Opinion Leaders in Online Cancer Support Groups: An Investigation of Their Antecedents and Consequences

ABSTRACT

With a focus on the nature and dynamic process of social interactions among breast cancer patients, this study argues that the notion of opinion leaders can be another crucial factor in explaining positive psychosocial health outcomes within computer-mediated social support (CMSS) groups. This study investigates the relationship between opinion leaders and their psychosocial health benefits by considering two overarching questions: (a) Who are the opinion leaders? (b) What role do these opinion leaders play in explaining health outcomes? The data analyzed in this study resulted from merging human-coded content analysis of discussion group messages, action log data analysis of interactive health system usage, and longitudinal survey data. Surveys were administered to 221 women with breast cancer; participants were provided free access to and training for the CMSS groups developed by the Comprehensive Health Support System (CHESS) project. The findings suggest that opinion leaders obtained psychosocial health benefits, such as higher levels of cancer information competence, breast cancer knowledge, and better problem-focused coping strategies. Those who had a higher baseline level of breast cancer knowledge and optimism in coping with challenges in their life were more likely to act as opinion leaders. Implications for research and improving psychosocial interventions for people with health concerns are discussed.

Funding

This study was funded by P50 CA095817-05 from the National Cancer Institute.

Notes

¹ Each condition was provided different numbers and types of support services. The first condition (Internet Only, n = 112) is the control group that received training on how to navigate and search for relevant information in the Internet. The second condition (CHESS Information Services, n = 118) received only the CHESS information services. The third condition (CHESS Information and Support Services, n = 109) received both the information and support services from CHESS. The Full CHESS condition (CHESS Information + Support + Interactive Coaching Services, n = 111) received all three types of CHESS services. The fifth condition (Human Cancer Mentor Only, n = 106) received customized, confidential services from only cancer experts without the use of any CHESS services. The final condition (Full CHESS + Human Cancer Mentor, n = 105) was offered both human cancer mentoring and all CHESS services. Refer to Hawkins et al. (2011) and Baker et al. (2011) for more details about the original study design.

² We have categorized those who did not post or read a message as nonusers and excluded this group of people in our analysis. However, some people may think that we should include this group, which comprises a substantial number of participants, in increasing the external validity. Therefore, we have run post hoc analyses using all participants in our sample. We found a marginally significant positive relationship between opinion leadership and cancer information competence (β = .18, p < .1). Similarly, opinion leadership was marginally positively related to breast cancer knowledge (β = .20, p < .1). Similar to our previous result, we found that Life Orientation Test–Revised (LOT-R) was positively related to opinion leadership measure (β = .24, p < .05). Interestingly, among covariates, we have found that those who live alone were less likely to gain cancer information competence (β = –.16, p < .05). Also, those who spent more time in discussion groups were more likely to have a better quality of life (β = .16, p < .05). In summary, we found a somewhat weak but similar trend toward significance when including nonusers. Despite the fact that we did not find the same significant patterns when including nonusers, here are some reasons why it is valid to exclude nonusers (n = 104) in our analyses: First, we agree that opinion leadership should be considered as a continuous variable, rather than a simple dichotomy, because it has the potential to yield a more sensitive classification of opinion leaders (Shah & Scheufele, 2006; Weimann, 1994). When we include nonusers, it would be difficult to differentiate between nonusers and non-leaders/followers at the lower end of our scale on the basis of our conceptual definition of opinion leaders. Next, most of health intervention studies at CHESS focuses on how people use different types of computer-based system of integrated services and how different types of engagement to this intervention produce beneficial outcomes to individuals with a health crisis (Han et al., 2009). Given the fact that nonusers who are self-selected are not different from users in terms of demographics and some psychosocial factors at the baseline survey, we believe that the use of CMSS groups can offer some positive changes to health behaviors for people with health concerns. In line with this reasoning, this study puts more emphasis on how participants consume cancer online support groups and on how these users produce significant improvement on their health outcomes rather than on how users and nonusers are different in their psychological health outcomes. Finally, we opted for excluding nonusers in part due to the heavily skewed distributions of the messages written and read measures and thus potentially violating the normality assumption in subsequent analyses. While that debate (i.e., inclusion of nonusers) is beyond our scope here, future studies will also benefit from categorizing different subgroups of users (i.e., nonusers, lurkers, followers, opinion leaders, etc.) in all initial participants and comparing any differences among different groups.

Additional information

Funding

This study was funded by P50 CA095817-05 from the National Cancer Institute.