Guest article by Karen Tian, finalist of the 2025 SERVSIG Best Dissertation Award.
Digital health services, such as online health communities (OHCs; e.g., mental health communities on Reddit), are redefining how we experience care. At the heart of this transformation lies not just access to technology, but something profoundly human: social support. Whether it’s finding reassurance from others with similar experiences or receiving encouragement during difficult times, social support is becoming a vital complement to professional healthcare.
But here’s the catch: while digital health services create new avenues for connection, the support healthcare consumers receive isn’t always effective. Sometimes, they get the wrong kind of help; Or worse, feel brushed off by well-meaning but hollow responses. While digital health providers don’t directly offer social support, they can play a powerful role in facilitating it. However, there is limited guidance on what these providers (including OHC moderators) can do to improve support outcomes.
Seeking to address these issues, my PhD dissertation, Social Support in Digital Health Services (Tian 2024), explores what makes social support in digital spaces truly meaningful, and how providers can help it thrive.
Three Studies, One Goal: Enhancing Social Support in Digital Health Services
Using various methods (e.g., meta-analysis, text analysis, longitudinal analysis), I investigated the following questions via three interrelated studies. Here’s what I learned:
1. What effects does perceived social support have on healthcare consumers’ engagement and well-being?
Despite growing interest, existing research across disciplines offers fragmented and inconsistent findings on the value of perceived social support in digital health services. Synthesising the current literature, I found that when users perceive a digital health platform as socially supportive—especially when support is emotional (e.g., “I know how you feel”), informational (e.g., advice or tips), or esteem-based (e.g., encouragement or recognition)—they engage more and feel better. These effects are even stronger when healthcare professionals contribute alongside peers.
2. Do people actually receive the kind of social support they sought? What shapes those outcomes?
Not always. We often assume that any support is helpful, but decades of research (Cutrona & Russell 1990) show that support only works when it fits the recipient’s needs—asking for an apple and getting an orange, or several, simply doesn’t help. In OHCs, where communication is largely text-based and lacks context, mismatches are common. While esteem support tends to align well, emotional and informational support are frequently mismatched. However, how support seekers express their needs matters: directness, self-disclosure, and referencing past experiences all increase the likelihood of receiving helpful responses. In short, how people ask shapes what they receive.
3. What shapes the long-term quality and value of social support interactions?
Even when support matches the seeker’s needs, its quality can vary. Thoughtful, relevant replies are key to sustaining a community’s value (Ludwig et al. 2014), but they’re hard to maintain (Petrič et al. 2023). My large-scale analysis of OHC discussions revealed that linguistic markers of social capital (e.g., using language similar to the support seeker) in early replies can improve response quality over time. Positive tone counterintuitively reduces the quality of following discussion (i.e., the phenomenon of “toxic positivity”; Lecompte-van Poucke 2022), while a carefully managed critical tone fosters deeper, more valuable conversations. Interestingly, high-quality early replies can also unintentionally discourage further contributions.
What Can Digital Health Providers Do?
– Help support seekers ask better. The way support seekers articulate their needs shapes the support they receive. Onboarding prompts, phrasing examples, and light guidance can encourage clearer, more direct requests.
– Set the tone. Supportive communities rely on authenticity. Encourage empathy and honesty—not just positivity—through community guidelines, moderator modelling, and tone-setting content.
– Encourage participation. When strong early responses limit further input, platforms can experiment with prompts (e.g., “What else could be added?”) or interface cues to sustain discussion.
– Integrate professional presence. Involvement from healthcare professionals (e.g., as moderators or content contributors) can greatly enhance support outcomes, and model effective responses.
Looking Ahead
As digital health becomes more embedded in everyday care, getting social support “right” is increasingly essential. I hope this research sheds light on when and how support is most effective, and how service providers can foster it. In doing so, we can build online spaces that aren’t just connected, but compassionate and truly impactful.
Karen Tian, Ph.D.
Early Career Academic Fellow
School of Marketing | UNSW Business School
University of New South Wales Sydney, Australia
References
• Cutrona & Russell (1990), “Type of Social Support and Specific Stress: Toward a Theory of Optimal Matching,” in Social Support: An Interactional View. John Wiley & Sons, 319–366.
• Lecompte-van Poucke (2022), “‘You Got This!’: A Critical Discourse Analysis of Toxic Positivity as a Discursive Construct on Facebook,” Applied Corpus Linguistics, 2 (1), 100015.
• Ludwig et al. (2014), “Take Their Word for It: The Symbolic Role of Linguistic Style Matches in User Communities,” MIS Quarterly, 38 (4), 1201–1218.
• Petrič et al. (2023), “The Quality of Informational Social Support in Online Health Communities: A Content Analysis of Cancer-Related Discussions,” Digital Health, 9, 20552076231155681.
• Tian (2024). Social Support in Digital Health Services [Doctoral dissertation, University of New South Wales Sydney]. UNSWorks. https://doi.org/10.26190/unsworks/30318
