This study uses a narrative analysis approach, combining inductive thematic coding with a culturally and critically informed interpretive framework to examine how illness narratives are constructed and negotiated in a digital context [17]. Rather than treating narratives as neutral reflections of experience, this approach understands them as culturally embedded meaning-making practices shaped by social norms, technological affordances, and broader discursive structures [18]. Initial coding was conducted following principles of reflexive thematic analysis as outlined by Braun and Clarke [19,20], while subsequent stages of analysis drew on illness narrative theory, particularly Frank’s typology, as well as sociological perspectives on stigma, identity, and digital culture [21,22]. In terms of illness narrative types, Frank classified patient illness narratives into 3 categories: restitution, chaos, and quest [23]. This dual approach enabled both data-driven pattern identification and theoretically grounded interpretation.

Data were collected from RedNote, a Chinese social media platform characterized by user-generated lifestyle and health-related content [24]. The platform provides a space for young users to share personal experiences through text, images, and short videos, often in diary-like formats [3].

Given the exploratory and interpretive nature of this study, a purposive sampling strategy was used. Accounts were identified through iterative searching and long-term observation between March 2023 and April 2024, using a combination of diabetes-related keywords (eg, “diabetes,” “insulin,” and “blood sugar”). The sampling process prioritized accounts that met the following criteria: (1) self-identified young individuals (primarily university students) living with diabetes; (2) regularly posted first-person narratives related to illness experiences; (3) provided sufficiently detailed and longitudinal content for narrative analysis; and (4) represented noncommercial, nonpromotional personal accounts. Through this process, 13 accounts were selected as information-rich cases suitable for in-depth qualitative analysis. While the sample is not statistically representative, it is appropriate for narrative inquiry aimed at understanding meaning-making processes rather than population-level generalization. The final dataset comprised 303 narrative posts generated by 13 young adults living with diabetes, including 213 text-based posts and 90 video posts (Table 1). For video content, spoken narratives, captions, and on-screen text were transcribed verbatim, and relevant contextual cues (eg, tone, setting, and embodied expression) were documented to support interpretation.

The analytical process proceeded in 3 iterative stages, and all authors participated in the coding process [19]. First, inductive coding: all posts were read multiple times to achieve familiarization. Open coding was conducted by the research team (ZL, DF, and YL) to identify recurring patterns related to illness experience, emotional responses, social interactions, and self-management practices. Coding was primarily conducted in Chinese to preserve linguistic and cultural nuances. Second, thematic organization: initial codes were grouped into broader thematic categories through iterative comparison and discussion among the researchers (ZL, DF, and YL). At this stage, the analysis remained largely inductive, focusing on patterns emerging from the data rather than imposing predefined categories. Third, narrative interpretation and theoretical integration: in later stages, the analysis moved beyond descriptive themes toward interpretive narrative analysis. Drawing on the illness narrative typology of Frank [23], as well as sociological theories of stigma, identity, and digital culture, the research team (ZL and DF) examined how different narrative patterns functioned as culturally situated meaning-making strategies.

Through this process, 4 narrative types were identified: chaos, stigma, resilience, and solidarity. While partially informed by existing theoretical frameworks, these categories were refined inductively to reflect culturally specific experiences in the Chinese context. Key analytical concepts, such as familial responsibility and filial piety, emerged through iterative engagement between data and theory. Discrepancies in interpretation were addressed through collaborative discussion among the authors until analytical consensus was reached.

This study follows a reflexive approach to qualitative rigor, emphasizing transparency and interpretive awareness rather than positivist criteria such as intercoder reliability [25]. All authors are native Chinese speakers with cultural familiarity with the context under study, which facilitated nuanced interpretation but also required critical reflexivity. Reflexive journaling was maintained throughout the research process to document analytical decisions, emerging assumptions, and potential biases. These reflections informed ongoing interpretation rather than serving as a post hoc validation strategy. To enhance methodological rigor, the study engaged with criteria commonly used in qualitative research. Credibility was strengthened through repeated reading and iterative analysis of 303 narrative posts on RedNote, including both textual and video-based content, which enabled the refinement of emerging narrative patterns. Dependability was supported by documenting coding procedures, category development, and interpretive discussions throughout the analytical process. Confirmability was enhanced through reflexive discussions among the research team regarding how cultural familiarity and theoretical perspectives shaped interpretation, ensuring that findings remained grounded in the data. Transferability was addressed by providing contextual descriptions of the narratives, the experiences of young Chinese adults with diabetes, and the platform environment of RedNote.

All analyses were conducted in Chinese to preserve the integrity of the original narratives. Selected excerpts were translated into English by the first author (ZL) and independently reviewed by a bilingual researcher (YM) to ensure conceptual equivalence. Discrepancies were resolved through discussion. The research team’s shared linguistic and cultural background provided an insider perspective, which was both an analytical strength and a potential source of bias. Reflexive practices were therefore integral to the interpretive process.

This study analyzed publicly available social media content and did not involve direct interaction with users. In accordance with institutional guidelines for internet research, formal ethics board approval was not required [26]. However, given the sensitive nature of health-related narratives, several measures were taken to minimize potential harm following procedures adopted in previous research [27]. All user accounts were anonymized (A1-A13), and identifying details were removed or modified. Data were reported in aggregate form where possible, and excerpts were selected to avoid traceability through search engines. The study adhered to the terms of service of the RedNote platform and followed established ethical guidelines for research using publicly accessible online data. There were no human participants in this study, and informed consent was not required.

We identified 4 distinct illness narratives among young adults with diabetes: chaos, stigma, resilience, and solidarity. While chaos and stigma narratives illustrate how these patients navigate a complex biopsychosocial landscape in which chronic illness disrupts identity, autonomy, and social integration, resilience and solidarity narratives highlight how individuals actively develop coping strategies, reframe meaning, and build support systems through both familial and networked relationships.

This study examined how young Chinese individuals with diabetes construct illness narratives in digital environments. Through narrative analysis of 303 posts on RedNote, 4 narrative types were identified: chaos, stigma, resilience, and solidarity. These narratives demonstrate that chronic illness is experienced not only as a biographical disruption but also as an ongoing process of identity reconstruction shaped by cultural expectations, social pressures, and digital interaction.

The findings indicated that young patients with diabetes face intertwined dilemmas of biographical disruption and identity reconstruction, requiring them to renegotiate their lifestyles, social roles, and self-perceptions. In the Chinese cultural context, where individuals are embedded within interdependent familial structures, illness is often experienced not solely as a personal condition but as a disruption to familial continuity and social expectations [33]. Diabetes-induced guilt therefore intensifies identity crises, as patients may perceive their illness as a failure to fulfill filial responsibilities and future obligations [34]. These pressures are further reinforced by broader structural conditions, including the legacy of the one-child policy, competitive educational systems, and familial expectations surrounding academic achievement, economic success, and marriage.

Situating these findings within the Chinese cultural context helps explain the distinctive features of these narratives. This study offers a culturally grounded reinterpretation of the illness narrative framework of Frank [23]. In the Chinese context, chaos narratives are often intertwined with culturally specific elements such as familial guilt and moral responsibility, which extend the scope of the original concept. Regarding the other narrative types, they reflect contextually grounded variations and emergent categories shaped by the sociocultural and digital environment under study. For example, the resilience narrative differs from restitution, in that it does not center on returning to a preillness state, but rather on ongoing adaptation and disciplined self-management. The stigma narrative captures socially imposed processes of devaluation that are not fully encompassed by chaos, while the solidarity narrative highlights digitally mediated forms of collective coping that extend beyond the individual-oriented trajectory implied in quest narratives.

At the same time, the findings reveal how digital environments reshape both illness identity and health governance. Young patients were simultaneously burdened by intergenerational pressures derived from Confucian family ethics while benefiting from forms of “liquid solidarity” fostered through online communities [35]. Through narrative sharing, peer interaction, and emotional support, patients actively engaged in self-healing, meaning-making, and identity reconstruction. Familial support, social networks, and digitally mediated peer communities emerged as critical resources that enabled patients to normalize illness experiences, reframe emotional distress, and gradually develop systems of self-care. Frequent self-referencing as “sugar warriors” reflected a shift in illness identity from stigma toward a digitally networked form of resistance and collective belonging. This transformation aligns with Castells’ [22] framework of identity formation in network society, in which patients construct counter-public spaces and solidarity communities through algorithmically connected peer networks.

However, these digitally mediated forms of empowerment also operate within broader structures of health neoliberalism. As bodily functions increasingly become tied to ideals of productivity, discipline, and self-optimization, chronic illness may be framed as a form of personal failure rather than a socially embedded condition. Within this context, seemingly neutral disease-related content on digital platforms often reproduces a “self-management supremacist” governance logic that transforms structural inequalities into matters of individual responsibility [36]. Consequently, digital illness narratives function not only as spaces of support and resistance [37] but also as sites where broader moral expectations surrounding health and self-discipline are reproduced and negotiated. This tension highlights the ambivalent role of digital platforms, which simultaneously enable collective empowerment and reproduce normative pressures surrounding health, productivity, and self-governance.

Rather than focusing solely on individual-level coping or behavioral change, the findings of this study point to the need for a structurally informed approach to diabetes care and communication. The narratives analyzed here reveal how responsibility for disease management is often moralized and individualized, particularly within digital environments shaped by health neoliberalism. As such, clinical and public health interventions should move beyond emphasizing self-discipline and adherence, and instead work to demoralize chronic illness by recognizing the structural, cultural, and psychosocial conditions that shape patients’ experiences.

At the clinical level, this calls for greater sensitivity to the moral and emotional burdens associated with self-management, particularly in contexts where familial expectations and intergenerational responsibility intensify patients’ sense of guilt. Clinicians should be attentive to how patients interpret illness in relation to identity, family roles, and social expectations. At the platform level, the findings suggest the need to critically examine how digital health content and algorithmic visibility may reinforce a “self-management–centered” logic. Social media platforms should consider how to diversify representations of illness experiences, making space for narratives that reflect structural constraints, ambivalence, and nonlinear coping trajectories, rather than privileging idealized forms of disciplined self-management. More broadly, this study calls for a shift in health communication from framing diabetes as an individual failure of control to understanding it as a socially and culturally mediated condition, shaped by intersecting forces of family structure, educational pressure, and digital media environments. Such a shift is essential for developing more equitable and context-sensitive approaches to chronic illness care.

This study has several limitations. First, the sample consists of 13 users from a single platform, which limits the generalizability of the findings. Although purposive sampling was used to identify information-rich cases, the dataset may not capture the full diversity of illness experiences among young people with diabetes. The predominance of female college students in the sample may also reflect platform-specific participation patterns rather than broader population characteristics. Second, the study focuses on publicly available social media content, which provides valuable insights into self-expression but may not fully represent offline experiences or less visible forms of coping. Users may selectively present certain aspects of their lives while omitting others, leading to potential bias in the narratives analyzed. Third, the platform context of RedNote may shape both the style and content of narratives. As a platform oriented toward lifestyle sharing and social engagement, it may privilege particular modes of storytelling while marginalizing others. Future research could compare multiple platforms to better understand how different digital environments influence illness narratives. Fourth, this study relies solely on publicly available user-generated content and does not include interviews with patients or family members. As a result, interpretations of family dynamics are based on patients’ self-representations. Future research could combine digital trace data with interviews to strengthen validity.

This study demonstrates that illness narratives among young Chinese individuals with diabetes are shaped by the intersection of cultural values, social structures, and digital media environments. By identifying 4 narrative types, the study highlights how patients move beyond disruption to actively reconstruct identity, negotiate stigma, and build forms of resilience and solidarity. More broadly, the findings suggest that digital platforms are not merely spaces for sharing experiences, but active sites of meaning-making that transform how chronic illness is understood and managed. Recognizing these dynamics has important implications for health communication, particularly in designing culturally sensitive and platform-aware interventions that support young patients in navigating chronic illness. Rather than viewing diabetes solely as a biomedical condition, this study underscores the importance of understanding it as a socially and culturally mediated experience. Future research should further explore how digital storytelling shapes long-term health outcomes and how intergenerational communication may mitigate the moral pressures associated with illness in collectivist contexts.