stakeholders and participatory action research enhances the development of digitally enabled measurement tools.
... While the forums were Australian-based, it was clear that some members lived overseas and that even those who lived in Australia were using products purchased from foreign countries. The forums allowed members from different geographical locations who would not normally encounter each other in person to share advice and tips, a benefit listed in previous studies exploring forum use among hidden populations or those experiencing issues which can be surrounded by stigma [59,60]. Members relied on others' personal experiences, especially holding more senior members including moderators and administrators in high esteem as well as valuing consistency among multiple members' opinions about certain products or brands. ...
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Background: A primary consequence of illicit drug markets and the absence of regulation is the variable quality or purity of the final product. Analysis of anabolic-androgenic steroid seizures shows that these products can contain adulterated products, product not included on the label, or product of unsatisfactory standard. While the potential negative effects of counterfeit anabolic-androgenic steroids (AAS) use is a recognised risk associated with use, no study has explored personal experiences associated with use. The aim of the present study was to use online discussion forums to investigate and explore the experiences associated with the purchase and consumption of counterfeit AAS among consumers. Methods: An online search was conducted to identify online forums that discussed counterfeit or contaminated AAS; three were deemed suitable for the study. The primary source of data for this study was the 'threads' from these online forums, identified using search terms including 'counterfeit', 'tampered', and 'fake'. Threads were thematically analysed for overall content, leading to the identification of themes. Results: Data from 134 threads (2743 posts from 875 unique avatars) was included. Two main themes were identified from the analysis: (1) experiences with counterfeit product and (2) harms and benefits associated with counterfeit product. Conclusions: The use of counterfeit or contaminated substances represents a public health concern. Those who report using performance and image enhancing drugs such as AAS for non-medical purposes report consuming these substances and experiencing harm as a result. Consumers take steps to limit coming into contact with counterfeit or contaminated product, though recognise that many of these have limitations. The implementation of accessible drug safety checking services may provide an opportunity to provide consumers with information to assist them with making healthier choices.
... However, with notable recent exceptions (Shanahan et al., 2019), much of the literature that has explored these potential positives of online self-harm interactions draws on studies of more static entities such as websites and forums rather than the fragmented, heterogeneous and dynamic current landscape of social media (Baker & Fortune, 2008;Jones et al., 2011;Smithson et al., 2011). Evidence regarding the harms and benefits of young people's engagements with self-harm content on social media is therefore very limited. ...
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Background There is emerging evidence of the potentially detrimental impact of social media on young people’s mental health. Against this background, online self‐harm content has been a recent focus of concern across academia, policy and the media. It has been argued to encourage or even cause acts such as self‐cutting through mechanisms of contagion. However, little is known about why a young person might engage with such content or about its impact on behaviour or well‐being. Methods Online ethnographic observation of interactions around self‐harm on Twitter, Reddit and Instagram : collection and analysis of 10,169 original posts and 36,934 comments, both written and pictorial, at two time‐points in 2018 and 2019. Ten in‐depth semi‐structured interviews exploring engagements with self‐harm content on social media. Results Our data show that peer support is the central component of online interactions around self‐harm. Young people accessing such content are likely to already be self‐harming; they may turn to social media to understand, and seek help for, their actions and feelings in a context of offline stigma and service support gaps. This paper engages with the mechanisms, complexities and impact of this peer‐support, reflecting on the benefits and dangers to caring for oneself and others through social media. Conclusions Self‐harm content is a fraught issue at the centre of current debates around risks and opportunities for child and adolescent mental health in the digital age. Whilst the importance of supporting young people’s online safety is clear, moves to eradicate self‐harm content must be undertaken with caution so as not to cause unintentional harm. Our research highlights a need to think beyond a model of contagion, instead attending to other mechanisms of harm and benefit. In so doing, it challenges prevailing attitudes towards online communication about self‐harm and accepted approaches to managing this.
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