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Research studies involving health-related online communities have focused on examining network structure to understand mechanisms underlying behavior change. Content analysis of the messages exchanged in these communities has been limited to the “social support” perspective. However, existing behavior change theories suggest that message content plays a prominent role reflecting several sociocognitive factors that affect an individual’s efforts to make a lifestyle change. An understanding of these factors is imperative to identify and harness the mechanisms of behavior change in the Health 2.0 era.
The objective of this work is two-fold: (1) to harness digital communication data to capture essential meaning of communication and factors affecting a desired behavior change, and (2) to understand the applicability of existing behavior change theories to characterize peer-to-peer communication in online platforms.
In this paper, we describe grounded theory–based qualitative analysis of digital communication in QuitNet, an online community promoting smoking cessation. A database of 16,492 de-identified public messages from 1456 users from March 1-April 30, 2007, was used in our study. We analyzed 795 messages using grounded theory techniques to ensure thematic saturation. This analysis enabled identification of key concepts contained in the messages exchanged by QuitNet members, allowing us to understand the sociobehavioral intricacies underlying an individual’s efforts to cease smoking in a group setting. We further ascertained the relevance of the identified themes to theoretical constructs in existing behavior change theories (eg, Health Belief Model) and theoretically linked techniques of behavior change taxonomy.
We identified 43 different concepts, which were then grouped under 12 themes based on analysis of 795 messages. Examples of concepts include “sleepiness,” “pledge,” “patch,” “spouse,” and “slip.” Examples of themes include “traditions,” “social support,” “obstacles,” “relapse,” and “cravings.” Results indicate that themes consisting of member-generated strategies such as “virtual bonfires” and “pledges” were related to the highest number of theoretical constructs from the existing behavior change theories. In addition, results indicate that the member-generated communication content supports sociocognitive constructs from more than one behavior change model, unlike the majority of the existing theory-driven interventions.
With the onset of mobile phones and ubiquitous Internet connectivity, online social network data reflect the intricacies of human health behavior as experienced by health consumers in real time. This study offers methodological insights for qualitative investigations that examine the various kinds of behavioral constructs prevalent in the messages exchanged among users of online communities. Theoretically, this study establishes the manifestation of existing behavior change theories in QuitNet-like online health communities. Pragmatically, it sets the stage for real-time, data-driven sociobehavioral interventions promoting healthy lifestyle modifications by allowing us to understand the emergent user needs to sustain a desired behavior change.
Unhealthy behaviors such as smoking, physical inactivity, poor diet, and alcohol consumption contribute to 835,000 deaths in the United States annually [
Several studies on online social networks provide valuable insights into social influence, information spread, behavioral diffusion, and the structural aspects (who has ties to whom) [
In this paper, we describe the results of a grounded theory-based [
Several health behavior theories and models have been formulated to explain behavior change in general (see
TTM tries to explain the behavior change mechanisms by synthesizing several constructs drawn from other theories [
TRA suggests that the behavior of a person is determined by one’s behavioral intention [
The SCT is a theory based on reciprocal determinism between a behavior, the environment, and a person [
HBM is one of the most widely used conceptual frameworks for explaining and changing individual health behavior. HBM evolved from a cognitive theory perspective and is a value-expectancy theory, which attempts to explain and predict individual’s attitudes toward objects and actions [
Abraham et al defined a set of theory-linked behavior change techniques that can be used to characterize and differentiate between different types of intervention content [
Theoretical constructs from behavior change theories (adapted from Revere & Dunbar [
Theory | Concept | Definition |
Health Belief Model | Perceived susceptibility | One’s opinion of chances of getting a condition |
Perceived severity | One’s opinion of how serious a condition and its consequences are | |
Perceived benefits | One’s opinion of the efficacy of the advised action to reduce risk or seriousness of impact | |
Perceived barriers | One’s opinion of the tangible and psychological costs of the action | |
Cues to action | Strategies to activate readiness | |
Self-efficacy | Confidence in ability to take action and persist in action | |
Stages of Change Model | Pre-contemplation | Unaware of problem, hasn’t thought about changes |
Contemplation | Thinking about changes | |
Preparation | Making a plan to change | |
Action | Implementations of a specific action plan | |
Maintenance | Continuation of desirable actions, or repeating periodic recommended step(s) | |
Consciousness raising | Increasing awareness via information, education, and personal feedback about the healthy behavior | |
Dramatic relief | Feeling fear, anxiety, or worry because of the unhealthy behavior, or feeling inspiration and hope when they hear about how people are able to change to healthy behaviors | |
Self-reevaluation | Realizing that the healthy behavior is an important part of who they are and want to be | |
Environmental reevaluation | Realizing how unhealthy behavior affects others | |
Social liberation | Realizing that society is more supportive of the healthy behavior | |
Self-liberation | Believing in one’s ability to change and making commitments and recommitments | |
Helping relationships | Finding people who are supportive of their change | |
Counter-conditioning | Substituting healthy ways of acting and thinking for unhealthy ways | |
Reinforcement management | Increasing the rewards that come from positive behavior and reducing those that come from negative behavior | |
Stimulus control | Using reminders and cues that encourage healthy behavior as substitutes for those that encourage the unhealthy behavior | |
Theory of Planned Behavior and Theory of Reasoned Action | Behavioral intervention | Perceived likelihood of performing the behavior; prerequisites for action |
Attitude | One’s favorable or unfavorable evaluation of the behavior | |
Behavioral belief | Belief that the behavioral performance is associated with certain attributes or outcomes | |
Normative belief | Subjective belief regarding approval or disapproval of the behavior | |
Subjective norm | Influence of perceived social pressure weighted by one’s motivation to comply with perceived expectations | |
Perceived behavioral control | One’s perception of how easy or difficult it will be to act | |
Social Cognitive Theory | Reciprocal determinism | Behavior change results from interaction between individuals and environment |
Behavioral capability | Knowledge and skills to influence behavior | |
Expectations | Beliefs about likely results of action | |
Self-efficacy | Confidence in ability to take action and persist in action | |
Observational learning | Beliefs based on observing others | |
Reinforcement | Responses to a person’s behavior that increase or decrease chances of recurrence | |
Emotional coping responses | Strategies or tactics that are used by a person to deal with emotional stimuli. |
QuitNet is one of the first online social networks for health behavior change [
The objective of this qualitative analysis was to characterize the nature of communication content exchanged by QuitNet members, thus capturing essential meaning of communication and factors affecting smoking cessation. This sort of analysis ultimately enables the abstraction of communication themes as they emerge from the data itself. Such inductive analysis is the principle technique used in the grounded theory method generating themes, where themes emerge from data itself [
Often the messages exchanged among network members reflect a local language that is ingrained in the network’s unique culture. However, when it is interpreted out of context, they lose their context-specific meaning. Similarly, in a much more general sense, before the advent of Twitter (an online social networking and microblogging service), the word “tweeps” (defined as followers of a person/organization on Twitter) was never used. Interestingly, current trends suggest having a high number of “tweeps” as a metric to measure how well followed a person is. Emergence of local language is a commonly found feature of a community, and the same can be applied to online communities as well. Therefore, when analyzing online social network data to understand communication patterns underlying human behavior, understanding community-specific context is mandatory to derive meaningful inferences from the data.
A grounded theory approach was used to analyze QuitNet data to understand the core concepts, the interrelations among concepts, and the roles played by these concepts in an individual’s smoking cessation activity. The first step in the coding process involved open coding, where a line-by-line analysis was performed on the messages to derive abstract concepts from the data. The messages considered for analysis were selected at random using a scripted random number generator [
Examples of open codes included “statistics,” “pregnancy,” “boredom,” “temper,” “patch,” and “pledge.” This process was repeated until no new concepts were produced from the dataset. Appropriateness of code assignment was ascertained using constant comparison, where instances of codes were compared in an iterative manner to make sure they reflected the same concept. The second step was performed by re-organizing and re-grouping the open codes using axial coding. Axial coding allowed for the identification of unifying, repeated patterns underlying the concepts and their relationships, thereby revealing core themes relevant to smoking cessation. Examples of core themes include “Family and friends,” “Obstacles,” and “Traditions.” Initial coding was performed manually, and later the NVivo software suite for qualitative analysis was used to analyze themes and their patterns of occurrence in the data. A total of 585 randomly selected messages were analyzed as described using grounded theory principles. Furthermore, the analysis was carried out for an additional 210 messages to ensure no new concepts emerged. Once themes were identified, a second coder conducted thematic analysis of a subset of 100 messages to ascertain the applicability of the derived themes to other QuitNet messages. This second round of coding was used to measure interrater reliability using Cohen’s kappa measure. This qualitative analysis allowed for an in-depth evaluation of the interactions among people in the QuitNet virtual community and thereby a deeper understanding of the behavior change processes that QuitNet users undergo when attempting to cease smoking.
This thematic taxonomy derived from our grounded theory analysis was then mapped to theoretical constructs derived from SCT, TTM, HBM, and TRA, since these theories had been applied to several published studies on smoking-related behavior change. In addition, we also used the original behavior change taxonomy, developed by Abraham et al, with 26 theory-linked behavior change strategies [
A total of 43 different concepts were identified, which were then grouped under 12 themes. Examples of the grouping strategy employed to arrive at the thematic level are shown in
QuitNet themes, definitions, and example messages.
Theme | Definition | Example message |
Quit Obstacles | Messages in which members talk about the hurdles they are dealing with or have dealt with to stay abstinent (eg, sleepiness, weight gain, temper) | I lost quits in the past because I was so mean and nasty that my family and friends told me to smoke. |
Teachable Moments | Messages where the senders mention about the incentives one gets for not smoking in terms of quality of life | Food is wonderful...smell is wonderful...I smoked from 14-46...I never knew what I was missing. |
Quit Readiness | Messages that attempt to provide inspiration and prompt readiness to quit and initiate a smoke-free life | You can do anything if you would want it bad enough... |
Cravings | Messages that capture the real-time expressions of the users urge to smoke | I want a cigarette very much. I am trying to resist. |
Conflict | Messages that reflect a rift between two group members | No one likes being called a liar, especially if they are NOT. Go sit |
Relapse (confessions, reasons, retries) | Messages in which members explain why they relapsed and/or share their emotions after they suffered a relapse | I hate myself, I slipped again. I lighted the nicodemon |
Traditions | Messages that focus exclusively on QuitNet-specific events such as bonfires, pledges, games, and so on | I’ve got over 5K unsmoked cigs which I’d be delighted to unload onto a raging bonfire. |
Quit Progress | Messages in which members communicate their progress based on abstinence time and/or number of unsmoked cigarettes | Gratefully smoke free for 33 days, 17 hours, 1 minute and 6 seconds. |
Family and Friends | Message in which members mention their spouses, children, or friends as motivators | My hubby...poor guy used to get to sleep when I smoked...now he is sleepless but smiling... |
Virtual Rewards | Messages in which members mention the virtual gifts (such as bracelet, virtual pet, socks) received on QuitNet marking a milestone | awesome three days. I like the bracelet. |
Social Support | Messages where the content reflects the elements of praise, advice, empathy, and guidance | Almost a year already.//// Congratulations to you, what a great accomplishment. |
Pharmacotherapy | Messages where members explicitly discuss and evaluate various pharmacotherapy options and best practices for management of nitone withdrawal symptoms | I did not use any nrt though I recently went on welburtin after days ct |
A detailed distribution of the themes across messages is shown in
QuitNet members exchange messages pertaining to traditions that are specific to QuitNet. Examples of traditions are as follows: (1) bonfire: a virtual event hosted regularly where members bring their unsmoked cigarettes and throw them into a fire, and (2) pledge: a member virtually extends their hand to another member indicating their commitment towards staying abstinent. This represents the support the member offers to the next person in line to help them stay smoke-free, and as such is one example of the content of messages belonging to the social support category. These messages provide guidance, express empathy, convey admiration, and promote bonding. Expressions of empathy, love, trust, and caring, which form the basis of emotional support, were also communicated using phrases such as “hugs,” “flowers,” and “kisses.” Members use measurable metrics such as the number of unsmoked days and cigarettes, the amount of money not spent on cigarettes, and the number of days of life saved by staying smoke-free to measure their “Progress.” These metrics are automatically calculated by the website using a user’s recorded quit date and displayed to the user and can be embedded in messages similar to an email signature. Members refer to these calculated metrics when providing positive feedback to others and utilize them for self-monitoring.
Analysis of the QuitNet data provided crucial insights into the relapse experiences of smokers and ex-smokers. Work-related stress, family tragedies, inability to ward off cravings, and a false notion of “just one puff” (denotes weak moments where members smoke a cigarette thinking that it would not affect their ability to stay abstinent from then on) were cited as common reasons for relapse. Relapse is a common problem encountered by smokers who are trying to quit and ex-smokers who successfully quit [
The day-to-day urges to smoke in QuitNet members’ journeys towards smoke-free lives were defined by cravings for cigarettes. This theme (“Cravings”) includes messages with content where successful quitters explained to fellow members how they dealt with cravings. Some messages even contained information about members’ experiences and efforts as they dealt with cravings in real-time. Messages relevant to the quit readiness theme displayed an effort made by QuitNet members to encourage fellow members by making inspiring, engaging, and thought-provoking comments on the role played by personality traits such as attitude and willpower in a successful quit attempt. Messages also have content through which members mentioned the obstacles they were facing, or have faced, at some point of their abstinence phase. Weight gain, temper, problems with sleep, and boredom were among these hurdles. Family (eg, spouse, children) and friends are mentioned in some of the messages as support network or motivators or obstacles. For instance, members mentioned not being able to stay abstinent because of watching their spouses smoke. Pharmacotherapy options are also discussed in QuitNet messages. Usage of patches and gums and going “cold turkey” (ie, quitting without any pharmaceutical assistance) are discussed as facilitators of behavior change. The members requested information about withdrawal effects and side-effects associated with the use of nicotine replacement therapies. Also, successful quitters advised newer members to make use of a patch to fight cravings and avoid relapse. Another emergent behavior exhibited by QuitNet members involved the role of virtual rewards. Some of these rewards included bracelets, virtual pets, socks, and access to an “elder lodge” where successful quitters meet virtually. Rewards were given when members met milestones such as 3-day, 15-day quit, and 100-day quits, 1-year anniversaries, and so forth.
Themes in QuitNet.
Two researchers independently coded another subset of 100 randomly selected messages using the thematic terminology developed using grounded theory techniques. The codes they assigned to the messages had a Cohen’s kappa measure of 81.6%, where the 84 of the 100 messages had observed agreement. Disagreement was resolved using discussion, and the majority of the disagreement (12/16 discrepancies) was attributable to messages with “dual” content, where they could potentially be deemed as observing a community-specific tradition or measuring user progress in their smoking cessation efforts.
Grounded theory-based qualitative analysis of 795 messages.
The themes identified in QuitNet communication relate to the sociobehavioral and cognitive constructs of the existing behavior change theories.
As described above, several constructs from the existing intra- and inter-individual behavior change theories are put together and compared with the themes derived from QuitNet content. The graphs in
Theme-theory matrix: conflict, virtual rewards, pharmacotherapy, family and friends, quit obstacles, and quit benefits.
Themes/Theoretical constructs | Conflict | Virtual rewards | Pharmacotherapy | Family and friends | Quit obstacles | Quit benefits |
Susceptibility |
|
|
|
|
|
X |
Severity |
|
|
|
|
|
X |
Benefits |
|
|
|
|
|
X |
Expectations |
|
|
|
|
|
|
Expectancies |
|
|
|
|
|
X |
Barriers |
|
|
|
|
X |
|
Cue to action |
|
|
X |
|
|
|
Self-efficacy | X | X |
|
|
|
|
Intention |
|
|
|
|
|
X |
Belief |
|
|
|
|
|
|
Norm | X |
|
|
|
|
|
Control |
|
|
|
|
|
|
Decisional balance |
|
|
|
|
X | X |
Consciousness raising | X |
|
X |
|
|
|
Dramatic relief |
|
|
|
|
|
|
Self-reevaluation |
|
|
|
|
|
X |
Environmental re-evaluation | X |
|
|
X |
|
X |
Self-liberation |
|
|
|
|
|
|
Helping relationships | X |
|
|
X |
|
|
Counterconditioning |
|
X | X |
|
|
|
Reinforcements |
|
X |
|
|
|
|
Stimulus control |
|
X |
|
|
|
|
Social liberation | X |
|
|
X |
|
|
Environment |
|
X |
|
X |
|
|
Behavioral capability |
|
|
|
|
|
|
Self-control |
|
X |
|
|
|
|
Observational learning |
|
X |
|
X |
|
|
Emotional coping response |
|
|
|
X |
|
|
Theme-theory matrix: quit readiness, cravings, relapse, quit progress, social support, and traditions.
Themes/Theoretical constructs | Quit readiness | Cravings | Relapse | Quit progress | Social support | Traditions |
Susceptibility | X |
|
X |
|
|
|
Severity | X |
|
|
|
|
|
Benefits |
|
|
|
|
|
|
Expectations |
|
|
X |
|
|
|
Expectancies |
|
|
|
|
|
|
Barriers |
|
X | X |
|
X |
|
Cue to action |
|
|
|
|
X |
|
Self-efficacy | X |
|
X | X |
|
X |
Intention |
|
|
|
|
|
|
Belief | X |
|
|
|
|
|
Norm |
|
|
|
|
|
X |
Control | X |
|
|
|
|
X |
Decisional balance |
|
X |
|
|
|
|
Consciousness raising |
|
|
|
|
X |
|
Dramatic relief |
|
X | X |
|
|
|
Self-reevaluation |
|
|
|
|
|
X |
Environmental re-evaluation |
|
|
|
|
|
|
Self-liberation |
|
|
|
|
|
X |
Helping relationships |
|
|
X |
|
X | X |
Counterconditioning |
|
|
|
|
|
X |
Reinforcements |
|
|
|
|
|
|
Stimulus control |
|
|
|
X |
|
X |
Social liberation | X |
|
|
|
|
|
Environment |
|
|
|
|
|
X |
Behavioral capability |
|
|
X |
|
|
X |
Self-control |
|
|
|
X |
|
X |
Observational learning |
|
X | X | X |
|
X |
Emotional coping response |
|
X | X |
|
X | X |
Thematic and theoretical prevalence in QuitNet content.
The themes identified in QuitNet communication relate to the 21 standardized theory-linked behavior change techniques put together by Abraham et al.
Theme-taxonomy matrix: conflict, virtual rewards, pharmacotherapy, and family and friends.
Behavior change techniques | Conflict | Virtual rewards | Pharmaco-therapy | Family and friends |
Provide information about behavior health link | – | – | – | – |
Provide information on consequences | – | – | – | – |
Provide information about others’ approval | – | ✓ | – | ✓ |
Prompt intention formation | – | – | – | ✓ |
Prompt barrier identification | – | – | – | – |
Provide general encouragement | – | ✓ | – | ✓ |
Set graded tasks | – | ✓ | – | – |
Provide instruction | – | – | ✓ | – |
Model or demonstrate the behavior | – | ✓ | – | ✓ |
Prompt specific goal setting | – | ✓ | – | – |
Prompt review of behavioral goals | – | ✓ | – | – |
Prompt self monitoring of behavior | – | – | ✓ | – |
Provide feedback on performance | – | – | – | – |
Provide contingent rewards | – | ✓ | – | – |
Teach to use prompts or cues | – | – | ✓ | – |
Agree on behavioral contract | – | ✓ | – | – |
Prompt practice | – | – | – | – |
Use follow-up prompts | – | – | – | – |
Provide opportunities for social comparison | – | ✓ | – | ✓ |
Plan social support or social change | – | ✓ | – | ✓ |
Prompt identification as a role model | – | ✓ | – | – |
Prompt self-talk | ✓ | ✓ | – | – |
Relapse prevention | – | – | ✓ | – |
Stress management | – | – | ✓ | – |
Motivational interviewing | – | – | – | – |
Time management | – | – | – | – |
Theme-taxonomy matrix: quit obstacles, quit benefits, cravings, and relapse.
Behavior change techniques | Quit obstacles | Quit benefits | Cravings | Relapse |
Provide information about behavior health link | ✓ | ✓ | – | – |
Provide information on consequences | ✓ | ✓ | – | – |
Provide information about others’ approval | – | – | ✓ | ✓ |
Prompt intention formation | – | ✓ | – | – |
Prompt barrier identification | ✓ | – | ✓ | ✓ |
Provide general encouragement | – | – | – | – |
Set graded tasks | – | – | – | – |
Provide instruction | – | – | ✓ | ✓ |
Model or demonstrate the behavior | – | – | ✓ | – |
Prompt specific goal setting | – | – | – | – |
Prompt review of behavioral goals | – | – | – | – |
Prompt self monitoring of behavior | – | – | – | – |
Provide feedback on performance | – | – | – | ✓ |
Provide contingent rewards | – | – | – | – |
Teach to use prompts or cues | – | – | – | – |
Agree on behavioral contract | – | – | – | – |
Prompt practice | – | – | – | – |
Use follow-up prompts | – | – | – | – |
Provide opportunities for social comparison | – | – | – | ✓ |
Plan social support or social change | – | – | ✓ | ✓ |
Prompt identification as a role model | – | – | – | – |
Prompt self-talk | – | – | – | ✓ |
Relapse prevention | – | – | ✓ | ✓ |
Stress management | – | – | ✓ | ✓ |
Motivational interviewing | – | – | – | – |
Time management | – | – | – | – |
Theme-taxonomy matrix: quit progress, social support, traditions, and quit readiness.
Behavior change techniques | Quit progress | Social support | Traditions | Quit readiness |
Provide information about behavior health link | – | – | – | ✓ |
Provide information on consequences | – | – | – | ✓ |
Provide information about others’ approval | – | ✓ | ✓ | ✓ |
Prompt intention formation | – | – | ✓ | ✓ |
Prompt barrier identification | – | – | – | ✓ |
Provide general encouragement | ✓ | ✓ | ✓ | ✓ |
Set graded tasks | ✓ | – | ✓ | – |
Provide instruction | – | ✓ | ✓ | ✓ |
Model or demonstrate the behavior | ✓ | – | ✓ | – |
Prompt specific goal setting | ✓ | – | ✓ | – |
Prompt review of behavioral goals | ✓ | – | ✓ | – |
Prompt self monitoring of behavior | ✓ | – | ✓ | – |
Provide feedback on performance | ✓ | – | ✓ | – |
Provide contingent rewards | – | – | ✓ | – |
Teach to use prompts or cues | – | – | – | – |
Agree on behavioral contract | – | – | ✓ | – |
Prompt practice | – | – | ✓ | – |
Use follow-up prompts | – | – | – | – |
Provide opportunities for social comparison | ✓ | – | ✓ | – |
Plan social support or social change | – | ✓ | ✓ | – |
Prompt identification as a role model | ✓ | – | ✓ | – |
Prompt self-talk | ✓ | – | ✓ | ✓ |
Relapse prevention | – | – | – | – |
Stress management | – | ✓ | – | ✓ |
Motivational interviewing | – | ✓ | – | ✓ |
Time management | – | – | ✓ | ✓ |
Taxonomy-based analysis of QuitNet themes.
In the case of QuitNet, activities such as pledges and bonfires emerged from within the community and each of those events marks a specific aspect of the smoking-cessation process. With the evolution of communication channels from being traditional face-to-face conversations to virtual social networks powered by Web-based mHealth systems, the validity of existing behavior change theories in the digital era has been questioned [
Qualitative methods form a very important toolkit to conduct nuanced analysis of health-related communications in online platforms. As we have shown, inductive analytic techniques that are data-driven enabled us to characterize peer interactions in QuitNet. Further, use of grounded theory analysis allowed us to develop thematic representations of QuitNet messages that are empirically driven and not theoretically biased. Subsequently, comparison analysis consisting of (1) sociobehavioral constructs from existing behavior change theories and (2) theoretically linked taxonomy of behavior change techniques allowed us to understand the theoretical roots and operational features of consumer-driven QuitNet communication. The methodological process itself is immensely informative, comprehensive, and generalizable, while being empirically grounded and theoretically aligned simultaneously. The applicability of the methods discussed in this paper can be taken well beyond the analysis of a small scale sample through use of automated text analysis methods. Communication exchanges in online communities are time-stamped and digitized and therefore are amenable to machine learning [
This paper provides insights into the ways that consumer interactions in online communities can be conducted using methods that are empirically motivated and theoretically driven. Such qualitative analysis provided useful insights into prominent themes in QuitNet communication. Although we have ensured the study of coding and reliability was conducted before we formulated theme-theory linking as a potential next step in order to minimize the influence of predispositional knowledge on theme identification, the analysis may be amenable to subjective knowledge. In addition, manual coding is highly labor-intensive and time-consuming. Consequently, the analysis is limited to a small sample size, potentially limiting the generalizability of these results. It is possible that given the low fraction of messages thematically coded, the distribution of the themes might not have been accurately represented. To attempt to address this, 210 messages were coded to reach thematic saturation. However, it may be possible that the remainder of the dataset contains additional themes that were not captured. The rapid growth of digital technologies will further complicate this issue, as it will generate a data deluge of millions of messages transmitted over the Web and mobile media. Therefore, for large datasets, one needs to complement the qualitative method with an automated technique that can optimize resource utilization. The QuitNet dataset considered in our analysis was recorded in 2007. For future studies, we will attempt to obtain further data drawn from recent datasets. However, we strongly believe that the findings from the reported data on human behavior still hold, since the basic tenet of forum-based communication (structure and logistics) remains the same. Even emerging health-related network platforms (eg, PatientsLikeMe) also embed online forums to facilitate peer-to-peer communication. Threaded discussions in the form of comments in contemporary platforms also provide forum-like environments to facilitate text-based communication among users in online platforms. In addition, this analysis does not take into account seasonal patterns that might affect an individual’s behavior change (eg, New Year’s resolutions) because of the limited size and time period of our QuitNet dataset. We will attempt to address these issues through use of larger longitudinal datasets. Similarly, there have been some novel developments with respect to modes of nicotine intake (eg, e-cigarettes) [
This paper describes a qualitative analysis of online social network communication using a grounded theory approach. The key contributions of this study are as follows:
The study describes the first grounded theory–based qualitative analysis of the communication in an online social network developed to promote behavior change. Contrary to prior qualitative studies that focused on a specific behavior change mechanism (either social support or emotional coping), our paper presents an empirically driven perspective on manifestations of theoretical behavior change constructs in online platforms.
The methodological process allows investigation of consumer-driven behavior change attempts in online communities from the perspective of existing behavior change theories.
The study attempts to understand the applicability of hypothesis-driven behavior change constructs to organically evolving user communication in online platforms.
This is the first reported attempt of analyzing online user interactions using the taxonomy of behavior change techniques, subsequently imposing the structure of common vocabulary to understand the ways that consumer interactions implicitly operationalize sociobehavioral and cognitive constructs of existing behavior change theories.
Capturing the essence of the meaning underlying the messages exchanged during different situations and contexts in this manner provides important information to guide further investigations. Qualitative analysis of communication between members of an online social network can provide valuable insights into the mechanisms underlying human behavior change. With the onset of mobile phones and ubiquitous Internet connectivity, online social network data reflect the intricacies of human health behavior as experienced by real people in real time. Therefore, analysis of these data can also provide us with the much needed theoretical and empirical foundations for the design of effective intervention strategies. This study offers insights into the various kinds of behavioral constructs prevalent in the messages exchanged among QuitNet users. In addition, it underlines the need for the use of inductive approaches for the analysis of online social network data to capture community-specific culture. As such, these findings suggest the need for an aggregation of multiple theoretical constructs from more than one inter- and intra-individual theory. Given the context-rich nature of the messages, they yield empirical understanding of human behavior change. This understanding has important implications for both theory and practice. Theoretically, inductive analysis of virtual communities provides us with a basic understanding of human behavior in the digital era. In terms of practical implications, the study sets the stage for (1) modeling supervised machine learning algorithms that can scale the theoretically valid findings to large datasets [
Health Belief Model
Theory of Reasoned Action
Transtheoretical Model
Social Cognitive Theory
Research reported in this publication was supported by the National Library of Medicine of the National Institutes of Health under Award Number 1R21LM012271-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
None declared.