Lessons Learned for Online Health Community Moderator Roles: A Mixed-Methods Study of Moderators Resigning From WebMD Communities

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Lessons Learned for Online Health Community Moderator Roles: A Mixed-Methods Study of Moderators Resigning From WebMD Communities | Huh | Journal of Medical Internet Research


Background: Online health community (OHC) moderators help facilitate conversations and provide information to members. However, the necessity of the moderator in helping members achieve goals by providing the support they need remains unclear, with some prior research suggesting that moderation is unnecessary or even harmful for close-knit OHCs. Similarly, members’ perceptions of moderator roles are underexplored. Starting January of 2013, WebMD moderators stopped working for WebMD communities. This event provided an opportunity for us to study the perceived role of moderators in OHCs.
Objective: We examine the OHC members’ perception on OHC moderators by studying their reactions toward the departure of moderators in their communities. We also analyzed the relative posting activity on OHCs before and after the departure of moderators from the communities among all members and those who discussed moderators’ departures.
Methods: We applied a mixed-methods approach to study the posts of all 55 moderated WebMD communities by querying the terms relating to discussions surrounding moderators’ disappearance from the WebMD community. We performed open and axial coding and affinity diagramming to thematically analyze patients’ reactions to the disappeared moderators. The number of posts and poster groups (members and moderators) were analyzed over time to understand posting patterns around moderators’ departure.
Results: Of 821 posts retrieved under 95 threads, a total of 166 open codes were generated. The codes were then grouped into 2 main themes with 6 total subthemes. First, patients attempted to understand why moderators had left and what could be done to fill the void left by the missing moderators. During these discussions, the posts revealed that patients believed that moderators played critical roles in the communities by making the communities vibrant and healthy, finding solutions, and giving medical information. Some patients felt personally attached with moderators, expressing they would cease their community participation. On the other hand, patients also indicated that moderators were not useful or sometimes even harmful for peer interactions. The overall communities’ posting activity, which was already in decline, showed no significant difference before and after the moderators’ departure. In fact, the overall posting activities of the communities were declining well before the moderators’ departure. These declining posting activities might be the reason why WebMD removed the moderators.
Conclusion: Compassionate moderators who provide medical expertise, control destructive member posts, and help answer questions can provide important support for patient engagement in OHCs. Moderators are in general received positively by community members and do not appear to interfere with peer interactions. Members are well aware of the possibility of misinformation spreading in OHCs. Further investigation into the attitudes of less vocal community members should be conducted.

J Med Internet Res 2016;18(9):e247

Introduction

In-person patient support groups, often organized by hospitals and clinical moderators, are a well-established mechanism to encourage peer-patient interaction, help patients improve self-efficacy, and educate patients about self-care management [1-4]. As Web 2.0 and social media spread as one of the main Internet activities, OHCs have also proliferated, often without moderators [5]. Unmoderated communities can suffer from the negative consequences of misinformation and poor social dynamics (eg, trolling) if not well-maintained by community members [6-8], especially when the interest of the community is health. The addition of moderators or active commitment by the members can diminish such negative consequences of OHCs [6-9]. However, the cost of resources is high for hiring moderators, preferably those with clinical backgrounds. In addition, moderating thousands of posts [5], and motivating moderators to voluntarily participate in OHCs can be difficult [10].

To successfully administer OHCs, we need to understand the critical role that moderators have in OHCs. A study revealed effective moderation styles for various negative online behaviors (eg, trolling) [11]. Although the effectiveness of moderation styles (eg, rewarding vs punishing) has been studied, there is no consensus regarding the necessity and role of moderators on OHC retention and improving levels of social support, where prior research reveals conflicting results. A study showed that moderators may be important for both the vibrancy of forums and improving patient outcomes [7,12]. Moderators review postings, redirect conversations, and stimulate dialogue when forum activity lags. They also execute a “process function” and help establish and enforce community rules [13]. Moderators offer valuable help that clinicians cannot provide, including suggesting ways to communicate with health care providers and finding useful health information resources for self-management [14]. The necessity of such external governance in moderating troll conversations may be dependent on the specific community. For those OHCs where patients have already established strong rapport with one another and are self-policing community conversations, external governance can be unnecessary [15] or sometimes even disruptive [16]. Online health communities independently run by patients only can self-maintain high information quality [17], although a systematic review showed that the effectiveness of purely peer-patient–based OHCs in terms of clinical outcomes lacks RCT-based evidence [18]......