Published on in Vol 16, No 12 (2014): December

Personal Experiences and Emotionality in Health-Related Knowledge Exchange in Internet Forums: A Randomized Controlled Field Experiment Comparing Responses to Facts Vs Personal Experiences

Personal Experiences and Emotionality in Health-Related Knowledge Exchange in Internet Forums: A Randomized Controlled Field Experiment Comparing Responses to Facts Vs Personal Experiences

Personal Experiences and Emotionality in Health-Related Knowledge Exchange in Internet Forums: A Randomized Controlled Field Experiment Comparing Responses to Facts Vs Personal Experiences

Original Paper

Knowledge Media Research Center (KMRC), Knowledge Construction Lab, Tübingen, Germany

Corresponding Author:

Joachim Kimmerle, Dipl-Psych, Dr rer nat

Knowledge Media Research Center (KMRC)

Knowledge Construction Lab

Schleichstr 6

Tübingen, 72076


Phone: 49 7071 979 363

Fax:49 7071 979 100


Background: On the Internet, people share personal experiences as well as facts and objective information. This also holds true for the exchange of health-related information in a variety of Internet forums. In online discussions about health topics, both fact-oriented and strongly personal contributions occur on a regular basis.

Objective: In this field experiment, we examined in what way the particular type of contribution (ie, factual information vs personal experiences) has an impact on the subsequent communication in health-related Internet forums.

Methods: For this purpose, we posted parallelized queries to 28 comparable Internet forums; queries were identical with regard to the information contained but included either fact-oriented descriptions or personal experiences related to measles vaccination. In the factual information condition, we posted queries to the forums that contained the neutral summary of a scientific article. In the personal experiences condition, we posted queries to the forums that contained the same information as in the first condition, but were framed as personal experiences

Results: We found no evidence that personal experiences evoked more responses (mean 3.79, SD 3.91) from other members of the Internet forums than fact-oriented contributions (mean 2.14, SD 2.93, t26=0.126, P=.219). But personal experiences elicited emotional replies (mean 3.17, SD 1.29) from other users to a greater extent than fact-oriented contributions (mean 2.13, SD 1.29, t81=3.659, P<.001).

Conclusions: We suggest that personal experiences elicited more emotional replies due to the process of emotional anchoring of people’s own style of communication. We recommend future studies should aim at testing the hypotheses with more general and with less emotionally charged topics, constructing different fact-oriented posts, and examining additional potential factors of influence such as personality factors or particular communication situations.

J Med Internet Res 2014;16(12):e277



The Internet is an essential platform for sharing and exchanging information on a multitude of topics [1,2]. There is, however, great variety in the types of information that are shared on the Internet, ranging from purely fact-oriented information exchange to sharing very personal information [3-5]. People with a common interest in a particular topic may come together on the Internet as online communities in order to share information [6,7]. Platforms that are particularly relevant for information exchange are Internet forums [8,9]. These forums are virtual places where users can ask questions, express their opinions, and share their knowledge and experiences [10]. Participants in Internet forums can post messages that other users can pick up and reply to—instantly or at a later point in time. Many forums are organized and arranged according to certain topics or subtopics [8,10].

One subject area for which the Internet is an important platform for information search and information exchange is the field of health-related issues [11,12]. In the exchange of health-related information in pertinent Internet forums [5,10,13,14] and online health communities [15-18], there is also a wide range in the variety of contributions, with both fact-oriented information exchange and the transfer of personal information. Health-related Internet forums make it possible for everyone to make contributions, that is, ask or answer questions.

At the same time, this type of very open information exchange involves the risk that the reliability of health information is often very unclear [19-22]. Moreover, users who ask questions in an Internet forum are often not aware of the kinds of replies they can expect. They also cannot know under which circumstances their chances of receiving an answer are good or bad, if any answer at all [23]. Should they make their request as matter-of-factly, objectively, and neutrally as possible? Or do queries have a higher chance of eliciting an answer when they express personal concerns and experiences? And beyond the pure frequency of answers, what will reply posts look like then in terms of personalization and emotionalization? Will objective or personal queries elicit, in turn, answers that are respectively more neutral or more emotional?

Previous research has shown that people are very interested in personal information and care a lot about communication that includes personal and emotional aspects [4,24-26]. In particular, personal experience is considered a highly legitimate form of giving advice regarding health-related issues [26-28]. Accordingly, we state the following hypothesis: Hypothesis 1: users will reply more frequently to health-related queries that consist of personal experiences than to corresponding queries that contain fact-oriented information.

In addition, research has found that humans tend to imitate other people’s behavior [29] and the communication style of their communication partners [30-32]. In particular, people have a propensity to imitate expressions of emotion [33-35]. Moreover, emotionally expressive people were found to be more cooperative than people with a low level of emotional expressivity [36]. Accordingly, we state an additional hypothesis: Hypothesis 2: users will reply in a more emotional manner to health-related queries that consist of personal experiences than to corresponding queries that contain fact-oriented information.


We selected 28 Internet forums for this study. We took into consideration six different types of forums with regard to topic: 8 forums had a focus on health, 8 on family issues, 2 were sports forums, 2 dealt with naturopathy, 2 were vaccination critique forums, and 6 were general forums that dealt with a wide variety of topics including sports, health, etc.

From those considered, we selected only forums in which posts had occurred on the day of selection. Moreover, we ensured that the forums selected all had a comparable level of activity. A complete list of all 28 forums is included in Multimedia Appendix 1.


We applied a procedure that allowed for a randomized and controlled approach in combination with a high level of ecological validity. We created two experimental conditions: (1) factual information, and (2) personal experiences. In the factual information condition, we posted queries to the forums that contained the neutral summary of a scientific article. In the personal experiences condition, we posted queries to the forums that contained the same information as in the first condition, but were framed as personal experiences (see below). We randomly assigned an equal number of the different types of forums to the two experimental conditions, resulting in an allocation of 4 health forums, 4 family forums, 1 sports forum, 1 naturopathy forum, 1 vaccination critique forum, and 3 general forums in each condition.

We created user accounts for all forums on the same day and with the same gender-neutral user name. These accounts were used to post the queries in the respective forums on the identical day. We recorded the answers to these posts in the subsequent 4 weeks. In order to maintain absolute standardization of the experimental procedure, we did not reply to any answers or counter questions.

Experimental Material

Both queries dealt with the topic of measles vaccination. We chose this topic because vaccination is a heavily debated issue about which many people have strong opinions and tend to express them on the Internet [37,38]. Accordingly, it appeared to be plausible that a substantial number of forum users would be willing to reply to such queries and express their opinion on this topic.

The query in the factual information condition was developed on the basis of an article published in the official journal of the German Medical Association [39]. This article reported the outbreak of measles in a medium-sized town and provided statistical descriptions of this epidemic. The query that was posted in this condition indicated that this user was looking for opinions about measles vaccination and had already gathered some information. This introduction was followed by a brief summary of the journal article including the complete reference. The provision of the reference was intended to emphasize the pure fact-orientation of this query and to make clear to the recipients that this information did not result from any kind of personal experience. This post consisted of 87 words.

The query in the personal experiences condition also stated that the user was looking for opinions about measles vaccination and had previously gathered some information. This introduction was followed by the same information as in the previous condition (regarding the age of the children concerned and the symptoms), but was framed in terms of personal experience with the outbreak of measles in a day-care center. This post did not refer to the journal article and consisted of 69 words.


We counted the number of replies and captured the average number of replies to the posts in the two experimental conditions in order to test Hypothesis 1. In addition, two independent raters evaluated the emotionality of the replies on 5-point Likert scales ranging from 1 (neutral) to 5 (very emotional), in order to allow for examining Hypothesis 2. Those raters were blind to the respective experimental condition and to the general research questions, and reached consensus on their final rating in cases of disagreement.

The following reply is an example of a very emotional statement:

For me, measles vaccination is obligatory and I was really glad that my little kid could finally be vaccinated now in May! Because I am extremely frightened of the long-term consequences and I personally rather put up with the very unlikely vaccination adverse effects than running the risk of a measles infection. Once in the hospital I had to care for a child suffering from meningitis, which died then, and this experience has probably affected me …

This reply, in contrast, is an example of an emotionally neutral statement:

Yes, measles are contagious, yes, children can fall ill with them, and yes, one can be vaccinated against them, which is worthwhile, because measles are known for having an impact on fertility.

Statistical Analysis

We compared the number of replies within the different types of forums using chi-square tests. In order to test Hypothesis 1, we compared the number of replies with a chi-square test and conducted an independent samples t test with the average number of replies as dependent variable. To take the distribution of this variable into account, we additionally conducted a Mann-Whitney U test and a Mood’s median test. For testing Hypothesis 2, we conducted an independent samples t test with emotionality of the replies as dependent variable.

Ethical Considerations

Since this study used information posted in open online forums, contributions were considered as belonging to the public domain [40,41]. The posts of all users in all forums could be openly read by everybody; usernames and passwords were only required for posting. So the behavior of research participants did not occur in a private context [42]. In line with the requirements of the local ethics committee at the Knowledge Media Research Center (Tübingen, Germany), the dignity and integrity of participants were not violated in any way in this study. We did not give medical advice to the forum users. We did not provide any medically questionable or incorrect information in the online forums.

We made sure that our queries did not confront the users with any kind of information that they would not otherwise encounter in Internet forums or many other communication situations. Thus, the forum users were not taken advantage of in any respect; there was absolutely no infringement of the users’ rights. In order to protect the individual user’s personal or online identity, we do not provide information about the names or online identities of contributors in this article. In order to avoid an individual’s identity being traced by searching for the quoted phrases, we use only English translations of direct quotes [42,43].

Number of Replies

There was a wide range in the number of replies among the different Internet forums: the number of replies per forum varied from 0 to 13. The most replies were found in the 8 family forums (a total of n=37; mean 4.63, SD 3.89) compared to the other 20 forums (a total of n=46; mean 2.30, SD 3.18), as indicated by a chi-square test (χ210=22.12, P=.015). The other forum types did not differ among each other in the frequency of replies, all Ps>.370.

Regarding Hypothesis 1, there appeared to be more replies (n=53) to the personal experiences than to the factual information (n=30), with a median of 2 in the personal experiences condition and a median of 1 in the factual information condition. But the two conditions did not differ significantly from each other when we compared the number of replies with a chi-square test (χ210=8.40, P=.590).

The same finding occurred when we conducted an independent samples t test with the average number of replies as dependent variable (t26=1.26, P=.219). In the factual information condition, the posts received on average 2.14 (SD 2.93) replies per forum. In the personal experiences condition, we found 3.79 (SD 3.91) replies.

We also conducted further nonparametric tests, but both a Mann-Whitney U test (P=.178) and a Mood’s median test (P=.257) confirmed that the difference was non-significant.

Emotionality of Replies

As expected in Hypothesis 2, in a t test the replies of the other forum users were significantly more emotional in the personal experiences condition (mean 3.17, SD 1.29) than the answers in the factual information condition (mean 2.13, SD 1.29; t81=3.66, P<.001).

Principal Findings

Contrary to our initial assumptions, personal experiences did not elicit more replies than factual information. This absence of a significant effect was probably due to the very large variance of replies in the different forums. It might also be the case that forum users tended to regard factual information and personal experience as equivalent. This interpretation would be consistent with previous findings that forum users in health-related contexts do not adequately distinguish between verifiable and non-verifiable information [10,16,21,22].

The key finding of this field experiment is that answers to a post containing personal experiences were significantly more emotional than replies to factual information. Reasons for this could be that inquirers who reported private information were perceived as more personable or that the recipients of the initial posts felt addressed on a personal level and, accordingly, replied on the same level. This behavior might be explained by effects of anchoring and adjusting [44-46], in that participants used the initial post as an emotional anchor to which they adjusted their own style of communication.

Limitations and Future Work

The finding that reply rates were rather low overall could be due to the topic we selected. Potentially, and contrary to our expectations that people would feel strongly about the topic, the subject area of measles vaccination is only important to a limited group of people, that is, people who have young children themselves. It may be a rather abstract or even an irrelevant topic for childless people, such as singles or adolescents. This interpretation is supported by the finding that the family forums were the most active ones regarding our queries, compared to forums concerned with other topics. In addition, most answers implied that they were written by people who had personal experience with this topic. This might also indicate that vaccination is in fact an emotionally charged topic for many people, a circumstance that may have had an impact on their response behavior. Future studies should aim to test the hypotheses with different, that is, more general topics with a broader base of interest and with a less emotionally charged subject matter.

Another limitation of our study is that the queries in the factual information condition might have been perceived to be quite uncommon or peculiar, because it is rather seldom that posts in Internet forums include a reference to a journal article. Even though the provision of this reference was intended to underline the fact-orientation of the post, it is not clear how the forum users perceived this information. Future research should try to find ways to construct fact-oriented posts that do not appear to be peculiar to other forum users.

In addition, the emotionality of the reply posts was only evaluated by two independent raters. Future studies might consider applying additional assessment methods, such as identifying key words of emotionality in the reply post of the forum users [47,48].

Finally, it might be worthwhile for further research to examine additional potential factors of influence that may have an impact on the way people express their answers. This may include certain personality factors, such as social value orientation [49], agreeableness [50], or people’s need for self-presentation and self-esteem [51,52]. In addition, these factors of influence may also include aspects of the communication situation, such as anonymity [53], identifiability [54-56], or the synchronicity [57-59] of information exchange. The current study represents only a beginning to potential research into what impact particular kinds of contributions have on the subsequent exchanges of health-related information in Internet forums.


We would like to thank the participants of the Knowledge Communication course within the Psychology degree program at the University of Tübingen in the summer term 2012 for contributing to the preparation of the stimulus material and the collection of the data.

Conflicts of Interest

None declared.

Multimedia Appendix 1

List of Internet forums.

PDF File (Adobe PDF File), 14KB

  1. Bargh JA, McKenna KY. The internet and social life. Annu Rev Psychol 2004;55:573-590. [CrossRef] [Medline]
  2. Joinson A, McKenna KYA, Postmes T, Reips UD. The Oxford handbook of Internet psychology. Oxford: Oxford University Press; 2007.
  3. Barnett S, Jones SC, Caton T, Iverson D, Bennett S, Robinson L. Implementing a virtual community of practice for family physician training: a mixed-methods case study. J Med Internet Res 2014;16(3):e83 [FREE Full text] [CrossRef] [Medline]
  4. Humphreys L, Gill P, Krishnamurthy B. Twitter: a content analysis of personal information. Information, Communication & Society 2013 Oct 18;17(7):843-857. [CrossRef]
  5. Stjernswärd S, Hansson L. A web-based supportive intervention for families living with depression: content analysis and formative evaluation. JMIR Res Protoc 2014;3(1):e8 [FREE Full text] [CrossRef] [Medline]
  6. Preece J. Sociability and usability in online communities: Determining and measuring success. Behaviour & Information Technology 2001 Jan;20(5):347-356. [CrossRef]
  7. Preece J, Maloney-Krichmar D. Online communities: Design, theory and practice. J Comput Mediat Commun 2005;10(4):1. [CrossRef]
  8. Holtz P, Kronberger N, Wagner W. Analyzing internet forums. Journal of Media Psychology: Theories, Methods, and Applications 2012 Aug 31;24(2):55-66. [CrossRef]
  9. Sudau F, Friede T, Grabowski J, Koschack J, Makedonski P, Himmel W. Sources of information and behavioral patterns in online health forums: observational study. J Med Internet Res 2014;16(1):e10 [FREE Full text] [CrossRef] [Medline]
  10. Kimmerle J, Gerbing KK, Cress U, Thiel A. Exchange of complementary and alternative medical knowledge in sport-related Internet fora. Sociol Sport J 2012;29(3):348-364.
  11. Lima-Pereira P, Bermúdez-Tamayo C, Jasienska G. Use of the Internet as a source of health information amongst participants of antenatal classes. J Clin Nurs 2012 Feb;21(3-4):322-330. [CrossRef] [Medline]
  12. McInnes N, Haglund BJ. Readability of online health information: implications for health literacy. Inform Health Soc Care 2011 Dec;36(4):173-189. [CrossRef] [Medline]
  13. Hua M, Alfi M, Talbot P. Health-related effects reported by electronic cigarette users in online forums. J Med Internet Res 2013;15(4):e59 [FREE Full text] [CrossRef] [Medline]
  14. Keeling D, Khan A, Newholm T. Internet forums and negotiation of healthcare knowledge cultures. Journal of Services Marketing 2013 Feb 18;27(1):59-75. [CrossRef]
  15. Aarts JW, Faber MJ, den Boogert AG, Cohlen BJ, van der Linden PJ, Kremer JA, et al. Barriers and facilitators for the implementation of an online clinical health community in addition to usual fertility care: a cross-sectional study. J Med Internet Res 2013 Aug;15(8):e163 [FREE Full text] [CrossRef] [Medline]
  16. Kimmerle J, Thiel A, Gerbing K, Bientzle M, Halatchliyski I, Cress U. Knowledge construction in an outsider community: Extending the communities of practice concept. Computers in Human Behavior 2013 May;29(3):1078-1090. [CrossRef]
  17. Zhao J, Ha S, Widdows R. Building trusting relationships in online health communities. Cyberpsychol Behav Soc Netw 2013 Sep;16(9):650-657. [CrossRef] [Medline]
  18. Zaslow E. Revalorizing feminine ways of knowing: the challenge to biomedical epistemology in an online mothers’ health community. Inf Commun Soc 2012 Dec;15(9):1352-1372. [CrossRef]
  19. Craigie M, Loader B, Burrows R, Muncer S. Reliability of health information on the Internet: an examination of experts' ratings. J Med Internet Res 2002;4(1):e2 [FREE Full text] [CrossRef] [Medline]
  20. Hardey M. Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise. Sociol Health & Illness 1999 Nov;21(6):820-835. [CrossRef]
  21. Miah A, Rich E. The medicalization of cyberspace. Oxon & New York: Routledge; 2008.
  22. Rains SA. The anonymity effect: the influence of anonymity on perceptions of sources and information on health websites. Journal of Applied Communication Research 2007 May;35(2):197-214. [CrossRef]
  23. Gabbiadini A, Mari S, Volpato C. Virtual users support forum: do community members really want to help you? Cyberpsychol Behav Soc Netw 2013 Apr;16(4):285-292. [CrossRef] [Medline]
  24. Colombo C, Mosconi P, Confalonieri P, Baroni I, Traversa S, Hill SJ, et al. Web search behavior and information needs of people with multiple sclerosis: focus group study and analysis of online postings. Interact J Med Res 2014 Jul;3(3):e12 [FREE Full text] [CrossRef] [Medline]
  25. Greene DD, Heeteer C. Personal stories within virtual environments: a cancer patient information software case study. CyberPsychology & Behavior 1998 Jan;1(3):201-211. [CrossRef]
  26. Maloney P. Online networks and emotional energy: how pro-anorexic websites use interaction ritual chains to (re)form identity. Information, Communication & Society 2013 Feb;16(1):105-124. [CrossRef]
  27. McCosker A, Darcy R. Living with cancer: Affective labour, self-expression and the utility of blogs. Information, Communication & Society 2013 Oct;16(8):1266-1285. [CrossRef]
  28. Sillence E. Giving and receiving peer advice in an online breast cancer support group. Cyberpsychol Behav Soc Netw 2013 Jun;16(6):480-485. [CrossRef] [Medline]
  29. Chartrand TL, Lakin JL. The antecedents and consequences of human behavioral mimicry. Annu Rev Psychol 2013 Jan;64:285-308. [CrossRef] [Medline]
  30. Moore R. Imitation and conventional communication. Biol Philos 2012 Oct 20;28(3):481-500. [CrossRef]
  31. Seitz S, Stewart C. Imitation and expansions: some developmental aspects of mother-child communications. Developmental Psychology 1975;11(6):763-768. [CrossRef]
  32. Shea N. Imitation as an inheritance system. Philos Trans R Soc Lond B Biol Sci 2009 Aug 27;364(1528):2429-2443 [FREE Full text] [CrossRef] [Medline]
  33. Häfner M, Ijzerman H. The face of love: spontaneous accommodation as social emotion regulation. Pers Soc Psychol Bull 2011 Dec;37(12):1551-1563. [CrossRef] [Medline]
  34. van der Velde SW, Stapel DA, Gordijn EH. Imitation of emotion: When meaning leads to aversion. Eur J Soc Psychol 2009;40(3):536-542. [CrossRef]
  35. Wallbott HG. Recognition of emotion from facial expression via imitation? Some indirect evidence for an old theory. Br J Soc Psychol 1991 Sep;30(3):207-219. [CrossRef]
  36. Schug J, Matsumoto D, Horita Y, Yamagishi T, Bonnet K. Emotional expressivity as a signal of cooperation. Evolution and Human Behavior 2010 Mar;31(2):87-94. [CrossRef]
  37. Betsch C, Sachse K. Debunking vaccination myths: strong risk negations can increase perceived vaccination risks. Health Psychol 2013 Feb;32(2):146-155. [CrossRef] [Medline]
  38. Zimmerman RK, Wolfe RM, Fox DE, Fox JR, Nowalk MP, Troy JA, et al. Vaccine criticism on the World Wide Web. J Med Internet Res 2005 Jun;7(2):e17 [FREE Full text] [CrossRef] [Medline]
  39. Arenz S, Kalies H, Ludwig MS, Hautmann W, Siedler A, Liebl B, et al. Der Masernausbruch in Coburg [The measles epidemic in Coburg]. Deutsches Ärzteblatt 2003 Jul;100(49):3245-3249.
  40. Hewitt-Taylor J, Bond CS. What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards. J Med Internet Res 2012 Dec;14(6):e155 [FREE Full text] [CrossRef] [Medline]
  41. Hookway N. 'Entering the blogosphere': some strategies for using blogs in social research. Qualitative Research 2008 Feb 01;8(1):91-113. [CrossRef]
  42. Eysenbach G, Till JE. Ethical issues in qualitative research on internet communities. BMJ 2001 Nov 10;323(7321):1103-1105. [CrossRef]
  43. Snee H. Web 2.0 as a social science research tool. 2008.   URL: [accessed 2014-11-23] [WebCite Cache]
  44. Kimmerle J, Cress U. The impact of cognitive anchors on information-sharing behavior. Cyberpsychol Behav Soc Netw 2013 Jan;16(1):45-49. [CrossRef] [Medline]
  45. Mussweiler T, Strack F. The semantics of anchoring. Organizational Behavior and Human Decision Processes 2001 Nov;86(2):234-255. [CrossRef]
  46. Mussweiler T, Strack F. Hypothesis-consistent testing and semantic priming in the anchoring paradigm: a selective accessibility model. Journal of Experimental Social Psychology 1999 Mar;35(2):136-164. [CrossRef]
  47. Strapparava C, Mihalcea R. Learning to identify emotions in text. In: Proceedings of the 2008 ACM Symposium on Applied Computing. 2008 Presented at: ACM Symposium on Applied Computing; March 16-20, 2008; Fortaleza, Ceará, Brazil.
  48. Strapparava C, Mihalcea R. Annotating and identifying emotions in text. In: Intelligent Information Access. Berlin, Heidelberg: Springer; 2010:21-38.
  49. Kimmerle J, Wodzicki K, Jarodzka H, Cress U. Value of information, behavioral guidelines, and social value orientation in an information-exchange dilemma. Group Dynamics: Theory, Research, and Practice 2011;15(2):173-186. [CrossRef]
  50. Landers RN, Lounsbury JW. An investigation of Big Five and narrow personality traits in relation to Internet usage. Computers in Human Behavior 2006 Mar;22(2):283-293. [CrossRef]
  51. Rui JR, Stefanone MA. Strategic image management online: Self-presentation, self-esteem and social network perspectives. Information, Communication & Society 2013 Oct;16(8):1286-1305. [CrossRef]
  52. van Uden-Kraan CF, Drossaert CH, Taal E, Seydel ER, van de Laar MA. Self-reported differences in empowerment between lurkers and posters in online patient support groups. J Med Internet Res 2008 Jun;10(2):e18 [FREE Full text] [CrossRef] [Medline]
  53. Frost J, Vermeulen IE, Beekers N. Anonymity versus privacy: selective information sharing in online cancer communities. J Med Internet Res 2014;16(5):e126 [FREE Full text] [CrossRef] [Medline]
  54. Cress U, Kimmerle J. Endowment heterogeneity and identifiability in the information-exchange dilemma. Computers in Human Behavior 2008 May;24(3):862-874. [CrossRef]
  55. Douglas KM, McGarty C. Internet identifiability and beyond: A model of the effects of identifiability on communicative behavior. Group Dynamics: Theory, Research, and Practice 2002;6(1):17-26. [CrossRef]
  56. Douglas KM, McGarty C. Identifiability and self-presentation: computer-mediated communication and intergroup interaction. Brit J Soc Psychol 2001 Sep;40(3):399-416. [CrossRef]
  57. Cress U, Kimmerle J, Hesse FW. Impact of temporal extension, synchronicity, and group size on computer-supported information exchange. Computers in Human Behavior 2009 May;25(3):731-737. [CrossRef]
  58. Helquist JH, Krus J, Nunamaker Jr JF. Synchronicity and group ability to autonomously cluster brainstorming ideas. Int J e-Collab 2009;5(4):67-81. [CrossRef]
  59. Swaab RI, Galinsky AD, Medvec V, Diermeier DA. The communication orientation model: explaining the diverse effects of sight, sound, and synchronicity on negotiation and group decision-making outcomes. Pers Soc Psychol Rev 2012 Feb;16(1):25-53. [CrossRef] [Medline]

Edited by G Eysenbach; submitted 07.08.14; peer-reviewed by P Talbot, H Potts, N Walton; comments to author 11.09.14; revised version received 27.09.14; accepted 06.11.14; published 04.12.14


©Joachim Kimmerle, Martina Bientzle, Ulrike Cress. Originally published in the Journal of Medical Internet Research (, 04.12.2014.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.