ReviewGender differences in computer-mediated communication: A systematic literature review of online health-related support groups
Introduction
Gender differences in how men and women seek help and support for health-related concerns are well documented in the literature. A growing body of research suggests that men of different ages, ethnicities and social backgrounds are less likely to seek help from health care professional than women for a variety of physical and mental health problems [1], [2], [3], [4], [5]. Furthermore, in situations where men do seek medical advice, they are less likely to report feelings of distress or psychosocial problems during consultation when compared with women [6]. These differences also extend to interactions with friends, family and peers, for instance men have been found to be more reluctant to seek lay support for mental health issues such as feelings of distress and depression [7], [8]. In addition, it has been noted that while women typically have a large network of individuals who they can confide in and turn to for social support when faced with health problems; in adulthood men tend to rely exclusively on their partner as their sole source of emotional support [9].
In keeping with these findings, numerous studies have shown that patient support group participants are more likely to be female, for instance within the cancer literature women have been found to outnumber men at a rate of four to one in many support groups [10], [11]. Furthermore, differences have also been observed in how men and women utilize support groups. Research shows that while females show a strong preference for support groups that focus on the discussion of emotional issues, males appear to prefer information oriented support groups. For example, Gray et al. [12] found that patients in a prostate cancer support group emphasised the importance of information and advocacy, whereas patients in breast cancer groups showed a stronger preference for smaller group discussions focussing on emotional expression and friendship. This mirrors findings from the wider literature on gender differences which, indicates that when faced with a problem men value concrete assistance or activities that distract them from their problems far more than the discussion of their emotions [13].
From a sociological perspective, the differences apparent in how men and women deal with illness may be linked to variations in gender norms [14]. Traditionally, male behavioural norms emphasise self-reliance, decisiveness and emotional control, whereas female behavioural norms promote emotional sensitivity, compassion, nurturing, and supportive activities [15], [16]. Consequently, when faced with health-related concerns, men may feel particularly uncomfortable discussing highly emotional and sensitive issues within their wider social networks. In comparison, women, who are more accustomed to sharing personal experiences, are likely to feel at ease seeking support within a larger network of individuals.
In addition to the difference in dealing with illness, gender role socialisation may also explain men's reluctance to seek professional help for health problems [1]. Help seeking behaviour essentially involves admitting a need for support and relying on others for assistance, thus by asking for help men may feel they are highlighting an area of personal weakness, which contradicts core aspects of male gender identity that emphasise self-reliance and emotional control [17]. For example, Chapple et al. [18] report that some men delayed seeking treatment for testicular cancer due to a fear of appearing weak and lacking in masculinity. In a similar vein, Moynihan et al. [19] conclude that male cancer survivors experiencing anxiety or depression were reluctant to seek help for their problems due to a desire to appear controlled and silent about their emotions. This suggests that men and women's help seeking behaviour for health-related concerns may be constrained by traditional constructions of feminity and masculinity.
Over recent years there has been a proliferation in the size and number of computer-mediated patient support groups available to individuals experiencing various health-related problems. These online communities offer patients new opportunities to communicate and seek support for various concerns within a network of individuals who share similar experiences. In particular, a relatively unique characteristic of this medium is the lack of social and physical cues, which allows the opportunity for participants to keep their identities entirely anonymous if they wish to do so. This may encourage some individuals to disclose information that they may otherwise feel uncomfortable discussing openly due to fear of embarrassment or stigmatisation in face-to-face settings [20], [21].
Online health-related support groups therefore have the potential to encourage participants to engage in behaviours that deviate from stereotypical gender norms. For instance, some men may feel that the anonymity provided by the Internet offers an ideal venue in which they can more openly share their concerns and thus break out of the traditional masculine role to ask for help [22]. Indeed several authors examining computer-mediated communication have suggested that online interaction may in fact mitigate gender differences observed in face-to-face communications. Bellman et al. [23] for instance, found that women in an anonymous online bulletin board were more likely to adopt an aggressive and assertive manner online than in face-to-face interactions. Likewise, in an analysis of 3000 newsgroups postings, Witmer and Katzman [24] observed that women were sending more flames and challenges in their posts compared to men. It can thus be hypothesised that the unique features of the Internet (i.e. anonymity) might remove some of the gender differences that exist in face-to-face health-related communication and support seeking behaviour.
However, despite the evidence suggesting that gender might be less important in computer-mediated communication, findings from studies focusing specifically on health-related communities are inconsistent. While some authors argue that gendered patterns of communication are replicated online [25], others report striking similarities between the communication patterns of men and women [26]. A systematic integration and consolidation of findings is thus warranted to help understand the extent of gender differences in online health communications.
In recent years a considerable body of research examining the content and communication processes in various online health-related support groups has emerged. However, to date we are not aware of any published work that has attempted to systematically synthesise findings across these research studies in order to explore the extent to which gendered patterns of communication occur in online health-related communities. Gaining a clearer understanding of gender differences in online health communication can serve as a guide for health care professionals when designing online interventions to ensure the needs and communication styles of male and female patients are met. The aims of the present study were therefore to identify, synthesise and evaluate research studies that have addressed gender differences in communication patterns within health-related online support groups.
Section snippets
Identification of relevant studies
An extensive literature search was carried out in order to identify all studies relevant to the objectives of the review. Literature searches were conducted in accordance with the guidelines in place for traditional systematic reviews [27], [28]. Initially a broad search strategy was developed under the following key concepts: online support group, gender, and message. To maximise the search in the different databases, various synonyms and combinations of the search concepts were used. Studies
Included studies
Based on the database search, a total of 1284 abstracts were identified from the databases (see Table 1 for results of database search). From the initial screening of the abstracts, sixteen articles that appeared to be relevant to the objectives of the research were identified and their full texts were retrieved for further examination. In total eleven studies met the inclusion criteria and were selected for review. Two of the five articles excluded only explored a single sex online health
Discussion
The current study aimed to explore whether the unique features of the online environment might remove some of the gender differences that exist in face-to-face health-related communication and support seeking, through a literature review of studies addressing the role of gender in communication processes within health-related online support groups. From the results of our review of the relevant literature it is apparent that there are conflicting and inconsistent findings regarding gender
References (45)
Sex differences in general practice attendance and help seeking for minor illness
J Psychosom Res
(1990)- et al.
Confiding in crisis: gender differences in pattern of confiding among cancer patients
Soc Sci Med
(1995) - et al.
The who and the what of usage of two cancer online communities
Comput Hum Behav
(2007) - et al.
Gender, cancer experience and internet use: a comparative keyword analysis of interviews and online cancer support groups
Soc Sci Med
(2006) - et al.
Investigation of the effects of gender and preparation on quality of communication in Internet support groups
Comput Hum Behav
(2003) - et al.
Men, masculinity, and the contexts of help seeking
Am Psychol
(2003) No man's land: men, illness, and the NHS
Brit Med J
(2001)- et al.
Men and health help-seeking behaviour: literature review
J Adv Nurs
(2005) - et al.
Male gender role conflict and patterns of help seeking in Costa Rica and the United States
Psychol Men Masculinity
(2005) - et al.
Age, gender, and the under utilization of mental health services: the influence of help-seeking attitudes
Aging Ment Health
(2006)
Factors influencing help seeking in mentally distressed young adults: a cross sectional survey
Brit J Gen Pract
Help-seeking behaviour in men and women with common mental health problems: cross-sectional study
Brit J Psychiatry
Cancer support groups: the state of the art
Cancer Pract
Gender and cancer support group participation
Cancer Pract
Breast cancer and prostate cancer self-help groups: reflections on differences
Psycho-oncol
Emotional expression online: gender differences in emoticon use
Cyber Psychol Behav
Constructions of masculinity and their influences on men's well-being: a theory of gender and health
Soc Sci Med
Masculinity, social support, and sense of community: the men's group experience in Western Australia
J Men Stud
Gender accommodation in online cancer support groups
Health
Use of social support: gender and personality differences
Sex Roles
Qualitative study of men's perceptions of why treatment delays occur in the UK for those with testicular cancer
Brit J Gen Pract
Evaluation of adjuvant psychological therapy in patients with testicular cancer: randomised controlled trial
Brit Med J
Cited by (125)
Risk and protective factors for intuitive and rational judgment of cybersecurity risks in a large sample of K-12 students and teachers
2021, Computers in Human BehaviorCitation Excerpt :As a result, a wide variety of significant risk factors have been identified. For example, similar to age as a significant risk factor (Grimes et al., 2010; Sheng et al., 2010), gender differences exist in various online contexts, such as E-health (Mo et al., 2009; Stern et al., 2012), E-commerce (Craciun & Moore, 2019; Lin et al., 2019), E-learning (González-Gómez et al., 2012; Park et al., 2019), E-working (Anwar et al., 2017; Tifferet & Vilnai-Yavetz, 2018), and E-gaming (Liu, 2016; Winn & Heeter, 2009). Males and females have been found to perceive online risks differently, leading to distinct cybersecurity behaviors in privacy tendency (Tifferet, 2019), in the workplace (Anwar et al., 2017), and online shopping (Lin et al., 2019).