Perceived Stress in Online Prostate Cancer Community Participants: Examining Relationships with Stigmatization,Social Support Network Preference,and Social Support Seeking

Men with prostate cancer often need social support to help them cope with illness-related physiological and psychosocial challenges. Whether those needs are met depends on receiving support optimally matched to their needs. This study examined relationships between perceived stress, prostate cancer-related stigma, weak-tie support preference, and online community use for social support in a survey of online prostate cancer community participants (n = 149). Findings revealed a positive relationship between stigma and perceived stress. This relationship, however, was moderated by weak-tie support preference and online community use for social support. Specifically, stigma was positively related to perceived stress when weak-tie support was preferred. Analyses also showed a positive relationship between stigma and perceived stress in those who used their online community for advice or emotional support. Health communication scholars should work collaboratively with diagnosed men, clinicians, and online community administrators to develop online interventions that optimally match social support needs.     

Seeing Others Receive Support Online: Effects of Self-Disclosure and Similarity on Perceived Similarity and Health Behavior Intention

Participation in online support groups leads to improved health. While viewing others’ interactions is one of the major activities in online support groups and lurkers comprise the majority of online support group participants, the literature on how participants benefit from viewing others’ posts and comments is sparse. Building upon the Social Penetration Theory and the narrative persuasion process, this study focused on two key features of online support groups, self-disclosure and similarity. It tested their direct effects on viewers’ perceived similarity with the poster and indirect effects on viewers’ behavior intention through three mediators: perceived similarity, identification, and perceived support availability. A 2 (similarity vs. dissimilarity) by 3 (factual vs. cognitive vs. emotional self-disclosure) online experiment involving 280 overweight adult participants was conducted. Findings showed similarity of health status led to increased level of perceived similarity and moderated the effects of self-disclosure. Self-disclosure and similarity increased dieting intention through increasing perceived similarity, identification, and perceived support availability. This study provides experimental evidence suggesting viewers can benefit from online support groups through a narrative persuasion process.     

The Exchange of Social Support on Online Bariatric Surgery Discussion Forums: A Mixed-Methods Content Analysis

Bariatric surgery patients often experience physical and psychosocial stressors, and difficulty adjusting to significant lifestyle changes. As a result, social support groups that provide patients with support, coping skills, and nutritional information are valuable components of bariatric care. Support group attendance at bariatric centers is associated with greater post-surgery weight loss; however, several barriers hinder attendance at in-person support groups (e.g., travel distance to bariatric centers). Consequently, online support forums are an increasingly utilized resource for patients both before and after surgery. This study examined and described the type and frequency of social support provided on a large online bariatric surgery forum. A total of 1,412 messages in the pre- (n = 822) and post-surgery (n = 590) sections of the forum were coded using qualitative content analysis according to Cutrona and Suhr’s (1992) Social Support Behavior Code model (i.e., including informational, tangible, esteem, network, and emotional support types). The majority of messages provided informational and emotional support regarding: a) factual information about the bariatric procedure and nutrition; b) advice for coping with the surgery preparation process, and physical symptoms; and c) encouragement regarding adherence to surgical guidelines, and weight loss progress. Network, esteem, and tangible support types were less frequent than informational and emotional support types. The results inform healthcare providers about the types of social support available to bariatric patients on online support forums and, thus, encourage appropriate referrals to this resource.     

The Effects of Repetitive Information Communication through Multiple Channels on Prevention Behavior during the 2015 MERS Outbreak in South Korea

Although people nowadays engage in information communication repetitively through multiple channels during a public health crisis, the impacts of this communication on behavioral outcomes have not been fully examined. The present study empirically tests the effects of repetitive information communication through multiple channels (RICMC) on risk-prevention behavior. Additionally, the mediating roles of knowledge, perceived susceptibility, severity, response efficacy, and self-efficacy in the association between RICMC and risk-prevention behavior are examined. Analyses of online survey data (N = 1,036) collected during the 2015 Middle East respiratory syndrome (MERS) outbreak in South Korea revealed that RICMC was positively associated with MERS-prevention behavior. Furthermore, this association was mediated by perceived susceptibility, severity, and self-efficacy. Although response efficacy and knowledge were not significant mediators, RICMC was positively associated with all mediating variables. The implications, theoretical contributions, and limitations of this study are discussed.     

Latinos’ Access to Online and Formal Mental Health Support

Research on mental health services disparities affecting minority populations of the USA tends to neglect online mental health support (OMHS). The main objective of this study was to investigate online mental health support and help-seeking of Latino citizens living in US communities by estimating associations linking OMHS with a selection of individual and community variables. In addition, the extent to which unmet mental health treatment needs among adults are associated with key variables was examined. Variables of interest included economic resources, health insurance and coverage, confidentiality, perceived stigma, and accessibility. Data are from 39,630 Latino adult participants in the National Surveys on Drug Use and Health (NSDUH), 2004–2010. Results indicate that for every 10,000 US Latino adults, fewer than 25 individuals received recent OMHS, as compared to a recently published estimate of 270–330 per 10,000 for the US population generally. Among Latinos with self-described unmet mental health needs, an estimated 40% identified cost of treatment as a prominent barrier that explained why they had not received formal mental health treatment services. Research and policy health disparities implications are discussed.     

Cognitive and Emotional Health Risk Perceptions Among People Living in Poverty

Many theories of risk perception and health behavior examine cognitive dimensions of risk (i.e., perceived susceptibility or severity) but not emotional dimensions. To address this gap, the authors examined the emotional component of risk perception (as worry) and its relation to cognitive assessments of risk, self-efficacy and response efficacy, and health protective action. Although people in poverty are at high risk for many health conditions, little is known about how concerned they are about these conditions or how their risk perceptions influence health actions. African Americans and Whites with incomes ≤$35,000 were surveyed (N = 431). Participants reported their worry level for 10 health risks. Among their highest worry risks, they identified the risk they took the most action and the risk they took the least action to prevent. Worry was low or moderate for each health risk and chronic conditions were of the most concern. For high- and low-action risks, response efficacy moderated the relation between cognitive risk perception and health protective action. For low-action risks, decisions to act were affected independently by cognitive and emotional responses. The results support the Risk Perception Attitude Framework and indicate the importance of using cognitive and emotional dimensions of risk in behavior change models.     

Modeling Online Health Information-Seeking Behavior in China: The Roles of Source Characteristics,Reward Assessment,and Internet Self-Efficacy

The outbreak of severe acute respiratory syndrome (SARS) in 2003 marked the explosion of health information seeking online in China and the increasing emergence of Chinese health websites. There are both benefits and potential hazards of people’s online health information seeking. This article intended to test part of Wilson’s second model of information behavior, including source characteristics and activating mechanisms, and to identify the relationships among perceived access, perceived expertise credibility, reward assessment, Internet self-efficacy, and online health information-seeking behavior. Data were drawn from face-to-face surveys and an online survey of health information seekers (N = 393) in China. The results showed that source characteristics predicted activating mechanisms, which in turn predicted online health information-seeking behavior. Activating mechanisms, that is, reward assessment and Internet self-efficacy, mediated the relationship between source characteristics (i.e., access and credibility) and online health information-seeking behavior. Strategies for improving information access, expertise credibility, and Internet self-efficacy are discussed in order to maximize the benefits of online health information seeking and to minimize the potential harm.     

Psychosocial Correlates of Health Literacy Among Older Patients With Coronary Heart Disease

This study examined psychosocial correlates of health literacy (HL) scores among older patients with coronary heart disease (CHD). A cross-sectional survey assessed psychosocial factors relating to the following: self-efficacy (i.e., perception of ability to perform a specified behavior) for diet, exercise, medication, and for a future attempt to quit smoking; social support; social stigma; appointment attendance; knowledge of heart problems; and understanding of health information. Health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM). Of 321 patients, 70 had a REALM score in the low HL range (<60). When adjusting for demographics, a lower REALM score was significantly associated with reports of increased difficulty understanding health information (p < .001), less knowledge of heart problems (p = .002), increased discomfort about asking for explanations of health information (p = .014), less support with discussing health problems (p = .020). Patients with CHD and low HL are likely to face psychosocial challenges when managing their health problems. In order to encourage these individuals to seek help, health professionals need to be aware of the psychosocial characteristics of patients with low HL. These individuals may need behavioral support to increase both their self-efficacy and their understanding of their medical condition.     

Multidimensional Social Support and the Health of Homeless Individuals

Homeless individuals often suffer from serious health problems. It has been argued that the homeless are socially isolated, with low levels of social support and social functioning, and that this lack of social resources contributes to their ill health. These observations suggest the need to further explore the relationship between social networks, social support, and health among persons who are homeless. The purpose of this study was to examine the association between multidimensional (cognitive/perceived and behavioral/received) social support and health outcomes, including physical health status, mental health status, and recent victimization, among a representative sample of homeless individuals in Toronto, Canada. Multivariate regression analyses were performed on social support and health outcome data from a subsample of 544 homeless adults, recruited from shelters and meal programs through multistage cluster sampling procedures. Results indicated that participants perceived moderately high levels of access to financial, emotional, and instrumental social support in their social networks. These types of perceived social supports were related to better physical and mental health status and lower likelihood of victimization. These findings highlight a need for more services that encourage the integration of homeless individuals into social networks and the building of specific types of social support within networks, in addition to more research into social support and other social contextual factors (e.g., social capital) and their influence on the health of homeless individuals.     

Associations Between Caregiving,Social Support,and Well-Being Among Parents of Children With Childhood Apraxia of Speech

This study tested a path model that examined the impact of contextual caregiving variables (i.e., severity of child's symptoms, caregiving demands, and perceived caregiving) and different forms of received romantic partner social support (i.e., emotional, esteem, network, tangible, and information) on depressive and somatic symptoms among parents with a child diagnosed with childhood apraxia of speech (CAS), a severe childhood speech disorder. In total, 169 parents of a child with CAS participated in this study. Results provide some support for one stress process model of caregiving, which further highlights the need to look at relational variables as mediators between contextual stressors and health outcomes in caregiving contexts.     

An extension of the extended parallel process model (EPPM) in television health news: the influence of health consciousness on individual message processing and acceptance

The purpose of this study is to examine the role of health consciousness in processing TV news that contains potential health threats and preventive recommendations. Based on the extended parallel process model (Witte, 1992), relationships among health consciousness, perceived severity, perceived susceptibility, perceived response efficacy, perceived self-efficacy, and message acceptance/rejection were hypothesized. Responses collected from 175 participants after viewing four TV health news stories were analyzed using the bootstrapping analysis (Preacher & Hayes, 2008). Results confirmed three mediators (i.e., perceived severity, response efficacy, self-efficacy) in the influence of health consciousness on message acceptance. A negative association found between health consciousness and perceived susceptibility is discussed in relation to characteristics of health conscious individuals and optimistic bias of health risks.     

Social Media Use and Well-Being in People with Physical Disabilities: Influence of SNS and Online Community Uses on Social Support,Depression, and Psychological Disposition

This study examined the relationships across social media use, social support, depression, and general psychological disposition among people with movement or mobility disabilities in Korea. First, with survey data (n = 91) collected from users of social network sites (SNSs) and online communities, hypotheses regarding positive associations between intensity of an individual’s engagement in social media and four different types of social support—emotional, instrumental, informational, and appraisal support—were tested as well as hypotheses regarding mediation effects of the social support variables in the association between social media use and depression. Second, through focus group interviews (n = 15), influences of social media use on social support were more thoroughly explored as well as their influences on general psychological disposition. Results from hierarchical regression analyses confirmed that both intensity of SNS use and online community use significantly predicted instrumental, informational, and appraisal support, while they did not predict emotional support. Further regression and Sobel tests showed that higher levels of intensity of SNS use and of online community use both led to lower levels of depression through the mediation of instrumental and informational support. Analysis of the interviews further revealed the positive roles of social media use in building social support and healthy psychological dispositions. However, analysis also revealed some negative consequences of and limitations to social media use for those with physical disabilities. These findings expand our knowledge of the context and implications of engaging in online social activities for people with physical disabilities.     

Gendered aspects of perceived and internalized HIV-related stigma in China

Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.     

Predictors of supportive message expression and reception in an interactive cancer communication system

Social support in computer-mediated settings is an important variable in health communication research, yet little is known about the factors that influence the amount of social support one gives and receives in online support groups. To shed some light on this issue, the authors examined demographics, disease-related factors, psychosocial factors, and strategies for coping with breast cancer as potential determinants of which patients provide support to others and which ones consume it. Data collected from 177 participants in the Comprehensive Health Enhancement Support System "Living With Breast Cancer" program revealed that individuals who are younger, have higher levels of positive reframing, and lower levels of self-blame are more likely to provide emotional support in online settings. In contrast, individuals who are more educated, have less perceived availability of social support, and have lower levels of religious coping are more likely to receive emotional support from others. The authors discuss the theoretical and practical implications for providing effective psychosocial support for women with breast cancer.     

Predictors of Supportive Message Expression and Reception in an Interactive Cancer Communication System

Social support in computer-mediated settings is an important variable in health communication research, yet little is known about the factors that influence the amount of social support one gives and receives in online support groups. To shed some light on this issue, the authors examined demographics, disease-related factors, psychosocial factors, and strategies for coping with breast cancer as potential determinants of which patients provide support to others and which ones consume it. Data collected from 177 participants in the Comprehensive Health Enhancement Support System “Living With Breast Cancer” program revealed that individuals who are younger, have higher levels of positive reframing, and lower levels of self-blame are more likely to provide emotional support in online settings. In contrast, individuals who are more educated, have less perceived availability of social support, and have lower levels of religious coping are more likely to receive emotional support from others. The authors discuss the theoretical and practical implications for providing effective psychosocial support for women with breast cancer.     

Offline Social Relationships and Online Cancer Communication: Effects of Social and Family Support on Online Social Network Building

This study investigates how social support and family relationship perceptions influence breast cancer patients’ online communication networks in a computer-mediated social support (CMSS) group. To examine social interactions in the CMSS group, we identified two types of online social networks: open and targeted communication networks. The open communication network reflects group communication behaviors (i.e., one-to-many or “broadcast” communication) in which the intended audience is not specified; in contrast, the targeted communication network reflects interpersonal discourses (i.e., one-to-one or directed communication) in which the audience for the message is specified. The communication networks were constructed by tracking CMSS group usage data of 237 breast cancer patients who participated in one of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of a diagnosis of primary breast cancer or recurrence at the time of recruitment. Findings reveal that breast cancer patients who perceived less availability of offline social support had a larger social network size in the open communication network. In contrast, those who perceived less family cohesion had a larger targeted communication network in the CMSS group, meaning they were inclined to use the CMSS group for developing interpersonal relationships.     

The Effects of Gain-, Loss-, and Balanced-Framed Messages for Preventing Indoor Tanning among Young Adult Women

Indoor tanning (IT) increases the risks of skin cancer, but evidence on how to design health education messaging targeting IT among young adult women remains limited. This study investigated the effects of theory-guided gain-, loss-, and balanced-framed IT prevention messages. Young adult women ages 18–30 who indoor tan (n = 552, mean age = 24.9 years [standard deviation = 3.1]) were recruited online, completed pre-exposure measures, and were randomized to view a gain-, loss-, or balanced-framed message. Participants completed post-exposure measures of message response (emotional response, message receptivity), IT risk (perceived severity, susceptibility), and efficacy (self-efficacy, perceived benefits of avoiding IT) beliefs, and IT behavioral intentions. Loss- and balanced-framed messages promoted significantly greater emotional response and message receptivity and lower IT behavioral intentions than gain-framed messages. The effects of loss- and balanced-framed messages on IT behavioral intentions were mediated by greater emotional response and message receptivity compared with the gain-framed message. These results can inform the development of public health education campaigns to prevent and reduce IT among young adult women. Future research can build from these findings by investigating additional message themes and tailoring strategies to maximize their effects, examining the effects of framed messages prospectively, and investigating ways to enhance message receptivity, such as through novel message delivery channels (e.g., mobile devices).     

An Experimental Examination of the Effectiveness of Framing Strategies to Reduce Mental Health Stigma

The media are often blamed for perpetuating the stigma surrounding mental illnesses, but they can also be used to counter stigmatizing narratives. Drawing on framing theory, this study tested the potency of two framing strategies (deframing and reframing) to reduce mental health stigma, using an online between-subject posttest-only survey experiment (N = 400), conducted in Belgium in November 2017.

For people without a personal history of mental illness, deframing (i.e. refuting the stigmatizing narrative) was able to significantly reduce public stigma, while reframing (i.e. introducing a new frame) significantly lowered perceived stigma. For people with a personal history of mental illness, however, the framed texts failed to significantly reduce public stigma, perceived stigma, or internalized stigma. In some cases, these texts even increased their public and perceived stigma.

In summary, this study demonstrates that framing can serve as a tool in creating anti-stigma messages, although frames may have different effects on people with and without a stigmatized condition. Finally, it is important to keep the frame’s persuasiveness into account, as unpersuasive frames can increase support for the opposing position.     

Investigating the Influence of Threat Appraisals and Social Support on Healthy Eating Behavior and Drive for Thinness

This study examined the relationship between perceived obesity threats, social support, and college students' eating attitudes and behaviors. Results showed that perceived vulnerability to obesity negatively predicted healthy eating behavior. In addition, the perceived severity of obesity-related health problems positively predicted women's drive for thinness. Social support played a significant role in explaining health behaviors. Specifically, appraisal by others indirectly predicted college students' healthy eating behavior through increased self-efficacy. Among women, informational support moderated the relationships between both vulnerability and severity on healthy eating behavior. At low levels of support, vulnerability and severity negatively predicted students' healthy eating behavior. Overall, results suggest that messages designed to increase perceived vulnerability and severity may be detrimental when trying to improve people's dietary habits; however, among women certain types of social support may buffer the defensive responses resulting from obesity threats.