title: The role of an online community for people with a rare disease: content analysis of messages posted on a primary biliary cirrhosis mailinglist.
abstract: BACKGROUND
  This study focuses on the role of an Internet-based group for people who have an autoimmune liver disease, primary biliary cirrhosis. Primary biliary cirrhosis is a relatively rare disease, affects primarily women in their 40's and older, and is not well understood. The PBCers Organization (PBC stands for primary biliary cirrhosis) provides electronic mailinglists (listservs) and informational resources for those with primary biliary cirrhosis.
  
  
  OBJECTIVE
  (1) to identify the issues of greatest importance to those posting to the listserv, specifically the relative importance of biomedical, socioemotional, and organizational/systems messages; (2) to compare frequency and content of posts by people at different stages of disease; (3) to identify how people with primary biliary cirrhosis represent the psychosocial challenges and dilemmas (role and identity change, uncertainty, and stigma) identified in the social-scientific literature as key elements of the experience of chronic disease.
  
  
  METHODS
  The paper is based on content analysis of messages posted during two months to the Daily Digest listserv for people who have primary biliary cirrhosis. To analyze the posts, we developed a coding system with three major categories--biomedical, socioemotional, and systems/organizations--and 12 codes in each category.
  
  
  RESULTS
  A total of 275 people posted 710 messages. Of the 250 people for whom information on gender was available, 239 (95.6%) were women and 11 (4.4%) were men. Analysis of 710 messages posted to the listserv revealed a predominance of requests for and reports of biomedical information, such as health care providers (32.7%), medications (30.9%), tests and procedures (25.8%), and symptoms (25.7%), combined with very frequent expressions of emotional support. The most frequent single topics were peer support (included in 40.6% of all posts) and positive emotions (25.3%). Posters who reported fewer years since diagnosis were more likely to be seeking biomedical information than those who were further in time from their diagnosis (r= -.241, P<.001, n=313). Those in later stages posted an average of 3.87 messages, compared to an average of 2.64 for people in earlier stages (t= 1.786, P=.08, n=90), which is different from what we expected. No relation between years since diagnosis or age and number of messages was found. Contrary to our expectations, the topics reflecting issues of role change/identity (2.9%), stigma (0.7%), and thoughts about the future (3.9%), all identified in social-scientific literature as key concerns for people with chronic illness, appeared infrequently in this set of messages.
  
  
  CONCLUSIONS
  Messages exchanged on this particular mailing list have a biomedical, rather than socioemotional or organizational, emphasis. The Internet offers a highly valued opportunity for those with rare diseases to connect with, learn from, and provide support to others having similar experiences. Research that compares those with primary biliary cirrhosis, who are involved in an Internet support group and those who are not, would be an important next step to better understanding the role of the Internet among patients with chronic liver disease and the implications of it in the course of their illness.
authors.affiliation: Department of Sociology and Anthropology, Lehigh University, 681 Taylor Street, Bethlehem, PA 18015, USA. judith.lasker@lehigh.edu
authors.forename: Judith N
authors.initials: JN
authors.lastname: Lasker
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Sogolow
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Sharim
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020407:Internet; D008105:Liver Cirrhosis, Biliary / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D035583:Rare Diseases; D012657:Self-Help Groups; D012944:Social Support