Exploring healthcare experiences among online interactive weight loss forum users
Introduction
Internet use is prevalent in the U.S., with approximately 85% of the adult population having used the Internet as of May 2013 (Zickuhr & Smith, 2013). Use of the Internet as a source of health information is also common (Baker et al., 2003, Fox and Jones, 2009, Ybarra and Suman, 2006), with over half of all U.S. adults seeking health information from the Internet within the past 12 months (Koch-Weser et al., 2010, Ybarra and Suman, 2006). Internet health information-seeking is more common among certain populations including individuals who are women, white, young, possess high levels of education, possess high levels of income, or have current health problems (Koch-Weser et al., 2010, Renahy et al., 2008, Ybarra and Suman, 2006).
The Internet is an appealing consumer health information source for several reasons. Despite geographical location or time of day, information can be accessed from online communities of individuals sharing common interests (Chung, 2013, Robinson and Turner, 2003, White and Dorman, 2001). The Internet also provides the opportunity for individuals to easily find others who have similar health concerns, including those with mobility difficulties (Braithwaite, Waldron, & Finn, 1999) or rare diseases (Lasker, Sogolow, & Sharim, 2005). Health information from the Internet might be sought from various sources, including read-only websites and interactive websites where individuals can share and exchange information. Interactive, peer-to-peer websites have gained popularity over time (Brenner, 2012, Sarasohn-Kahn, 2008). They provide users with several benefits, including access to a wider social network and differing points of view (Tanis, 2008, Wright and Bell, 2003), higher levels of perceived social support (Ballantine and Stephenson, 2011, Hwang et al., 2010), and higher levels of perceived informational support (Ballantine & Stephenson, 2011).
The Internet also appeals to those who feel embarrassed about their health conditions or who prefer to remain anonymous (Gallagher and Doherty, 2009, Powell et al., 2003, Rains, 2014, Tanis, 2008), and it might provide a space where individuals avoid judgment based on physical appearance (McKenna & Bargh, 2000). For these reasons, the Internet could be an especially appealing source of health information for those who have stigmatizing characteristics or conditions, including overweight and obese individuals or those who are trying to lose weight.
Obesity is stigmatized in medical settings (Anderson and Wadden, 2004, Puhl and Brownell, 2001, Puhl and Heuer, 2009), which might lead patients with overweight and obesity to seek weight loss assistance and information from sources other than their healthcare providers. Studies have shown that negative encounters and lower quality relationships with providers are associated with Internet information-seeking (Anderson, 2004, Hou and Shim, 2010, Lewis et al., 2011, Rice, 2006, Tustin, 2010). A study of obese patients by Wadden et al. (2000) found that nearly half (45%) did not rely “at all” on their physicians for help with their weight, and an additional 30% reported that they relied on their physicians only a “slight amount.” In lieu of seeking information from providers, individuals trying to lose weight might preferentially turn to another source of health information such as the Internet. Despite this possible link between experiences in healthcare settings and the use of the Internet for weight loss information, however, few studies have examined relationships between these variables.
One available source of Internet-based weight loss information is online interactive forums. Limited research has examined these weight loss-related forums, but some studies have suggested that participation in these communities might result in greater weight loss (Johnson and Wardle, 2011, Neve et al., 2011). Even with these potential benefits, concerns have been raised about the quality of health information provided on forums. Interactive Internet forums might potentially provide access to some incorrect, misleading, or potentially harmful information (Esquivel et al., 2006, Hoch et al., 1999, Hwang et al., 2007), although some of this incorrect information might be later corrected by other forum users (Esquivel et al., 2006, Hoch et al., 1999, Hwang et al., 2007, Mursch and Behnke-Mursch, 2003).
Understanding of healthcare-related influences on using online interactive weight loss forums is limited. The purpose of this study, therefore, was to explore characteristics of healthcare experiences (e.g., various aspects of patient-provider communication) and their influence on health information-seeking behaviors as discussed by users of online weight loss forums. Our goal was to improve understanding of potentially modifiable healthcare experiences that could be targeted to promote open patient-provider communication about health information sought online and to inform the design of interventions to facilitate appropriate and beneficial use of the Internet for weight loss information.
Section snippets
Methods
Because little is known about how healthcare experiences might influence weight loss information-seeking from online interactive forums, we utilized qualitative methods to explore discussions of healthcare experiences that occurred on such forums. Generally speaking, Internet forums are interactive online spaces where forum users can post a topic to which other forum users can respond (known as a “thread”). The number of peer responses in a single thread could vary from zero to several hundred,
Results
We identified five themes involving experiences and general impressions of encounters with providers and with the healthcare system; all five themes capture factures that influenced health information-seeking behaviors among forum users. Each theme is described below. Theme 1 Access to (and Time with) Providers Impacts Health Information-Seeking.
Forum users discussed primarily negative experiences related to their healthcare providers' availability, accessibility, and time to provide health information
Discussion
Our results suggest that experiences before, during, and after visiting healthcare providers might influence where, when, and from whom some weight loss forum users seek weight loss information. Infrequent discussion of personal healthcare experiences might indicate that healthcare experiences might not play an important role in use of weight loss forums. Alternatively, this finding might reflect a preference for focusing on other topics (e.g., weight loss goals, recipes, or sharing success
Acknowledgments
We thank Adam Branscum, Ellen Smit, Marie Harvey, and Minjeong Kim for their contribution and review of this research project.
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