Language of authority: Issues of identity and authority in an online community

  • Armstrong N, Koteyko N, Powell J. (2011). ‘Oh dear, should I really be saying that on here?’ Issues of identity and authority in an online diabetes community. Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 16(4), 347- 365.
  • http://hea.sagepub.com/content/16/4/347
  • https://lra.le.ac.uk/bitstream/2381/10005/6/ARMSTRONG_VC%20Postings%20paper%20-%20accepted%20version.pdf

We explore peer-to-peer discussions which took place in a UK-based diabetes ‘Virtual Clinic’ online community. In particular, we seek to understand the rhetorical nature and content of exchanges over a period of six months from the community’s inception. Data were captured weekly and analysis based on thematic discourse analysis. Two key issues emerged regarding how the community shaped the nature of the discussion forum. First, the identity of the forum was established, and boundaries drawn about what was, and was not, acceptable. Second, participants sought to present themselves as reliable and authoritative sources of information. Internet discussion communities are shaped in important ways early on by the community of users, including how the character and focus of discussion is formed, and how both information and users can be constructed as authoritative and reliable.

Introduction

The promise, or at least the rhetoric, of self-management by increasingly ‘expert’ patients has obvious attractions for health services needing to make cost-savings in the face of ageing populations living longer with chronic disease (Holman & Lorig, 2004; Department of Health, 2007). Self-management programmes generally aim to support healthy living by improving self-efficacy and health knowledge (Pearson et al., 2007). Diabetes is an area which has seen a plethora of initiatives in recent years and there is evidence that self-management can reduce long-term complications (Brownson et al., 2009). Diabetes is a chronic and debilitating disease characterised by an inability to regulate blood glucose levels adequately and its prevalence is rising rapidly. There are 2.8 million people currently diagnosed with diabetes in the UK (Diabetes UK, 2011). Day-to-day management is carried out almost exclusively by the patient and can often be complex and emotionally challenging, meaning that many do not achieve good control over their blood glucose level s. For patients to be effective self-managers of their diabetes they need to be provided with the information and support necessary to make informed decisions.

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As health-related internet use has grown, the sociological literature has considered whether the informed e-consumer presents a challenge to professional dominance (Hardey, 1999) or whether online health information continues to support a model of biomedical authority (Fox et al., 2005; Nettleton et al., 2005). Research on peer-to peer interaction in virtual communities suggests that these too can reinforce mainstream discourses of medical knowledge (Fox et al., 2005; Sandaunet, 2008). At the same time, they can address issues not dealt with (or at least not to individuals’ satisfaction) in traditional settings (Sandaunet, 2008; Schaffer et al., 2008).

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Through the sharing of experiential information, users can re-shape ideas of authoritative knowledge (Schaffer et al., 2008) and construct online identities as expert patients (Fox & Ward, 2006).

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Online communities are not without their problems, though. For example, in addition to these positive outcomes, studies of computer-mediated communication have also often commented on the phenomenon of online hostilities of variable intensity such as disagreements, criticism or aggressive emotional outbursts (Burnett and Buerkle, 2004) that can potentially cause stress and anxiety both for the interactants involved and other community members. If the potential benefits of online communities are to be most effectively harnessed then it is important to understand how they develop from the very early stages as the community’s character is likely to be established relatively quickly and may then prove difficult to change. Understanding the processes through which a community’s character develops highlights useful lessons that those setting up, or moderating, such communities could learn from as they seek to ensure they are as effective as possible at promoting information-sharing and supporting users to feel confident in their ability to manage their condition.

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In order to harness the potential benefits, health services need to acquire a multi-faceted understanding of the social processes that occur in online communities, including how the character and focus of the discussion is formed over time, and how both information and individual users can be constructed as authoritative and reliable. Health practitioners should note that such communities can have clear empowering benefits and at the same time that concerns about the propagation of inaccurate or misleading information are not supported by our findings. Future research should consider the influences of participant authority and identity on the health behaviour of participants in internet communities.

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