Background With the pervasiveness of social media, online health communities (OHCs) are an important tool for facilitating information sharing and support among people with chronic health conditions. Importantly, OHCs offer insight into conversations about the lived experiences of people with particular health conditions. Little is known about the aspects of OHCs that are important to maintain safe and productive conversations that support health. Objective This study aimed to assess the provision of social support and the role of active moderation in OHCs developed in accordance with and managed by an adaptive engagement model. This study also aimed to identify key elements of the model that are central to the development, maintenance, and adaptation of OHCs for people with chronic health conditions. Methods This study used combined content analysis, a mixed methods approach, to analyze sampled Facebook post comments from 6 OHCs to understand how key aspects of the adaptive engagement model facilitate different types of social support. OHCs included in this study are for people living with multiple sclerosis, migraine, irritable bowel syndrome, rheumatoid arthritis, lung cancer, and prostate cancer. An exploratory approach was used in the analysis, and initial codes were grouped into thematic categories and then confirmed through thematic network analysis using the Dedoose qualitative analysis software tool. Thematic categories were compared for similarities and differences for each of the 6 OHCs and by topic discussed. Results Data on the reach and engagement of the Facebook posts and the analysis of the sample of 5881 comments demonstrate that people with chronic health conditions want to engage on the web and find value in supporting and sharing their experiences with others. Most comments made in these Facebook posts were expressions of social support for others living with the same health condition (3405/5881, 57.89%). Among the comments with an element of support, those where community members validated the knowledge or experiences of others were most frequent (1587/3405, 46.61%), followed by the expression of empathy and understanding (1089/3405, 31.98%). Even among posts with more factual content, such as insurance coverage issues, user comments still had frequent expressions of support for others (80/213, 37.5%). Conclusions The analysis of this OHC adaptive engagement model in action shows that the foundational elements—social support, engagement, and moderation—can effectively be used to provide a rich and dynamic community experience for individuals with chronic health conditions. Social support is demonstrated in a variety of ways, including sharing information or validating information shared by others, expressions of empathy, and sharing encouraging statements with others.

BACKGROUND Online health communities (OHC) can be a powerful tool to facilitate communication among patients, professionals and family members who live with or care for someone with a chronic health condition(s). Health Union LLC’s OHC Adaptive Engagement Model engages, empowers and encourages people to take an active role in their health. OHCs included in this study are for people living with multiple sclerosis, migraine, IBS, rheumatoid arthritis, lung cancer, and prostate cancer. OBJECTIVE This research uses qualitative methods to identify themes supporting the constructs of the Health Union OHC model.  Key components of the model to be tested include: content tailored to needs of community, facilitation and encouragement of social support, active moderation, opportunities for active and passive engagement, and transparency of community norms and rules. METHODS A sample of over 5,800 comments exported from over 40 Facebook posts from 6 OHCs was analyzed using the Dedoose™ qualitative data analysis software. Comments from these Facebook posts were extracted, imported into Dedoose™ software and coded. Interrater reliability of initial coding was calculated using Pearson’ Correlation Coefficient. An exploratory approach was taken in the analysis and initial codes were grouped into thematic categories and then confirmed through thematic network analysis using the Dedoose™ software tool. Thematic categories were compared for similarity and differences for each of the 6 OHCs, and by content descriptive category. RESULTS Qualitative thematic network analysis of posts and comments from 6 OHCs correspond to the primary components of the Health Union OHC Adaptive Engagement Model.  This analysis suggests that the structural elements of the model, including active site moderation, support high levels of community engagement and information sharing and mutual support of OHC participants. CONCLUSIONS Qualitative data from the 6 OHCs demonstrate the positive impact the community has on participants, often helping them reframe their healthcare experience and coping strategies. The principle of adaptive engagement is demonstrated by the thematic network analysis and illustrates the Health Union OHC Adaptive Engagement Model constructs. Different community segments have different patterns of was. This study has practical significance as it helps to demonstrate the value of online health communities for people living with chronic health conditions by providing meaningful engagement, support, and information in an accessible environment.

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With the pervasiveness of social media, online health communities (OHCs) are an important tool for facilitating information sharing and support among people with chronic health conditions. Importantly, OHCs offer insight into conversations about the lived experiences of people with particular health conditions. Little is known about the aspects of OHCs that are important to maintain safe and productive conversations that support health.