Helping you to help me: Exploring Supportive Interaction in Online Health Community

Transcription

1 Helping you to help me: Exploring Supportive Interaction in Online Health Community Katherine Y. Chuang Drexel University College of Information Science and Technology, 3141 Chestnut Street, Philadelphia, PA Christopher C. Yang Drexel University College of Information Science and Technology, 3141 Chestnut Street, Philadelphia, PA ABSTRACT People are able to express support for each other through online support groups by communicating their feelings and exchanging personalized information. In the domain of health information, this ability enables patients to connect with each other to build their own sense of community filled with healthy, supportive relationships. This paper reports a comparison of levels of social support types (informational, nurturant, and instrumental) that were identified among interactions across three different types of computer-mediated communication tools (forum, journals, and notes) from an online alcoholism support community. Findings show that people use each communication tool for different purposes, which can be associated with each tool s inherent design characteristics. Forums were used for exchanging information, whereas journals and notes were used for exchanging nurturant support. We suggest that this difference may be explained by the perceived levels of social support for each communication tool. These results can prove useful to health professionals in the development of social support systems for their patients that encourage health behavior change. Keywords Social networking, social support, healthcare INTRODUCTION People go online for many reasons, with common activities on the Internet being informational and communicative or social (Tufekci, 2008). The Internet allows people to seek help from their social networks, such as to gather information and to find support as they face important decisions (Boase et al., 2006). In 2006, the Pew Internet & American Life Research Center found that over seven million Americans searched for online health information, many of which seek help from their social networks to care for someone with a major illness or medical condition. With respect to online health behavior (Boase et al., 2006): 81% asked for health information from their core ties, and 46% from at least one of their significant ties. 17 million Americans said that the Internet played ASIST 2010, October 22 27, 2010, Pittsburgh, PA, USA. important role in helping with at least one major life decision in past 2 yrs regarding a medical condition or major illness. 28% said that the Internet helped them connect to people when seeking for help in decision making, and 30% said that the Internet allowed them to compare options. A more recent study published last year showed that, e- patients are more likely to access user-generated or justin-time someone-like-me health information(fox & Jones, 2009).. 41% of e-patients have read someone else's commentary or experience about health or medical issues on an online news group, website, or blog. 39% used a social networking site (i.e. MySpace, Facebook) 12% shared updates about themselves or viewed updates about others Surveys conducted in 2002, 2004, 2006, 2007, and 2008 consistently found that between 75-83% of internet users looked online for health information (Fox & Jones, 2009). By 2009, 60% said they or an acquaintance was helped by following medical advice or health information found on the internet. This number increased since 2006 when 31% reported being aware of helpful outcomes (Fox & Jones, 2009). Patients using online communities as support groups benefit from sharing experiences, discussing information, and exchanging social support through CMC. Social support can improve an individual s ability to cope with stress and also increase access to information (Cohen, 2004; McCormack, 2010). Sharing personal experiences may involve personal information. Information types can vary from treatment options, links to other websites, or book recommendations. Exchanging emotional support is important for building a supportive environment. Peer communication such as establishing social norms or role models and sharing feelings can also play a role in facilitating new health habits, such as quitting smoking (Ancker et al, 2009). Studying the behavior of users as they connect with others about their health concerns will give insight into better understanding of their information and emotional needs. For instance, many users join online support groups for a

2 sense of community with those who share similar experiences (Wright & Bell, 2003). Social network sites (SNS) enables users with common interests to find each other and build connections (Ahn et al, 2007), while offering a spectrum of communication spaces for individuals to communicate and provide an opportunity for the exchange of social support between users. The objective of this research is to identify the types of social support in an online healthcare social networking site across three different text-based communication tools; discussion forums, personal journals, and notes. People use these tools for different purposes in order to seek support. This study will present empirical data as evidence that people exchange different types of social support online using different tools. LITERATURE REVIEW The Internet opens a door for users to a social environment where users can communicate with each other and build a sense of belonging to a community (Hoybye et al, 2005). In particular, SNS provide users the capability to represent themselves with an online presence that contains shareable personal info, such as birthday, hobbies, preferences, photographs, writings, etc (boyd & Ellison, 2007). Convenient features allow users to form and maintain online network friends, where if one user invites another user to be friend and if accepted, a relationship is established on the website. However, this friendship does not distinguish the strength of ties. The friend feature is convenient tool to exchange messages and stay in touch. (Ahn et al, 2007) Friends can communicate through SNS in several ways, including private and public messaging systems (Thelwall & Wilkinson, 2010). We are interested in studying some of the community features that allow users to engage with each other. Computer-Mediated Communication Computer-mediated communication (CMC) is one of the ways in which individuals can exchange information and build intimacy in their relationships. Communicating online, especially through use of an SNS, provides benefits at varying levels. It encourages disparate individuals to connect, communicate, and take action (Ellison et al, 2009) especially because identity information from online profiles can assist in developing common ground and facilitate initial interactions. Relationship Maintenance Expressing emotion can be important in the daily management of relationships, for instance positive comments between friends are often observed on general SNS websites such as MySpace between friends (Thelwall & Wilkinson, 2010). Unlike in other online communities, SNS users tend to expect to gratify their social-emotional needs rather than informational needs (Rau et al, 2008). The appropriate perception and communication of emotion is important for maintaining human relationships and friendships, not just intimate relationships (Thelwall & Wilkinson, 2010). It has been observed that close friends are sources of emotional support that can help women cope in difficult times or to improve mental health (Gilbert & Karahalios, 2009; Schaefer et al, 1990; Thelwall et al, 2010). People with strong ties often communicate thru many channels (Gilbert & Karahalios, 2009; Haythornthwaite, 2002). We suspect that communication channels can reveal different types of relationships based upon type of social support identified. MedHelp Support Communities The MedHelp website provides open forums for both peer support communities and ask a doctor expert communities. Each community includes several tools through which users can interact with each other, such as discussion forums, journals, and notes. The forum for each support community is unmoderated where any MedHelp user is able to post questions and respond to them with comments. Journals allow users to record thoughts and feelings. Notes are a way for users to keep in touch with each other on MedHelp. While the communication on each of these CMC tools might be displayed publicly depending on privacy level settings (public, friends, private), the interactions on each may differ based on expected audience and the purpose of communication. Attributes for each communication tool are listed in Table 1. When posting to forum and journals, ticker data (Figure 4) can be added. All forum content created by users will be publicly accessible. Journals and notes features can be set to one of three options: Everyone, Only my friends, Only Me. New posts to the forum can be viewed on the forum page, which is also known as the support community page. Updates to public journals (new posts or new comments) are listed on the support community page under recent activity box. There is also a section that lists community members with links to their profile pages. Each profile page, displays sections regarding the user s activity in forums, on their public journal, or any public notes. If the setting for journal and notes are set to only my friends then only users who are friended may view these content. If setting is set to only me, only the user can see their own content when logged in. The content in each of these tools is organized chronologically. CMC Access Tags Other features Forum Public Yes Select topic, Add to watch list, Show Ticker Journal Notes Everyone Only my friends Only Me Everyone Only my friends Only Me Yes Show Ticker, Add Photo Add as friend

3 Table 1. Comparison of CMC Attributes Posting content The communication tools offered by MedHelp support communities include forum, journals, and notes. Each has specific formats for posting content. Users can post questions or polls to the forum. They are required to fill out a title, select a topic, describe their question, and are free to add tags (figure 1). Posting to journals can include title, entry, tags, photos, with selected privacy options (figure 2). Posting notes on a user s profile includes type of note and the content in the note (figure 3). If the user is not a friend, there is an option to befriend the user. The screen shots are shown below. Figure 3. Posting Note Figure 4. Ticker Data The research question we explore in this study is, What are the different levels of support across different communication channels? We study the patterns of interactions among the three communication tools that allow users to engage with each other in order to answer the question. Figure 1. Posting Forum Question Figure 2. Posting Journal Post APPROACH All public data from the MedHelp alcoholism community (forums, journals, notes) were downloaded via a web crawler on September 9, 2009 and saved as text files. Data spanned several years and it was too large a dataset for manageable preliminary study, so we limited analysis to three months. Three samples were selected for analysis: messages from (1) the alcoholism community forum, (2) the personal journals of users belonging to alcoholism forum, and (3) the profile notes of users belonging to alcoholism forum. Each sample contains user generated content between a three month period of June 9, 2009 and September 9, Messages contained the sender s user name, the timestamp for the message, and the content itself. Related studies used qualitative content analysis to categorize online patient community messages of discussion boards using approximately 300 messages (Eichhorn, 2008; Winzelberg, 1997). A qualitative approach was used here to classify support types because as Gilbert and Karahalios (2009) mention, emotional support is hard to quantify and there are currently no accurate methods to automatically classify natural language text for emotional content (Gilbert & Karahalios, 2009). Additionally, people engaged in interactions usually exchange more than one type of support that would require careful reading to distinguish them. After identifying social support in the interactions, the results were reported with descriptive quantitative analysis.

4 Social support definitions were developed inductively from reviewing examples from related literature and also from matching them with the data (Bambina, 2007; Cutrona & Suhr, 1992; McKenna et al, 2002; Winzelberg, 1997). First, we conducted a literature search to find related studies that identified social support types in online health communities (Chuang & Yang, 2010). Concepts and their definitions were drawn out and organized into the three categories (information, nurturant, instrumental). Next, these definitions were tested on a small sample (one month of forum posts). Afterwards, samples were coded with the support types. There are primarily two types of support found in the data informational support and nurturant support. A third type, instrumental support, is more typically found in face-to-face support groups and not found in the data. Definitions Informational Support is information relating to treatment or coping with alcoholism or withdrawal symptoms, such as clarifying the problem or making suggestions (Bambina, 2007; Eichhorn, 2008; McCormack, 2010; Radin, 2001; Winzelberg, 1997; Wright & Bell, 2003). There are five types of information identified in the data. Advice: offers ideas and suggests actions; provides detailed information, facts, or news about the situation; or skills needed to deal with situation. Offered: Campral works better...ask u r doc about it! Requested: are you suppose to like wean off the alcohol like you do drugs? Fact: reassesses the situation and presents facts. Offered: Drinking too much alcohol daily can be a high risk to your health, you might fall into alcohol addiction. Requested: is there a medicine to take to stop the craving for alcoholic drink? Personal experience: stories about person s experiences or incidents as a way of presenting information. Offered: I have been going though something like that with an addict using in our bathroom and. Requested: can I ask you why you took an unreliable test? Opinion: a view or judgment formed about something, not necessarily based on fact or knowledge. This is different from advice because it does not provide a suggestion for action, but rather thoughts on a situation. Offered: From what have you posted, it seems that you are in the stage where you have been looking to drink everyday and it is a clear sign of alcohol addiction. Requested: Am I going crazy? Referral: refers the recipient to some other source of help. Offered: Im gonna send you a link that might help. Requested: Have you tried contacting a local AA??? Nurturant Support is expressions that show signs of listening, expressing sympathy, or expressing the importance of relationship (Bambina, 2007; Eichhorn, 2008; McCormack, 2010; Radin, 2001; Winzelberg, 1997; Wright & Bell, 2003). There are three types of nurturant support: Esteem: positive comments intended to praise support seekers abilities or to alleviate their feelings of guilt. Offered: Congratulations on your sobriety! Requested: What you had to say was so good to hear. Needs to be heard Network: messages to help support seeker from feeling alone. Offered: Just reach out and I will be there ok? Requested:.u r needed in this forum!please stay in touch!!! Emotional: providing understanding of situation, express sorrow, provide with hope and confidence. Offered: You're going through a rough time... or Hang in there hon Requested: please pray for me Instrumental Support is provision of material or financial aid, or services (Cutrona & Suhr, 1992; Eichhorn, 2008). There are no examples available of this type of support from the samples. An example is offering to drive someone to Alcoholics Anonymous meeting. FINDINGS Three months of data (June 9, 2009 Sept 9, 2009) were examined using qualitative content analysis to identify the different types of support. Each message that was created in this time period was coded with multiple types of support. The three sample sizes were (n=493, n=423, and n=1180) for forums, journals, and notes respectively and summarized in Table 2. The forum and journal samples are subdivided into posts and comments. There were 81 forum posts (FP), 412 forum comments (FC), 88 journal posts (JP), and 335 journal comments (JC). A majority of FP were created by an author seeking information for him or herself, 14 by caretakers, and 11 that were unidentified. Journals have one author but anyone who can read the JP is allowed to comment. Friends and same community members are more likely to notice new posts. There were collectively 1180 notes from 74 profiles. Sample Forums Journals Notes Size N = 493 N = 423 N=1180 Posts FP = 81 JP = 88 Comments FC = 412 JC = 335 Table 2. Summary of samples Nurturant and informational were the only occurring themes, with no observation of instrumental support. Most messages had more than one support type (i.e. informational and nurturant); however each message was coded only once per support type. The results are presented first by support offered then by support received.

5 Forum Journals Summary Informational Nurturant Used for exchanging - Posts are more likely to offer and request Hardly used for nurturant support information information. - Replies are more likely to offer and request information. Used by journal keeper to document information and feelings and for supportive comments - Posts contain information, possibly to document experiences. - Replies seek information, probably to clarify type of emotional support to offer. - Posts implicitly request nurturant support. - Replies offer nurturant support. Notes Used for keeping in touch - Seeks information, mostly of the form how are you? Table 3. Summary of Results - Many messages contain expressions of nurturant support. Support Offered There were greater levels of informational support offered in the forum posts (FP) and forum comments (FC) than nurturant support. Journal posts (JP) also typically offered informational support. On the other hand, notes and journal comments (JC) were more likely to offer nurturant support. (n=81) FP (n=412) FC (n=88) JP (n=335) JC (n=1180) Notes Informational Nurturant 679 Figure 4. Support offered % of FP offered informational support, which is much more than 16% that offered nurturant support. This shows that users who create forum posts are more likely to offer information. 85.2% of FC offered informational support, whereas 66.9% offered nurturant support. This shows that users replying to forum posts are more likely to offer information than emotional support. When FP and FC results are added together, 84.7% messages offer information whereas 58.6% offers nurturant support. This shows that in general forums are a source of informational support. 92.0% of JP offered informational support, which is much more than 73.8% that offered nurturant support. This shows that users who keep journals are more likely to be documenting information. 51.2% of JC offered informational support, whereas 82.0% offered nurturant support. This shows that users replying to journal posts are much more likely to offer nurturant support. When JP and JC results are added together, 53.1% messages offer information whereas 80.3% offers nurturant support. This shows that overall, journals are a source of nurturant support. 57.5% of notes offered informational support, whereas 84.9% offered nurturant support. This shows that users posting notes on friends profiles are much more likely to express nurturant support. Support Requested Forum messages and notes were more likely to request for information than nurturant support. In contrast to the forum sample, journal posts were more likely to request nurturant support. (n=81) FP (n=412) FC (n=88) JP (n=335) JC (n=1180) Notes Informational Figure 5. Support Requested % of FP requested informational support, which is much more than 44.4% that requested nurturant support. This shows that users who create forum posts are more likely to request information. 64 Nurturant

6 15.5% of FC requested informational support, whereas 6.3% requested nurturant support. This shows that users replying to forum posts are more likely to request information, probably to clarify information being requested in the posts. When FP and FC results are added together, 24.9% messages request information whereas 15.0% sought nurturant support. This shows that overall; forums are perceived as a source of informational support. 13.6% of JP requested informational support, which is much less than 36.3% that sought nurturant support. This shows that users who keep journals are more likely to be seeking nurturant support. 8.35% of JC requested informational support, whereas 0.29% requested nurturant support. This shows that users replying to journal posts are much more likely looking for more information, maybe to clarify what kind of nurturant support to give. When JP and JC results are added together, 10.6% messages offer information whereas 14.6% offers nurturant support. This shows that overall journals are a source of nurturant support. 20.0% of notes requested informational support, whereas 1.4% requested nurturant support. This shows that users posting notes on friends profiles are much more likely to seek specific information about their friend, most likely to get updates. In comparing these three samples, it is clear that forums are used for both providing and seeking information support more than nurturant support. A summary is shown in Table 3. This difference is explored more in the following section. Information Support in Forum The bias of using the forum as an information resource brings to question the type of information being exchanged. Among the five informational support types, FP tends to exhibit only personal experiences or opinions. FC, on the other hand, exhibits all types, with mostly personal experiences and advice as leading forms of information. Referral Advice Opinion Personal Fact FP (n = 81) FC (n = 412) 0.0% 13.6% 0.0% 0.0% 4.9% 32.5% 33.3% 18.7% 74.1% 64.8% Figure 6. Information support offered FP messages sought personal experiences, advice, and referrals more often than other types. However, while FC also seeks personal experience, it happens considerably less. Perhaps the forum users are disclosing personal experiences as a strategy for seeking support. Referral Advice Opinion Personal Fact FP (n = 81) 1.7% 1.9% 1.2% 0.5% 4.9% 0.0% 16.0% 12.4% FC (n=412) 27.2% 48.1% Figure 7. Information support requested Posts include a mixture of offering opinions and personal experiences, with requests for all types of information. In this sample users do not create posts that offer information referral, advice, or facts. Perhaps there is a sense of uncertainty that brings them to the forum to post questions. Forum comments have almost the opposite effect where users offer all types of information support but mainly request some personal experience. People replying to forum posts are not seeking as much support as those who create threads. The order in which information types are sought for personal experience, advice, and referral match with those offered. Surprisingly, users offer more opinion than facts, especially when the reverse is requested. There are a

7 number of possible reasons for these patterns, and they are discussed in the next section. DISCUSSION Examining CMC interactions of non-expert participants, namely the people suffering from alcohol addiction and their caregivers allowed us to identify various types of social support in the three samples (online forum, journals, and notes) of the MedHelp Alcoholism support community. Interactions show that each tool serves a different purpose. It is valuable to study these online interactions because the internet has become a prime venue for social interaction for people sharing aspects of their daily lives (McKenna et al, 2002). We speculated that the characteristics of each communication medium will have impact on supportive interactions and our results show this is especially evident in forums, which are used as for exchanging information support. People are drawn to these support communities for information and also to form supportive relationships. Communication is important in the relationship building process, for instance keeping in touch by using emotional expressions. Our results support previous findings that users participate in online health support communities to find peers with similar experiences and to seek social support. For example, they might want to obtain an alternate source of information than what is provided by their physician, to seek personalized information, or to seek out others with understanding of the situation that are able to provide more compassion (Wright & Bell, 2003). Finding other patients is important because by listening to others stories one can discover insights about what it really feels like and what to expect next, in a way that only someone with personal experience can (Wright & Bell, 2003). It was especially evident in the forum sample, where users are exchanging informational support with each other. Additionally, participation in these communities usually consists of posting positive comments or sharing experiences and worries (McCormack, 2010). This was especially evident in the journal comments where users offer more esteem support. Participation is active in this MedHelp support community, because people in online support groups go in search of people who will listen to them and who will address everyday issues and fears that healthcare providers may either not realize or have time to address (Wright & Bell, 2003), because they have difficulty finding this type of support in person. In our study, users who create forum posts are more likely to request information and offer information. However, while they offer opinions and personal experiences, they tend to request personal experiences and advice. Perhaps a substantial part of supportive communication is in hearing multiple opinions. It is possible that these forum users are disclosing personal experiences as a strategy for seeking support from a spectrum of perspectives. It is important that users are able to exchange support, especially because social support is known to produce positive benefits for health outcomes, as well as assisting in the creation of new relationships among friends. The perceived benefits can make a patient reduce stress associated with their health condition (Bambina, 2007; McCormack, 2010; Wright & Bell, 2003). The particularly high amount of information support exchanged in the forums may be a support seeking strategy. In order for users to seek help, they need to be able to describe their problem (Eichhorn, 2008). In order for users to be helped and engage in supportive interactions, they need to be willing to open up and describe their problem. In fact, a side effect of writing ones problem is the ability for self-reflection and more clarity one s situation (Wright & Bell, 2003). There may be some differences in these online supportive interactions when compared to face-to-face interactions, such as those that occur at Alcoholic Anonymous meetings. Firstly, CMC interaction provides some anonymity as opposed to face-to-face, which allows a person to discuss fears, ask factual questions and discuss common experience to reduce isolation (Wright & Bell, 2003) and also to help each other cope with shared problems (McCormack, 2010). Although social interaction through CMC resembles face-to-face interactions, the greater anonymity can produce greater intimacy and closeness because it gets past the traditional gates such as stigma, which cause ridicule and rejection (McKenna et al, 2002). People often engage in greater self disclosure with strangers because they worry less about repeated interactions with all other friends, however, relationships may still develop closeness and intimacy faster over internet than those which began offline (McKenna et al, 2002). While users tend to attract others who are similar and share opinions and interests, sometimes physical gates such as stuttering, stigma, visible shyness, social anxiety, and physical attraction inhibit relationship formation during face-to-face interactions (McKenna et al, 2002). CMC can increase the number of potential supporters a person may receive because it helps the person overcome geographic and time constraints and also stigma (McKenna et al, 2002; Wright & Bell, 2003). The Internet is a potentially powerful tool in motivating and assisting problematic drinkers due to its anonymity and accessibility, where participants may not feel the same stigma associated with participation in face to face intervention (Humphreys, 2001). Our results show that the CMC format has impact on supportive interactions (i.e. exchanging information vs. nurturant support), for instance, the users from this study are likely to explicitly request emotional support from those they are already connected to. In particular, forum users typically exchange informational support, which may be accounted for the fact that users may feel weaker connection to those members. It may be a tool for finding answers, and not to therapeutically discuss their feelings. On the other hand, because more nurturant support was observed in the other two samples, this study supports

8 previous findings that people are more likely to express emotions with those whom they feel are close ties (Gilbert & Karahalios, 2009; Singla & Richardson, 2008). Differences in social support variation across the three samples may also be due to relationship closeness. Online communities allow people to form and strengthen relationships, but to form relationships; users must first find a shared goal and a reason to initiate contact. This is possible in the forum where users can pose questions to anyone in the community. Journals and notes are designed so that friends are more likely to keep in the loop with each other. This helps people form relationships as they are able to interact regularly (McKenna et al., 2002). The more time they spend talking with each other, the stronger this relationship is and more likely they are to share interests (i.e. quitting alcohol addiction) than a random pair of users (Singla & Richardson, 2008). Wright (1999) found that the more time people spend in an online group, the larger their online social network and the higher the satisfaction with the received support. It is valuable to study the interactions within each communication channel, since information tends to flow through the connections within a social network (Singla & Richardson, 2008) and because communication is a key component of social support to manage psychosocial stressors (Wright & Bell, 2003). In particular, studying the nurturant support will give us insight into the level of intimacy that characterizes these relationships. Emotional support is more intimate kind of support (Bambina, 2007) as it requires a relationship with a greater amount of trust and interaction to be requested or provided. (p.142). In addition, self-disclosure and partner disclosure increases people s experience of intimacy in interactions (McKenna et al, 2002). Intimacy is the greatest predictor of tie strength between two individuals in a social network, which is built upon a process of forming trust through communication (Gilbert & Karahalios, 2009; McKenna et al, 2002; Radin, 2001). Thelwall et al. (2010) suggest that SNS members should be sensitive to the emotion conveyed by friends and try to reciprocate to show support for each other (Thelwall et al, 2010). In this study, we see users exhibiting nurturant support (especially in journal comments and in notes), which probably demonstrates a more intimate nature provided by those tools. Furthermore, users may be more comfortable in requesting that type of support when using those tools through which they feel there is a closer tie. Forums are not seen as an intimate arena but rather as a tool for finding people to ask questions and fish for social support. Notes are an interesting feature for SNS, because they can help with maintaining relationships through periodic, short interactions such as notes brief communications between friends, and are essential component of the popularity of SNS (Kim & Yun, 2007). Users remind each other of their presence in notes to maintain their relationship. For instance users in this community who post notes on friends profiles are more likely to be expressing nurturant support. In addition, users replying to FP are more likely to offer information than emotional support but request information, probably to clarify information being requested in the posts. MySpace profile wall posts are found to be relatively rapid but rarely used for prolonged exchanges, because they primarily fulfill two purposes: making initial contact and keeping in touch (Thelwall & Wilkinson, 2010). The notes sample in this study showed that users left short messages for each other. On the other hand, users in this MedHelp alcoholism community who keep journals are more likely to be documenting information with long posts while implicitly seeking nurturant support. Users replying to journal posts are much more likely to be seeking specific information such as updates or clarifying what was said, but mostly to offer nurturant support. Our results support previous findings about the availability of informational and emotional support in online support groups among patients and caregivers; however there are still some limitations to this work. Because not all users are active in these neither groups nor are all relationships are created equal (Gilbert & Karahalios, 2009), it would be useful for further research to differentiate the different positions people hold in a support network. In addition, some other variables may influence the supportive communication in such groups, namely gender, culture, intimacy, audience, age, and stigma attached to illness. These could also be studied in future work. It would also be interesting to study the order of support exchanges, for instance whether support is offered preceding requests, or post requests. CONCLUSION The work has provided empirical evidence that compares different communication tools with each other as users exchange support. We started by identifying and classifying the various support types in different CMC using qualitative content analysis. Findings show that forum users were more likely to seek and provide informational support than emotional support. This deviates from findings from journal and notes, which shows higher levels of emotional support than informational support. Based on patterns found among the samples in this study, people do use each communication tool for a different purpose. The user interface does not show any explicit constraints on the type of social supports that users can seek or offer. Previous studies point to users disclosing information as a support seeking strategy, however here we speculate that users also have reasons for selecting a communication tool when seeking support. REFERENCES Ahn, Y-Y, Han, S., Kwak, H., Moon, S., and Jeong, H.. (2007). Analysis of topological characteristics of huge online social networking services. WWW '07:

9 Proceedings of the 16th international conference on World Wide Web. (pp ). New York, NY, USA. Ancker, J.S., Carpenter, K.M., Greene, P., Hoffman, R., Kukafka, R., Marlow, L.A.V., et al. (2009). Peer-to-Peer Communication, Cancer Prevention, and the Internet. Journal of Health Communication: International Perspectives, 14(1 supp 1), Bambina, A. D. (2007) Online Social Support: The Interplay of Social Networks and Computer-Mediated Communication. Cambria Press. Boase, J., Horrigan, J., Wellman, B., & Rainie, L. (2006). The Strength of Internet Ties: The internet and aid users in maintaining their social networks and provide pathways to help when people face big decisions. Pew Internet and American Life Project. Retrieved from boyd, d. m., & Ellison, N. B. (2007). Social network sites: Definition, history, and scholarship. Journal of Computer-Mediated Communication, 13, 1 (11). Chuang, K., Yang, C.C., (2010). Social Support in Online Healthcare Social Networking. Proceedings of iconference, Urbana-Champaign, IL, February 3-6, Cohen, S. (2004). Social Relationships and Health. American Psychologist, 59(8), Cutrona, C.E., & Suhr, J.A. (1992). Controllability of Stressful Events and Satisfaction With Spouse Support Behaviors. Communication Research, 19, 2 (1992), Eichhorn, K.C. (2008). Soliciting and Providing Social Support Over the Internet: An Investigation of Online Eating Disorder Support Groups. Journal of Computer- Mediated Communication, 14(1), Ellison, N., Lampe, C., & Steinfield, C. (2009). Social Network Sites and Society: Current Trends and Future Possibilities. Interactions Magazine (16) 1. Fox, S., & Jones, S. (2009). The Social Life of Health Information Americans pursuit of health takes place within a widening network of both online and offline sources. Pew Internet & American Life Project. Retrieved from Life-of-Health-Information.aspx Gilbert, E., & Karahalios, K. (2009). Predicting Tie Strength With Social Media. In Proceedings of CHI. Boston, MA. Haythornthwaite, C Strong, Weak, and Latent Ties and the Impact of New Media. Information Society, 18(5), Hoffman, M., (2008). Empathy and prosocial behaviour, In: Michael Lewis, Jeannette M. Haviland Jones, and Lisa Feldman Barrett (editors). Handbook of emotions. Third edition. New York: Guildford Press, pp Høybye, M. T., Johansen, C., & Tjørnhøj-Thomsen, T. (2005). Online interaction. Effects of storytelling in an internet breast cancer support group. Psycho-Oncology, 14(3), doi: /pon.837 Humphreys K. & Klaw E., (2001). Can targeting nondependent problem drinkers and providing internetbased services expand access to assistance for alcohol problems? A study of the moderation management selfhelp/mutual aid organization. J Stud Alcohol. 62: Kim, K., & Yun, H. (2007). Cying for Me, Cying for Us: Relational Dialectics in a Korean Social Network Site. Journal of Computer-Mediated Communication, 13 (1). Retrieved from Kramer, N. & Winter, S. (2008). Impression Management 2.0: The Relationship of Self-Esteem, Extraversion, Self- Efficacy, and Self-Presentation Within Social Networking Sites. Journal of Media Psychology: Theories, Methods, and Applications,20 (3). Kumar, R., Novak, J., and Tomkins, A. (2006). Structure and evolution of online social networks. Proceedings of 12th International Conference on Knowledge Discovery in Data Mining (KDD-2006). (pp ). ACM Press. Philadelphia, Pennsylvania, August 20-23, McCormack, A. (2010). Individuals with eating disorders and the use of online support groups as a form of social support. Computers, Informatics, Nursing: CIN, 28(1), doi: /ncn.0b013e3181c04b06 McKenna, K. Y. A., Green, A. S., & Gleason, M. E. J. (2002). Relationship Formation on the Internet: What's the Big Attraction? Journal of Social Issues, 58(1), Radin, P. M. (2001). "Hello, my friends": Social capital and transformations of trust in a grassroots breast cancer. Dissertation. University of Washington. Rau, P. P., Gao, Q., & Ding, Y. (2008). Relationship between the level of intimacy and lurking in online social network services. Computers in Human Behavior, 24(6), doi: /j.chb Schaefer, C., Coyne, J. C., et al. (1990). The Health-related Functions of Social Support. Journal of Behavioral Medicine, 4(4), Singla, P., & Richardson, M. (2008). Yes, there is a correlation: - from social networks to personal behavior on the web. In Proceeding of the 17th international conference on World Wide Web (pp ). Beijing, China: ACM. doi: /

10 Steinfield, C., Ellison, N., and Lampe, Cliff. (2008). Social capital, self-esteem, and use of online social network sites: A longitudinal analysis. Journal of Applied Developmental Psychology,29 (6). Stoppard, J. M., & Gunn Gruchy, C. D. (1993). Gender, Context, and Expression of Positive Emotion. Pers Soc Psychol Bull, 19(2), Thelwall, M. and Wilkinson, D. (2010). Public dialogs in social network sites: What is their purpose?. Journal of the American Society for Information Science and Technology,61(2), Thelwall, M., Wilkinson, D, and Uppal, S.. (2010). Data mining emotion in social network communication: Gender differences in MySpace. Journal of the American Society for Information Science and Technology,61(1), Tufekci, Zeynep. (2008). Can You See Me Now? Audience and Disclosure Management in Online Social Network Sites. Bulletin of Science and Technology Studies. Wellman, B., Quan Hasse, A.J., Boase,, J., Chen, W., Hampton, K., de Diaz, I., Miyata, K., (2003). The social affordances of the Internet for networked individualism, Journal of Computer Mediated Communication, 8(3), at Winzelberg, A. (1997). The analysis of an electronic support group for individuals with eating disorders. Computers in Human Behaviour, 13, Wright, K. B., & Bell, S. B. (2003). Health-related Support Groups on the Internet: Linking Empirical Findings to Social Support and Computer-mediated Communication Theory. J of Health Psychology, 8(1), doi: / Wright, K.B. (1999). Computer-mediated support groups: An examination of relationships among social support, perceived stress, and coping strategies. Communication Quarterly, 47(4):