open access:
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 [-].
As Web 2.0 and social media spread as one of the main Internet
activities, OHCs have also proliferated, often without moderators [].
Unmoderated communities can suffer from the negative consequences of
misinformation and poor social dynamics (eg, trolling) if not
well-maintained by community members [-],
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 [-].
However, the cost of resources is high for hiring moderators,
preferably those with clinical backgrounds. In addition, moderating
thousands of posts [], and motivating moderators to voluntarily participate in OHCs can be difficult [].
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) [].
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 [,].
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 [].
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 [].
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 [] or sometimes even disruptive []. Online health communities independently run by patients only can self-maintain high information quality [],
although a systematic review showed that the effectiveness of purely
peer-patient–based OHCs in terms of clinical outcomes lacks RCT-based
evidence []......
