Diseases and Emotions: An Automated Content Analysis of Health Narratives in Inquiries to an Online Health Consultation Service

ABSTRACT

The internet is increasingly used as a source of health-related information by individuals making a medical decision. Online consultation services offer a safe and anonymous time- and place-independent space in which users can ask health-related questions combined with related individual health narratives, including associated emotions. Research on emotions in health narratives and medical communication is still at an early stage. This study investigates the users of an online consultation service themselves and the content of their inquiries related to health narratives, queried diseases, and the emotions expressed. An automated content analysis of all online inquiries to the University Hospital Zurich from 09/08/1999 to 07/06/2018 was conducted (N = 55,476 inquiries). The majority of users were female. Over time, however, significantly more men and older adults began to submit inquiries. The wide variety of medical inquiries submitted to the service extended across all categories in the International Statistical Classification of Diseases and correlated with the statistical incidence of diseases in Switzerland. In line with theoretical assumptions about mood management and mood adjustment, users’ health narratives most frequently expressed negative emotions like suffering, fear, worry, and shame. The results find support for a close link between health narratives and emotions. By providing an anonymous space where users can talk about diseases that may be a source of stigma or shame, online consultation services can empower patients and promote health literacy through the provision of individualized health information.

Notes

1. Shame is “a negative emotion that arises when one is seen and judged by others (whether they are present, possible or imagined) to be flawed in some crucial way, or when some part of one’s self is perceived to be inadequate, inappropriate or immoral” (Dolezal & Lyons, 2017, p. 257). Shame threatens one’s core identity and social bonds, especially feelings of belonging and acceptance in interpersonal and social contexts (Davidoff, 2002; Dolezal, 2015; Dolezal & Lyons, 2017).

2. Data cleaning eliminated inquiries in English (545), French (66), Italian (17), as well as test questions and cases with empty text fields (337), double cases (2455), and cases where the necessary permissions were not granted (464). Plausibility tests were conducted for the following variables: age (0 < x < 111), weight (1 < x < 200), height (50 < x < 210), and BMI (5 < x < 100).

3. C. Martindale (translated by R. Delphendahl); retrieved from https://www.provalisresearch.com/products/content-analysis-software/wordstat-dictionary/regressive-imagery-dictionary/.

4. Retrieved from https://www.synonyme.woxikon.de/.

5. Levene’s test for equality of variances indicated unequal variances (F = 781.8, p < .001).

6. Levene’s test for equality of variances indicated unequal variances (F = 4.2, p < .05).

7. Levene’s test for equality of variances indicated unequal variances (F = 270.8, p < .001).

8. Levene’s test for equality of variances indicated unequal variances (F = 39.4, p < .001).

9. Levene’s test for equality of variances indicated unequal variances (F = 302.4, p < .001).

10. Levene’s test for equality of variances indicated unequal variances (F = 104.6, p < .001).