“I didn’t want everybody on Facebook knowing that my butt muscle hurt today”: The joys of oversharing about health online

“It’s not that I don’t have problems, I’m just not putting them on Facebook”: Challenges and Opportunities in Using Online Social Networks for Health

Mark W Newman¹, Debra Lauterbach¹, Sean A. Munson¹, Paul Resnick¹ and Margaret E Morris²

University of Michigan¹ and Intel

This paper discusses the way that people use online social networks to pursue social goals related to their health. It compares the use of online health communities (OHCs) such as Spark People and Diabetes Daily with the use of Facebook. The authors are interested in finding out what tools participants use to meet their social and health goals from the many options available to them and why they choose them.

OHCs are “online environments in which users interact with one another around a set of common interests or purpose related to health.” [p.2] These platforms share a number of tools with traditional social networks including discussion boards chat, virtual environments and direct messaging – all of which will be familiar to Facebook users. The similarity of features begs the question why bother with a separate site at all? Especially when, as Newman et al identify this inevitably entails the challenge of building and maintaining multiple networks. The authors supply two answers to this question. Firstly, there are issues of relevance, experience, knowledge and interest in a niche topic. Secondly the authors identify OHCs as “Non-judgemental spaces” [p.2] something which they later contrast with the environment on Facebook which with its proliferation of ‘weak ties’ and a consequential worry about status and what our high school friends think of us. Participants in the study contrasted the positivity of OHCs to the “sarcastic and negative” responses people sometimes receive on Facebook.

The study involved 90 minute interviews with 14 people struggling with weight loss and diabetes management who regularly use both Facebook and an OHC. Responses were coded and during a group discussion among authors themes were iteratively generated and refined. The authors identified a number of goals that users sought to achieve through the use of OHC and Facebook including seeking emotional support, motivation, accountability and advice.

The authors used these goals as a framework for the exploration of their findings. In the discussion they went on to identify two key challenges for users. Firstly, building shaping and selectively accessing one’s network and secondly, managing impressions while meeting health needs”. They then identify several “design opportunities” [p.8] including an opportunity for social networks to “explore lightweight ways to increase the precision of one’s communication” or put another way “custom lenses”[p.8] which would enable participants to identify health-specific connections thereby reducing fear of social stigma when posting about their health. They also believe that an analysis of communication patterns could reveal more or less effective communication strategies to enable users to meet their health (and other) goals.

One of the themes that interested me is the ongoing conflict between maintaining a positive self-image and asking for help. One participant even said “I want everyone to think I’m perfect” [p.7]. This raises questions around truthfulness and bragging – something that I guess most users have encountered on Facebook at one time or another (and part of the reason I got sick of it).

Another issue raised by the paper is the potential proliferation of harmful advice online. One participant describes how he and a more experienced user talked about “our doctors and frustration and how to get what we want, how to present our problems to our doctors”. Here the participant is openly discussing manipulating the information presented to the doctor in order to achieve an outcome that he or she thinks is correct at least partly based on the advice of someone they don’t know and who is not in a position to advise the user on the best course of action. The dangers of users prioritising this advice over medical advice are clear however it is not even discussed in this paper, which is surprising given its title.

The other paper I read this week was Social Network Activity and Social Well-Being by Moira Burke et al. In contrast to the Newman paper it was more positive about Facebook: “engagement with Facebook is correlated with greater overall wellbeing”. (A more sceptical person than myself might say that the fact that two of the three authors worked for Facebook at the time the article was written while the main author Burke went on to work for them within two years might suggest a potential conflict of interests…) Despite that I actually found this paper more enlightening than the paper above as it delved more deeply into the different ways that people use Facebook, highlighting the difference between “directed communication” and “consumption” and the effect these have on social capital and loneliness.  Summary: direct communication good, consumption less so.