Giving and receiving social support in online substance use disorder forums: How self-efficacy moderates effects on relapse.

OBJECTIVE: Individuals in recovery for substance use disorders (SUDs) increasingly use online social support forums, necessitating research on how communicating through these forums can affect recovery. This study examines how giving and receiving support within an SUDs recovery forum predict substance use, and considers whether effects vary according to participants' self-efficacy. METHODS: We applied content analysis to 3440 messages that were posted by 231 participants in an online SUDs forum. Surveys assessed social support reception and substance use at three timepoints. We assessed relationships between giving and receiving support and substance use (risky drinking days, illicit drug use days), and the interactions between self-efficacy and social support in predicting substance use outcomes. RESULTS: Receiving more emotional support was associated with reduced illicit drug use at 6 and 12 months. For those with low self-efficacy, giving more emotional support predicted less risky drinking at month 12, whereas giving more informational support predicted more risky drinking at month 12. CONCLUSION: These results suggest conditional benefits of exchanging support in an online SUDs forum, depending upon type of support (informational versus emotional), the participants' role (giver or receiver), and their self-efficacy. PRACTICE IMPLICATIONS: We discuss implications for designing and using peer-to-peer support platforms.

Interactivity, Presence, and Targeted Patient Care: Mapping e-Health Intervention Effects Over Time for Cancer Patients with Depression.

This study examined the interplay of depression and different types of e-health interventions on breast cancer patients' perceived healthcare competence, emotional processing, and social well-being over time. The three e-health interventions--Internet Only as a control condition, CHESS (Comprehensive Health Enhancement Support System) Only, and CHESS with a Human Mentor, a cancer information specialist--provided varying degrees of interactivity and presence. A total of 328 women with breast cancer participated in one of the three interventions for a 6-month period. Women were further split into two groups based on reported levels of depression. For perceived healthcare competence and social well-being, results revealed significant interaction effects for intervention type by depression over time, such that breast cancer patients with higher levels of depression benefited most from the CHESS with Mentor intervention over the 6-month study period. For emotional processing, depressed cancer patients benefited more from the CHESS with Mentor than the other two interventions, regardless of time. These findings have (a) theoretical implications on how mental health factors can intersect with interactivity and presence to influence psychosocial outcomes, (b) conceptual implications for the role of human interaction within e-health systems, and (c) practical implications for the development of e-health interventions for cancer patients with depression.

Lifestyle segmentation and political ideology: Toward understanding beliefs and behavior about local food.

This research sought to better understand local food consumers and take steps to begin to identify how targeted messages could engage different groups. In order to accomplish these aims, data was collected through a survey mailed to a random sample of Wisconsin households with a final sample size of 577. These consumers were then segmented based on variables related to the food related lifestyle (FRL) and political ideology. Political ideology was included as it influences the media to which individuals pay attention, and how they interpret messages. Identified groups were further profiled with variables related to local food purchasing, frequency of shopping at farmers' markets and natural food stores, willingness to pay a premium for local food, perceptions related to local food, communication habits, and demographics. Five segments were identified, with three standing out as likely consumers of local produce. The liberal, "Adventurous" consumers showed a strong interest in local food, perceiving local food to be superior for its environmental benefits, among other reasons. The "Traditional" and "Rational" groups were not interested in local food for environmental reasons, and may find such messages unappealing. In order to engage these other groups, messages should address the high quality of local food, how it can be incorporated into traditional recipes (for the "Traditional" group), and ways to make local food affordable and convenient to buy (for the "Rational" group).

When support is needed: Social support solicitation and provision in an online alcohol use disorder forum.

BACKGROUND: Obtaining adequate social support presents a challenge for many in addiction recovery. Increasingly, individuals in recovery use online forums to exchange support with peers, yet it is unclear which help-seeking strategies most effectively recruit peer support, and which forms of support are most valued by recipients. METHODS: This study applied quantitative content analysis to examine social support solicitation and delivery in an online forum for alcohol use disorder (AUD). We compared the frequency with which peers provided informational, emotional, and companionship support after solicitations that: (1) were direct or indirect, (2) disclosed positive or negative emotions, and (3) mentioned or did not mention recovery problems. We assessed likelihood that recipients would express gratitude after receiving each type of support, and assessed whether the "match" between solicitation and disclosure styles influenced rates of gratitude expression. RESULTS: Emotional disclosures, whether positive or negative, received the highest volume of supportive replies. Emotional support was the most common response to solicitations overall, and was disproportionately offered after recipients disclosed positive emotions. Informational support was disproportionately offered after recipients disclosed negative emotions or recovery problems, or explicitly requested help. Regardless of their solicitation style, recipients expressed more gratitude after receiving emotional support than other support types. CONCLUSIONS: Providing emotional support was common in an online AUD forum, and precipitated expressing gratitude from recipients to support providers. The results may be helpful in guiding participants to more effectively obtain and provide recovery support in online forums.

The role of the family environment and computer-mediated social support on breast cancer patients' coping strategies.

Despite the importance of family environment and computer-mediated social support (CMSS) for women with breast cancer, little is known about the interplay of these sources of care and assistance on patients' coping strategies. To understand this relation, the authors examined the effect of family environment as a predictor of the use of CMSS groups as well as a moderator of the relation between group participation and forms of coping. Data were collected from 111 patients in CMSS groups in the Comprehensive Health Enhancement Support System "Living with Breast Cancer" intervention. Results indicate that family environment plays a crucial role in (a) predicting breast cancer patient's participation in CMSS groups and (b) moderating the effects of use of CMSS groups on breast cancer patients' coping strategies such as problem-focused coping and emotion-focused coping.

Validity and reliability of the Early Childhood Caries Perceptions Scale (ECCPS) to assess health beliefs related to early childhood caries prevention among primary caregivers of children under 5 years of age.

Primary caregivers' child oral health care beliefs and practices are major factors in the prevention of Early Childhood Caries (ECC). This study assessed the validity and reliability of a newly-developed scale--the Early Childhood Caries Perceptions Scale (ECCPS)--used to measure beliefs regarding ECC preventive practices among primary caregivers of young children. The ECCPS was developed based on the Health Belief Model. The construct validity and reliability of the ECCPS were examined among 254 low-socioeconomic status primary caregivers with children under five years old, recruifed from 4 Bangkok Metropolitan Administration Health Centers and a kindergarten school. Exploratory factor analysis (EFA) revealed a four-factor structure. The four factors were labeled as Perceived Susceptibility, Perceived Severity, Perceived Benefits and Perceived Barriers. Internal consistency measured by the Cronbach's coefficient alpha for those four factors were 0.897, 0.971, 0.975 and 0.789, respectively. The ECCPS demonstrated satisfactory levels of reliability and validity for assessing the health beliefs related to ECC prevention among low-socioeconomic primary caregivers.

Public attitudes toward biofuels. Effects of knowledge, political partisanship, and media use.

Despite large-scale investments and government mandates to expand biofuels development and infrastructure in the United States, little is known about how the public conceives of this alternative fuel technology. This study examines public opinion of biofuels by focusing on citizen knowledge and the motivated processing of media information. Specifically, we explore the direct effects of biofuels knowledge and the moderating effect of partisanship on the relationship between media use and benefit vs. risk perceptions in the following four domains: environmental impacts, economic consequences, ethical/social implications, and political ramifications. Our results suggest that more knowledgeable respondents see fewer benefits of biofuels relative to risks, and that Democrats and Republicans are affected differently by media use when forming opinions about biofuels. Among Democrats, greater attention to political media content leads to a more favorable outlook toward the technology across several domains of interest, while among Republicans, an increase in attention to political content has the opposite effect. Possible reasons for these results, as well as implications of the findings at the intersection of politics and the life sciences, are discussed.

Measuring risk/benefit perceptions of emerging technologies and their potential impact on communication of public opinion toward science.

This study presents a systematic comparison of two alternative measures of citizens' perceptions of risks and benefits of emerging technologies. By focusing on two specific issues (nanotechnology and biofuels), we derive several insights for the measurement of public views of science. Most importantly, our analyses reveal that relying on global, single-item measures may lead to invalid inferences regarding external influences on public perceptions, particularly those related to cognitive schema and media use. Beyond these methodological implications, this analysis suggests several reasons why researchers in the area of public attitudes toward science must revisit notions of measurement in order to accurately inform the general public, policymakers, scientists, and journalists about trends in public opinion toward emerging technologies.

Creating a bond between caregivers online: effect on caregivers' coping strategies.

Numerous studies have investigated the effect of Interactive Cancer Communication Systems (ICCSs) on system users' improvements in psychosocial status. Research in this area, however, has focused mostly on cancer patients, rather than on caregivers, and on the direct effects of ICCSs on improved outcomes, rather than on the psychological mechanisms of ICCS effects. To understand the underlying mechanisms, this study examines the mediating role of perceived caregiver bonding in the relation between one ICCS (the Comprehensive Health Enhancement Support System [CHESS]) use and caregivers' coping strategies. To test the hypotheses, a secondary analysis of data was conducted on 246 caregivers of lung cancer patients. These caregivers were randomly assigned to (a) the Internet, with links to high-quality lung cancer websites, or (b) access to CHESS, which integrated information, communication, and interactive coaching tools. Findings suggest that perceived bonding has positive effects on caregivers' appraisal and problem-focused coping strategies, and it mediates the effect of ICCS on the coping strategies 6 months after the intervention has begun.

Optimizing eHealth breast cancer interventions: which types of eHealth services are effective?

Little is known about the effective elements of Interactive Cancer Communication Systems (ICCSs). A randomized trial explored which types of services of a multifaceted ICCS benefited patients and the nature of the benefit. Women with breast cancer (N=450) were randomized to different types of ICCS services or to a control condition that provided internet access. The Comprehensive Health Enhancement Support System (CHESS), served as the ICCS. ICCS services providing information and support, but not coaching such as cognitive behavior therapy, produced significant benefits in health information competence and emotional processing. Provision of Information and Support ICCS services significantly benefited women with breast cancer. More complex and interactive services designed to train the user had negligible effects.

Online health consultation: examining uses of an interactive cancer communication tool by low-income women with breast cancer.

PURPOSE: To examine how psychosocial variables predicted use of an online health consultation service among low-income breast cancer patients and in turn how using this service affected these same psychosocial outcomes. METHOD: This retrospective study included 231 recently diagnosed, low-income (at or below 250% of the federal poverty level) breast cancer patients provided a free computer with 16 weeks of access to the Internet-based 'Ask an Expert' service offered as part of the Comprehensive Health Enhancement Support System (CHESS) "Living with Breast Cancer" program. The use activity included a total of 502 messages submitted to the online health consultation service. The data included five psychosocial variables: information seeking, social support, health self efficacy, participation in health care, and doctor-patient relationship, were collected at both the pre-test and 16-week post-test after using the service. Correlation tests were conducted to examine the relationship between pre- and post-test, and use activity. A multiple regression model was formed for each of five psychosocial variables to examine how use activity of the consultation service was associated with various psychosocial measurements. RESULTS: In total, 865 distinct consulting queries from 502 messages were identified as measurement of patients' use activities (3.74 consulting queries per participant). Use activity had significant negative relationships with pre-test scores across all five psychosocial variables. The regression models found significant positive main effects (use activity) associated with three of these psychosocial variables: health self efficacy, participation in health care and doctor-patient relationship. Use activity of the online consultation service did not have significant relationships with the dependent variables of information seeking and perceived social support. CONCLUSION: Low-income breast cancer patients sought out information from an online cancer information expert. Patients with more negative perceptions at pre-test tended to use the service more. Greater use of the service was associated with improvement in patients' perception of health self-efficacy, participation in health care and doctor-patient relationship. Moreover, use of online health consultation appears to level the differences, narrowing the gaps between those who were worse and better off at pre-test. These findings suggest that online health consultation can serve as an effective complement to other resources, which help low-income, breast cancer patients feel more confident to participate more actively in their health care, become more actively involved in making decisions about their treatments and enhance the relationship with their doctors.

An e-health solution for people with alcohol problems.

Self-management of chronic diseases has been a research focus for years. Information and communication technologies (ICTs) have played a significant role in aiding patients and their families with that management task. The recent dramatic increase in smartphone capabilities has expanded the potential of these technologies by facilitating the integration of features specific to cell phones with advanced capabilities that extend the reach of what type of information can be assessed and which services can be provided. A recent review of the literature covering the use of ICTs in managing chronic diseases, including addiction, has examined the effectiveness of ICTs, with an emphasis on technologies tested in randomized controlled trials. One example of an addiction-relapse prevention system currently being tested is the Alcohol Comprehensive Health Enhancement Support System (A-CHESS) Program.

Explicating an evidence-based, theoretically informed, mobile technology-based system to improve outcomes for people in recovery for alcohol dependence.

Post-treatment relapse to uncontrolled alcohol use is common. Currently available communication technology can use existing models for relapse prevention to cost-effectively improve long-term relapse prevention. This paper describes: (1) research-based elements of alcohol consumption-related relapse prevention and how they can be encompassed in self-determination theory (SDT) and Marlatt's cognitive behavioral relapse prevention model, (2) how technology could help address the needs of people seeking recovery, (3) a technology-based prototype, organized around sexual transmitted disease and Marlatt's model, and (4) how we are testing a system based on the ideas in this article and related ethical and operational considerations.

Web-based cancer communication and decision making systems: connecting patients, caregivers, and clinicians for improved health outcomes.

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS-the Comprehensive Health Enhancement Support System (CHESS)-for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS.

Interactivity and Presence of Three eHealth Interventions.

A number of researchers have identified interactivity and presence as potentially important attributes of e-Health applications, because they are believed to influence users to interact with systems in ways that increase commitment, learning, and other desirable responses. This paper reports on the development of brief scales to assess the two concepts, and on use of them with participants in six conditions of a large-scale trial of interventions for breast cancer patients. Overall, the Internet scored very low on both measures. Versions of an integrated system of services (CHESS) scored higher, particularly as conditions added features to different versions of the system. Interventions involving a human Cancer Information Mentor scored highest, though even the Mentor was perceived as more interactive and having more presence when combined with the integrated eHealth system.

Predictors and Effects of Training on an Online Health Education and Support System for Women with Breast Cancer.

Many breast cancer patients currently turn to Internet-based education and support to help them cope with their illness. This study explores the role of training in influencing how patients use a particular Interactive Cancer Communication System (ICCS) over time and also examines what pre-test characteristics predict which people are most likely to opt in or out of training in the first place. With use of pre-test survey and unobtrusive individual records of ICCS system use data (N = 216), nonparametric tests revealed that only having a later stage of cancer predicted whether or not patients participated in training. Results indicated that participating in training was a significant predictor of higher levels of using the CHESS system. In particular, the repeated measures analysis of covariance found the significant interaction as well as main effect of group (i.e., training vs. no training) and time (i.e., individual's CHESS usages at different times) in interactive and information CHESS services, suggesting that 1) the training group has a higher level of usage than the no training group, 2) both of the groups' usage decreased over time, and 3) these joint patterns hold over time. Practical guidelines for future ICCS campaign implementation are discussed.

Unraveling Uses and Effects of an Interactive Health Communication System.

By developing a number of measures distinguishing amount, type of content, and when and how that content is used, the current study revealed effective patterns of use that are associated with quality of life benefits during an eHealth intervention. Results generally suggest that the benefits depend on how a patient uses the system, far more than on sheer amount of exposure or even what type of content is chosen. The next generation of eHealth system should focus on providing new and varying content over time, but even more on encouraging intensity of use and long-term commitment to the system.

Expressing positive emotions within online support groups by women with breast cancer.

Based upon Fredrickson's Broaden-and-Build Theory of Positive Emotions, this study examined the role of expressing positive emotions in online support groups for women with breast cancer. Underserved women with breast cancer in rural Wisconsin and Detroit, Michigan were recruited from 2001 to 2003, and they were given access to online support groups. Both pretest and four-month posttest surveys were conducted with a sample of 231 women. Messages from 96 active participants were analyzed using a computerized text analysis program. Psychological benefits that occurred following the expression of positive emotions were greater among those who expressed more negative emotions.

Communicating about self and others within an online support group for women with breast cancer and subsequent outcomes.

Research suggests communicating too much about one's self within an online support group may amplify breast cancer patients' focus on their own problems and exacerbate negative emotions while focusing on others may have the opposite effects. This study explored how pronoun usage within an online support group was associated with subsequent mental health outcomes. There were 286 patients recruited into the study who filled out the pre-test and 231 completed post-tests four months later with survey measures including breast cancer-related concerns and negative emotions. Messages were analyzed using a program counting first person and relational pronouns. A positive relationship was found between use of first person pronouns and negative emotions.

Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application of the Cognitive-Social Health Information Processing (C-SHIP) model.

Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.