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The author thanks Drs. Margaret McLaughlin, Michael Cody, and Maryalice Jordan-
Marsh for their invaluable guidance for this study. The authors also thank the moderators of
four online support groups and survey participants for their assistance in data collection.
Address correspondence to Jae Eun Chung, School of Communication Studies, Kent State
University, 135 Taylor Hall, Kent, OH 44242, USA. E-mail: jchung3@kent.edu
1
Journal of Health Communication, 0:1–21, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1081-0730 print/1087-0415 online
DOI: 10.1080/10810730.2012.757396
Social Networking in Online Support
Groups for Health: How Online Social
Networking Benefits Patients
JAE EUN CHUNG
School of Communication Studies, Kent State University,
Kent, Ohio, USA
An increasing number of online support groups (OSGs) have embraced the fea-
tures of social networking. So far, little is known about how patients use and
benefit from these features. By implementing the uses-and-gratifications frame-
work, the author conducted an online survey with current users of OSGs to
examine associations among motivation, use of specific features of OSG, and
support outcomes. Findings suggest that OSG users make selective use of varied
features depending on their needs, and that perceptions of receiving emotional
and informational support are associated more with the use of some features
than others. For example, those with strong motivation for social interaction
use diverse features of OSG and make one-to-one connections with other users
by friending. In contrast, those with strong motivation for information seeking
limit their use primarily to discussion boards. Results also show that online social
networking features, such as friending and sharing of personal stories on blogs,
are helpful in satisfying the need for emotional support. The present study sheds
light on online social networking features in the context of health-related OSGs
and provides practical lessons on how to improve the capacity of OSGs to serve
the needs of their users.
The use of the Internet for health information has increased, with 8 in 10 Internet users
in the United States searching online for health information (Fox, 2011). Recently,
online social media, such as patient blogs, Internet support groups, and health-related
social networking sites, have emerged as popular sources of health information. A
report has shown that approximately one third of online health information seek-
ers have used such social media resources (Elkin, 2008). The number of people using
health-related online social media and seeking help and information from peer patients
is also expected to grow (Fox & Purcell, 2010; Jupiter Research, 2007; Sarasohn-Kahn,
2008, 2009).
Among health-related online social media, online support groups (OSGs) are
particularly useful for connecting individuals to large numbers of others with similar
health concerns (Walther & Boyd, 2002). With the rising popularity of OSGs, sub-
stantial research efforts have been directed at understanding the motivation behind
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2 J. E. Chung
their use (e.g., Buchanan & Coulson, 2007; Maloney-Krichmar & Preece, 2005), types
of support exchanged among OSG members (e.g., Barnett & Hwang, 2006; Coulson,
2005; Eysenbach, Powell, Englesakis, Rizo, & Stern, 2004; Malik & Coulson, 2008;
Meier, Lyons, Frydman, Forlenza, & Rimer, 2007), and outcomes associated with
their use (e.g., Baum, 2004; Montazeri et al., 2001; Rodgers & Chen, 2005). Previous
research has revealed a good deal about why people use OSGs, what they discuss in
OSGs, and what types of health benefits OSGs afford.
Despite the extensive literature on OSGs, little is known about how individuals
make use of OSGs in varied ways and how varied patterns of use may affect what
individuals gain from OSGs. Researchers have suggested that OSGs do not work in
the same way for all (Shaw, McTavish, Hawkins, Gustafson, & Pingree, 2000) and
that use of different website features yields different outcomes for each individual (An
et al., 2008). For example, benefits from OSG use accrued by each individual can
vary by motivation (Tanis, 2008; Wright, 2002), health condition (Cummings, Sproull,
& Kiesler, 2002; Davison, Pennebaker, & Dickerson, 2000), pattern of OSG use (An
et al., 2008), and level of participation (Pleace, Burrows, Loader, Muncer, & Nettleton,
2000; Richardson et al., 2010; Schweizer, Leimeister, & Krcmar, 2006; Shaw, Hawkins,
McTavish, Pingree, & Gustafson, 2006). These studies have shown the importance of
acknowledging individual differences in the study of OSG use. Furthermore, as OSGs
add new features and expand their functionalities (Bender, O’Grady, & Jadad, 2008;
Kamel Boulos & Wheeler, 2007), the mechanism through which OSGs empower and
benefit patients increases in complexity, resulting in a growing need to understand how
the features are used and affect the experience of individual OSG users.
Focusing on individual differences in the use of OSG, the present study details
the association among motivation, use of specific features of OSG, and support out-
comes. The researcher employed the uses-and-gratifications perspective (Rosengren,
1974; Rubin, 2002) to answer the following questions: What motivates people to use
OSGs? How is the salience of various needs related to the use of different features
available on OSG sites? How do OSG users develop feelings of being cared for and
supported? Can the use of any specific features of the OSGs be more beneficial than
others to patients with certain needs? Answers to these questions can help advance
an understanding of patients’ use of OSGs as healthcare resources and improve the
capacity of online support communities to serve the needs of OSG users.
Characteristics and Benefits of OSGs
Upon diagnosis of illness, many patients experience a range of psychological, social,
and physical distress. Social support facilitates coping with such distress (Krause, Liang,
& Yatomi, 1989; Penninx et al., 1998), improves mood (Dunn, Steginga, Occhipinti, &
Wilson, 1999), and expedites recovery from disease (Burg et al., 2005). With the rapid
growth of the Internet over the past decade, the number of people seeking online social
support has increased (Fox & Purcell, 2010).
Several characteristics of computer-mediated communication make OSGs an
attractive venue for support seeking (Robinson & Turner, 2003). First, OSGs are
unconstrained by temporal and geographical boundaries. Individuals can access OSGs
at times and locations convenient to them. Those with mobility constraints (Braithwaite,
Waldron, & Finn, 1999) and those with rare health conditions (Lasker, Sogolow, &
Sharim, 2006) can easily find others dealing with same health issues. Second, the
limited social cues available in computer-mediated communication provide a unique
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Social Networking in Online Support Groups 3
opportunity for self-presentation. People can freely talk about embarrassing health
topics (Cooper, 2004; Davison et al., 2000). Last, in OSGs, a person can remain com-
pletely invisible. Such anonymity offers an opportunity for participation to those who
want to learn from others’ experiences but remain unseen. This opportunity is related
to silent support, which involves little emotional cost (Bolger, Zuckerman, & Kessler,
2000) and little expectation for reciprocity from those who receive support (von dem
Knesebeck & Siegrist, 2003).
The concept of silent support is particularly relevant in understanding lurking
behaviors online. Studies have shown that lurkers in OSGs feel informed and emo-
tionally supported as much as posters do (Mo & Coulson, 2010; van Uden-Kraan,
Drossaert, Taal, Seydel, & van de Laar, 2008). Another line of research, however,
showed that posters receive additional benefits through the process of writing and
emotional disclosure (Shim, Cappella, & Han, 2011) and social interaction opportunities
(Nonnecke, Andrews, & Preece, 2006). Because many OSGs no longer operate on a
simple discussion board format and now run on a platform of expanded and compli-
cated features, moving beyond the dichotomy between lurkers and posters is necessary
in the study of OSGs.
Social Networking Features in OSGs
Over time, OSGs have added a number of features that facilitate social interaction
among OSG users, such as private messaging, real-time chatting, and online social
networking (An et al., 2008; Cummings et al., 2002; Feil, Noell, Lichtenstein, Boles,
& McKay, 2003; Lu, Shaw, & Gustafson, 2011). One of the latest additions included
online social networking features (Bender et al., 2008; Kamel Boulos & Wheeler,
2007), such as profile page for each individual and friend list (Boyd & Ellison, 2007).
Although these social networking features have been integrated to enhance con-
nectivity among OSG users (Bender et al., 2008; Kamel Boulos & Wheeler, 2007),
little is known about how they are adopted and used by patients (Newman, Lauterbach,
Munson, Resnick, & Morris, 2011; Takahashi et al., 2009). Abundant studies were
conducted on general-purpose social networking sites, such as Facebook and MySpace
(e.g., Ellison, Steinfield, & Lampe, 2007; Fogel & Nehmad, 2009; Ross et al., 2009;
Sheldon, 2008), and yet no studies have been published about how online social
networking features are used as supportive care resources in health-related online
communities (Bender et al., 2008).
Uses and Gratifications as a Theoretical Framework
The uses-and-gratifications approach emphasizes why people use particular media
and how they use media to satisfy their needs (Rosengren, 1974; Rubin, 2002). Accord-
ing to this approach, individual differences in the patterns of media selection and use
originate from differences in needs, which also influence the way individuals assesses
their media use (Blumler & Katz, 1974). Dutta and Feng (2007) suggested that the
uses-and-gratifications approach can be particularly helpful in understanding indi-
viduals’ use of OSGs.
Although many researchers have identified motivations for participating in OSGs
(e.g., Buchanan & Coulson, 2007; Coulson, 2005; Kral, 2006; Maloney-Krichmar &
Preece, 2005; Meier et al., 2007; Preece & Ghozati, 2001), they have rarely tapped into
the next research question: how those motivations affect use patterns and how use
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4 J. E. Chung
patterns in turn affect appreciation of online support. A few scholars have suggested a
need for conducting a focused evaluation of each feature on OSG sites (An et al., 2008;
Barrera et al., 2002), yet little is known about how individuals with different moti-
vations use the features in varied ways and how the use of various features delivers
different support outcomes. With uses and gratifications as a theoretical framework,
the present study thus examines relationships among the following three variables:
motivation, use pattern, and appreciation.
Research Questions
A number of studies have revealed motivations for using OSGs. The most often dis-
cussed motivations are the exchange of information and advice (Buchanan & Coulson,
2007; Coulson, 2005; Leimester & Krcmar, 2006; Meier et al., 2007; Rodgers & Chen,
2005; Tanis, 2008) and the sharing of emotions (Buchanan & Coulson, 2007; Kral,
2006; Preece & Ghozati, 2001; Rodgers & Chen, 2005; Tanis, 2008). Patients visit OSGs
to exchange information on management and treatment of illness (e.g., Meier et al.,
2007; Rubenstein, 2009) and to find others to whom they can emotionally relate
(e.g., Buchanan & Coulson, 2007; Kral, 2006; Shim et al., 2011).
Questions remain as to the reasons behind using OSGs that have incorporated
online social networking features (Bender et al., 2008; Kamel Boulos & Wheeler,
2007). Previous studies have been primarily conducted on OSGs on the basis of e-mail
listservs or discussion boards. In these older-generation OSGs, users are often known
only by their usernames, and interaction among them occurs through many-to-many
e-mails and online postings. In these e-mails and postings, conversations tend to focus
on a specific health theme and leave little room for one-to-one interaction, render-
ing group-level social identity much more salient than individuals’ personal identity
(Spears & Lea, 1992). On the contrary, newer-generation OSGs that include social
networking features provide many more opportunities for personal expression and
one-to-one interaction (Sheldon, 2010). In the newer-generation OSGs, individuals
can share personal details on their profile pages and connect to others on a person-
to-person level through the friend list (Mayfield, 2005; Rau et al., 2008). Thus, motivation
to use older- and newer-generation OSGs may differ.
Differences can also be found in the motivation to use online social networking
features in health-related communities and in general-purpose communities. Numerous
studies on general-purpose social networking sites have shown that the primary moti-
vations for using such sites are to strengthen already existing relationships and to
reconnect with friends one knows offline (Ellison et al., 2007; Subrahmanyam, Reich,
Waechter, & Espinoza, 2008). By contrast, little is known about the motivation to use
social networking features included in health-specific OSGs. Therefore, the present
study poses the following question, seeking to identify the primary motivation behind
using newer-generation OSGs.
Research Question 1: What are people’s primary motivations for using
OSGs that include online social networking features?
Newer-generation OSGs often operate on a combination of diverse features and
contents. For example, they often include discussion forums, where members can post
messages for the whole group; informational resources, where members can obtain
knowledge about a specific health concern; and social networking features, which are
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Social Networking in Online Support Groups 5
new additions to OSG sites. With social networking features, OSG users can set up
individual profile pages, share personal stories on blogs or profile pages, create friend
lists, and share photos and videos.
According to the uses-and-gratifications framework, when using media, individu-
als have different patterns of media use because their decisions as to the kinds of
contents to consume and features to use are driven by motivation. Certain motivations
lead to the use of some types of media contents but not others. Especially when using
the Internet, individuals make strategic and active choices as to which pages to open,
depending on their needs (Rayburn, 1996). Some people with certain motivations are
expected to use certain features on OSG sites more than others. For example, a study
on OSG for HIV/AIDS has shown that some patients spent more time using conver-
sational and communicative features (e.g., discussion boards), whereas others spent
more time using educational and informational features (Smaglik et al., 1998).
Although diverse features are available in newer-generation OSGs, no study to
date has shown how individual users make selective use of these features. The integra-
tion of social networking features into OSGs is new, and thus knowledge of how OSG
participants make use of these new features is limited. Therefore, the present study
explores the link between motivation and use patterns in the context of OSG. The
following research question addresses variations in use pattern by motivation.
Research Question 2: How does the use of different features on OSGs
relate to motivation?
In addition to the link between motivation and use, the uses-and-gratifications
framework supports the study of the link between use and appreciation of consumed
content. Several studies have shown that specific psychological outcomes result from
the use of specific features of OSGs (Barrera et al., 2002; Freeman, Barker, & Pistrang,
2008; Shaw et al., 2007; Weis et al., 2003). For example, among cancer patients, the use
of communicative and social features was found to enhance patients’ emotional and
functional well-being when other features did not (Beaudoin & Tao, 2007; Walther,
Pingree, Hawkins, & Buller, 2005). In a study of the use of OSGs by diabetes patients,
the perception of received support was much greater among those who used peer-to-
peer discussion forums compared to those who did not (Barrera et al., 2002). Similarly,
people who participated in discussion forums adhered to their health goals longer than
those who did not (Richardson et al., 2010). These studies suggest that differences in
use patterns can result in various outcomes for individuals.
Building on the uses-and-gratifications framework and the findings of previous
studies, the present study is undergirded by the assumption that some features are
more effective than others in providing certain types of support (Han et al., 2009).
Because one major function of online social networking is the development of inter-
personal relationships (Ellison et al., 2007; Subrahmanyam et al., 2008), this study
hypothesizes a positive relation between the use of social networking features and
perceptions of social support. The following research question is designed to examine
the link between use and perception of social support with the tentative expectation
that those who use social networking features perceive the OSG site as a more
supportive venue.
Research Question 3: How does the use of different features on OSGs
relate to perception of social support?
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6 J. E. Chung
Method
Participant Recruitment for Online Survey
An online survey was conducted with current users of OSGs. Participants were
recruited through a message posted on four OSG sites. The recruitment message
included brief information about the study, a link to the online survey, and a note on
participation criteria: Respondents must be (a) 18 years or older and (b) using the site
for their own health concerns.
Selection of Study Sites
We compiled a list of OSG sites from various sources, including magazine and news-
paper articles and websites, such as 100bestsocialnetworksites.com and findasocialnet-
work.com. From the list, only those that met the following four criteria were selected:
(a) the content deals with specific health concerns instead of general wellness (such as
exercise and diet), (b) the goal is to provide support to patients, (c) the site includes
features of online social networking as defined by Boyd and Ellison (2007; profile page
and friend list), and (d) at least one new message was posted on discussion boards
during the most recent week at the time of screening. An e-mail soliciting permission
to recruit participants was sent to the moderators of the 12 sites that met the above
criteria. Of the 12 sites, four moderators approved participant recruitment from their
sites (2 diabetes, 1 prostate cancer, and 1 young adult cancer).
Survey Administration
For each OSG site, the online survey was open for one month. The survey, which took
an average of 15 min to complete, did not require any personally identifiable informa-
tion. Participants were given an opportunity to enter a drawing for an online retailer
gift certificate.
From the four OSG sites, a total of 245 people participated in the survey. Responses
from 50 participants were excluded because they did not meet the two participation
criteria mentioned above. Responses from the remaining 195 were analyzed.
Measures
Motivation
Because no previous studies have yielded specific information on motivation to use
OSGs that include features of online social networking, the present study drew on
previous research that measured motivation for using the Internet (Grace-Farfaglia,
Dekkers, Sundararajan, Peters, & Park, 2006; Papacharissi & Rubin, 2000), social net-
working sites (Bumgarner, 2007; Ellison et al., 2007; Joinson, 2008; Sheldon, 2008),
and OSGs (Tanis, 2008; Hwang et al., 2010). A total of 28 statements were gleaned.
To each statement, respondents indicated their degree of agreement or disagreement
on a 5-point Likert scale.
OSG Feature Use
Respondents were asked to report their frequency of using the following 14 features on
OSG sites: discussion board (posting, reading, and replying), blog (writing, reading,
and commenting), photo sharing and browsing (posting, viewing, and commenting),
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Social Networking in Online Support Groups 7
video sharing and browsing (posting, viewing, and commenting), and messaging
(sending and receiving). Response options were daily (= 6), two to three times a week
(= 5), once a week (= 4), two to three times per month (= 3), once a month (= 2), and
never (= 1). In addition, respondents were asked about the number of friends they
have on their friend list.
OSG Support Perception
Perceived social support from OSG was measured using two subscales (informational
and emotional support) of the Social Support Behaviors Scale (Vaux, Riedel, & Stewart,
1987). From the original scale that was used to measure friends’ support, five items
with the highest factor loadings were adapted to the context of OSGs. Respondents
were asked to indicate how likely OSG members would provide a specific type of support
when asked. The response option was 5-point scale ranging from “no one would do
this (= 1)” to “most would certainly do this (= 5).” Items for informational support
included “would tell who to talk to for help.” Items for emotional support included
“would comfort me if I was upset.” Cronbach’s alphas were .93 for informational
support and .92 for emotional support.
Control Variables
Control variables included age, gender, coresidency (live alone or with someone), edu-
cation, urban–rural residency, race, self-reported health status, and the duration of
OSG use (the number of months using the OSG).
Analysis
We used SPSS 17.0 for data analysis. For Research Question 1, the 28 motivation
statements were analyzed using factor analysis. For Research Question 2, items for
OSG feature use were analyzed using factor analysis and then entered into regres-
sions models as dependent variables with motivation factors as independent variables.
For Research Question 3, regression models were run with OSG support perception
(emotional and informational support) as dependent variables and OSG feature use
as independent variables.
Results
Descriptive Statistics
Table 1 describes demographic and health characteristics of participants. The mean
age was 48 years, and about half were male (47.8%). The majority of respondents were
White (91.8%). About 4 in 10 (44.3%) had completed college or earned higher degrees.
Most participants (79.2%) lived with someone else. About 70% described their heath
as good or excellent.
Table 2 presents the correlation matrix. All correlation coefficients were below the
recommended threshold of .70 (Campbell, 1998) except one between the two variables
of OSG support perception.
Results for Research Questions
Research Question 1 dealt with primary motivations for using OSG sites that include
social networking features. The 28 statements were analyzed using principal component
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8 J. E. Chung
Table 1. Demographic and health characteristics of participants (N = 195)a
Variables %
Age, in years (M = 48, SD = 16.29)
19–29 17.1
30–39 15.2
40–49 14.6
50–59 27.8
60–69 16.5
70+ 8.9
Gender
Female 52.2
Male 47.8
Live alone
Yes 20.8
No (live with someone) 79.2
Education 22.8
No formal education or elementary school 32.9
Junior high school, some high school, or high school graduate 23.4
Some college or college graduate 20.9
Graduate or professional degree
Residency 34.6
Urban 65.4
Rural/suburban
Race 91.8
White 1.5
Black 1.5
Asian 3.0
Other
Health status 33.3
Excellent 38.4
Good 20.1
Fair 8.2
Poor
Duration of online support group use (M = 9.2, SD = 8.1)
Less than 3 months 27.0
3–6 months 14.4
6–9 months 10.9
9–12 months 9.3
1–1.5 years 22.4
1.5–3 years 16.0
aSample size slightly varies for each variable because of missing data.
factor analysis with Varimax rotation procedures. Using the rule of a minimum eigen-
value of 1.00 per factor, five factors were retained. Four statements with a factor load-
ing less than .40 were excluded for further analysis (Hair, Black, Babin, Anderson, &
Tatham, 1998). After removal of the four statements, factor analysis was repeated, and
a summary of factor loadings is reported in Table 3.
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9
Table 2. Means, standard deviations, and zero-order correlations (N = 195)
1 2 3 4 5 6 7 8 9 10 11
1 Motivation to relax —
2 Motivation to help
others
.324**
3 Motivation to meet
others
.551** .590**
4 Motivation to seek
information
.020 .188*.207**
5 Motivation to
maintain offline
relationship
.477** .459** .677** .160*
6 Discussion board use –.253** –.433** –.573** –.274** –.407**
7 Photo and video
sharing and
browsing
–.179*–.126+–.234** –.094 –.347** .000
8 Blog use –.406** –.303** –.351** .052 –.300** .000 .000
9 Friending (number of
friends)
.221** .494** .523** –.024 .373** .549** .134+.206**
10 Informational
support
.172*.296** .353** .204** .152+.417** –.076 .091 .337**
11 Emotional support .257** .426** .549** .137+.342** .527** .020 .204** .535** .839** —
M 2.82 4.04 3.50 4.28 2.51 0.00 0.00 0.00 0.00 3.49 3.26
SD 1.10 0.81 1.01 0.62 1.03 1.00 1.00 1.00 1.00 1.14 1.26
Note. Sample size slightly varies because of missing data.
+p < .10. *p < .05. **p < .01 (two-tailed).
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10 J. E. Chung
Table 3. Exploratory factor analysis of motivation
Factor loadings
The reason why I visit [site name] is … 1 2 3 4 5
Factor 1: Motivation to relax
To pass time .92
To entertain myself .88
To occupy my time .88
To spend time when I am bored .78
To forget my worries .61
Factor 2: Motivation to help others
To help others .85
To provide support to others .82
To show others encouragement .80
To contribute to discussions .68
Factor 3: Motivation to meet others
To make new friends with similar interests .82
To meet new people with similar interests .69
To get to know other people .61
To keep in touch with people I have met
through [site name]
.61
To find people like me .56
To communicate with like-minded people .55
Factor 4: Motivation to seek information
To gather information .82
To find out things that I need to know .75
To look for information I need .74
To talk to a knowledgeable individual about
topics of my health issues
.71
To get answers to specific questions .61
Factor 5: Motivation to maintain offline
relationship
To keep connected with people who I otherwise
would have lost contact with
.74
To find out what old friends are doing now .72
To deepen relationships with people that I have
met offline
.67
To keep in touch with people who live far
away
.55
Excluded items
To learn what others think about something
To feel relaxed
To give my opinion on a topic of conversation
To respond to others on topics of interest to me
Cronbach’s alpha .93 .90 .91 .85 .86
Eigenvalue 4.8 4.4 4.1 3.6 2.8
Note. Factor loadings below .40 are suppressed and not shown.
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Social Networking in Online Support Groups 11
For each factor, an average was calculated and compared. Mean comparisons show
that motivation to seek information was strongest (M = 4.28, SD = 0.62), followed by
motivation to help others (M = 4.04, SD = 0.81), motivation to meet others in similar
conditions (M = 3.50, SD = 1.01), and motivation to relax (M = 2.82, SD = 1.10). The
weakest motivation was to maintain offline relationships (M = 2.51, SD = 1.03). All
mean differences were statistically significant (p < .001).
Research Question 2 was used to test whether any relation exists between motiva-
tion and OSG feature use. To determine this relation, the 15 items on OSG feature use
were analyzed using the principal component factor analysis method and Varimax
procedures. Two items that loaded high (greater than .5) simultaneously on two factors
were eliminated (Hair et al., 1998). The factor analysis was then repeated and yielded
four factors: photo and video sharing and browsing, discussion board use, blog use,
and friending (Table 4). The rotated factor scores were then saved for further analyses.
Higher scores indicated more intensive use of OSG features.
Table 4. Exploratory factor analysis of OSG feature use
Factor loadings
1234
Factor 1: Photo and video sharing and browsing
How frequently do you …
Post photos (excluding profile photos)? .66
View others’ photos? .66
Comment on others’ photos? .82
Post videos? .63
View others’ videos? .87
Comment on others’ videos? .88
Factor 2: Discussion board use
How frequently do you …
Read postings on discussion forum? .82
Reply to postings on discussion forum? .84
Post messages on discussion forum, excluding
replying comments?
.70
Factor 3: Blog use
How frequently do you …
Write blogs? .88
Read others’ blogs? .72
Comment on others’ blogs? .69
Factor 4: Friending
How many people are on your friend list? .87
Excluded items
How frequently do you …
Send private messages?
Receive private messages?
Cronbach’s alpha .90 .83 .83
Eigenvalue 3.8 2.6 2.3 1.2
Note. Factor loadings below .40 are suppressed and not shown.
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12 J. E. Chung
Regression models were run to test the relation between motivation and the use
of OSG features. Table 5 shows the results of regression analyses predicting the use of
the discussion board, photo and video sharing and browsing, blog use, and use of the
friending feature, respectively. Holding control variables constant, results show that
use of the discussion board was significantly related to motivation to seek information
(β = .218, p < .01), motivation to help others (β = .352, p < .001), motivation to meet
others (β = .485, p < .001), and motivation to maintain offline relationships (β = .319,
p < .001). Use of photo and video features was significantly related to the motivation to
meet others (β = .189, p < .05) and to maintain offline relationships (β = .299, p < .001).
For the use of blog features, motivation to relax (β = .208, p < .01) and motivation to
maintain offline relationships (β = .185, p < .01) were the two significant predictors.
For the use of friending feature, motivation to help others (β = .278, p < .001), motivation
to meet others (β = .287, p < .001), and motivation to maintain offline relationships
(β = .220, p < .001) were the three significant predictors.
Research Question 3 was designed to examine how the use of specific features is
related to the perception of support from OSGs. The variables for the two types of sup-
port were entered into two separate regression models for their high correlation. Tables 6
(informational support) and 7 (emotional support) show the results of multiple regression
analyses in which two types of perception of support from OSGs were regressed against
the four factors of OSG feature use. The only feature significantly related to the perception
of informational support was the use of the discussion board (β = .321, p < .01; Table 6).
Table 7 shows that the perception of emotional support was dependent on the use of dis-
cussion board (β = .364, p < .001), blog (β = .128, p < .10), and friending (β = .237, p < .05).
Discussion
Summary of Findings
Online social networking features have been increasingly adopted on OSGs (Bender
et al., 2008; Kamel Boulos & Wheeler, 2007), yet little is known about OSG users’
Table 5. Multiple ordinary least squares regression analysis predicting use of different
features from motivation
Model 1:
Discussion
board use
Model: Photo
and video
sharing and
browsing
Model 3:
Blog use
Model 4:
Friending
(number of
friends)
Motivation to seek
information
.218** .100 .091 –.064
Motivation to help others .352*** .138 .093 .278***
Motivation to meet others .485*** .189* .143 .287***
Motivation to relax .128 .034 .208* –.570
Motivation to maintain
offline relationship
.319*** .299*** .185* .220***
Note. Control variables include age, gender, coresidency (live alone or with someone),
education, urban-rural residency, race, self-reported health status, and duration of OSG use. To
avoid multicollinearity issues, five motivation factors were entered separately to the regression
models following control variables.
* p < .05. **p < .01. ***p < .001.
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Social Networking in Online Support Groups 13
experiences with regard to these new features. Thus, the present study surveyed current
users of OSGs and examined how the various features on OSGs are used and appreci-
ated by individuals with diverse needs. A number of interesting results emerged and
are subsequently presented in the order of the research questions.
The first research question was designed to investigate motivation behind using
OSGs that incorporate features of online social networking. Consistent with previous
research on OSGs (Buchanan & Coulson, 2007; Coulson, 2005; Leimester & Krcmar,
2006; Meier et al., 2007; Rodgers & Chen, 2005; Tanis, 2008), the strongest motivation
was information seeking: to learn more about one’s health condition, to find informa-
tion about treatment, and to seek out advice from people undergoing or having under-
gone similar health problems. It is interesting that the second strongest motivation
was the provision of support to other OSG users. Previous researchers on OSG have
rarely tapped into this motivation as a primary reason to visit OSGs, but the literature
on social support includes the positive effects of helping gestures, such as feelings of
belongingness and reduced distress and mortality (Brown, Nesse, Vinokur, & Smith,
2003; Midlarsky, 1991; Riessman, 1965; Taylor & Turner, 2001). In the use of OSG,
helping can be empowering because the act of helping can offer the feeling of becom-
ing a better and useful person (Reeves, 2000; van Uden-Kraan, Drossaert, Taal, Shaw,
et al., 2008).
The motivation to meet new people also emerged as a primary reason to visit OSGs.
Unlike general social networking sites for which the major motivation is to maintain
Table 6. Multiple ordinary least squares regression analyses predicting OSG informa-
tional support from OSG feature use
Standardized β
Control variables
Age –.109 –.081
Gender (referent = male) –.079 .040
Live alone (referent = no) .028 .044
Education –.188* –.062
Residency (referent = rural/suburban) .016 –.003
Race (referent = non-White) .209** .171*
Health status (referent = poor)
Excellent –.030 .005
Good .025 .031
Fair .016 .017
Duration of OSG use .156+.139+
OSG feature use
Discussion board use .321**
Photo and video sharing and browsing –.047
Blog use .050
Friending (number of friends) .101
Incremental R2.097**
Total R2.162 .259
F2.789** 3.499*
Note. OSG = online support group.
+p < .10. *p < .05. **p < .01.
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14 J. E. Chung
contact with offline friends (Ellison et al., 2007; Raacke & Bonds-Raacke, 2008), OSGs
were found to be valued as a venue for making new online friends. Through these new
relationships with people having similar health problems, OSG users can recover a
sense of normalcy (Festinger, 1954) and achieve distance from those who may hold
unrealistic anticipation for fast recovery (Newman et al., 2011; Tanis, 2007).
The second research question focused on the link between motivation and use of
various features of OSGs. According to the uses-and-gratifications framework, indi-
viduals use media in the way to fulfill their needs and thus consume certain contents
more often than others (Blumler & Katz, 1974). The findings show that blog features
are most frequently used by people who used the site as a means of relaxation. Photo
and video sharing features are most frequently used by those who use the site as a
way for social interaction. It is not surprising that those who join OSGs mainly for
information make the least use of diverse features available on OSGs. Information
seekers use online social networking features to a minimum degree and limit their
use primarily to discussion board. Information seekers’ passive patterns of use were
also documented by previous studies on lurking behaviors (Mo & Coulson, 2010;
Nonnecke et al., 2006; Nonnecke, Preece, & Andrews, 2004). Compared to posters,
lurkers are little interested in companionship in online communities, yet they are keen
on learning new information as much as posters (Nonnecke et al., 2006; Nonnecke
et al., 2004; Preece, Nonnecke, & Andrews, 2004).
Table 7. Multiple ordinary least squares regression analyses predicting OSG emo-
tional support from OSG feature use
Standardized β
Control variables
Age –.161+–.061
Gender (referent = male) –.249** –.068
Live alone (referent = no) .060 .089
Education –.178* –.005
Residency (referent = rural/suburban) .031 –.004
Race (referent = non-White ) .163* .132+
Health status (referent = poor)
Excellent .059 .126
Good .069 .104
Fair .071 .075
Duration of OSG use .189* .146*
OSG feature use
Discussion board use .364***
Photo and video sharing and
browsing
–.001
Blog use .128+
Friending (number of friends) .237*
Incremental R2.172***
Total R2.292 .464
F5.888*** 8.580***
Note. OSG = online support group.
+p < .10. *p < .05. **p < .01. ***p < .001.
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Social Networking in Online Support Groups 15
By contrast, socializers actively friend others and make intensive use of photo and
video sharing features. A close look at friending, a distinct feature of social network-
ing sites, reveals that those who friend many people tend to have a strong motivation
to meet new people, maintain offline relationships, and help others. OSG users take
advantage of social networking and other various features only when they believe that
these features will help fulfill their social and emotional needs (Rau et al., 2008).
The third and final research question was designed to examine how perceptions
develop toward availability and types of support in the OSG depending on the use of
different OSG features. Results show that use of discussion boards is related to the
perception that the OSG offers both informational and emotional support. Uses of
blog features and friending, on the contrary, are associated only with the perception
that OSG provides emotional support. These results show that online social network-
ing features, such as friending and sharing of personal stories on blogs, are indeed
helpful in satisfying the need for emotional support whereas the need for informa-
tional support is met primarily through the use of discussion boards.
Implications
Overall, the present study sheds light upon online social networking features in the
context of health-related OSGs. As increasing numbers of people turn to OSGs,
understanding the ways these new venues and features are used and appreciated as
support and healthcare resources is essential.
In a theoretical sense, the present study demonstrates that the uses-and-gratifi-
cations framework is useful in conducting a focused assessment of each feature and
understanding individual users’ experiences in OSGs (Barrera et al., 2002; Dutta &
Feng, 2007). Findings show that OSGs do not deliver the same degrees and types of
benefits to all users. They also support the argument of the uses-and-gratifications
framework as well as optimal matching theory (Cutrona & Russell, 1990; Turner,
Grube, & Meyers, 2001) that any variations in media choice and appreciation need to
be viewed in conjunction with individual differences in needs and motivations.
In a methodological sense, by surveying people who have been using OSG in natu-
ral settings, this study captured the links among motivation, use of various OSG fea-
tures, and support perception. Despite their own merits, experiments (Barrera et al.,
2002; Freeman et al., 2008) are unable to explain thoroughly the processes through
which OSGs become efficacious for their users (Han et al., 2009). In experiments,
subjects are arbitrarily assigned to participate in OSGs, and thus understanding the
motivations that precede OSG use is not feasible.
In addition, two practical lessons can be drawn from the findings. First, the pres-
ent study empirically supports the claim that the integration and use of online social
networking features are advantageous to OSG users (Fenech, 2009; Holahan, 2008;
Landro, 2006; Miller, 2008; Morphy, 2008), especially to those in need of emotional
support. Healthcare professionals can also use OSGs and social networking features to
reach out to those in need and to understand patients’ perspectives and emotional cop-
ing strategies with regard to their health concerns. Second, findings of the present study
have implications for the design of OSGs. Findings have shown that OSG members use
some features more often than others depending on their needs (e.g., information seek-
ing, social interaction, relaxation). Therefore, one way to optimize the OSG user experi-
ence is to screen the needs of OSG users, learn patterns of use by people with diverse
needs, and then customize the display of features according to their use patterns.
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16 J. E. Chung
Limitations and Directions for Future Research
Several limitations of the present study point to directions for future research. First,
the present study examined only one positive outcome associated with OSG use: per-
ception of support. More research is required to understand any possible negative
aspects of OSG use, such as decreased face-to-face interaction (Demiris, 2006) and
excessive reliance on OSGs (Adams, 2007; Caplan, 2003).
Second, future research should implement other study designs, such as longitu-
dinal and experimental designs, and investigate how the support received from the
use of OSGs translates into psychological and health outcomes. Research suggests
that support received from OSGs has the potential to foster feelings of empower-
ment and a sense of control and independence (Barak, Boniel-Nissim, & Suler, 2008;
van Uden-Kraan, Drossaert, Taal, Seydel, et al., 2008), which in turn bring positive
changes in health (Barak et al., 2008; Seckin, 2009). Such change in health can be
captured only in longitudinal studies. Experiments can also help clarify the causal
link between the use of each individual OSG feature and psychological and physical
outcomes.
The last limitation involves measurement. Some respondents may have inaccu-
rately recalled the frequency of their use of certain features. When coupled with sur-
vey data, system-recorded data (such as log of each participant’s connecting time,
frequency of visit, and continuity of use) can provide more accurate and complete
information about the use of OSGs (Han et al., 2009).
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