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Communication in health-related online social

support groups/communities: a review of research
on predictors of participation, applications of social
support theory, and health outcomes
Wright, Kevin B.

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Wright, K. B. (2016). Communication in health-related online social support groups/communities: a review of research
on predictors of participation, applications of social support theory, and health outcomes. Review of Communication
Research, 4, 65-87. [Link]

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OPEN ACCESS Top-Quality Science Review of Communication Research
Peer Reviewed 2016, Vol.4
Open Peer Reviewed doi: 10.12840/issn.2255-4165.2016.04.01.010
Freely available online ISSN: 2255-4165

Communication in Health-Related Online Social Support

Groups/Communities: A Review of Research on Predictors
of Participation, Applications of Social Support Theory,
and Health Outcomes

Kevin B. Wright
George Mason University, VA. USA
kwrigh16@[Link]

Abstract

This article reviews literature on online support groups/communities for individuals facing health concerns. Spe-
cifically, the article focuses on predictors of online support group/community participation, major theoretical frame-
works that have been applied to the study of online support groups/communities, and coping strategies and health
outcomes for individuals facing health concerns. Finally, the article discusses the strengths and limitations of existing
empirical studies in this area; presents a critique of the relative merits and limitations of a number of theoretical
frameworks that have been applied to the study of online support groups/communities for people facing health con-
cerns; and it provides an agenda for future communication research on health-related online support groups/com-
munities.

Highlights

• Overview of growth and impact of online support groups/communities

• Predictors of online support group/community participation
• Key theoretical frameworks applied to online support groups/communities
• Critique of online support group theory and empirical studies
• Overview and critique of online support groups/communities and health outcomes
• Agenda for future research

Suggested citation: Wright, K. B. (2016). Communication in Health-Related Online Social Support Groups/
Communities: A Review of Research on Predictors of Participation, Applications of Social Support Theory, and
Health Outcomes. Review of Communication Research, 4, 65-87. doi:10.12840/issn.2255-4165.2016.04.01.010

Keywords: Online Social Support Groups/Communities, Health Communication, Social Support Theory, Computer-
Mediated Communication, Coping, Health Outcomes

Editor: Giorgio P. De Marchis, Universidad Complutense de Madrid, Madrid, Spain

Received: April 20 th , 2015 Open peer review: Oct. 14 th Accepted: Jan. 23 rd Published: Jan. 31st , 2016
Kevin B. Wright

Content

GROWTH OF ONLINE SUPPORT GROUPS/COMMUNITIES...........................67

PREDICTORS OF PARTICIPATION IN ONLINE SUPPORT GROUPS/COMMU-
NITIES................................................................................................................68
Limited Access to Adequate Support within Traditional Social Network(s)............68
Health-Related Stigma.......................................................................................68
Perceived Similarity/Credibility of Online Support Providers...............................69
Convenience and Other Features of Computer-Mediated Communication.............69
KEY THEORETICAL FRAMEWORKS USED IN THE STUDY OF ONLINE
SUPPORT GROUPS/COMMUNITIES................................................................69
The Buffering Effect Model................................................................................70
The Optimal Matching Model............................................................................71
Social Comparison Theory ................................................................................72
Social Information Processing Theory/Hyperpersonal Interaction .......................73
Strength of Weak Ties Theory............................................................................74
OVERALL CRITIQUE OF THEORETICAL FRAMEWORKS USED IN ONLINE
SUPPORT GROUP/COMMUNITY STUDIES.....................................................75
ONLINE SOCIAL SUPPORT GROUPS/COMMUNITIES, COPING, AND HE-
ALTH OUTCOMES.............................................................................................76
Online Social Support and Coping .....................................................................76
Online Social Support and Health Outcomes.......................................................77
LIMITATIONS OF EXISTING ONLINE SUPPORT GROUP/COMMUNITY
RESEARCH/THEORY AND AN AGENDA FOR FUTURE RESEARCH.............79
CONCLUSION....................................................................................................80
REFERENCES....................................................................................................80
COPYRIGHTS AND REPOSITORIES.................................................................87

The ability to effectively mobilize social support fol- McKay, 1984; Goldsmith, 2004; Thoits, 2011). In the past
lowing a stressful life event is central to a person’s health 15 years, scholars from many disciplines, including com-
and well-being (Goldsmith, 2004; Uchino, 2004). Few life munication, have become increasingly interested in the
events are as stressful as being diagnosed with a disease, growing use of new technologies, such as the Internet and
living with chronic illness, or managing other physical social media, for social support in terms of helping indi-
or mental health concerns. The benefits of social support viduals cope with health-related issues (Chen & Choi,
have been demonstrated across a wide variety of contexts 2011; Gustafson et al., 2005; Lieberman & Goldstein,
and populations in terms of helping individuals cope bet- 2006; Tanis, 2008; Wright & Bell, 2003; Wright, Johnson,
ter with health-related problems, and leading to positive Averbeck, & Bernard, 2011).
psychological and physical health outcomes (Cohen & The ubiquitous use of personal computers and mobile

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 Communication in Health-Related Online Social Support Groups/Communities

devices, coupled with a growing ease of access to the from these earlier reviews by including both empirical
Internet, has proliferated online support groups/com- work as well as theoretical perspectives that have been
munities. While there are no widely accepted definitions applied to the study of online social support in previous
in the literature, one definition that has been used to communication research in an attempt to organize what
some extent is Preece’s (2001) contention that an online often appear to be disparate areas of research and theory
support community is “any virtual social space where development in the online support groups/community
people come together to get and give information or literature. For example, many theories relevant to online
support, to learn, or to find company” (p. 348). The support are discussed at length in certain types of publi-
popularity and expansion of online support groups/ cations (mostly book chapters), but only a small amount
communities as well as other, less formal, types of online of space is typically devoted to theory in published em-
social support groups (e.g., informal groups within Face- pirical studies in the online support literature. The current
book) have led social support researchers to investigate article attempts to discuss both theoretical and empirical
a variety of communication phenomena related to online work in greater depth than is seen in previous reviews.
support groups/communities. Despite a growing amount Finally, the article discusses the strengths and limitations
of theory development and empirical research in this of existing empirical studies in this area; presents a cri-
area, there remain many questions regarding the psy- tique of the relative merits and limitations of a number
chological and relational predispositions of online sup- of theoretical frameworks that have been applied to the
port group/community participants, social support com- study of online support groups/communities for people
munication processes, and the relationships among social facing health concerns; and it provides an agenda for
support and key health outcomes. future communication research on health-related online
In an attempt to shed light on these questions, this support groups/communities.
article reviews the current literature on communication
issues related to social support within online support Growth of Online Support
groups/communities for individuals facing health con- Groups/Communities
cerns. While social support for health-related concerns
certainly occurs in other contexts of online communica- Over the past two decades, we have witnessed tremen-
tion (e.g., personal emails, texts) as well as in face-to-face dous growth in online social support group/community
interactions, covering the literature on these everyday activity. The use of online support groups/communities
types of social support is beyond the scope of this article. for people facing health concerns has proliferated during
Specifically, this article focuses on theoretical and em- this time period, expanding from several thousand sup-
pirical studies that have been published within the com- port groups/communities in the late 1990’s to hundreds
munication and health communication literature (and of thousands of groups/communities by 2012 (National
some from related disciplines, such as public health, Cancer Institute, 2013; Fox, 2012; Koch-Weser, Bradshaw,
nursing, and psychology) during the past 15 years. The Gualtieri, & Gallagher, 2010; Wright & Bell, 2003). Sev-
author searched for relevant literature by conducting key eral studies within the last five years have documented
word searches for terms related to communication and the growth of online information-seeking and support for
online social support groups/communities on various people coping with health concerns. For example, 60%
search engines in an effort to locate articles and book of adult Internet users in 2011 reported that they engaged
chapters for the review. In addition, the typology for the in online activities such as reading someone else’s com-
current review (e.g., the major sections of the article mentary or experience about health issues (Fox, 2011).
presented below) was also derived from examining themes The National Cancer Institute (2013) estimates that 15%
from existing published reviews and/or meta-analyses of all adult Americans used a health-related peer support
of online support groups/communities (See Hong, community during 2012. Finally, data from the Pew
Pena-Purcell, & Ory, 2012; Mo, Malik, & Coulson, 2009; Internet and American Life Project (Fox, 2012) suggest
Rains, Peterson, & Wright, 2015; Rains & Young, 2009; that one in five Internet users used online groups/com-
Wright & Bell, 2003). However, the current article differs munities for peer support during 2011.

67 2016 , 4, 65-87
Kevin B. Wright

Predictors of Participation in Online Support

Groups/Communities is low). In general, online support has been shown to be
an important resource which helps people to connect with
others, gather information, share experiences, and reduce
The following sections examine each of the following uncertainty about health-related issues (Chen & Wellman,
predictors of participation in online support groups/com- 2008; Chen & Choi, 2011; Tanis, 2008). Similarly, older
munities: (1) limited access to adequate support within adults or people with disabilities may have limited mobil-
traditional social network(s), (2) living with health-relat- ity, making it difficult to form and maintain relationships
ed stigma, (3) perceived similarity/credibility of support with others in the off line world (Braithwaite, Waldron,
providers, and (4) convenience and other features of & Finn, 1999). As a result, they may voluntarily withdraw
computer-mediated communication. from interacting with members of off line networks and
turn to the convenience of online support in an effort to
Limited Access to Adequate Support within reduce feelings of loneliness and social isolation.
Traditional Social Network(s)
Health-Related Stigma
A variable that appears to predict whether or not in-
dividuals participate in online support groups/communi- A second important predictor of participating in some
ties (as well as their sustained membership in these groups) type of online support group/community is the degree to
is if they experience limited access to traditional face-to- which individuals feel they are stigmatized because of the
face social support resources. Compared to face-to-face health issues they face (Ballantine & Stephenson, 2011;
support networks, online health support groups/com- Faith, Thorburn, & Sinky, 2016; Lewis, Thomas, Blood,
munities are frequently used by individuals with rare Castle, Hyde, & Komesaroff, 2011; Rains, 2014; Wright
health conditions/issues that are not well understood by & Rains, 2013). Health-related stigma is a significant
physicians, conditions/issues that are difficult for health problem that many individuals facing health concerns
care providers to explain in layperson terms, or if members have to deal with on a daily basis (Herek & Glunt, 1988).
of one’s primary social network (i.e., friends and family It has been linked to reductions in the size of individuals’
members) have limited knowledge of their health condi- support networks, problems discussing concerns with
tion (Campbell-Grossman, Hudson, Keating-Lef ler, & others, dissatisfaction with one’s support network, reduced
Heusinkvelt, 2009; Tanis, 2008; Tong, Heinmann-LaFave, compliance with treatment recommendations, and in-
Jeon, Kolodziej-Smith, & Warshay, 2013). Due to these creased health problems (Vanable, Carey, Blair, &
issues, many people feel that they receive inadequate Littlewood, 2006). Stigmatized health issues have been
informational support from their traditional social net- linked to increased stress and depression (Riggs, Vosvick,
works and health care providers; and they may perceive & Stallings, 2007; Wolitski, Pals, Kidder, Courtenay-
online support groups/communities as a better alternative Quirk, & Holtgrave, 2008), substance abuse, anxiety, and
for receiving health information (Wicks et al., 2010). increased physical health problems (Duncan, Hart,
Online sources of social support appear to replace or Scoular, & Bigrigg, 2001).
extend traditional off line support networks in terms of These negative health effects of stigma can even be
providing greater access to the increased social capital seen within the general health care system. Individuals
available in a larger, easier to maintain, network of indi- who live with stigmatized health problems are less likely
viduals who are often geographically separated (Chung, to benefit from the depth and breadth of available physi-
2013; Ellison, Steinfield, & Lampe, 2007; Walther & Boyd, cal health care services than people with non-stigmatized
2002). The Internet can help individuals facing health health concerns (Corrigan & Phelan, 2004). Another form
concerns during times of stress and transition to access of stigma, self-stigma, refers to perceptions that oneself
new networks of support, such as connections with others is socially unacceptable as a result of some f law or char-
facing the same or similar transitions and stressors (such acteristic, including living with a health problem (Vogel,
as if a person moves to a small town where the likelihood Wade, & Haake, 2006). Research by Vogel, Wade, and
of meeting others living with a similar health condition Hackler (2007) indicates that greater levels of public

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 Communication in Health-Related Online Social Support Groups/Communities

Convenience and Other Features of

stigma are associated with greater levels of self-stigma, Computer-Mediated Communication
which result in less favorable attitudes toward treatment
and a lower willingness to seek support. Self- perceptions Several studies have found that participation in online
of health-related stigma can lead to diminished levels of support groups/communities is inf luenced by perceptions
self-esteem and self-efficacy (Herek & Glunt, 1988). of the convenience, f lexibility, and relative anonymity of
Researchers have found that people with stigmatized computer-mediated communication associated with these
health problems are drawn to online support groups/ groups. For example, online support groups/communities
communities because these groups/communities help typically include greater accessibility (e.g., lack of time
them to manage stigma (Lewis et al., 2011; Rains, 2014; and travel constraints), anonymity, and the ability to
Wright & Miller, 2010; Wright & Rains, 2013). obtain information without having to personally interact
with others (Eichhorn, 2008; Green-Hamann, Campbell
Perceived Similarity/Credibility of Online Eichhorn, & Sherblom, 2011; Wright & Bell, 2003) com-
Support Providers pared to face-to-face forms of social support. Unlike
face-to-face support groups, online support venues offer
A third predictor of participation in online support participants access via computer and other Internet ac-
groups/communities is perceived similarity. Perceived cessible devices 24 hours a day and access to potential
similarity predisposes people to more attraction, trust, support providers all over the world. So, it is not surpris-
and understanding than one would find in dissimilar ing that researchers have found that perceived convenience
individuals. Close, personal networks tend to be homoph- is associated with participation in these groups (Tanis,
ilous, although even weaker ties online can exhibit situ- 2008; Wright & Bell, 2003). Online support groups/com-
ational similarity (Walther & Boyd, 2002; Wright, 2000) munities can also help people overcome accessibility
in terms of stressful situations (i.e. health problems) that barriers and high service fees associated with other (more
online communicators have in common. Similarity be- traditional) sources of information and support, such as
tween a sender and receiver may increase the persuasive- therapy (Barrera, Glasgow, McKay, Boles, & Feil, 2002).
ness of the messages that are exchanged in online support The asynchronous and mediated nature of online com-
groups/communities. For example, Wang, Walther, munication helps alleviate time and space barriers that
Pingree, and Hawkins (2008) showed that perceived sim- exist for support settings that require the simultaneous
ilarity of support group members inf luenced perceptions presence of conversational partners (Turner, Grube, &
of their credibility and, in turn, the evaluation of health Meyers, 2001). In addition, the anonymity of online
information they provided. In addition, Wright (2000) groups/communities appears to inf luence increased self-
and Campbell and Wright (2002) found that similarity disclosure of one’s health issues to other group/commu-
was a key perception that was associated with social sup- nity members (Huang, 2016; Li, Feng, Li, & Tan, 2015;
port satisfaction with support providers within health- Wright & Bell, 2003).
related online support groups (which may be a motivation Future research should continue to examine these and
to participate). Perceptions of similarity appear to be other predictors of online support groups/communities
particularly important in cases where individuals are using studies that draw upon broader, more diverse, sam-
living with a relatively unique life stressor, such as a rare ples of individuals who both currently use (and those who
disease. Online support groups/communities can facilitate do not currently use) health-related online support groups/
the process of bringing people with rare diseases togeth- communities.
er. Moreover, the collective experience of the many peo-
ple who make up these groups/communities along with Key Theoretical Frameworks Used
the information they possess is often perceived as more in the Study of Online Support
credible than the information a person receives from Groups/Communities
health care providers (Coulson, Buchanan, & Aubeeluck,
2007; Hu & Sundar, 2009). This section provides an overview and analysis of key
theoretical frameworks that have been used in the study

69 2016 , 4, 65-87
Kevin B. Wright

of online support groups/communities as well as an over- In another study, Wright (1999) examined social sup-
view of studies that have drawn upon them. While sev- port, perceived stress, and coping strategies among 148
eral of these theories originated outside of the communi- people from twenty-four health-related online support
cation discipline (e.g., psychology), communication groups. The results indicated that the amount of time a
scholars have drawn upon them to help explain a variety person reported spending communicating with others in
of communication issues related to social support within on-line support groups was positively related to the size
online groups/communities. of his or her support group network and satisfaction with
the support he or she received in online support groups.
The Buffering Effect Model Satisfaction with both on-line supportive relationships
and face-to-face supportive relationships was correlated
One prominent social support theory that has been with degree of reduction in perceived life stress. Simi-
applied to the study of online support groups/communi- larly, Wright (2000), in another study that drew upon a
ties is the buffering effect model. Cobb (1976) first intro- buffering effect model perspective, investigated older
duced the concept of the buffering model to explain how adults using SeniorNet (largely for health-related con-
social support can protect a person against stress. The cerns). This study revealed that greater involvement with
buffering effect model states that psychosocial stress will the online community was predictive of significantly
have negative effects on the health and well-being of those lower perceived life stress.
with little or no social support. Psychosocial stress can Cumming, Sproull, and Kiesler (2002) drew upon the
be defined as both acute and cumulative life and rela- buffering effect model in random sample survey of an
tional events that increase physiological responses in the online support group for people coping with hearing loss.
limbic system. While most studies have focused on nega- Their study revealed that two factors predicted more ac-
tive stressful events, positive events (e.g., marriage, the tive participation in the group: (1) a lack of real-world
birth of a child) can trigger physiological responses. How- social support and (2) being comparatively effective
ever, those with strong support systems tend to experience (i.e., having less disability and/or coping more effec-
lessened or no negative effects on their health and well- tively). In line with the buffering model, their findings
being (Cohen & McKay, 1984; Thoits, 2011). revealed more active participation in the group was as-
In terms of online support group/community studies sociated with greater self-reported psychosocial benefits,
that have drawn upon the buffering effect model, Bass, including better coping and emotional well-being. These
Mcclendon, Brennan, and Mccarthy (1998) investigated authors also found that for some participants, increased
ComputerLink, a computer support network for family participation in the online group was related to increased
caregivers of people with Alzheimer’s disease. In a integration of potential supporters into people’s off line
12-month experiment, 102 caregivers were randomly as- social networks. Additionally, Eastin and Rose (2005),
signed to an experimental group that had access to Com- drawing from a buffering model perspective, found that
puterLink or to a control group that did not. This inves- online support activity increased online network size and
tigation examined whether caregivers in the experimental increased overall levels of perceived social support for
group had greater reductions in four types of care-related people seeking online support for a variety of issues, in-
strain by the end of the 1-year study. The results indi- cluding health concerns.
cated that ComputerLink reduced certain types of strain Rains and Young (2009) conducted a meta-anal-
if caregivers also had larger informal support networks, ysis of 28 published online support group studies dealing
were spouses, or did not live alone with their care receiv- with people coping with health concerns, found that
ers. More frequent use of the communication function greater participation in their online support groups was
was related to significantly reduced strain for caregivers related to increased perceived support, reduced depres-
who were initially more stressed and for non-spouse care- sion, increased quality of life, and increased self-efficacy
givers. Greater use of the information function was re- in terms of managing health problems. These authors
lated to significantly lower strain among caregivers who argue that the findings are consistent with the buffering
lived alone with care receivers. effect model. This study is one of the few that provides

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 Communication in Health-Related Online Social Support Groups/Communities

empirical support for the buffering effect model across tive health outcomes. Yet it is also possible that a recipi-
online support group studies. ent of support may perceive some types of support nega-
Although the buffering model has been used widely tively. For example, people may be reluctant to disclose
in social support research (mostly in face-to-face sup- certain problems or issues with members of their tradi-
portive contexts), the literature suggests that empirical tional face-to-face social networks in cases where there
support for the theory is best garnered using longitudinal are relational difficulties. Such a case may be when indi-
designs and careful controls for other variables that may viduals feel they will be judged by others due to behaviors
inf luence stress levels. Unfortunately, none of the online related to their health problem (e.g., substance abuse,
support group/community studies to date have employed risky sexual behavior), or if they are coping with a prob-
a longitudinal design, and most have only controlled for lem that is difficult or embarrassing to talk about
a few demographic variables at best. While the buffering (Adelman, Parks, & Albrecht, 1987; Albrecht & Goldsmith,
model appears to be sound theoretically, relatively little 2003; Green-Hamman & Sherblom, 2014; Wright & Miller,
is known about how features of the computer-mediated 2010).
environment may inf luence the stress-buffering effects of Other studies have shown role obligations and reciproc-
social support (that have been observed in face-to-face ity issues associated with traditional (off line) close ties
contexts). In addition, all of the online support group/ can lead to problems in the provision of social support,
community studies to date have relied completely on self- and thus suboptimal support. Supporting a loved one who
report measures while face-to-face studies have used more is ill, for example, can lead to increased conf lict, resent-
sophisticated measures of stress (such as measuring cor- ment, and negative feelings for both parties involved
tisol in the bloodstream). The buffering model was also (Albrecht & Goldsmith, 2003). Moreover, much of the
developed pre-Internet, and less is known about how the research using the optimal matching model has focused
negative aspects of the Internet and social media may on the controllability of a stressor (Cutrona & Russell,
detract from or compliment the effects of support received 1990; Cutrona & Suhr, 1992). Uncontrollable stressors
online. are those in which an individual has relatively little po-
tential to avoid the event or mitigate its consequences. As
The Optimal Matching Model proposed by Cutrona and colleagues, action-facilitating
types of support (i.e., information and tangible) tend to
Another theoretical framework that has received a be more useful for a controllable stressor (Cutrona &
large amount of attention in the online support group/ Russell, 1990; Cutrona & Suhr, 1992). Action-facilitating
community literature is the optimal matching model support can help the receiver engage in behavior that will
(Cutrona & Russell, 1990). Developed in the context of address the stressor or its consequences. McLaren and
face-to-face social support, the optimal matching model High (2015), drawing upon an optimal matching model
(Cutrona & Russell, 1990) suggests that matching the framework, found that being over-benefited in informa-
specific type of support offered with the dimensions of a tional support and being under-benefited in emotional
stressor (e.g., desirability, controllability, life domain, and esteem support is hurtful, and hurt corresponded
and duration of consequences) produces the most positive with negative relational consequences and reduced esteem
outcomes. For example, if an individual is seeking emo- improvement in a study of supportive relationships.
tional support for a health concern and he or she perceives The model has provided some important insights into
that members of his or her support network have expressed the supportive needs of individuals who seek support
empathy, and acknowledged the severity of the issue, then within online support groups/communities. For example,
this would be considered an example of an optimal match in one of the first online support group studies to use this
between the support seeker and support providers. framework, Braithwaite et al., 1999) conducted a content
Goldsmith (2004) contends that optimal matches in analysis of online support groups for people with dis-
supportive episodes may lead to more positive perceptions abilities. Their study found that the largest percentage of
of relational partners and the type of support that is being these messages offered emotional and informational sup-
offered, and this, in turn, may ultimately inf luence posi- port, whereas companionship and tangible assistance were

71 2016 , 4, 65-87
Kevin B. Wright

least frequently offered. They also found that many of the matches are predictive of key health outcomes, such as
support messages directly addressed limitations and chal- reduced stress, lower depression, increased coping abil-
lenges associated with disability-related mobility, social- ity, and improved physical health. Future research would
ization, and self-care. This study illustrates that online benefit from more elaborate designs that examine the link
support group/community participants typically seek between optimal support matching (or suboptimal
specific types of support that optimally meets their needs matching) and specific health outcomes. Such empirical
(as opposed to seeking a wide variety of support). In an- work would be helpful in terms of refining this theory,
other early study, Turner, Grube, and Meyers (2001) used particularly if it can account for computer-mediated inf lu-
optimal matching theory as a framework for explaining ences of the type and quality of support offered and re-
social support processes within online cancer support ceived in this context.
communities. These authors compared online participants’
perceptions of illness support from the list with the sup- Social Comparison Theory
port they received from a non-mediated relationship. The
findings indicated that people participated more within Social comparison theory (Festinger, 1954) has been
the online community only when they perceived that the another useful framework for understanding the process
depth and support that they received from the online of social support within online groups/communities.
community was high, and when the depth and support Within the context of health-related support, individuals
they received from the specific person in their life was make assessments about their own health and coping
low. mechanisms by comparing them to others in their social
More recently, Rains et al. (2015) conducted meta- network (Helgeson & Gottlieb, 2000). Helgeson and Got-
analytic review of published content analyses of online tlieb (2000) argue that lateral comparisons, comparisons
support groups drawing upon an optimal matching mod- to similar others, may normalize people’s experiences and
el framework. Across the 41content analyses examining reduce uncertainty and stress for those dealing with health
social support messages shared in health-related groups/ concerns. However, when individuals compare themselves
communities online, the prevalence of particular types to others, their self-assessment could be either positive or
of support messages varied based on several stressor negative. For example, if a person with cancer feels that
dimensions relevant to illness. In other words, the most he or she is coping with problems less effectively than
frequently offered types of social support were associated others in his network (such as a friend or relative who has
with the specific support needs of participants, implying or had cancer or a similar life-threatening illness), this
that people living with health concerns gravitate toward may create upward comparisons. This, in turn, could
groups/communities that offer very specific types of sup- produce feelings of frustration or serve as a source of
port (that optimally match their needs) as opposed to a inspiration to the person to cope more effectively by
wide variety of support messages. Rains et al. (2015) found emulating the successful behaviors of those other members.
that nurturant forms of support (i.e., emotional support; Conversely, downward comparisons to others in the social
validation) were more common among content analyses network, such as when an individual feels that he or she
examining health conditions likely to threaten personal is coping better than other members, can lead to positive
relationships and involve loss in the form death. Action- self-assessments and/or to negative feelings about people
facilitating types of support were more common among if interaction with the other members is perceived as be-
content analyses examining more chronic conditions. ing unhelpful.
While the optimal matching model has been applied Studies have found that participants often glean infor-
to several online support group/community studies in mation about the status of their health issues through
recent years, the existing research has been largely lim- social comparisons that take place within supportive
ited to counting the most frequent type of support offered interactions in online support groups/communities
within particular online support groups/communities or (Batenburg & Das, 2015; Vilhauer, 2009; Wright & Bell,
some stratification within such groups (e.g., age, sex, type 2003). Such social comparison processes do not even
of illness) as opposed to examining whether or not optimal require actual participation in the online group; rather,

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 Communication in Health-Related Online Social Support Groups/Communities

individuals may engage in these practices passively by foster anticipation of future interaction. Message receiv-
reading the posted group discussions. However, there are ers, in turn, tend to idealize the image of the sender due
also several significant limitations of support commu- to overvaluing minimal, text-based cues. Idealized per-
nity participation from a social comparison perspective. ceptions and optimal self-presentation in the computer-
The most common involves stress resulting from hearing mediated communication process tend to intensify in the
about difficulties experienced by other community mem- feedback loop, and this can lead to what Walther (1996)
bers (Holbrey & Colson, 2013; Malik & Coulson, 2008). labeled as “hyperpersonal interaction,” or a more intimate
Other drawbacks include social comparisons with others and socially desirable exchange than in face-to-face in-
who are improving (Malik & Coulson, 2008) and becom- teractions.
ing negatively focused on one’s illness (Holbrey & Coulson, Hyperpersonal interaction is enhanced when no face-
2013). to-face relationship exists, so that users construct impres-
Unfortunately, the existing online support group/ sions and present themselves “without the interference of
community studies that have drawn upon social com- environmental reality” (Walther, 1996, p.33), and it ap-
parison theory have not assessed the degree to which pears to skew perceptions of relational partners in positive
upward, downward, and lateral social comparisons inf lu- ways, and in some cases, online relationships may exceed
ence key variables like health information seeking and face-to-face interactions in terms of intensity (King &
health-related behaviors. For example, research using Moreggi, 1998; Walther, 1996; Wright, 2000). Despite the
social comparison theory could be strengthened by link- fact that individuals often disclose negative aspects of
ing a social comparison (such as an upward comparison) their health concerns, these studies have used hyperper-
to specific behaviors. For example, it would be helpful to sonal interaction to explain why online support group
know if when a person makes an upward comparison to participants develop positive perceptions about support
another online support group member whether or not he providers and often prefer online support over tradi-
or she emulates the types of behaviors of this person. tional face-to-face support. For example, Wright (2000)
Existing online support group/community studies using found that online support group participants perceived
this framework have not been able to demonstrate an others in the group to be more interpersonally competent
empirical link between social comparisons and health- and able to provide higher quality support than members
related behaviors or outcomes. Furthermore, current of their face-to-face network.
studies using this theory have been limited to qualitative Moreover, according to Walther (1996), the reduced
studies or cross-sectional survey research. number of available nonverbal cues in CMC increases
message-editing capabilities, and the temporal features
Social Information Processing Theory/ of CMC allow communicators to be more selective and
Hyperpersonal Interaction strategic in their self-presentation, form idealized impres-
sions of their partners, and, consequently, engage in more
A fourth theoretical perspective that has been useful intimate exchanges than people in face-to-face situations.
in terms of understanding the effects of computer-medi- These features of computer-mediated communication
ated channels on the perceptions of individuals who par- appear to offer people more interactional control over
ticipate in online support groups/communities is Social face-to-face communication, and they appear to inf luence
Information Processing Theory (Walther, 1992). Specifi- perceptions of the attractiveness of online relational part-
cally, the ways in which features of computer-mediated ners. For instance, Walther, Slovacek, and Tidwell (2001)
communication (CMC) alter participant perceptions of found that individuals rated online interaction partners
others within online support groups/communities (Walther as more socially attractive and affectionate when a photo
& Boyd, 2002; Wright & Bell, 2003) has been the focus was not present compared to those who did view a photo
of several studies. Walther (1992) asserts that within the of the interaction partner. In addition, dyads in comput-
context of computer-mediated communication (CMC), er-mediated settings also appear to self-disclose more than
message senders portray themselves in a socially favorable face-to-face dyads (Tidwell & Walther, 2002).
manner to draw the attention of message receivers and In terms of online support groups/communities, Wright

73 2016 , 4, 65-87
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(2000) found that older adults using SeniorNet reported well as components that predict positive changes in per-
disclosing information about their health to anonymous ceptions of support providers/supportive messages.
members of the online community that they were reluctant
to discuss with family members and friends in face-to-face Strength of Weak Ties Theory
settings. Anonymity led seniors using the community to
feel safer disclosing health information within the online Finally, a fifth theory that has been applied to the
group. Walther and Boyd (2002) found that hyperper- st udy of on li ne suppor t g roups/com mun it ies is
sonal interaction within online support groups/commu- Granovetter’s Strength of Weak Ties theory (1973). This
nities enhanced the attractiveness of seeking support theory posits that the spread of social support is dependent
within this context. In particular, these researchers found upon the structure of communication networks in com-
that perceived social distance from other participants munities. Specifically, social networks tend to be made
facilitated perceptions of reduced risk in terms of disclos- up of strong ties (such as close friends and family) as well
ing sensitive or stigmatized issues (including health con- as weak ties (such as coworkers, acquaintances, and peo-
cerns). Eysenbach (2003) drew upon social information ple with whom one has infrequent contact). Small clusters
processing theory, and found that anonymity of virtual made up of an individual and his or her strong ties may
support communities was particularly helpful in terms of be linked to other strong tie clusters by weak ties. Without
facilitating the participation of men living with health weak ties, communication can only f low among small
concerns to interact with others within these groups. clusters, and groups become information saturated. Weak
Eysenbach (2003) argued that the reduced cues in this ties reach larger numbers of people and longer distances
environment were particularly helpful for men to obtain than strong ties. Weak tie networks also offer greater op-
online support for health concerns since they tend to be portunities for the dissemination of informational support
culturally and socially conditioned not to ask for help and to a larger number people in comparison to information
support. through strong tie networks alone (Granovetter, 1973).
Although the online support group/community stud- The strength of weak ties theory is essential in adding an
ies mentioned above have used Social Information element of structure to understanding online-supportive
Processing Theory (particularly the concept of hyperper- interactions and for distinguishing the roles and relation-
sonal interaction) to explain attraction to using online ships inherent in the different positions people hold with-
support groups/communities and how perceptions of in online networks.
relational partners may become skewed in this context, Individuals often seek support through weak tie net-
no studies have directly manipulated or tested the effects works instead of within their strong tie network because
of hyperpersonal interaction on perceptions of support weak tie networks can provide access to more diverse
providers and supportive messages. Rather, these studies points of view and information that may not be available
simply used the theory to explain how characteristics of within more intimate relationships (Adelman et al., 1987).
computer-mediated communication may skew perceptions Typically, individuals form close relationships with others
of support providers/messages in positive ways. Future who are similar to them in terms of demographics, atti-
research would benefit from experimental studies that tudes, and backgrounds. This homogeneous preference
could directly test the effects of hyperpersonal interaction can limit the diversity of information and viewpoints
on online support group/community participants. More- obtained about topics, including health concerns. Access
over, other theories, such as the Social Identification and to more diverse viewpoints about health problems can
Deindividuation Effects (SIDE) Model (Postmes, Speares, provide individuals with more varied informational sup-
& Lee, 2000) posit that reduced nonverbal and social cues port about health issues, and interacting with varied types
in text-based CMC tend to facilitate negative forms of of people increases the number of social comparisons a
communication (such as “f laming” or strongly attacking person can make about his or her health condition vis-à-
others or their ideas). Future theoretical work in this area vis others (Adelman et al., 1987). In addition to diversity
would benefit from identifying elements of CMC that are of informational support, weak tie network members can
more likely to lead to negative shifts in perceptions as also be a source of emotional support (Colineau & Paris,

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 Communication in Health-Related Online Social Support Groups/Communities

2010; Winefield, 2006; Wright & Bell, 2003). According strength of ties among participants within online support
to Colineau and Paris (2010), people choose weak tie group/community. Social network analysis provides a
networks because of the members’ ability to understand tool to examine the actual strength of ties within online
their experience and because of the emotional distance communities as well as the degree of communication
afforded by the online communication. between participants. Future work in this area would
Another advantage of weak ties is that they tend to be benefit from conducting social network analyses of online
more plentiful than strong ties, and they are more likely support groups/communities and determining how these
to be different from the receiver and from one another. networks compare to participants’ off line (face-to-face)
This means there is a greater likelihood of being able to support networks. Moreover, scholars have not dealt with
find an expert in a particular area in weak tie rather than the issue that the strength of ties is dynamic. For example,
strong tie sources. Members of weak tie networks may be people within an online support group/community may
more willing to talk about illness since these individuals begin their relationship as weak ties. However, as time
tend to be less emotionally attached to a person (Adelman goes on, the relationship may evolve into a stronger tie
et al., 1987). Weak tie network members are often able to (including meeting in the face-to-face world). Future re-
provide more objective feedback about a problem since search using this theory would benefit from measuring
they are less emotionally attached to a person with health and explaining how the strength of ties between support
problems than family and friends. According to Goldsmith group/community participants changes over time.
and Albrecht (2011), weaker ties tend to be perceived as
helpful when a person is coping with an issue that requires
new information or skills (that may be limited within a Overall Critique of Theoretical Frameworks
close-knit family or friendship social network). These
Used in Online Support Group/Community
Studies
features of weak ties can be beneficial to people who are
coping with health concerns that may be difficult to ame-
liorate in strong ties due to lack of information and rela- Reviewing how these theories have been applied to
tional problems in close relationships (Winefield, 2006; studies of online support groups/communities, there ap-
Wright & Miller, 2010). pears to be a need to develop additional theoretical frame-
Several researchers have found weak tie network the- works that integrate overlapping concepts within these
ory to be applicable to explaining why some individuals theories. The theories presented in this section were
prefer to obtain social support online (including online largely developed in different disciplines, including psy-
support groups/communities) versus via traditional offline chology, sociology, and communication. In addition most
networks (Green-Hamman & Sherblom, 2014; Wright & of these theories were developed prior to the advent of the
Rains, 2013; Wright, Rains, & Banas, 2010; Wright & Internet and online support groups/communities. Yet,
Miller, 2010). When members of traditional off line social many of them exhibit conceptual overlap. For example,
networks have limited knowledge about a stressful situ- the reduced cues in computer-mediated communication
ation, there is evidence that individuals often turn to (particularly anonymity in text-based online support
online sources of information and social support (Wright groups as well as the geographical dispersion of partici-
& Miller, 2010) despite the fact that they may feel less pants) and the hyperpersonal interaction that often results
close relationally to the people with whom they interact from them creates an environment where weak tie rela-
online. Additionally, when online sources are able to tionships are plentiful. However, no theoretical work to
offer specialized information about a problem and/or may date has attempted to merge concepts from Social
be in a better position to offer desired types of social sup- Information Theory and the Theory of Weak Ties. More-
port (such as increased empathy and less judgment due over, these features of online support groups/communities
to sharing similar problems). also bring together people who share similar health con-
While online support group/community scholars have cerns, and this increases the opportunity for optimal
been drawn to Granovetter’s theory of the strength of matches between support seekers and support providers.
weak ties, studies to date have not measured the actual Few studies have merged concepts from the Optimal

75 2016 , 4, 65-87
Kevin B. Wright

Matching Model with related concepts from the Theory tion about a vast array of health concerns which may be
of Weak Ties (especially reduced judgment and stigmati- important for helping individuals cope with their health
zation from others due to sharing similar health concerns). issues (Wright & Bell, 2003). As we have seen, one ad-
Finally, theories such as Social Information Processing, vantage of using online support groups/communities over
Social Comparison Theory, and the Theory of Weak Ties off line social networks for coping with health issues is
are more communication process-oriented, while theories that they provide access to a larger number of individuals
such as the Buffering Effect Model of social support are how can offer very specific types of support individuals
more health outcome-oriented. Future theoretical work are seeking (which can make up for deficiencies in terms
would benefit from integrating overlapping concepts from of support available in face-to-face social networks). More-
these theories into a more comprehensive theoretical over, individuals who tend to cope with problems in a
framework that accounts form perceptions, communica- certain way, such as seeking information about the prob-
tion behaviors, and health outcomes. lem or venting their frustrations to others, are likely to
seek out individuals who will provide them with the type
of support that facilitates their preferred coping style
Online Social Support Groups/Communities, (Wright & Rains, 2013).
Coping, and Health Outcomes These features appear to play a key role in the problem-
focused dimensions of online coping. For example, Frost
The following sections review and critique studies that and Massagli (2008) compared online and off line support
have focused on the relationship between online support group members and found that online support group/
(obtained in online support groups/communities) and community users scored significantly higher in active
coping as well as online support group/community par- coping approaches (as opposed to avoidance coping) and
ticipation and health outcomes. planning their self-care. Other researchers argue that the
use of online support groups/communities can be con-
Online Social Support and Coping ceptualized as a type of self-efficacy or skill-building
intervention to restore a degree of control over a serious
One variable that is influenced by online social support chronic health problem (Martz & Livneh, 2007; Rottmann,
within online support groups/communities is coping. Dalton, Christensen, Frederiksen, & Johansen, 2010). In
Similar to off line coping (see Folkman & Moskowitz, other words, online support has a potential to inf luence
2004), online coping can be defined as thoughts and be- perceptions of coping competence.
haviors facilitated by online sources of support that help Most individuals have an innate desire for connection
people manage stressful situations. There are several with others, but when they feel disconnected from their
indications that the Internet is of rising importance when social networks due to health problems, loneliness is often
it comes to coping with stressful situations (van Ingen & the result. Loneliness is distinct from social isolation
Wright, 2015; Wright & Bell, 2003; Yoo, Shah, Shaw, (De Jong Gierveld, 1998); the former is an experienced
Kim, Smaglik, Roberts, et al., 2014). These scholars have deficiency in the quality of one’s network, and the latter
suggested that some of the mechanisms of coping are is actual disconnectedness. Loneliness is often related to
different online in comparison to off line coping, which inadequate social support (Hudson, Elek, & Campbell-
implies that more research and theory development in Grossman, 2000), and both the size and quality of one’s
this area is needed. Additionally, it appears that many social network are important determinants of the amount
individuals cope with stressful life events using both offline of coping resources individuals can access (De Jong
and online social networks (Vergeer & Pelzer, 2009), so Gierveld, 1998). Studies suggest that people who feel
it is important to consider how sources of online and of- socially disconnected (including due health concerns)
f line support inf luence coping. However, few studies to may also use the Internet, for distraction, entertainment,
date have tended to focus on coping within one context or to escape daily life as a form of coping (Vorderer,
or the other (van Ingen & Wright, 2015). Klimmt & Ritterfeld, 2004). Yet, other individuals are
In general, the Internet provides a wealth of informa- more proactive in their Internet use and try to battle

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 Communication in Health-Related Online Social Support Groups/Communities

health-related stigma and loneliness by searching for new son’s mood (Aneshensel & Stone, 1982; Cobb, 1976).
people or socializing with others online (Saunders & Moreover, the perception that one could gain access to
Chester, 2008; Wright & Bell, 2003). supportive others in online communities may make stress-
Other people, such as individuals with health problems ors appear less severe and more manageable than if such
and disabilities that limit mobility, may find it difficult resources were not available. This can help an individual
to form and maintain relationships with others in the to feel better about the health issues he or she may be
off line world (Braithwaite et al., 1999). As a result, they facing, which (in cases where one’s mood is elevated)
may voluntarily withdraw from interacting with members leads to the release of endorphins and other chemicals
of off line networks, which often leads to an increased into the bloodstream that can relieve stress (Billings &
sense of social isolation and loneliness. In an attempt to Moos, 1984; Lazarus & Folkman, 1984; Uchino, 2004).
compensate for these issues, many individuals turn to Most research examining the physical and mental
online support groups/communities to reduce feelings of health outcomes of support acquired in online support
loneliness and social isolation as well as to obtain support groups/communities has tended to focus on positive out-
to help them cope with health-related issues. comes. Moreover, mental health outcomes, such as depres-
Future research on online support groups/communities sion, appear to be more common than physical health
would benefit from attempting to better integrate theories outcomes in studies of online support groups/communi-
of coping with theories of social support. Although they ties (See reviews by Eysenbach, Powell, Englesakis, Rizo,
overlap to a considerable degree, both concepts have & Stern, 2004; Hong, Pena-Purcell, & Ory, 2012; Rains
typically been researched separately. Studies of social et al., 2015; Rains & Young, 2009).
support and studies of coping have evolved as two separate Several studies provide evidence that simply participat-
fields in many ways. However, both fields are related, and ing in a support community can be beneficial. For instance,
there is a need for theoretical development which takes the amount of time spent using online support communi-
into account the relationships between them. Future work ties has been shown to be associated with users’ size and
would also benefit from examining empirical links be- satisfaction with their online support network (Wright,
tween social-supportive messages and their effects on 2000) as well as decreased rates of depression over the
coping strategies. Finally, researchers have argued that course of a year among depression community members
the inability to receive immediate feedback (Haberstroh (Houston, Cooper, & Ford, 2002). In addition, Wright et
& Moyer, 2012) and receiving limited or negative feedback al. (2010) found that weak tie preference was negatively
(Yli-Uotila, Rantanen, & Suominen, 2014) within online associated with perceived stress. Participating in health-
support groups/communities may negatively inf luence related online support groups/communities has also been
coping strategies. Such negative inf luences on coping linked to other positive mental health outcomes such as
within online groups/communities should be investi- self-efficacy and optimism (Mo & Coulson, 2013). Other
gated in future studies. research has considered outcomes associated with mem-
bers’ perceived benefits or satisfaction with their com-
Online Social Support and Health Outcomes munity. Support community satisfaction is inversely as-
sociated with perceived stress (Wright, 2000) and the
The potential outcomes of obtaining social support in perceived benefits of online support are associated with
online support groups/communities have received in- members’ perceived coping ability (Seckin, 2013). In
creased attention in recent years, particularly in terms of general, studies have shown a positive association between
how support received in these contexts is associated with members’ well-being and support received from using
improved psychological and physical health outcomes. online groups/communities (Mo & Coulson, 2013; Oh,
As we have seen, social support appears to improve one’s Ozkaya, & LaRose, 2014; Rains & Keating, 2011).
ability to cope with a stressor or positively impact one’s Scholars have also examined other types of health
appraisal of stressors. Social support can also directly outcomes associated with receiving social support in
improve a person’s psychological health by providing a various online support groups/communities. For example,
person with new coping resources or by elevating a per- Turner, Robinson, Tian, Neustadtl, Angelus, Russell,

77 2016 , 4, 65-87
Kevin B. Wright

Mun, and Levine (2013), in a study of an online support groups/communities appear to inf luence greater self-ef-
community for people with diabetes, found that increas- ficacy among users in terms interacting with their health
es in emotional support messages were associated with care provider (Holbrey & Colson, 2013). However, the
improved blood sugar control among patients over the potential negative effects of using online support groups/
course of the intervention. Studies examining an online communities is a relatively understudied area, and future
support group for women with breast cancer have shown research is needed to assess ways in which online support
that receiving emotional support message is associated groups/communities may contribute to negative mental
with lower breast cancer concerns (Kim et al., 2012; Yoo and physical health outcomes.
et al., 2014). Moreover, studies of student social network- Finally, whether people are active or passive partici-
ing site users have revealed that perceived emotional pants within online support groups/communities appears
support from one’s social networking site is positively to inf luence health outcomes in a variety of ways. For
associated with health-self efficacy (Oh et al., 2013) and example, an individual may actively participate in a com-
negatively associated with perceived stress (Wright, 2012). munity by making and responding to others’ posts or by
Other researchers have found that time spent using “lurking” and reading the posts of others but not actively
online communities is associated with users’ size and contributing. Previous studies have found that as many
satisfaction with their online support network (Wright, as 50% of participants in online support groups/commu-
2000) as well as users’ perceptions of informational and nities were lurkers (Batenburg & Das, 2015; Setoyama,
emotional support received in HIV/AIDS (Mo & Coulson, Yamazaki, & Namayama, 2011). Mo and Coulson (2010)
2012) and weight-loss (Hwang, Ottenbacher, Green, found that relative to lurkers, active posters were signifi-
Cannon-Diehl, Richardson, Bernstam, & Thomas, 2010) cantly more likely to report that they received social
communities. One study found that people who used the support and useful information from the group and they
Internet perceived significantly greater levels of support were more satisfied with other members. Similarly, Setoya-
available than did non-users, including greater availabil- ma et al. (2011) found that lurkers were less satisfied with
ity of emotional, tangible, and companionship support health information than active par ticipants. Van
(Hampton, Goulet, Rainie, & Purcell, 2011). Liu and Uden-Kraan, Drossaert, Taal, Seydel, and van de Laar,
LaRose (2008) found a positive relationship between (2008) found that active participants reported greater
perceived support available online and amount of time psychological well-being than lurkers within an online
spent using the Internet. However, Batenburg and Das support groups. Moreover, Lawlor and Kirakowski (2014),
(2015) found that the relationship between online par- in a study of mental-health communities, found that ac-
ticipation (e.g., posting messages) and psychological well- tive participants reported better stigma recovery than
being was moderated by pessimistic social comparisons. lurkers.
Specifically, these authors found that increases in down- Unfortunately, the existing literature regarding stud-
ward comparisons predicted increased activity in an ies that have investigated the links between online social
online support group for women with breast cancer (sug- support and health outcomes appears to be fragmented.
gesting that social comparisons within these groups/ Some studies focus on psychosocial health outcomes such
communities are an important moderating variable to as well-being while others are more focused on physical
consider). Moreover, the therapeutic value of writing health outcomes. Many of the physical health outcome
about one’s thoughts and feelings in online support groups/ measures have been operationalized in relatively unreli-
communities has been found to alleviate depression and able ways, such as an over-reliance on self-reports or
loneliness, and reduce pain and stress (See Campbell & using physical or biological measures that are open to
Pennebaker, 2003). multiple interpretations regarding cause and effect and
Online support groups/communities also help people changes in these outcomes. Greater identification of key
reduce their sense of isolation (Holbrey & Colson, 2013; health outcomes and integration of the literature on psy-
Vilhauer, 2009). These groups/communities can help chosocial health outcomes and physical health outcomes
participants acquire new (specialized) information (Malik is needed.
& Coulson, 2008; Yli-Uotila et al., 2014). Online support

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 Communication in Health-Related Online Social Support Groups/Communities

Limitations of Existing Online Support

Group/Community Research/Theory and an have been crudely adapted to online environment). Such
Agenda for Future Research approaches make it difficult to isolate the implications
stemming from the unique characteristics of online in-
Despite the promise of online support groups/com- teraction.
munities and their potential effects on health outcomes, Although computer-mediated channels are able to
there are many limitations of the existing research in this connect individuals with larger, more diverse, networks
area that need to be addressed in future work. While a of individuals who may be able to offer types of social
number of theoretical frameworks have been utilized in support that transcend the quantity and quality of support
the study of online support and health outcomes, this area within traditional face-to-face networks (i.e., weak tie
would benefit from the development of new theories that support), less is known about potential negative aspects
shed light on features of online support that are unique of weak tie support, such as the potential for increased
from off line supportive contexts. This section discusses deception, manipulation, cyber-surveillance, and other
some of the key limitations to the existing research as problems that can occur when communicating with rela-
well as fruitful areas of research and theory development tive strangers (Barak, Boniel-Nissim, & Suler, 2008).
within this area. Given the potential benefits of computer-mediated support
One of the first limitations of previous studies concerns groups and the risks associated with seeking support
the need to account for the inf luence of overlapping sourc- online, it is important for support researchers to gain a
es of social support on key outcome variables, such as better understanding of how group members evaluate the
stress and depression. For example, according to credibility of online support providers and the supportive
Haythornthwaite (2002), both online and off-line sup- messages they create.
portive exchanges inf luence health outcomes. In short, it Finally, relatively little is known about how minority
becomes difficult to separate online supportive inf lu- groups and other populations facing health disparities
ences from off-line inf luences. Most individuals typi- use computer-mediated support groups. However, it ap-
cally mix face-to-face contact with e-mail, or searching pears that members of minority groups engage in a vari-
the Internet for health information and then discussing ety of online social support activities, and individuals
it with people in their face-to-face social network. Future within these groups may benefit from online support
research should assess the interaction of both online and group/community interventions (Hong, Pena-Purcell, &
face-to-face support networks on key outcome variables Ory, 2012). For example, Fogel, Albert, Schnabel, Ann
such as satisfaction, well-being, stress, depression, and Ditkoff, and Neugut (2003) found that while African-
physical health outcomes while also comparing differ- Americans, Hispanics, and Asian Americans tend to use
ences between support from these two networks in terms the Internet less than whites, their Internet use was as-
of how they uniquely contribute to these outcomes. sociated with greater ability to talk with someone about
Future research in this area would benefit from the problems and to obtain other types of social support.
development of theories and methods that take into ac- Weinert and Hill (2005) found that rural women (includ-
count a more comprehensive perspective of the inf luence ing a high percentage of minorities) using an online sup-
of social support on health outcomes, including the main port group intervention had lower levels of depression
effects and interaction effects of online and off-line sourc- and higher self-reported management of day-to-day chron-
es of social support, additional predictors of engaging in ic illness symptoms than a control group of similar rural
online support, mediated variables (i.e., the inf luence of women living with chronic illness. Irrizary, Downing,
different computer-mediated channels, contexts), and key and West (2002) and Wright (2000) found that online
demographic and environmental variables on health out- support communities were helpful in terms of helping
comes. Moreover, most studies of online support have isolated older adults facing health concerns to become
tended to be studied in cross-sectional designs, with rel- better connected with other individuals with similar cir-
atively small samples, and online support has primarily cumstances. In short, there is a great deal of potential for
been measured using scales that were developed to mea- scholars to develop and test online support group/com-
sure off line support (and in many studies these measures munity interventions with underserved populations.

79 2016 , 4, 65-87
Kevin B. Wright

Conclusion
to capture the complexity of this phenomenon. Scholars
should work on integrating overlapping concepts from
The findings from the reviewed literature provide sup- the major theories discussed in this article, and they should
port for the idea that online support groups/communities take into account the unique inf luences that computer-
appear to benefit certain populations (e.g., people coping mediated communication has on supportive relationships
with stigmatized health issues, individuals who lack sup- within these groups/communities. Although more recent
port resources in the face-to-face world). As online support studies have moved toward experimental designs and
among members of these populations will likely continue intervention approaches in an effort to better predict
in the future, researchers need to continue gaining a bet- health outcomes for individuals who participate in such
ter understanding of the nature of online support group/ groups/communities, more research is needed to gain a
community processes and outcomes. While scholars have better understanding of intervening variables that may
identified a number of theoretical frameworks that help inf luence the relationship between online support and
to explain key advantages and disadvantages of online various outcomes. Moreover, future studies in this area
support groups/communities and their relationship to would benefit from using longitudinal designs and that
health outcomes, new theoretical perspectives are needed target the health needs of more diverse populations.

Acknowledgments
Note from the Editor: Dr. Lijiang Shen (University of Pennsylvania) and Dr. Jude Mikal (University of Utah) have
served as blind reviewers for this article. After the acceptance of the manuscript they have agreed to sign their review.
I would like to thank both of them for their valuable help and insights.

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