Online Support Communities Research Articles

Online Communities for Child-Attracted Persons as Informal Mental Health Care: Exploring Self-Reported Wellbeing Outcomes.

Online support communities are gaining attention among child-attracted persons (CAPs). Though research has largely focused on the negative consequences these environments create for potential offending, they may also provide a beneficial alternative to more formal treatment settings. To assess the utility for clinical and therapeutic purposes, this analysis focused on subcultural dynamics to examine self-reported wellbeing outcomes of participation in a Dutch forum for CAPs. A total of 15 semi-structured interviews were conducted with moderators, members and mental health professionals involved in the community. Thematic analyses demonstrated that by means of informal social control, bonds of trust and social relational education, the network aims to regulate the behavior and enhance the wellbeing of its marginalized participants. Key outcomes include a decreased sense of loneliness and better coping with stigma, to the point that participants experience less suicidal thoughts. Association with prosocial peers also helps to set moral boundaries regarding behavior towards children, although we cannot fully rule out potential adverse influences. Online support networks offer a stepping stone to professional care that fits individual needs of CAPs, while also providing an informal environment that overcomes limitations of physical therapy and that extents principles of existing prevention and desistance approaches.

EXPLORING RELATEDNESS AS SOUGHT BY ADOLESCENTS AND YOUNG ADULTS IN AN ONLINE INSTAGRAM INFLAMMATORY BOWEL DISEASE SUPPORT COMMUNITY

Abstract INTRODUCTION Individuals with chronic conditions have flocked to social media as a source of information, connection, and support. Online social groups are particularly salient for individuals with isolating or stigmatized conditions such as inflammatory bowel disease (IBD). IBD self-management is complex, ongoing, and highly individualized. Adolescents and young adults (AYAs) often struggle with IBD self-management, resulting in increased risk for poor health outcomes. AYAs with IBD are active on social media sites, but little is known about the possible drivers of motivation for AYAs to engage in online support communities. Self-Determination Theory proposes that behavior is intrinsically motivated by an individual’s need for autonomy, competence, and relatedness. Relatedness has been defined as a sense of group belonging and has been theorized as a key component of behavior change. However, little is known about the way in which online communities may fulfill the need for relatedness for people with chronic conditions. In this study, we aim to explore the way AYAs with IBD find relatedness in an Instagram IBD support community. METHODS We extracted public Instagram posts published between January and December 2019 in a popular IBD support group. In this group, Instagram users sent questions about IBD to the group account owner via direct message. The owner screenshotted user messages and posted these anonymous screenshots to the group, allowing other users to leave comments. We extracted posts about IBD self-management from users who indicated that they had IBD and that they were 13-24 years old or in middle school, high school, or college. Eighty-three posts were included. Then, we screenshotted and transcribed comments under each post, resulting in 1,110 unique comments. Using thematic analysis, three investigators have begun familiarizing themselves with the data, independently coding comments, and identifying emerging themes. Themes will continue to be refined through an iterative process. RESULTS From preliminary analysis, five themes have emerged: Validation, Autonomy Support, Well Wishes, Shared Identity, and Connection Within and Beyond Illness. Instagram users connected with AYAs with IBD in a variety of ways by validating their concerns, supporting their autonomy in making self-management decisions, providing online human connection, and uplifting them in their illness journeys. CONCLUSION Relatedness is a critical component of behavioral interventions, but is poorly understood in reference to self-management support in AYAs with IBD. As AYAs seek relatedness online, it is crucial to understand this population’s needs for relatedness in developing future interventions that are effective, sustainable, and tailored to the self-management needs of AYAs with IBD.

‘I found it the only place that spoke the same language’: a thematic analysis of messages posted to an online peer support discussion forum for people living with dementia

Despite the proliferation of online support communities, little is known about how people with dementia engage with them. The aim of this study was to explore the content of messages exchanged between members of the asynchronous Talking Point online discussion forum. Using the sub-forum 'I have dementia', 100 conversation threads were randomly selected yielding 863 individual messages for analysis. Our data set was subjected to reflexive thematic analysis. Three themes were generated: journeying through dementia, reciprocal peer support and therapeutic creativity. The findings suggest that individuals used the forum to share their experiences of obtaining and adjusting to a dementia diagnosis, their current symptoms and how they addressed the challenges of daily living as well as the impacts on mood, confidence and connectedness. The forum was viewed as a safe space to reflect on the future and what it might hold for them and loved ones. Throughout these discussions, users supported each other, particularly in relation to the emotional impact of diagnosis and shared experiential information and advice, with referrals to external sources of support commonplace. Discussion around the role of therapeutic creativity was evident and its role as a coping mechanism described. Through engagement, a sense of community and companionship was evident and new members welcomed, supported and encouraged to join in. The forum appears to be filling an important gap in post-diagnostic support provision, particularly for those with rare forms of dementia. Clinicians, support workers and organisations could consider recommending online support forums to people with dementia.

Hubzero: Community Growth for Four Science Gateways Supporting Open Science

The research landscape has become increasingly interdisciplinary and complex with novel hardware, software, data, and lab instruments. Reproducibility of research results, the usability of tools, and sharing of methods are all crucial for timely collaboration for research and teaching. Hubzero is a widely used science gateway framework designed to support online communities with efficient sharing and publication processes. The paper discusses the growth of communities for the four science gateways nanoHUB, MyGeoHub, QUBEShub, and HubICL using the Hubzero Platform to foster open science and tackling education with a diverse set of approaches and target communities.

Nameless strangers, similar others: the affordances of a young people's anonymous online forum for health information practices

PurposeThe study examines how the technical features and associated social practices of an anonymous, text-based online forum intended for young people make it a unique platform for acquiring and sharing health information among peers.Design/methodology/approachThe features and content of a young people's section of a popular Finnish discussion forum were examined with a focus on health-related threads. Observational notes and thread content were analysed with a focus on the forum's affordances for health information practices.FindingsThe findings indicate that the forum's affordances including anonymity, persistence, searchability, cohesion and tolerance enabled the pooling of peer experiences, opinions and experience-based advice on health, rather than sharing factual information or embracing reciprocal discussion. As such, instead of competing for a cognitive authority position with medical authorities or offering emotional support like tight online support communities, the anonymous forum served as a platform for young people to gain information on others' experiences and opinions on sensitive, mundane and disnormative health issues and for reflecting their own lived experiences to those of others.Originality/valueThe study is original in its approach to examining the affordances of an online platform for health information practices. It helps in understanding young people's ways of using different resources to meet their diverse health information needs and the value of gaining access to experiential health information.

Social support in a parenting Facebook group during the COVID-19 pandemic.

This paper includes a mixed methods content analysis of a parenting Facebook group focused on COVID-19. We analyze participants' posts to identify the types of support parents sought and gave. The COVID-19 pandemic has resulted in increased parental stress and challenges related to children's development. Many families turned to social media as a source of information and social support. We analyzed 1,180 posts from a large, closed Facebook group focused on parenting during COVID-19. We coded posts using a modified version of social support theory and supplemented this analysis with codes related to giving and receiving support, post format, and topic. Participants frequently offered informational support, typically reposting content from other sources. There were fewer instances of soliciting support, but these posts had significantly more comments. The most common topics discussed were parenting and child development, remote schooling support, literacy, and adult mental health. Findings illustrate the benefits and challenges of online support communities for parents, especially those on social media platforms. These results suggest areas where parents may need or want support during and after COVID-19 and ways in which social media can serve as a form of parenting social support.

Exploring Social Support in an Online Support Community for Tourette Syndrome and Tic Disorders: Analysis of Postings.

BackgroundOnline support communities have become an accessible way of gaining social, emotional, and informational support from peers and may be particularly useful for individuals with chronic conditions. To date, there have been few studies exploring the online support available for tic disorders, such as Tourette syndrome. An exploratory study looking at users’ experiences with using online support communities for tic disorders suggested that members used such communities to share experiences, information, and strategies for tic management.ObjectiveTo build on these preliminary findings, this study examined the provision of social support in an online community for Tourette syndrome.MethodsData were collected from one publicly available online support community for Tourette syndrome and tics, from its inception to December 2019, by randomly selecting 10% of posts and their corresponding comments from each year for analysis. This resulted in 510 unique posts and 3802 comments posted from 1270 unique usernames. The data were analyzed using inductive thematic analysis.ResultsThe findings of this study suggest that users utilized the online community as a multifaceted virtual place where they could share and ask for information about tics, unload and share their feelings arising from living with Tourette syndrome, find people facing similar situations and experiences, and freely share the realities of living with Tourette syndrome.ConclusionsThe results complement the findings from a preliminary study and suggest that online support communities have a potentially valuable role as a mechanism for sharing and gaining information on illness experiences from similar peers experiencing tics and can promote self-management of tics. Limitations and recommendations for future research are discussed.

Unmet Sexual Health Needs of Patients and Female Partners Following Diagnosis and Treatment for Prostate Cancer

BackgroundProstate cancer (PCa) and its treatment can have significant and pervasive sexual side effects for patients and their partners; however, partner needs are not well understood, and most resources do not incorporate partner priorities. AimOur objective was to perform a qualitative study to identify unmet sexual needs of patients and female partners after PCa diagnosis. MethodsWe conducted a qualitative study of posts to the Inspire Us TOO Prostate Cancer Online Support and Discussion Community. Overall, 6,193 posts were identified in the Sexual Health & Intimacy forum of the community, of which 661 posts were from female authors. A random sample of 10% (n = 66) of posts from female partners and an equal number of randomly selected posts from male patients were analyzed. OutcomesWe assessed sexual health themes among patients and female partners. ResultsMultiple themes emerged that were unique to female partners of PCa survivors. These included expanding the sexual repertoire, feeling invisible, contextualizing sexual intimacy within the broader picture of survival, and addressing relationship concerns. Patients and their partners also shared common sexual health themes, including coming to terms with changes in sexual function and frustration with clinicians. Both patients and their partners use online health communities to get support and share their experiences with sexual recovery and use of sexual aids. Psychosocial treatments were infrequently mentioned, and may be particularly helpful to address partner concerns. Clinical ImplicationsA common concern for couples was not receiving sufficient information from healthcare providers regarding sexual side effects from PCa and its treatment. Strengths and LimitationsStrengths of the study include leveraging a unique data source to address an understudied topic of sexual health concerns among partners after PCa diagnosis. However, members of an online community may not be representative of all couples facing PCa. Also, this analysis is limited to female partners of patients with PCa, and further study is underway to examine the sexual health needs among gay and bisexual couples. ConclusionBoth patients and female partners have many unmet sexual health needs during PCa survivorship, and designing interventions to incorporate partner perspectives may improve the management of sexual side effects of PCa for couples.Li R, Wittmann D, Nelson CJ, et al. Unmet Sexual Health Needs of Patients and Female Partners Following Diagnosis and Treatment for Prostate Cancer. J Sex Med 2022;19:1797–1803.

A home away from home: building an organic online support community for Chinese students using WeChat

Traditional university support structures have generally been predicated on a ‘one size fits all’ approach that stresses a mechanistic, bureaucratic approach. Support is transactional in nature with students accessing it only when needed. Support focuses on both individual tutorial and centralised mechanisms which have proved effective for only some students. This paper proposes an organic student support system that is based around five features: agility in the environment, a tutor-student partnership, informal two-way communication, a student-led community, the inclusion of a knowledge-hub. The student support system in this article is based around Chinese students at a large UK university who felt disenfranchised by the current support mechanisms, so an alternative model was set up using the group-based instant-messaging social media platform, WeChat. The findings of surveys and interviews with Chinese students demonstrated that the featured organic student support system proved extremely successful and is something that could be replicated with other groups of students in the future in UK higher education.

Hearing Health Care Digital Therapeutics: Patient Satisfaction Evidence.

A digital therapeutic is a software-based intervention for a disease and/or disorder and often includes a daily, interactive curriculum and exercises; online support from a professional versed in the treatment base; and an online support community, typically active as a social chat group. Recently, the Consumer Technology Association published revised standards for digital therapeutics (DTx) that stipulate that a DTx must be evidence based and founded in scientific evidence showing effectiveness and must be supported by evidence showing improved patient satisfaction and adherence to an intervention. The purpose of this study was to investigate whether a DTx could help older adults better adjust to their hearing loss and acclimate to new hearing aids. Thirty older adults with mild or moderate hearing loss who had never used hearing aids participated. All hearing aids were fitted remotely. Participants used a hearing health care DTx (Amptify) for 4 weeks, either immediately following receipt of the hearing aids or 4 weeks after the fitting. A control condition was watching closed caption television. Participants completed a satisfaction questionnaire that queried about their impressions of the DTx, which had items that included both a rating scale of 1-7 and open-ended questions. Ninety-six percent of the participants reported positive benefits, and one-half reported that the DTx helped them to adjust to their new hearing aids. They assigned a score of 5.8 to one of the questionnaire items that is similar to a Net Promoter Score Benefits, which included an enhanced ability to engage in conversation and increased listening confidence. This investigation provides scientific evidence to support the use of a hearing health care DTx, paving the way for audiologists to be able to more easily and efficiently incorporate follow-up aural rehabilitation into their routine clinical services and to be able to provide services remotely.

Psycholinguistic changes in the communication of adolescent users in a suicidal ideation online community during the COVID-19 pandemic

Since the outbreak of the COVID-19 pandemic, increases in suicidal ideation and suicide attempts in adolescents have been registered. Many adolescents experiencing suicidal ideation turn to online communities for social support. In this retrospective observational study, we investigated the communication—language style, contents and user activity—in 7975 unique posts and 51,119 comments by N = 2862 active adolescent users in a large suicidal ideation support community (SISC) on the social media website reddit.com in the onset period of the COVID-19 pandemic. We found significant relative changes in language style markers for hopelessness such as negative emotion words (+ 10.00%) and positive emotion words (− 3.45%) as well as for social disengagement such as social references (− 8.63%) and 2nd person pronouns (− 33.97%) since the outbreak of the pandemic. Using topic modeling with Latent Dirichlet Allocation (LDA), we identified significant changes in content for the topics Hopelessness (+ 23.98%), Suicide Methods (+ 17.11%), Social Support (− 14.91%), and Reaching Out to users (− 28.97%). Changes in user activity point to an increased expression of mental health issues and decreased engagement with other users. The results indicate a potential shift in communication patterns with more adolescent users expressing their suicidal ideation rather than relating with or supporting other users during the COVID-19 pandemic.

Randomized Trial of a Web-Based Tobacco Treatment and Online Community Support for People With HIV Attempting to Quit Smoking Cigarettes.

Persons with HIV (PWH) in the United States (US) smoke cigarettes at approximately triple the rate of the general adult population and are less successful in their quit attempts than other smokers. This randomized trial tested whether a novel web-based cessation program for PWH yielded higher cigarette quit rates compared with a control program. Two urban HIV care sites in NYC and Baltimore. Between 2016 and 2020, 506 PWH were randomized to either Positively Smoke Free on the Web (PSFW+; N = 255), a multimodal platform, interactive web intervention hosted within an online social network to support quitting among PWH who smoke, and an attention-matched web-based control intervention (American Heart Association Getting Healthy; N = 251). All participants were offered 12 weeks of nicotine patch. Our primary outcome was biochemically confirmed exhaled carbon monoxide < 10 parts per million (ppm) 7-day point prevalence abstinence at 6 months. Participants were middle-aged (mean 50.2 years; range 23-73 years), 57% male, 19% Latinx, 83% Black, and 13% White. At 6 months, a significantly greater percentage of PSFW+ participants (14.9%) achieved biochemically confirmed 7-day point prevalence abstinence in intent-to-treat analysis compared with 8.8% of American Heart Association Getting Healthy participants [odds ratio =1.82 (95% confidence interval =1.04 to 3.18), P = 0.03]. PSFW+ is a promising cessation intervention composed of empirically tested content and real-time social support through an online social network that was found to promote abstinence. This digital approach has broad reach and scalability, can be easily integrated into comprehensive HIV care, and represents an advance in the fight against tobacco use among PWH.

Post Approvals in Online Communities

In many online communities, community leaders (i.e., moderators and administrators) can proactively filter undesired content by requiring posts to be approved before publication. But although many communities adopt post approvals, there has been little research on its impact on community behavior. Through a longitudinal analysis of 233,402 Facebook Groups, we examined 1) the factors that led to a community adopting post approvals and 2) how the setting shaped subsequent user activity and moderation in the group. We find that communities that adopted post approvals tended to do so following sudden increases in user activity (e.g., comments) and moderation (e.g., reported posts). This adoption of post approvals led to fewer but higher-quality posts. Though fewer posts were shared after adoption, not only did community members write more comments, use more reactions, and spend more time on the posts that were shared, they also reported these posts less. Further, post approvals did not significantly increase the average time leaders spent in the group, though groups that enabled the setting tended to appoint more leaders. Last, the impact of post approvals varied with both group size and how the setting was used, e.g., group size mediates whether leaders spent more or less time in the group following the adoption of the setting. Our findings suggest ways that proactive content moderation may be improved to better support online communities.

Facebook Feeds and Child Feeding: A Qualitative Study of Thai Mothers in Online Child Feeding Support Groups.

Mothers have traditionally sought child feeding information from social connections. While mothers are heavily engaged on social media and value peer support in online communities, very little is known about how they use online communities for information about child feeding practices after exclusive breastfeeding cessation. This study explores mothers’ perceptions of joining Facebook child feeding support groups. Individual semi-structured interviews with ten Thai mothers were conducted. The transcribed interviews were analyzed using a phenomenological hermeneutical approach. Our findings highlighted that Thai mothers participated in Facebook child feeding support groups in a deliberate effort to reduce their uncertainty by normalizing the process through accessing the shared experiences of others. One of their intentions was to seek menu recipes based on favorable psychosocial and environmental factors. Implications for using social media in health promotion and communication include the importance of building appropriate common practices through social collaboration and interactivity to supplement traditional knowledge and attitudes.

U.S. Immigrants and Mental Health: An Investigation of the Influence of Mental Health Stigma and Discrimination on Stress and Depression and Affordances Associated with Using Online Mental Health Applications and Online Support Groups

ABSTRACT Despite evidence that immigrants living in the United States experience significant threats to their mental health, they are less likely to seek and utilize mental health services than U.S.-born individuals. Online mental health resources may be an alternative to traditional mental health care for this population, but less is known about factors that influence immigrant mental health problems or how online technology affordances influence online mental health/therapy applications and online support communities with this population. Drawing upon minority stress theory and an affordance of health communication technology framework, the current study surveyed U.S. immigrants regarding the impact of mental health stigma and discrimination on stress and depression as well as predictors of immigrant use of online mental health/therapy applications and online mental health support communities. The study findings revealed that when controlling for number of years living in the United States, increased perceived mental health stigma was positively associated with greater perceived stress and depression. However, perceived discrimination did not predict stress or depression. Moreover, that higher perceived mental health stigma was a significant predictor of increased mental health mobile application use among immigrants, and greater weak-tie support preferences were predictive of increased online support community use. These findings are discussed alongside theoretical implications, practical considerations, limitations, and direction for future research.

Perspectives of partners on addressing unmet sexual needs following prostate cancer therapy

ABSTRACT Introduction Survivors of prostate cancer have reported physical and psychosocial sexual changes resulting from treatment of the disease that may challenge sexual recovery. Partners of prostate cancer patients experience sexual losses after patient treatment, yet their needs are not well understood and most resources do not incorporate partner priorities. Given that sexual intimacy requires mutuality, addressing unmet needs for partners is a key tenet in fostering sexual recovery for couples navigating the impact of prostate cancer treatment. Objective The objective was to perform a qualitative study of partner focused sexual health-related themes that are relevant for couples’ sexual recovery following prostate cancer therapy. Methods We performed a qualitative study of posts to the Inspire Us TOO Prostate Cancer online support and discussion community, which connects &amp;gt; 31,000 prostate cancer patients, family members, and caregivers. Text from anonymized, public available comments were reviewed from the prostate cancer and intimacy section. 6,193 posts were identified, of which 661 were from female authors. A random sample of 10% of these posts (n = 66) were analyzed, as well as an equal number of posts from patients. Results Multiple themes were discussed that reflect consensus in sexual health-related priorities across both patients and their partners. Patients and their partners identified similar challenges for sexual health after prostate cancer treatment, including coming to terms with changes in sexual function, frustration when interacting with clinicians, and barriers to access to sexual aids. Both parties frequently expressed appreciation for being able to share experiences with sexual recovery and sexual aids through forums such as online communities. However, several themes emerged that were unique to female partners. Partners were more likely to discuss the impact of sexual recovery on the couples’ relations, but emphasized the relative importance of survival over sexual quality of life. Many partners also highlighted constructive mechanisms for aiding sexual recovery, such as expanding sexual repertoire with new techniques and utilizing psychosocial support and therapy. Notably, partners commonly expressed feeling that their needs for intimacy and sexuality were overlooked when couples sought support or resources from healthcare providers. Conclusions Identifying unmet sexual needs for partners are critical for addressing barriers to sexual recovery following prostate cancer therapy. Our findings corroborate prior research in which partners reported feeling that their needs were excluded from addressing solutions to sexual health issues. Themes identified in this study can help the development of resources to improve sexual health support for partners of survivors of prostate cancer. They may also inform evaluation tools to assess partners’ sexual quality of life. Disclosure Work supported by industry: yes, by Department of Defense. A consultant, employee (part time or full time) or shareholder is among the authors (Gilead).

Death of a child, birth of a guild: Factors aiding the rapid formation of online support communities

In this article, we examine how a loosely knit, mediated community in the massively multiplayer online game EverQuest II rapidly coalesced to carry out collective action in response to a request to help a terminally ill child. We examine the factors that motivated hundreds of people to donate their time, expertise, and in-game resources to people they had never met. These factors included specific affordances of the many technologies relied upon, the emotional weight and urgency of the initial post, both trusted and well-connected actors in the network, and a sense of belonging to the greater community by many of those who helped. Furthering our knowledge on how rituals surrounding death and mourning work in digital networks can provide insights into the continued health of online communities in general.

P085 NRAS New2RA Right Start for people newly/recently diagnosed with RA

Abstract Background/Aims The National Rheumatoid Arthritis Society (NRAS) follows best practice, evidence-based standards in all we do. Whilst huge strides have been made in the diagnosis and treatment of Rheumatoid Arthritis (RA), the impact on quality of life can be significant and for many, RA remains hard to come to terms with. Anxiety and depression are frequent co-morbidities seen in RA, particularly in the early stages. This can impede people’s ability to acquire knowledge about their disease together with supported self-management skills and coping strategies. The aim of Right Start is to improve outcomes of the newly/recently diagnosed with RA through a framework of emotional, educational and peer support, and access to high quality supported self-management resources tailored to individual need. Methods Right Start involves a simple, 4-step process: • a call (up to 1 hr) with a member of our helpline. • 1:1 peer support from trained volunteers with RA, 24/7 online community support • a tailored package of hard copy information with e-links of interest sent by post • further follow up available by helpline and individual peer support Right Start enables health professionals to meet their responsibilities against NICE Quality Standard 33, Statement 3, on which they are audited through National Early Inflammatory Arthritis Audit (NEIAA), and the EULAR Recommendations for implementation of self-management strategies in inflammatory arthritis. Results Since launch at BSR 2019, 71 rheumatology units have referred over 400 patients to this service. Approx. 1/3rd couldn't be contacted and after 3 attempts, a letter and newly diagnosed pack are sent, inviting contact at future date. Anecdotally people are highly satisfied with this service and a number of units are referring multiple patients. To gather empirical data on the impact of the service NRAS has partnered with Manchester University to undertake an Enhanced Right Start pilot in 5 UK rheumatology units involving the use of validated patient reported outcome and experience measures from the users recruited, and quantitative and qualitative data from the health professionals. The pilot is due to commence before end 2021. Meantime, referrals continue to grow. Conclusion The NHS rheumatology workforce is in crisis and Right Start enables professionals to offer evidence-based education and supported self-management resources to optimise patient care. A Nurse Consultant (West Middx.) said of the service: “I have found Right Start to be an excellent resource for people who have recently been diagnosed with RA. When time is limited time in clinic, a referral provides the patient with tailored information which complements the education I have been able to provide. Feedback from patients has been positive particularly relating to the phone calls with the NRAS helpline team and the NRAS volunteer with RA. I would definitely recommend the service.” Disclosure A.M. Bosworth: None. I. McNicol: None.

From Receivers to Givers: Understanding Practice of Reciprocity in an Online Support Community

In online communities, members often join as resource receivers and later transition to contributors. This study aims to examine the process of the transition through the lens of reciprocity. In the context of Gomusin Café, an online support group where women with romantic partners serving in South Korean military exchange social support, we conducted semi-structured interviews (n = 16) probing how the members return the support they received to unspecified audience (generalized reciprocity) and to repeated interaction partners (direct reciprocity). We found experiencing common hardships and forming social attachment to the community as important preceding conditions for the members to practice generalized reciprocity. The members also sought direct reciprocity despite it's not technically and normatively supported in the platform. We discuss theoretical and practical implications of these findings.

Continuous Glucose Monitoring Plus an Online Peer Support Community Reinforces Healthy Behaviors in Hispanic Adults With Type 2 Diabetes.

Previous research has suggested beneficial glycemic outcomes for people with type 2 diabetes with the use of continuous glucose monitoring (CGM); yet, there is a dearth of data examining CGM in diverse populations. Additionally, the use of online peer support communities (OPSCs) can further support the application of CGM information to improve health behaviors. The purpose of this qualitative study was to assess participant experiences with a CGM+OPSC intervention. Semi-structured interviews were conducted after a 12-week combined CGM+OPSC intervention with Hispanic, Spanish-speaking people with type 2 diabetes not using insulin. The OPSC was managed by five trained bilingual peer facilitators. Interviews were conducted in Spanish. Audio recordings were translated and transcribed and then reviewed by the interviewer for accuracy. Emergent themes were identified through inductive thematic analysis. Twenty-six participants completed interviews. Three main themes emerged from the data: 1) CGM supports participants' understanding of the relationship between glucose levels and health behaviors such as healthy eating, being active, taking medication, stress reduction, and improving sleep; 2) the OPSC reinforced how to make healthy choices through personal experiments, collective learning, and social support; and 3) CGM+OPSC supports behavior change and increases confidence. When combined, CGM+OPSC interventions appear to create a positive feedback loop to reinforce and optimize healthy behaviors for diabetes self-management in individuals with type 2 diabetes who are not on insulin. The provision of such an intervention tailored to Hispanic, Spanish-speaking individuals has the potential to address the health care disparity seen in this population.