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.

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.

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.

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. Competing Interest Statement The authors have declared no competing interest. Funding Statement VD was partly funded through Research Capability Funding. This study was partly funded by a Programme Grants for Applied Research Programme (grant number: NIHR202037). Views articulated are those of the authors and not necessarily those of the National Health Service, NIHR, or the Department of Health and Social Care. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study used only openly available posts written publicly in the ALUK asthma online health community located at: https://healthunlocked.com/asthmalunguk-asthma I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data availability statement The datasets generated or analyzed during this study are not publicly available as they can easily be used to identify the participants, but are available from the corresponding author upon reasonable request. Abbreviations - ALUK - Asthma + Lung UK - BCT - Behaviour change technique - BTS - British thoracic society - HCP - Health care professional - NICE - National institute for health and care excellence - OHC - Online health community - OTC - Over the counter - SIGN - Scottish intercollegiate guidelines network