How engagement with an online health community can influence self-management behavior: insights from a qualitative analysis of a UK asthma online community using Behavior Change Techniques taxonomy

Background

Patients with long-term conditions take part in online health communities (OHCs) for advice and guidance from peers. Engagement with OHCs may prompt changes in self-management behavior. Limited information exists on determinants of behavioral change resulting from engagement with an OHC.

Aims

Firstly, to identify whether engagement with an OHC results in behaviour change. Secondly, to identify the behavior change outcomes, and whether specific behavior change techniques were used.

Design & Setting

Qualitative analysis of posts written between December 2022 and August 2023 in the asthma OHC of the Asthma + Lung UK (ALUK) charity.

Method

The search term ‘helped’ was used in the Google search engine to highlight relevant posts and threads. Two researchers read through these posts to identify threads that described behavior change as a result of OHC engagement and classified them based on the specific actions taken or intentions expressed by users. Earlier posts in the same threads that encouraged behavior change were classified using Michie’s Behavior Change Technique (BCT) Taxonomy to identify potential contributing techniques.

Results

Thirty-five threads were identified, with 703 posts contributed from 200 users. Users’ characteristics were mostly hidden. Seventeen (48.6%) of these threads included posts where the users who started the thread went back to it to describe their behavior change as a result of engaging with the OHC. Within these threads, 6 posts demonstrated actual behavior change, 32 posts intention to change behavior, and one post both intention and actual behavior change. Behavior change outcomes included: contacting primary care services; trying out other users’ recommendations; consulting a healthcare professional to change medication; and purchasing equipment.

Fifty-two distinct posts (out of a total of 362 posts) by 32 users were identified as prompting behavior changes, through the use of 12 out of 96 available BCTs. Common BCTs employed by users were: ‘Demonstration of behavior’ (n=30), ‘Action planning’ (n = 26), ‘Instruction on how to perform the behavior’ (n=17), ‘Adding objects to the environment’ (n=15), and ‘Pharmacological support’ (n= 10). All threads where a behavior change was prompted, contained 2 or more BCTs. Eighteen of the 200 users were very active (i.e., superusers), contributing at least 10 posts during the 9-month period of the study. 9/18 superusers were among the 32 users who posted in threads where actual behavior change or intention to change behavior was observed.

Conclusion

Engagement with an OHC can influence the self-management behavior of patients with long-term conditions. Recognized BCTs underpinned threads demonstrating self-management behavior change.