title: Measuring Use of Health-Related Support on the Internet: Development of the Health Online Support Questionnaire (HOSQ).
abstract: BACKGROUND
  Social support plays an important role for the perceived health in people with health problems and chronic diseases. Provision of different kinds of support during the disease trajectory is crucial for many people. Online support is ubiquitous and represents a promising modality for people with chronic diseases. There are no existing instruments that measure various aspects of online support.
  
  
  OBJECTIVE
  The objective of this study was to create a generic questionnaire regarding health-related support online that can be applied to people with various health problems and illnesses. Additionally, we wanted to test the questionnaire in a cancer population to assess its adequacy in the context of severe disease.
  
  
  METHODS
  Initial items for the Health Online Support Questionnaire (HOSQ) were inspired by sociologist James House regarding social support. An exploratory factor analysis was conducted in healthy persons or with minor health problems (n=243) on 31 initial items. The scale was reduced to 18 items and the internal consistency and reliability of the scale was examined along with content validity. Further validation was conducted by a confirmatory analysis on the 18-item scale in a cancer population (n=215). In addition, data on demographics, health problems experienced, and Internet use were collected.
  
  
  RESULTS
  The exploratory factor analysis on the final 18-item scale resulted in 2 factors. After scrutinizing the content, these factors were labeled "reading" and "interacting" and they demonstrated good internal consistency (Cronbach alphas .88 and .77, respectively). The factors were confirmed in the cancer population. The response pattern revealed expected differences both between the interaction and reading scales and according to age, gender, education, and health problems thereby supporting the validity of the HOSQ.
  
  
  CONCLUSIONS
  The HOSQ may be a reliable and valid instrument for measuring the use of online support for people with health problems, but the results ought to be replicated in more studies to confirm the results for different diagnoses. If the results of this study are corroborated by future studies, the HOSQ may be used as a basis for the development of different forms of support on the Internet.
authors.affiliation: Lifestyle and Rehabilitation in Long Term Illness, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. susanne.mattsson@pubcare.uu.se.
authors.forename: Susanne
authors.identifier: http://orcid.org/0000-0001-7322-0205
authors.initials: S
authors.lastname: Mattsson
authors.forename: Erik Martin Gustaf
authors.identifier: http://orcid.org/0000-0002-1591-7407
authors.initials: EM
authors.lastname: Olsson
authors.forename: Sven
authors.identifier: http://orcid.org/0000-0003-4570-5891
authors.initials: S
authors.lastname: Alfonsson
authors.forename: Birgitta
authors.identifier: http://orcid.org/0000-0001-6226-6849
authors.initials: B
authors.lastname: Johansson
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-5872-3864
authors.initials: M
authors.lastname: Carlsson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D015203:Reproducibility of Results; D012944:Social Support; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
keywords: Internet; oncology; questionnaires; social support