Empowerment among breast cancer survivors using an online peer support community

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Medina, Maria Serra-Blasco, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4169441/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 7 You are reading this latest preprint version Abstract Objectives : Breast cancer (BC) impacts the patient’s quality of life. Peer support can provide emotional understanding as well as enhance information access, social support, and coping strategies, aligning with empowerment. Comunitats is an online peer support community addressed to BC survivors, involving healthcare professionals. This study aims to explore how participation in Comunitats promotes empowerment, and which variables are related to it. Methods: 121 women diagnosed with BC were included in Comunitats. Emotional distress, post-traumatic growth and empowerment were assessed at inclusion and three months later. Correlations were used to guide linear regression analysis to identify which variables are able to predict greater empowerment outcomes. Results: Empowerment assessment indicated that participants felt empowered by their involvement in Comunitats . The empowerment outcomes more commonly experienced were 'being better informed' and 'improved acceptance of the illness'. 'Exchanging information' and 'finding recognition' were the strongest experienced empowerment processes. Conclusion: Involvement in Comunitats enhances empowerment in BC survivors. Empowering processes within the community partially predict overall empowerment outcomes. Practical Implications : Empowerment positively impacts self-care autonomy, self-efficacy, and treatment adherence, promoting healthier lifestyles and enhanced treatment outcomes. online communities empowerment peer support breast cancer oncology 1. Introduction Breast cancer (BC) is the most prevalent oncological disease worldwide, with an estimated incidence of 2.3 million diagnoses in 2020, representing 11.7% of cancer diagnoses [ 1 ]. The diagnosis of BC, the oncological treatment, and the subsequent adaptation to changes experienced during the process can have a negative impact on quality of life (QoL), including physical, emotional, social, and functional areas [ 2 , 3 ]. Nevertheless, several psycho-oncological interventions have proven their efficacy in reducing emotional distress, the fear of recurrence, and post-traumatic symptoms while facilitating better psychosocial adjustment to the diagnosis and contributing to an increase in health-related QoL [ 3 – 5 ]. A common factor among some of these interventions is the group component [ 6 , 7 ]; throughout an oncological process, social support emerges as a crucial factor. Studies suggest that patients lacking a social support network undergo more challenging healthcare experiences [ 8 ]. Moreover, social support, as highlighted by Gonzalez-Saenz de Tejada et al., plays a role in reducing emotional distress [ 9 ]. Within the broader framework of social support, one distinct form is 'peer support'. Peer support (PS), as defined by Hu et al. is a process where individuals with the same illness come together to exchange information, share experiences, and provide mutual support and encouragement to face and overcome difficulties [ 10 ]. Although research on the impact of PS on oncology patients does not lead to conclusive results, BC patients are often interested in knowing the experience of other patients who undergo similar situations [ 11 , 12 ]. Some studies suggest that PS can create a safe space leading to emotional support and mutual understanding [ 13 ]. Furthermore, interaction among patients beyond the support group, can alleviate feelings of loneliness and isolation [ 14 ]. The evidence supports the notion that PS could play a significant role in the emotional well-being and QoL of women with BC. Participation in support groups and communities can provide significant benefits, such as improvement in searching, obtaining, and understanding information, a greater perception of social support, an increase in recognition through the sharing of experiences, and even the learning of coping strategies [ 15 , 16 ]. The symbiotic relationship between improving information-related skills, perceiving increased social support, recognizing shared experiences, and learning coping strategies ultimately leads to a sense of empowerment within the community [ 15 – 17 ]. Previous research suggests that empowerment positively influences autonomy in self-care, perceived control, and feelings of self-efficacy [ 18 , 19 ]. It also fosters improved adherence to treatment, a significant aspect considering that some treatments may be self-administered at home [ 18 – 20 ]. Furthermore, empowerment has been observed to encourage healthier lifestyles, enhance attendance rates for medical tests, and contribute to improved treatment outcomes [ 20 – 22 ]. Empowerment is in fact understood as a multidimensional concept of the awareness of one's own strengths and the exertion of control over one's life [ 23 ]. As previously found in the study conducted by van Uden-Kraan et al., patients diagnosed with BC and chronic illnesses who participate in online support groups may undergo processes such the experiences’ exchange with other participants that contribute to empowerment outcome [ 17 ]. Traditionally, communities and support groups have been developed in face-to-face settings, which may not involve a professional facilitator [ 24 ]. However, for over a decade, the use and development of the internet and social media have given prominence to online support groups and virtual patient communities, not only in the field of oncology but also in mental health and chronic illnesses [ 17 , 24 , 25 ]. Research regarding differences between face-to-face and online PS experiences has identified common factors as well as benefits associated with specific delivery formats [ 24 ]. As specific benefits, online communities offer the possibility of staying anonymous, reducing implementation costs, and facilitating accessibility [ 23 , 26 ]. Eventually, it is essential to consider the digital literacy of patients to ensure that their participation is not hindered by difficulties in handling technology [ 27 ]. In 2019, the Catalan Institute of Oncology established a PS App for BC survivors called Comunitats in Catalonia and Oncommunities in Madrid (from now on, just called Comunitats ), which provides an accessible, secure, and anonymous space. The community operates asynchronously, allowing conversations to extend over time, in contrast to the limitations of face-to-face support groups. It also involves healthcare professionals such as psychologists, nurses, and social workers, and offers health education resources on topics that patients most frequently seek information about [ 11 ] Given the potential impact of PS reported in previous research, this study aims to investigate whether (1) participation in Comunitats promotes the empowerment among BC survivors, (2) empowerment processes within the community defined by Uden-Kraan [ 17 ] can predict empowerment outcomes and (3) empowerment outcomes are related with other variables, as posttraumatic growth and emotional distress. 2. Methods 2.1. Design and participants We conducted a prospective study, observing participants during their first three months in Comunitats . The study comprises 121 BC survivors, including women undergoing treatment and those in post-treatment phases. These participants were engaged in this virtual support community in Catalonia (n=92) and Madrid (n=29) between July 2019 and March 2023. Data have been analyzed following the methodology outlined by van Uden-Kraan et al. [17]. Participants were referred to the community by healthcare professionals. To participate in the support community, the inclusion criteria were: 1) having been diagnosed with BC; 2) having a smartphone; and 3) signing the informed consent document. 2.2 Comunitats : virtual patient community Comunitats is a governmental health department virtual patient community aimed at promoting PS, education and emotional/social support among women diagnosed with BC. Through the community, users can interact anonymously and in an asynchronous way in various chat rooms that are categorized into nine subjects, as shown in Table 1. In addition, to facilitate PS, the chat rooms are monitored and dynamized by healthcare professionals, including psychologists, nurses, and social workers, to promote participation and to address technical questions asked by users. Also, users in each chat room have access to psychoeducational resources related to the chat's subject of interest, such as informative videos, adapted scientific information, or infographics. Table 1. Chat rooms included in Comunitats Chat rooms topics Content information Information board Information about activities linked to cancer and healthcare. Healthy lifestyle Health promotion and well-being, such as exercise or diet. Oncological treatments and its effects Clinical cancer information, such as different oncological treatments and their adverse effects. Body image and sexuality Body image and sexuality during and after oncological process. Emotional response Emotional and coping issues related to BC. Interpersonal relationships Social and family relationships. Life changes after cancer Life changes after cancer, including positive or negative changes. Employment issues, social and community resources Work, sick leave, social activities and workshops. Technical issues To report any technical issue with the App. 2.3. Variables and Instruments Online assessments have been conducted via the secure online assessment tool Qualtrics (Qualtrics, Provo, UT) at two time points: at the time of inclusion in the community (T1), and three months after inclusion (T2). The following data have been collected: Sociodemographic and clinical variables At baseline (T1), sociodemographic variables such as age, marital status, employment status, and education were assessed. Clinical variables related to psychological and oncological history were also collected. At the second evaluation point (T2), updates on employment status and the clinical variables were requested. Emotional distress The Hospital Anxiety and Depression Scale (HADS) [28] evaluates distress in individuals facing physical illnesses. It comprises 14 items organized into two separate subscales for anxiety and depression symptoms, each scored on a 4-point scale from 0 to 3. Higher scores indicate increased distress, with scores of 10 interpreted as moderate and 16 or higher indicating elevated distress levels. The Spanish validation in oncological patients demonstrated high reliability (α = .82 for anxiety and α = .84 for depression). This scale was administered at T1 and at T2. Post-traumatic growth The Post-Traumatic Growth Inventory (PTGI) [29] measures perceived positive changes in individuals after suffering a traumatic event. It consists of 21 items graded on a Likert scale from 0 to 5. This self-administered inventory allows individuals to rate the level of change experienced, associating higher scores with a greater perceived positive impact of the traumatic experience and has been validated in Spanish with an oncological sample, demonstrating a high reliability (α = .95). The PTGI was administered at T1 and T2. Empowerment Van Uden-Kraan's Empowerment Questionnaire [17] was administered after the three-month period of participation. It is a specific and comprehensive questionnaire that measures two main concepts: Empowering processes : referring to the events or actions occurring within online PS groups that lead to empowerment in their participants (i.e. Exchanging information or Sharing experiences). Originally composed of 29 items, of which 27 were administered in our research due to two items being not applicable. Each item is rated on a 4-point scale from 1 'Rarely or never' to 4 'Often'. Empowerment outcomes : consequences of participating in the community (i.e. Being better informed or Enhanced social well-being). Composed of 38 items, scored on a 5-point scale from 1 'Completely disagree' to 5 'Completely agree'. Participation in the online community While actively participating in the online community, we collected usage-related data from the app. The gathered information specifically includes the number of postings made by participants. 2.4. Data analysis The data were analyzed using IBM SPSS Statistics 27.0 software (IBM corp., 2020). Shapiro-Wilk test was performed in the variables of interest and their distribution visually inspected, revealing a non-normal distribution of the data. Therefore, non-parametric tests were employed. After descriptive analyses of participants’ demographic and clinical data, correlations between variables were assessed with Spearman's rank correlation (Spearman Rho) test to guide subsequent regression analysis. To correct for multiple testing Benjamini–Hochberg procedure was used. Those variables with a statistically significant correlation with Empowerment Process and Outcomes subscales (p-value < .05), partial correlations controlling for age and time since diagnosis were conducted. Finally, a multiple linear regression analysis was used to predict overall empowerment outcomes based on processes occurring in the online community, since other variables did not yield significant values in partial correlations. 3. Results 3.1. Sociodemographic and clinical characteristics Among the 121 participating women, the mean age was 50.63 years (SD: 7.27), and the mean time between diagnosis and joining the community was 3.83 years (SD; 7.14). Baseline sociodemographic and clinical characteristics are listed in Table 2. Table 2. Baseline sociodemographic and clinical characteristics of participants N = 121 Age Mean (SD) 50.63 (7.27) Years since diagnosis Mean (SD) 3.39 (5.41) Finished treatment n (%) 88 (72.73) Marital status n (%) Married Divorced/separated Single Widow 82 (67.77) 20 (16.53) 18 (14.88) 1 (0.82) Education n (%) Primary education Secondary education Higher education University education 5 (4.1) 9 (7.4) 41 (33.9) 66 (54.5) Work status n (%) Active Work leave Unemployed Passive Retired Other 25 (20.7) 61 (50.4) 3 (2.5) 4 (3.3) 22 (18.2) 6 (5.0) Procedence n (%) Catalonia Madrid 92 (76.03) 29 (23.97) Emotional distress (HADS) Mean (SD) 16.44 (8.1) Post-traumatic growth (PTGI) Mean (SD) 50.15 (22.51) Abbreviations: HADS (Hospital Anxiety and Depression Scale) 3.2. Participation in the online community Regarding participation, 45.5% of participants (n=55) published posts in the community, with an average of 11.93 (SD=18.13) posts during the three-month period. Significant differences (p < .05) were observed in age and years since diagnosis, with younger and more recently diagnosed individuals being more active participants. 3.3. Empowerment processes and outcomes Regarding the empowering processes, the most commonly reported processes were 'exchanging information' and 'finding recognition' (Table 3). Individual item scores indicated that the respondents perceived the information shared in the online groups as both understandable (81.8%) and usable (73.5%). However, 51.2% of participants found that the information provided in the community was new only sometimes or even seldom. In addition, 66.1% of the survivors indicated to experience the sense of 'not being the only one'. To a minor extent, the respondents also 'shared experiences', 'helped others', and 'encountered emotional support' in the community. Table 3. Mean scores for each empowerment process Mean (SD) N=121 Exchanging information (1-4) 3.0 (.81) Finding recognition (1-4) 2.66 (.91) Sharing experiences (1-4) 1.99 (1.07) Helping others (1-4) 1.91 (.92) Encountering emotional support (1-4) 1.39 (.51) According to empowerment outcomes measured, those experienced in the strongest way were 'being better informed' followed by 'improved acceptance of the illness' (Table 4). Frequencies of separate items reveal that 62.8% of participants felt better informed as a patient and had the feeling that they now had the right knowledge to manage their illness. Additionally, 50.4% of participants reported an increased ability to seek help, while 48.8% felt more able to tell others when they were no longer able to do something. To a lesser degree, the participants also reported feeling more confident about the treatment, increased optimism and control, enhanced self-esteem, feeling more confident in the relationship with their physician and enhanced social well-being. Table 4. Mean scores for empowerment outcomes Mean (SD) N=121 Being better informed (1-5) 3.67 (.88) Improved acceptance of the illness (1-5) 3.35 (.83) Feeling more confident about the treatment (1-5) 3.27 (.78) Increased optimism and control (1-5) 3.24 (.58) Enhanced self-esteem (1-5) 3.16 (.82) Feeling more confident in the relationship with their physician (1-5) 3.07 (.64) Enhanced social well-being (1-5) 2.95 (.83) 3.4 Relationships between empowerment and other related variables All empowering processes during interaction across Comunitats showed a significant correlation with both individual empowerment outcomes and overall empowerment (Table 5). Table 5. Spearman Rho coefficients for the relationships between the processes that took place within online community and the outcomes experienced by the participants N=121 Outcomes Being better informed Confidence with the physician Confidence about the treatment Improved acceptance Optimism and control Enhanced self-esteem Enhanced social Well-being Overall empowerment Processes Exchanging information .574** .437** .448** .480** .398** .372** .390** .595** Encountering emotional support .281** .243* .354** .260** .263** .263** .301** .354** Finding recognition .624** .399** .459** .486** .495** .441** .421** .594** Helping others .314** .195* .251** .240* .253** .263** .269** .336** Sharing experiences .407** .282** .362** .339** .328** .295** .454** .456** * p <.05 **p <.01 Concerning the relationship between empowering outcomes and post-traumatic growth and emotional distress, PTGI displayed significant weak to moderate correlations with 'Feeling more confident about the treatment' (p <.05), 'increased optimism and control' (p <.01), 'enhanced self-esteem' (p <.01) and overall empowerment (p <.05). HADS showed a negatively significant weak to moderate correlation with 'enhanced self-esteem' (p <.05) and 'increased optimism and control' (p <.05). However, in partial correlation analyses, neither PTGI nor HADS yielded significant results, leading to their exclusion from the linear regression to streamline the model and enhance its interpretability by focusing on the most influential predictors of overall empowerment within the context of Comunitats . In the context of the regression analysis (Table 6), the findings suggest that the overall empowerment can be partially predicted by the processes taking place within Comunitats , as indicated by an adjusted R² of .371. This implies that 37.1% of the variance in overall empowerment can be accounted for by the model. Notably, the most influential predictors of overall empowerment are 'exchanging information' and 'finding recognition'. Table 6. Regression analysis results Total Empowerment Outcome (N= 121) Unstandardized Coefficient Standardized Coefficient B SE β p-value t R 2 Adj. R 2 .397 .371 (Constant) 12.633 1.551 <.001 8.147 Exchanging information* 1.641 .579 .272 .005 2.835 Encountering emotional support .118 .852 .012 .890 .138 Finding recognition** 2.010 .556 .372 <.001 3.615 Helping others -.346 .550 -.065 .531 -.628 Sharing experiences .489 .582 .107 .402 .841 * p <.01 **p <.001 4. Discussion and Conclusion 4.1. Discussion This study sought to examine the connections between empowering processes within Comunitats and reported empowerment outcomes by participants. Additionally, the study aimed to identify variables that could predict more substantial empowerment outcomes. In the line of previous research [15–17], results of this study reveal that participating in the PS community promotes an increasing recognition feeling through sharing experiences as well as an improvement of information and its management. The most prevalent empowering process observed in interactions within Comunitats was 'exchanging information', as found by van Uden-Kraan et al. [17]. As highlighted by Hu et al. [10], BC-related information provided by participants may be incomplete or biased due to a lack of training among peer supporters. However, as mentioned earlier, Comunitats offers psychoeducational resources and involves the participation of healthcare professionals who can correct information if needed or guide participants to the appropriate information source if the question exceeds the scope of the support community. Survivors reported 'finding recognition' in online community interactions, aligning with prior research emphasizing that PS fosters mutual understanding and recognition through shared experiences [13,16]. Based on our research findings, 'helping others' is the process that occurred to the least extent. Considering that 54.5% of the included participants ever posted in the online community, this result may be attributed to the fact that lurkers, participants who read the chats but do not actively participate, cannot engage in helping others. However, the data collected on community participation do not allow us to ascertain whether survivors who did not post are lurkers or simply did not access the conversation groups. As a result, we cannot determine if there is any difference between active participants and lurkers in this case. In the line of findings of van Uden-Kraan et al. [17] the empowerment outcome most reported was 'being better informed'. Prior research suggests that in PS groups, a predominant aspect of group participation involves the exchange of information, encompassing the sharing of knowledge related to the disease, treatment methods, or recommendations [15]. Further, although to a minor degree, 'increased optimism and control' is also reported, mainly, participants reported an increased ability to seek help and felt more able to tell others when they were no longer able to do something. Surprisingly, and in contrast to van Uden-Kraan et al. [17], the least reported empowerment outcome was 'enhanced social well-being'. This result may be influenced by the level of active engagement within the online community. Notably, fewer than 50% of participants made any posts during the three-month period, with an average post count below 12. This contrasts with the study conducted by van Uden-Kraan et al. [17], which included a larger and more actively participating sample. A potential explanation for these differences in participation may be related to the age of the sample and the time since diagnosis, as inferred from the results, with the most active participants being younger and more recently diagnosed. Likewise, the sample studied by van Uden-Kraan et al. [17] included younger participants and more recent diagnoses compared to our own. While no significant correlations were found between emotional distress, post-traumatic growth, and overall empowerment, both emotional distress and post-traumatic growth were significantly correlated with 'increased optimism and control' and 'enhanced self-esteem'. These findings are coherent with research suggesting that optimism and self-esteem are resources able to contribute to relieving emotional distress and increasing post-traumatic growth [30,31]. Regarding empowering processes undertaken in Comunitats , our results indicate a moderate capacity to explain the overall empowerment reported by participants. Particularly, 'finding recognition' and 'exchanging information' emerged as the most influential predictors, aligning with findings from van Uden-Kraan et al. [17]. Similar results were obtained in online support groups beyond BC; Liu & Wang found that information support and recognition positively influenced users’ confirmation of expectations about the community; expectation confirmation was linked with the willingness to continue using the online community [32]. Hence, future research may explore users’ expectations accomplishment as a mediator to gain a deeper understanding of the observed outcomes. This study has certain limitations that should be considered when interpreting the results. First, the three-month period imposes a time constraint, limiting the assessment of the long-term impact of participating in the community. In addition, the sample size was limited to 121 survivors, and the exclusive inclusion of women diagnosed with BC may restrict the generalizability of the findings to individuals with other types of cancer. Moreover, data about other activities, such as group psychotherapy or involvement in patients' associations, that may encompass PS components are not available, which might introduce a confounding variable in the relationship between participation in the community and the observed results. Furthermore, the participation measure was limited to a binary approach (whether participants did or did not make any posts) and the count of the number of messages, which prevents distinguishing differences between lurkers (those who consume information without actively contributing) and active participants. 4.2. Conclusion The results indicate that participation in Comunitats promotes empowerment among BC survivors. The findings reveal that, specific processes within the community, especially 'exchanging information' and 'finding recognition', contribute to overall empowerment. However, these processes only explain the empowerment outcomes to a modest extent. Future research is required to explore additional factors influencing the outcomes reported by participants and to identify the characteristics of participants who may derive greater benefits from participating in the community. 4.3 Practice Implications Offering online peer support communities in oncological processes could help participants to feel more empowered. Empowerment positively impacts self-care autonomy, self-efficacy, and treatment adherence, promoting healthier lifestyles and enhanced treatment outcomes. Knowing that there are different community processes that foster empowerment, it would be interesting that support professionals of the community would promote the exchange of information and mutual recognition among participants. Declarations Funding: This project was funded by the European Institute of Innovation and Technology (EIT) (19046 [1st year], 20536 [2nd year]; ONCOMMUNITIES: Online Cancer Support Communities). The Asociación Española Contra el Cáncer partially also funded the present study through a grant (no. PRYES211395OCHO). This work has also been supported by the Carlos III Health Institute under the FIS grant PI19/01880 (co-financed by the European Regional Development Fund (ERDF) ‘a way to build Europe’), as well as under the FIS grant PI22/01255. The Generalitat de Catalunya through the emergent research groups“Psychooncology and digital health” (2021SGR01003) has also supported this research. We thank CERCA Programme/Generalitat de Catalunya for institutional support . The Secretaria d'Universitats i Recerca of the Generalitat de Catalunya and The European Social Fund through the FI grant 2020FI_B00288 have also partially funded this research. Finally, the Programa Investigo for hiring young job seekers to carry out research and innovation initiatives (INVESTIGO 2023) from the Department of Research and Universities of the Generalitat de Catalunya, financed by the European Union – Next Generation EU, provided financial support. Authors contribution: Cristian Ochoa-Arnedo contributed to the study conception and design. Data were collected by Marina Ruiz-Romeo, Laura Ciria-Suarez, Arnau Souto-Sampera, Aida Flix-Valle, Alejandra Arizu-Onassis, Cristina Villanueva-Bueno, Vicente Escudero-Vilaplana and Eva Juan-Linares. Analysis were performed by Marina Ruiz-Romeo, Laura Ciria-Suarez, Joan C. Medina, Maria Serra-Blasco and Cristian Ochoa-Arnedo. The first draft of the manuscript was written by Marina Ruiz-Romeo and Laura Ciria-Suarez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conflicts of Interest: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of the INSTITUT CATALÀ D’ONCOLOGIA on the 25th of October 2018 (PR343/18). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. We confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story Acknowledgments: Authors want to express their gratitude to all BC women who agreed to participate in this project. References Global Cancer Observatory. 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Westman B, Bergkvist K, Karlsson Rosenblad A, Sharp L, Bergenmar M. Patients with low activation level report limited possibilities to participate in cancer care. Health Expectations 2022;25:914–24. https://doi.org/10.1111/hex.13438. Hibbard JH, Greene J. What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs. Health Aff 2013;32:207–14. https://doi.org/10.1377/hlthaff.2012.1061. Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. Health Aff 2015;34:431–7. https://doi.org/10.1377/hlthaff.2014.0452. Ziegler E, Hill J, Lieske B, Klein J, dem O von, Kofahl C. Empowerment in cancer patients: Does peer support make a difference? A systematic review. Psychooncology 2022;31:683–704. https://doi.org/10.1002/pon.5869. Gupta T, Schapira L. Online Communities as Sources of Peer Support for People Living With Cancer: A Commentary. J Oncol Pract 2018;14:725–30. https://doi.org/10.1200/JOP.18.00261. van Uden-Kraan CF, Drossaert CHC, Taal E, Shaw BR, Seydel ER, van de Laar MAFJ. Empowering Processes and Outcomes of Participation in Online Support Groups for Patients With Breast Cancer, Arthritis, or Fibromyalgia. Qual Health Res 2008;18:405–17. https://doi.org/10.1177/1049732307313429. Lepore SJ, Buzaglo JS, Lieberman MA, Golant M, Greener JR, Davey A. Comparing Standard Versus Prosocial Internet Support Groups for Patients With Breast Cancer: A Randomized Controlled Trial of the Helper Therapy Principle. J Clin Oncol 2014;32:4081–6. https://doi.org/10.1200/JCO.2014.57.0093. Lepore SJ, Rincon MA, Buzaglo JS, Golant M, Lieberman MA, Bauerle Bass S, et al. Digital literacy linked to engagement and psychological benefits among breast cancer survivors in Internet‐based peer support groups. Eur J Cancer Care (Engl) 2019;28. https://doi.org/10.1111/ecc.13134. Requena, G.C.; Martín, X.P.; Baró, M.S.; Moncayo, F.L.G. Discriminación del malestar emocional en pacientes oncológicos utilizando la escala de ansiedad y depresión hospitalaria (HADS) [Discrimination of emotional distress in oncology patients using the Hospital Anxiety and Depression Scale (HADS)]. Ansiedad y Estrés 2009;15:217–229. Costa-Requena, G., & Gil Moncayo, F. L. Crecimiento postraumático en pacientes oncológicos [Posttraumatic growth in oncology patients]. Análisis Y Modificación De Conducta 2007;33. https://doi.org/10.33776/amc.v33i148.1215 Jiménez MG, Montorio I, Izal M. The association of age, sense of control, optimism, and self-esteem with emotional distress. Dev Psychol 2017;53:1398–403. https://doi.org/10.1037/dev0000341. Prati G, Pietrantoni L. Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. J Loss Trauma 2009;14:364–88. https://doi.org/10.1080/15325020902724271. Liu J, Wang J. Users’ Intention to Continue Using Online Mental Health Communities: Empowerment Theory Perspective. Int J Environ Res Public Health 2021;18:9427. https://doi.org/10.3390/ijerph18189427. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 28 Aug, 2024 Reviews received at journal 15 May, 2024 Reviewers agreed at journal 06 May, 2024 Reviewers invited by journal 05 May, 2024 Editor assigned by journal 04 May, 2024 Submission checks completed at journal 26 Mar, 2024 First submitted to journal 26 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4169441","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284313334,"identity":"3c242a1c-8839-44e5-b341-d14e7900aec1","order_by":0,"name":"Marina Ruiz-Romeo","email":"","orcid":"","institution":"The Bellvitge Biomedical Research Institute IDIBELL","correspondingAuthor":false,"prefix":"","firstName":"Marina","middleName":"","lastName":"Ruiz-Romeo","suffix":""},{"id":284313335,"identity":"c72dd38e-1d24-4b74-ac1a-d4e5a30134d8","order_by":1,"name":"Laura Ciria-Suarez","email":"","orcid":"","institution":"Catalan Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Ciria-Suarez","suffix":""},{"id":284313336,"identity":"3e422d39-2efe-4aac-a1ed-b9c013e1e2c5","order_by":2,"name":"Joan C. Medina","email":"","orcid":"","institution":"Universitat Oberta de Catalunya","correspondingAuthor":false,"prefix":"","firstName":"Joan","middleName":"C.","lastName":"Medina","suffix":""},{"id":284313337,"identity":"9d358144-f580-44b1-9c23-70bbbd23acb4","order_by":3,"name":"Maria Serra-Blasco","email":"","orcid":"","institution":"Catalan Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Serra-Blasco","suffix":""},{"id":284313338,"identity":"a851b84b-1b1b-41f2-915a-677d18bbc0f1","order_by":4,"name":"Arnau Souto-Sampera","email":"","orcid":"","institution":"Catalan Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Arnau","middleName":"","lastName":"Souto-Sampera","suffix":""},{"id":284313339,"identity":"bde6f62d-b12e-40cb-8bfd-459ce304a8c6","order_by":5,"name":"Aida Flix-Valle","email":"","orcid":"","institution":"Catalan Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Aida","middleName":"","lastName":"Flix-Valle","suffix":""},{"id":284313340,"identity":"99dfa8e7-e2d8-4b3e-88d3-cf08e002ee05","order_by":6,"name":"Alejandra Arizu-Onassis","email":"","orcid":"","institution":"The Bellvitge Biomedical Research Institute IDIBELL","correspondingAuthor":false,"prefix":"","firstName":"Alejandra","middleName":"","lastName":"Arizu-Onassis","suffix":""},{"id":284313341,"identity":"5ab58635-342f-49da-8a9a-d80ecd7ec8c1","order_by":7,"name":"Cristina Villanueva-Bueno","email":"","orcid":"","institution":"Gregorio Marañón General University Hospital and Gregorio Marañón Health Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Villanueva-Bueno","suffix":""},{"id":284313342,"identity":"b736dceb-a5a5-4fb4-af29-d695586379fc","order_by":8,"name":"Vicente Escudero-Vilaplana","email":"","orcid":"","institution":"Gregorio Marañón General University Hospital and Gregorio Marañón Health Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Vicente","middleName":"","lastName":"Escudero-Vilaplana","suffix":""},{"id":284313343,"identity":"a306a9a2-7ddd-445a-b818-446f60da9b65","order_by":9,"name":"Eva Juan-Linares","email":"","orcid":"","institution":"Hospital of the Holy Cross and Saint Pau","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"","lastName":"Juan-Linares","suffix":""},{"id":284313345,"identity":"469ada8e-c172-4ee2-bfb0-86a61bf9a6df","order_by":10,"name":"Cristian Ochoa-Arnedo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYHACNiC24YGwCyBcYrSkQbUYwLQkENRymAGuhYGQFv725mcPPtScl+Fv7z344YOBjV0f+wG2Bx9/4NYiceaYueGMY7d5JM6cS5acYZCW3MaTwG44A48tBhI5bNI8bLd5gAwzZh6Dw8lsDAlAEYJa/p1D0sL/gE36DyEtvG0H4Frs2CSAtuDzPtAvZpIz+5KBfjljDPJLApvEwzbJnjTcWkAhJvHhm509f3uP4YcPFTb28v3JxyR+2ODWggESGxgYG0hQDwT2pCkfBaNgFIyCkQAAIz9EIANPRmUAAAAASUVORK5CYII=","orcid":"","institution":"Catalan Institute of Oncology","correspondingAuthor":true,"prefix":"","firstName":"Cristian","middleName":"","lastName":"Ochoa-Arnedo","suffix":""}],"badges":[],"createdAt":"2024-03-26 11:27:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4169441/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4169441/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-09119-5","type":"published","date":"2024-12-28T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":72640607,"identity":"69c39c31-cad3-4071-8854-465a4a9820ac","added_by":"auto","created_at":"2024-12-30 16:07:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":827489,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4169441/v1/ef3b990f-0a6b-4e60-8422-1652c6b9b2c4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empowerment among breast cancer survivors using an online peer support community","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBreast cancer (BC) is the most prevalent oncological disease worldwide, with an estimated incidence of 2.3\u0026nbsp;million diagnoses in 2020, representing 11.7% of cancer diagnoses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe diagnosis of BC, the oncological treatment, and the subsequent adaptation to changes experienced during the process can have a negative impact on quality of life (QoL), including physical, emotional, social, and functional areas [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Nevertheless, several psycho-oncological interventions have proven their efficacy in reducing emotional distress, the fear of recurrence, and post-traumatic symptoms while facilitating better psychosocial adjustment to the diagnosis and contributing to an increase in health-related QoL [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A common factor among some of these interventions is the group component [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]; throughout an oncological process, social support emerges as a crucial factor. Studies suggest that patients lacking a social support network undergo more challenging healthcare experiences [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, social support, as highlighted by Gonzalez-Saenz de Tejada et al., plays a role in reducing emotional distress [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin the broader framework of social support, one distinct form is 'peer support'. Peer support (PS), as defined by Hu et al. is a process where individuals with the same illness come together to exchange information, share experiences, and provide mutual support and encouragement to face and overcome difficulties [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although research on the impact of PS on oncology patients does not lead to conclusive results, BC patients are often interested in knowing the experience of other patients who undergo similar situations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Some studies suggest that PS can create a safe space leading to emotional support and mutual understanding [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, interaction among patients beyond the support group, can alleviate feelings of loneliness and isolation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The evidence supports the notion that PS could play a significant role in the emotional well-being and QoL of women with BC. Participation in support groups and communities can provide significant benefits, such as improvement in searching, obtaining, and understanding information, a greater perception of social support, an increase in recognition through the sharing of experiences, and even the learning of coping strategies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The symbiotic relationship between improving information-related skills, perceiving increased social support, recognizing shared experiences, and learning coping strategies ultimately leads to a sense of empowerment within the community [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Previous research suggests that empowerment positively influences autonomy in self-care, perceived control, and feelings of self-efficacy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It also fosters improved adherence to treatment, a significant aspect considering that some treatments may be self-administered at home [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, empowerment has been observed to encourage healthier lifestyles, enhance attendance rates for medical tests, and contribute to improved treatment outcomes [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Empowerment is in fact understood as a multidimensional concept of the awareness of one's own strengths and the exertion of control over one's life [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. As previously found in the study conducted by van Uden-Kraan et al., patients diagnosed with BC and chronic illnesses who participate in online support groups may undergo processes such the experiences\u0026rsquo; exchange with other participants that contribute to empowerment outcome [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditionally, communities and support groups have been developed in face-to-face settings, which may not involve a professional facilitator [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, for over a decade, the use and development of the internet and social media have given prominence to online support groups and virtual patient communities, not only in the field of oncology but also in mental health and chronic illnesses [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Research regarding differences between face-to-face and online PS experiences has identified common factors as well as benefits associated with specific delivery formats [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. As specific benefits, online communities offer the possibility of staying anonymous, reducing implementation costs, and facilitating accessibility [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Eventually, it is essential to consider the digital literacy of patients to ensure that their participation is not hindered by difficulties in handling technology [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2019, the Catalan Institute of Oncology established a PS App for BC survivors called \u003cem\u003eComunitats\u003c/em\u003e in Catalonia and Oncommunities in Madrid (from now on, just called \u003cem\u003eComunitats\u003c/em\u003e), which provides an accessible, secure, and anonymous space. The community operates asynchronously, allowing conversations to extend over time, in contrast to the limitations of face-to-face support groups. It also involves healthcare professionals such as psychologists, nurses, and social workers, and offers health education resources on topics that patients most frequently seek information about [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGiven the potential impact of PS reported in previous research, this study aims to investigate whether (1) participation in \u003cem\u003eComunitats\u003c/em\u003e promotes the empowerment among BC survivors, (2) empowerment processes within the community defined by Uden-Kraan [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] can predict empowerment outcomes and (3) empowerment outcomes are related with other variables, as posttraumatic growth and emotional distress.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e2.1. Design and participants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe conducted a prospective study, observing participants during their first three months in \u003cem\u003eComunitats\u003c/em\u003e. The study comprises 121 BC survivors, including women undergoing treatment and those in post-treatment phases. These participants were engaged in this virtual support community in Catalonia (n=92) and Madrid (n=29) between July 2019 and March 2023. Data have been analyzed following the methodology outlined by van Uden-Kraan et al. [17]. Participants were referred to the community by healthcare professionals.\u003c/p\u003e\n\u003cp\u003eTo participate in the support community, the inclusion criteria were: 1) having been diagnosed with BC; 2) having a smartphone; and 3) signing the informed consent document. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2 Comunitats\u003c/em\u003e: virtual patient community\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eComunitats\u003c/em\u003e is a governmental health department virtual patient community aimed at promoting PS, education and emotional/social support among women diagnosed with BC. Through the community, users can interact anonymously and in an asynchronous way in various chat rooms that are categorized into nine subjects, as shown in Table 1. In addition, to facilitate PS, the chat rooms are monitored and dynamized by healthcare professionals, including psychologists, nurses, and social workers, to promote participation and to address technical questions asked by users. Also, users in each chat room have access to psychoeducational resources related to the chat\u0026apos;s subject of interest, such as informative videos, adapted scientific information, or infographics.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1. Chat rooms included in Comunitats\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChat rooms topics\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent information\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInformation board\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eInformation about activities linked to cancer and healthcare.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy lifestyle\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eHealth promotion and well-being, such as exercise or diet.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOncological treatments and its effects\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eClinical cancer information, such as different oncological treatments and their adverse effects.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody image and sexuality\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eBody image and sexuality during and after oncological process.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional response\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eEmotional and coping issues related to BC.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterpersonal relationships\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSocial and family relationships.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLife changes after cancer\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eLife changes after cancer, including positive or negative changes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment issues, social and community resources\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eWork, sick leave, social activities and workshops.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnical issues\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTo report any technical issue with the App.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.3. Variables and Instruments\u003c/p\u003e\n\u003cp\u003eOnline assessments have been conducted via the secure online assessment tool Qualtrics (Qualtrics, Provo, UT) at two time points: at the time of inclusion in the community (T1), and three months after inclusion (T2). The following data have been collected:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSociodemographic and clinical variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt baseline (T1), sociodemographic variables such as age, marital status, employment status, and education were assessed. Clinical variables related to psychological and oncological history were also collected. At the second evaluation point (T2), updates on employment status and the clinical variables were requested. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEmotional distress\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Hospital Anxiety and Depression Scale (HADS) [28] evaluates distress in individuals facing physical illnesses. It comprises 14 items organized into two separate subscales for anxiety and depression symptoms, each scored on a 4-point scale from 0 to 3. Higher scores indicate increased distress, with scores of 10 interpreted as moderate and 16 or higher indicating elevated distress levels. The Spanish validation in oncological patients demonstrated high reliability (\u0026alpha; = .82 for anxiety and \u0026alpha; = .84 for depression). This scale was administered at T1 and at T2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePost-traumatic growth\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Post-Traumatic Growth Inventory (PTGI) [29] measures perceived positive changes in individuals after suffering a traumatic event. It consists of 21 items graded on a Likert scale from 0 to 5. This self-administered inventory allows individuals to rate the level of change experienced, associating higher scores with a greater perceived positive impact of the traumatic experience and has been validated in Spanish with an oncological sample, demonstrating a high reliability (\u0026alpha; = .95). \u0026nbsp;The PTGI was administered at T1 and T2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEmpowerment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eVan Uden-Kraan\u0026apos;s Empowerment Questionnaire [17] was administered after the three-month period of participation. It is a specific and comprehensive questionnaire that measures two main concepts:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEmpowering \u003cstrong\u003eprocesses\u003c/strong\u003e: referring to the events or actions occurring within online PS groups that lead to empowerment in their participants (i.e. Exchanging information or Sharing experiences). Originally composed of 29 items, of which 27 were administered in our research due to two items being not applicable. Each item is rated on a 4-point scale from 1 \u0026apos;Rarely or never\u0026apos; to 4 \u0026apos;Often\u0026apos;. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEmpowerment \u003cstrong\u003eoutcomes\u003c/strong\u003e: consequences of participating in the community (i.e. Being better informed or Enhanced social well-being). Composed of 38 items, scored on a 5-point scale from 1 \u0026apos;Completely disagree\u0026apos; to 5 \u0026apos;Completely agree\u0026apos;. \u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eParticipation in the online community\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhile actively participating in the online community, we collected usage-related data from the app. The gathered information specifically includes the number of postings made by participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.4. Data analysis\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using IBM SPSS Statistics 27.0 software (IBM corp., 2020). Shapiro-Wilk test was performed in the variables of interest and their distribution visually inspected, revealing a non-normal distribution of the data. Therefore, non-parametric tests were employed. After descriptive analyses of participants\u0026rsquo; demographic and clinical data, correlations between variables were assessed with Spearman\u0026apos;s rank correlation (Spearman Rho) test to guide subsequent regression analysis. To correct for multiple testing Benjamini\u0026ndash;Hochberg procedure was used. Those variables with a statistically significant correlation with Empowerment Process and Outcomes subscales (p-value \u0026lt; .05), partial correlations controlling for age and time since diagnosis were conducted. Finally, a multiple linear regression analysis was used to predict overall empowerment outcomes based on processes occurring in the online community, since other variables did not yield significant values in partial correlations.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1. Sociodemographic and clinical characteristics\u003c/p\u003e\n\u003cp\u003eAmong the 121 participating women, the mean age was 50.63 years (SD: 7.27), and the mean time between diagnosis and joining the community was 3.83 years (SD; 7.14). Baseline sociodemographic and clinical characteristics are listed in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2. Baseline sociodemographic and clinical characteristics of participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"387\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 121\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e50.63 (7.27)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears since diagnosis\u0026nbsp;\u003c/strong\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e3.39 (5.41)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinished treatment\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e88 (72.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced/separated\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e82 (67.77)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (16.53)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (14.88)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.82)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003cp\u003eUniversity education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (4.1)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (7.4)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 (33.9)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66 (54.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork status\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003cp\u003eWork leave\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003ePassive\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (20.7)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61 (50.4)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (2.5)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (3.3)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (18.2)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (5.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedence\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003cp\u003eCatalonia\u003c/p\u003e\n \u003cp\u003eMadrid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92 (76.03)\u003c/p\u003e\n \u003cp\u003e29 (23.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional distress (HADS)\u0026nbsp;\u003c/strong\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e16.44 (8.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75.71059431524547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-traumatic growth (PTGI)\u0026nbsp;\u003c/strong\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.289405684754524%\" valign=\"top\"\u003e\n \u003cp\u003e50.15 (22.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: HADS (Hospital Anxiety and Depression Scale)\u003c/p\u003e\n\u003cp\u003e3.2. Participation in the online community\u003c/p\u003e\n\u003cp\u003eRegarding participation, 45.5% of participants (n=55) published posts in the community, with an average of 11.93 (SD=18.13) posts during the three-month period. Significant differences (p \u0026lt; .05) were observed in age and years since diagnosis, with younger and more recently diagnosed individuals being more active participants.\u003c/p\u003e\n\u003cp\u003e3.3. Empowerment processes and outcomes\u003c/p\u003e\n\u003cp\u003eRegarding the empowering processes, the most commonly reported processes were \u0026apos;exchanging information\u0026apos; and \u0026apos;finding recognition\u0026apos; (Table 3). Individual item scores indicated that the respondents perceived the information shared in the online groups as both understandable (81.8%) and usable (73.5%). However, 51.2% of participants found that the information provided in the community was new only sometimes or even seldom. In addition, 66.1% of the survivors indicated to experience the sense of\u0026nbsp;\u0026apos;not being the only one\u0026apos;. To a minor extent, the respondents also \u0026apos;shared experiences\u0026apos;, \u0026apos;helped others\u0026apos;, and \u0026apos;encountered emotional support\u0026apos; in the community.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3. Mean scores for each empowerment process\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"314\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.65605095541402%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.343949044585987%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=121\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.65605095541402%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExchanging information\u0026nbsp;(1-4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.343949044585987%\" valign=\"top\"\u003e\n \u003cp\u003e3.0 (.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.65605095541402%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinding recognition\u0026nbsp;(1-4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.343949044585987%\" valign=\"top\"\u003e\n \u003cp\u003e2.66 (.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.65605095541402%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSharing experiences\u0026nbsp;(1-4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.343949044585987%\" valign=\"top\"\u003e\n \u003cp\u003e1.99 (1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.65605095541402%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHelping others\u0026nbsp;(1-4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.343949044585987%\" valign=\"top\"\u003e\n \u003cp\u003e1.91 (.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.65605095541402%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEncountering emotional support\u0026nbsp;(1-4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.343949044585987%\" valign=\"top\"\u003e\n \u003cp\u003e1.39 (.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAccording to empowerment outcomes measured, those experienced in the strongest way were \u0026apos;being better informed\u0026apos; followed by \u0026apos;improved acceptance of the illness\u0026apos; (Table 4). Frequencies of separate items reveal that 62.8% of participants felt better informed as a patient and had the feeling that they now had the right knowledge to manage their illness. Additionally, 50.4% of participants reported an increased ability to seek help, while 48.8% felt more able to tell others when they were no longer able to do something. To a lesser degree, the participants also reported feeling more confident about the treatment, increased optimism and control, enhanced self-esteem, feeling more confident in the relationship with their physician and enhanced social well-being.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;4. Mean scores for empowerment outcomes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"481\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=121\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeing better informed\u0026nbsp;(1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e3.67 (.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eImproved acceptance of the illness\u0026nbsp;(1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e3.35 (.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling more confident about the treatment\u0026nbsp;(1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e3.27 (.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncreased optimism and control\u0026nbsp;(1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e3.24 (.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnhanced self-esteem (1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e3.16 (.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling more confident in the relationship with their physician\u0026nbsp;(1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e3.07 (.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.45738045738045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnhanced social well-being\u0026nbsp;(1-5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.542619542619544%\" valign=\"top\"\u003e\n \u003cp\u003e2.95 (.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e3.4 Relationships between empowerment and other related variables\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll empowering processes during interaction across \u003cem\u003eComunitats\u0026nbsp;\u003c/em\u003eshowed a significant correlation with both individual empowerment outcomes and overall empowerment (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;5. Spearman Rho coefficients for the relationships between the processes that took place within online community and the outcomes experienced by the participants\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"687\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003eN=121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.13391557496361%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeing better informed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfidence with the physician\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfidence about the treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eImproved acceptance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptimism and control\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnhanced self-esteem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnhanced social\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWell-being\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall empowerment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcesses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExchanging information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.574**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e.437**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e.448**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.480**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e.398**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.372**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e.390**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e.595**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEncountering emotional support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.281**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e.243*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e.354**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.260**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e.263**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.263**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e.301**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e.354**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinding recognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.624**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e.399**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e.459**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.486**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e.495**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.441**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e.421**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e.594**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHelping others\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.314**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e.195*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e.251**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.240*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e.253**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.263**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e.269**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e.336**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.518195050946142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSharing experiences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.407**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.06259097525473%\" valign=\"top\"\u003e\n \u003cp\u003e.282**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.91703056768559%\" valign=\"top\"\u003e\n \u003cp\u003e.362**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.353711790393014%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.339**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75254730713246%\" valign=\"top\"\u003e\n \u003cp\u003e.328**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.189228529839884%\" valign=\"top\"\u003e\n \u003cp\u003e.295**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.625909752547306%\" valign=\"top\"\u003e\n \u003cp\u003e.454**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043668122270743%\" valign=\"top\"\u003e\n \u003cp\u003e.456**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.3478893740902476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.03493449781659%\" colspan=\"11\" valign=\"top\" style=\"width: 99.8592%;\"\u003e\n \u003cp\u003e* p \u0026lt;.05 **p \u0026lt;.01\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eConcerning the relationship between empowering outcomes and post-traumatic growth and emotional distress, PTGI displayed significant weak to moderate correlations with \u0026apos;Feeling more confident about the treatment\u0026apos; (p \u0026lt;.05), \u0026apos;increased optimism and control\u0026apos; (p \u0026lt;.01), \u0026apos;enhanced self-esteem\u0026apos; (p \u0026lt;.01) and overall empowerment (p \u0026lt;.05). HADS showed a negatively significant weak to moderate correlation with \u0026apos;enhanced self-esteem\u0026apos; (p \u0026lt;.05) and \u0026apos;increased optimism and control\u0026apos; (p \u0026lt;.05). However, in partial correlation analyses, neither PTGI nor HADS yielded significant results, leading to their exclusion from the linear regression to streamline the model and enhance its interpretability by focusing on the most influential predictors of overall empowerment within the context of \u003cem\u003eComunitats\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the context of the regression analysis (Table 6), the findings suggest that the overall empowerment can be partially predicted by the processes taking place within \u003cem\u003eComunitats\u003c/em\u003e, as indicated by an adjusted R\u0026sup2; of .371. This implies that 37.1% of the variance in overall empowerment can be accounted for by the model. Notably, the most influential predictors of overall empowerment are \u0026apos;exchanging information\u0026apos; and \u0026apos;finding recognition\u0026apos;.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;6. Regression analysis results\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"632\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.49367088607595%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61.075949367088604%\" colspan=\"8\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Empowerment Outcome\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N= 121)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.620253164556964%\" colspan=\"3\"\u003e\n \u003cp\u003eUnstandardized\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\"\u003e\n \u003cp\u003eStandardized\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj. R\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e12.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\" valign=\"top\"\u003e\n \u003cp\u003e1.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\" valign=\"top\"\u003e\n \u003cp\u003e8.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExchanging information*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\" valign=\"top\"\u003e\n \u003cp\u003e.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\" valign=\"top\"\u003e\n \u003cp\u003e2.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEncountering emotional support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\" valign=\"top\"\u003e\n \u003cp\u003e.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\" valign=\"top\"\u003e\n \u003cp\u003e.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinding recognition**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\" valign=\"top\"\u003e\n \u003cp\u003e.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\" valign=\"top\"\u003e\n \u003cp\u003e3.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHelping others\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\" valign=\"top\"\u003e\n \u003cp\u003e.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\" valign=\"top\"\u003e\n \u003cp\u003e-.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.430379746835442%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSharing experiences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.183544303797468%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\" valign=\"top\"\u003e\n \u003cp\u003e.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.873417721518987%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.177215189873417%\" valign=\"top\"\u003e\n \u003cp\u003e.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.867088607594937%\" valign=\"top\"\u003e\n \u003cp\u003e.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.069620253164556%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.61392405063291%\" colspan=\"10\" style=\"width: 100%;\"\u003e\n \u003cp\u003e* p \u0026lt;.01 \u0026nbsp;**p \u0026lt;.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Discussion and Conclusion","content":"\u003cp\u003e4.1. Discussion\u003c/p\u003e\n\u003cp\u003eThis study sought to examine the connections between empowering processes within \u003cem\u003eComunitats\u0026nbsp;\u003c/em\u003eand reported empowerment outcomes by participants. Additionally, the study aimed to identify variables that could predict more substantial empowerment outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the line of previous research\u0026nbsp;[15\u0026ndash;17], results of this study reveal that participating in the PS community promotes an increasing recognition feeling through sharing experiences as well as an improvement of information and its management.\u003c/p\u003e\n\u003cp\u003eThe most prevalent empowering process observed in interactions within \u003cem\u003eComunitats\u003c/em\u003e was \u0026apos;exchanging information\u0026apos;, as found by van Uden-Kraan et al.\u0026nbsp;[17].\u0026nbsp;As highlighted by Hu et al.\u0026nbsp;[10], BC-related information provided by participants may be incomplete or biased due to a lack of training among peer supporters. However, as mentioned earlier, \u003cem\u003eComunitats\u003c/em\u003e offers psychoeducational resources and involves the participation of healthcare professionals who can correct information if needed or guide participants to the appropriate information source if the question exceeds the scope of the support community. Survivors reported \u0026apos;finding recognition\u0026apos; in online community interactions, aligning with prior research emphasizing that PS fosters mutual understanding and recognition through shared experiences\u0026nbsp;[13,16]. Based on our research findings, \u0026apos;helping others\u0026apos; is the process that occurred to the least extent. Considering that 54.5% of the included participants ever posted in the online community, this result may be attributed to the fact that lurkers, participants who read the chats but do not actively participate, cannot engage in helping others. However, the data collected on community participation do not allow us to ascertain whether\u0026nbsp;survivors who did not post are lurkers or simply did not access the conversation groups. As a result, we cannot determine if there is any difference between active participants and lurkers in this case.\u003c/p\u003e\n\u003cp\u003eIn the line of findings of van Uden-Kraan et al.\u0026nbsp;[17]\u0026nbsp;the empowerment outcome most reported was\u0026nbsp;\u0026apos;being better informed\u0026apos;. Prior research suggests that in PS groups, a predominant aspect of group participation involves the exchange of information, encompassing the sharing of knowledge related to the disease, treatment methods, or recommendations\u0026nbsp;[15]. Further, although to a minor degree,\u0026nbsp;\u0026apos;increased optimism and control\u0026apos; is also reported, mainly, participants reported an increased ability to seek help and felt more able to tell others when they were no longer able to do something. Surprisingly, and in contrast to van Uden-Kraan et al. [17], the least reported empowerment outcome was \u0026apos;enhanced social well-being\u0026apos;. This result may be influenced by the level of active engagement within the online community. Notably, fewer than 50% of participants made any posts during the three-month period, with an average post count below 12. This contrasts with the study conducted by van Uden-Kraan et al. [17], which included a larger and more actively participating sample. A potential explanation for these differences in participation may be related to the age of the sample and the time since diagnosis, as inferred from the results, with the most active participants being younger and more recently diagnosed. Likewise, the sample studied by van Uden-Kraan et al. [17] included younger participants and more recent diagnoses compared to our own.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile no significant correlations were found between emotional distress, post-traumatic growth, and overall empowerment, both emotional distress and post-traumatic growth were significantly correlated with \u0026apos;increased optimism and control\u0026apos; and \u0026apos;enhanced self-esteem\u0026apos;. These findings are coherent with research suggesting that optimism and self-esteem are resources able to contribute to relieving emotional distress and increasing post-traumatic growth [30,31].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding empowering processes undertaken in \u003cem\u003eComunitats\u003c/em\u003e, our results indicate a moderate capacity to explain the overall empowerment reported by participants. Particularly, \u0026apos;finding recognition\u0026apos; and \u0026apos;exchanging information\u0026apos; emerged as the most influential predictors, aligning with findings from van Uden-Kraan et al. [17]. Similar results were obtained in online support groups beyond BC; Liu \u0026amp; Wang found that information support and recognition positively influenced users\u0026rsquo; confirmation of expectations about the community; expectation confirmation was linked with the willingness to continue using the online community [32]. Hence, future research may explore users\u0026rsquo; expectations accomplishment as a mediator to gain a deeper understanding of the observed outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has certain limitations that should be considered when interpreting the results. First, the three-month period imposes a time constraint, limiting the assessment of the long-term impact of participating in the community. In addition, the sample size was limited to 121 survivors, and the exclusive inclusion of women diagnosed with BC may restrict the generalizability of the findings to individuals with other types of cancer. Moreover, data about other activities, such as group psychotherapy or involvement in patients\u0026apos; associations, that may encompass PS components are not available, which might introduce a confounding variable in the relationship between participation in the community and the observed results. Furthermore, the participation measure was limited to a binary approach (whether participants did or did not make any posts) and the count of the number of messages, which prevents distinguishing differences between lurkers (those who consume information without actively contributing) and active participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.2. Conclusion\u003c/p\u003e\n\u003cp\u003eThe results indicate that participation in \u003cem\u003eComunitats\u0026nbsp;\u003c/em\u003epromotes empowerment among BC survivors. The findings reveal that, specific processes within the community, especially \u0026apos;exchanging information\u0026apos; and \u0026apos;finding recognition\u0026apos;, contribute to overall empowerment. However, these processes only explain the empowerment outcomes to a modest extent. Future research is required to explore additional factors influencing the outcomes reported by participants and to identify the characteristics of participants who may derive greater benefits from participating in the community.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.3 Practice Implications\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOffering online peer support communities in oncological processes could help participants to feel more empowered. Empowerment positively impacts self-care autonomy, self-efficacy, and treatment adherence, promoting healthier lifestyles and enhanced treatment outcomes. Knowing that there are different community processes that foster empowerment, it would be interesting that support professionals of the community would promote the exchange of information and mutual recognition among participants.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis project was funded by the European Institute of Innovation and Technology (EIT) (19046 [1st year], 20536 [2nd year]; ONCOMMUNITIES: Online Cancer Support Communities). The Asociaci\u0026oacute;n Espa\u0026ntilde;ola Contra el C\u0026aacute;ncer partially also funded the present study through a grant (no. PRYES211395OCHO). This work has also been supported by the Carlos III Health Institute under the FIS grant PI19/01880 (co-financed by the European Regional Development Fund (ERDF) \u0026lsquo;a way to build Europe\u0026rsquo;), as well as under the FIS grant PI22/01255. The Generalitat de Catalunya through the emergent research groups\u0026ldquo;Psychooncology and digital health\u0026rdquo; (2021SGR01003) has also supported this research. We thank CERCA Programme/Generalitat de Catalunya for institutional support\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe Secretaria d\u0026apos;Universitats i Recerca of the Generalitat de Catalunya and The European Social Fund through the FI grant 2020FI_B00288 have also partially funded this research. Finally, the Programa Investigo for hiring young job seekers to carry out research and innovation initiatives (INVESTIGO 2023) from the Department of Research and Universities of the Generalitat de Catalunya, financed by the European Union \u0026ndash; Next Generation EU, provided financial support. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution:\u0026nbsp;\u003c/strong\u003eCristian Ochoa-Arnedo contributed to the study conception and design. Data were collected by Marina Ruiz-Romeo, Laura Ciria-Suarez, Arnau Souto-Sampera, Aida Flix-Valle, Alejandra Arizu-Onassis, Cristina Villanueva-Bueno, Vicente Escudero-Vilaplana and Eva Juan-Linares. Analysis were performed by Marina Ruiz-Romeo, Laura Ciria-Suarez, Joan C. Medina, Maria Serra-Blasco and Cristian Ochoa-Arnedo. The first draft of the manuscript was written by Marina Ruiz-Romeo and Laura Ciria-Suarez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eThe study was conducted according to the guidelines of the\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDeclaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of the INSTITUT CATAL\u0026Agrave; D\u0026rsquo;ONCOLOGIA on the 25th of October 2018 (PR343/18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all subjects involved in the study. We confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eAuthors want to express their gratitude to all BC women who agreed to participate in this project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlobal Cancer Observatory. Breast cancer fact sheets 2020. https://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf\u003c/li\u003e\n\u003cli\u003eCiria-Suarez L, Jim\u0026eacute;nez-Fonseca P, Palac\u0026iacute;n-Lois M, Anto\u0026ntilde;anzas-Basa M, Fern\u0026aacute;ndez-Montes A, Manzano-Fern\u0026aacute;ndez A, et al. Breast cancer patient experiences through a journey map: A qualitative study. 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Psychooncology 2023. https://doi.org/10.1002/pon.6216.\u003c/li\u003e\n\u003cli\u003eGonzalez-Saenz de Tejada M, Bilbao A, Bar\u0026eacute; M, Briones E, Sarasqueta C, Quintana JM, et al. Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients. Psychooncology 2017;26:1263\u0026ndash;9. https://doi.org/10.1002/pon.4303.\u003c/li\u003e\n\u003cli\u003eHu J, Wang X, Guo S, Chen F, Wu Y, Ji F, et al. Peer support interventions for breast cancer patients: a systematic review. Breast Cancer Res Treat 2019;174:325\u0026ndash;41. https://doi.org/10.1007/s10549-018-5033-2.\u003c/li\u003e\n\u003cli\u003eOchoa-Arnedo C, Flix-Valle A, Casellas-Grau A, Casanovas-Aljaro N, Herrero O, Sumalla EC, et al. An exploratory study in breast cancer of factors involved in the use and communication with health professionals of Internet information. 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Support Care Cancer 2020;28:2659\u0026ndash;67. https://doi.org/10.1007/s00520-019-05069-5.\u003c/li\u003e\n\u003cli\u003eJablotschkin M, Binkowski L, Markovits Hoopii R, Weis J. Benefits and challenges of cancer peer support groups: A systematic review of qualitative studies. Eur J Cancer Care (Engl) 2022;31. https://doi.org/10.1111/ecc.13700.\u003c/li\u003e\n\u003cli\u003eJ\u0026oslash;rgensen CR, Thomsen TG, Ross L, Dietz SM, Therkildsen S, Groenvold M, et al. What Facilitates \u0026ldquo;Patient Empowerment\u0026rdquo; in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature. Qual Health Res 2018;28:292\u0026ndash;304. https://doi.org/10.1177/1049732317721477.\u003c/li\u003e\n\u003cli\u003evan Uden-Kraan CF, Drossaert CHC, Taal E, Seydel ER, van de Laar MAFJ. Participation in online patient support groups endorses patients\u0026rsquo; empowerment. Patient Educ Couns 2009;74:61\u0026ndash;9. https://doi.org/10.1016/j.pec.2008.07.044.\u003c/li\u003e\n\u003cli\u003ete Boveldt N, Vernooij‐Dassen M, Leppink I, Samwel H, Vissers K, Engels Y. Patient empowerment in cancer pain management: an integrative literature review. Psychooncology 2014;23:1203\u0026ndash;11. https://doi.org/10.1002/pon.3573.\u003c/li\u003e\n\u003cli\u003eN\u0026aacute;fr\u0026aacute;di L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One 2017;12. https://doi.org/10.1371/journal.pone.0186458.\u003c/li\u003e\n\u003cli\u003eWestman B, Bergkvist K, Karlsson Rosenblad A, Sharp L, Bergenmar M. Patients with low activation level report limited possibilities to participate in cancer care. Health Expectations 2022;25:914\u0026ndash;24. https://doi.org/10.1111/hex.13438.\u003c/li\u003e\n\u003cli\u003eHibbard JH, Greene J. 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J Oncol Pract 2018;14:725\u0026ndash;30. https://doi.org/10.1200/JOP.18.00261.\u003c/li\u003e\n\u003cli\u003evan Uden-Kraan CF, Drossaert CHC, Taal E, Shaw BR, Seydel ER, van de Laar MAFJ. Empowering Processes and Outcomes of Participation in Online Support Groups for Patients With Breast Cancer, Arthritis, or Fibromyalgia. Qual Health Res 2008;18:405\u0026ndash;17. https://doi.org/10.1177/1049732307313429.\u003c/li\u003e\n\u003cli\u003eLepore SJ, Buzaglo JS, Lieberman MA, Golant M, Greener JR, Davey A. Comparing Standard Versus Prosocial Internet Support Groups for Patients With Breast Cancer: A Randomized Controlled Trial of the Helper Therapy Principle. J Clin Oncol 2014;32:4081\u0026ndash;6. https://doi.org/10.1200/JCO.2014.57.0093.\u003c/li\u003e\n\u003cli\u003eLepore SJ, Rincon MA, Buzaglo JS, Golant M, Lieberman MA, Bauerle Bass S, et al. Digital literacy linked to engagement and psychological benefits among breast cancer survivors in Internet‐based peer support groups. Eur J Cancer Care (Engl) 2019;28. https://doi.org/10.1111/ecc.13134.\u003c/li\u003e\n\u003cli\u003eRequena, G.C.; Mart\u0026iacute;n, X.P.; Bar\u0026oacute;, M.S.; Moncayo, F.L.G. Discriminaci\u0026oacute;n del malestar emocional en pacientes oncol\u0026oacute;gicos utilizando la escala de ansiedad y depresi\u0026oacute;n hospitalaria (HADS) [Discrimination of emotional distress in oncology patients using the Hospital Anxiety and Depression Scale (HADS)]. Ansiedad y Estr\u0026eacute;s 2009;15:217\u0026ndash;229. \u003c/li\u003e\n\u003cli\u003eCosta-Requena, G., \u0026amp; Gil Moncayo, F. L. Crecimiento postraum\u0026aacute;tico en pacientes oncol\u0026oacute;gicos [Posttraumatic growth in oncology patients]. An\u0026aacute;lisis Y Modificaci\u0026oacute;n De Conducta 2007;33. https://doi.org/10.33776/amc.v33i148.1215\u003c/li\u003e\n\u003cli\u003eJim\u0026eacute;nez MG, Montorio I, Izal M. The association of age, sense of control, optimism, and self-esteem with emotional distress. Dev Psychol 2017;53:1398\u0026ndash;403. https://doi.org/10.1037/dev0000341.\u003c/li\u003e\n\u003cli\u003ePrati G, Pietrantoni L. Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. J Loss Trauma 2009;14:364\u0026ndash;88. https://doi.org/10.1080/15325020902724271.\u003c/li\u003e\n\u003cli\u003eLiu J, Wang J. Users\u0026rsquo; Intention to Continue Using Online Mental Health Communities: Empowerment Theory Perspective. Int J Environ Res Public Health 2021;18:9427. https://doi.org/10.3390/ijerph18189427.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"online communities, empowerment, peer support, breast cancer, oncology","lastPublishedDoi":"10.21203/rs.3.rs-4169441/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4169441/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: Breast cancer (BC) impacts the patient’s quality of life. Peer support can provide emotional understanding as well as enhance information access, social support, and coping strategies, aligning with empowerment. \u003cem\u003eComunitats\u003c/em\u003e is an online peer support community addressed to BC survivors, involving healthcare professionals.\u003cstrong\u003e \u003c/strong\u003eThis study aims to explore how participation in \u003cem\u003eComunitats\u003c/em\u003e promotes empowerment, and which variables are related to it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e121 women diagnosed with BC were included in \u003cem\u003eComunitats. \u003c/em\u003eEmotional distress, post-traumatic growth and empowerment were assessed at inclusion and three months later. Correlations were used to guide linear regression analysis to identify which variables are able to predict greater empowerment outcomes.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eEmpowerment assessment indicated that participants felt empowered by their involvement in \u003cem\u003eComunitats\u003c/em\u003e. The empowerment outcomes more commonly experienced were 'being better informed' and 'improved acceptance of the illness'. 'Exchanging information' and 'finding recognition' were the strongest experienced empowerment processes. \u003cstrong\u003eConclusion: \u003c/strong\u003eInvolvement in \u003cem\u003eComunitats\u003c/em\u003eenhances empowerment in BC survivors. Empowering processes within the community partially predict overall empowerment outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical Implications\u003c/strong\u003e: Empowerment positively impacts self-care autonomy, self-efficacy, and treatment adherence, promoting healthier lifestyles and enhanced treatment outcomes.\u003c/p\u003e","manuscriptTitle":"Empowerment among breast cancer survivors using an online peer support community","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 10:15:00","doi":"10.21203/rs.3.rs-4169441/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-29T00:59:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-15T08:23:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180421429853951616716363249452961211810","date":"2024-05-06T07:19:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-05T22:45:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-04T05:55:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-27T02:18:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-03-26T11:25:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a4117034-d144-4d81-9785-f5fa482e1653","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-30T16:00:46+00:00","versionOfRecord":{"articleIdentity":"rs-4169441","link":"https://doi.org/10.1007/s00520-024-09119-5","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-12-28 15:57:26","publishedOnDateReadable":"December 28th, 2024"},"versionCreatedAt":"2024-03-29 10:15:00","video":"","vorDoi":"10.1007/s00520-024-09119-5","vorDoiUrl":"https://doi.org/10.1007/s00520-024-09119-5","workflowStages":[]},"version":"v1","identity":"rs-4169441","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4169441","identity":"rs-4169441","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}