online health communities online health communities online health communities are online social networks related to health. they primarily provide a means for patients and their families to learn about illnesses, to seek and offer social support, and to connect with others in similar circumstances. these online groups can be composed of individuals with illnesses, groups of medical professionals with shared interests, non-professional caregivers and family of patients, or a combination. the term "online health community" is primarily academic jargon. changes in the health care system coupled with increased infiltration and use of the internet have resulted in heavier reliance on the internet for disease and health education. eighty percent of american adult internet users currently go online to find health care information for themselves and their loved ones, with health searches one of the most popular uses of the internet. furthermore, 1 in 4 of people with an illness have gone online to find other people who share similar experiences. individuals access these communities searching for a variety of resources. existing medical and health websites, such as webmd and health cloud, have recognized that they will have more visitors if they offer interactive community features such as discussion or internet forums. depending on the specific community, patients and medical professionals are able to engage in behaviors such as sharing their illness experiences, exchange knowledge, and increase disease-specific expertise. even more, these online communities provide users with a breadth of social resources that may be directly beneficial to their health. these communities have been particularly useful in providing emotional and informational support to those with various illnesses such as cancer, hiv/aids, infertility, diabetes, and other rare illnesses. these communities are distinct from general online communities in that they focus exclusively on health-related topics for those currently navigating the world of diseases, illness, and medicine. furthermore, they also differ from other health-related sites that only allow users to retrieve information. the main hallmark of these communities is that they allow for communication between multiple people. that said, they can take a variety of forms, and vary drastically in their scope. history with the invention of email for arpanet in 1972, communication through a computer to distant geographies became substantially easier. listservs, which allow a multitude of respondents to interact with an email thread and bulletin boards, an online representation of the community bulletin boards commonly found on campuses, were introduced contemporary with one another. these three tools along with usenet provided the tools for rudimentary online communities to begin to coalesce around health related topics. in 1991 cern labs introduced the world wide web, allowing a more graphical representation of the topic to be discussed. this change lessened barriers to communication and enhanced community building. for example, the growth potential from linear to geometric was made possible through this change primarily because audiences could access static content more easily without the author's knowledge or synchronicity in time. furthermore, the graphical nature of the world wide web made the exchange of medically relevant information more easily possible. lastly, the widespread use of the world wide web in pc's made during the mid-1990s made the technology available to a much wider audience than previous technologies. by 1997, the world wide web was the predominant medium for ad hoc online health communities to form. even more, with the evolution of web 2.0 functionality and internet penetration during the 2000s, web-based programs became increasingly utilized as a mechanism by which to incorporate social, interactive, and guided behavior change processes. many of these behaviors for patients and medical providers increasingly centered around the exchange or health-based information. as these communities emerged, more and more research was conducted assessing their benefits, complications, and other features. much of this research has supported their beneficial aspects. as a result of these benefits, medical health organizations increasingly began including online health communities as part of their patient support services. examples of these organizations include kaiser permanente, johns hopkins, cleveland medical center, and md anderson cancer center. currently, online health networks run by both private companies, public hospitals, and even decentralized social groups are a regular part of the illness experience for many individuals. beneficial outcomes the importance of online health communities is evidenced by their popularity, as well as the significant impact they have on the lives of their members. that said, there is limited consensus on best practices in online health community design, and research on the benefits of online health communities is slightly limited. despite that lack of extensive research on its benefits, there are still many situations where online health communities appear to aid patients and medical professionals. additionally, many of these benefits are seen within specific illnesses, and are most beneficial for certain individuals, and would be otherwise unattainable outside of the context of online health communities. psychological benefits there are multiple psychological constructs that are shown to benefit from online health communities. this list identifies various beneficial outcomes from the most frequently studies constructs. social support across a variety of chronic and acute illnesses, online health communities have shown a positive effect on social support. this support can be beneficial to patients in a number of ways, such as helping them adjust to the stress of a particular condition. support is also a consistent indicator of survival for many conditions. patients interact with others in online health communities in a number of different ways. as a result, various types of social support occur in communities. when users are seeking advice, education, or referrals about a certain condition or experience, they receive informational support. alternatively, when users are seeking things like encouragement, empathy, affirmation, or validation, they receive emotional support. finally, when users are engaging in behaviors such as chatting or humor, they receive support in the form of companionship. disease knowledge patients who utilize online health networks often experience increases in knowledge specific to the disease or condition that they are dealing with. this increased disease knowledge can help patients make more informed decisions about their health. perceived empathy patients show increased perceptions of empathy as a result of information seeking behavior on online health communities. in general, perceptions of empathy are shown to have potential benefits for impacting the success of health care treatment, as well as the healing process. furthermore, traditional medical provider empathy is costly and time consuming. perceptions of empathy from online health communities can act as a feasible replacement for provider empathy. behavioral benefits online health communities not only can have psychological benefits, but they can also have benefits for health behaviors. treatment adherence patients who use online health communities may also see increased adherence to health treatments. given the resources such as social support that these communities provide, they are more able to manage the tasks and responsibilities that their treatment requires. self management traditionally, patients are not well-equipped to manage their own illnesses. the resources that online health communities provide cut down on the need for in-person visits with medical professionals and allow patients to address many low level health issues on their own. institutional benefits beyond the effects that online health communities can have on specific psychological and behavioral outcomes in various illnesses, there are several other broad benefits that they can provide to the institution and structure of health care. interdisciplinary collaboration for medical professionals, online health communities can be valuable tools to help foster interdisciplinary collaboration across various institutions. this collaboration can help medical professionals provide more diverse and beneficial care to patients. medical professional knowledge in online health communities composed of medical professionals, participation can lead to increased exchange of medical information, as well as the adoption of disease specific knowledge that can be used to inform treatment and other medical decisions. patient centered care patient centered care is a health care strategy that is focused on engaging patients to become more active participants in their health care. the use of this strategy has shown to improve the efficiency of care, patient-doctor communication, treatment compliance, health outcomes, and decrease overall health care utilization. through improved access to personalized information, patient participation, and emotional support, online health communities promote patient centered care practices. health care utilization at current rates, the number of patients who need specialized health care is growing more rapidly than the supply of well-trained professionals who can address these needs. as a result, current utilization rates of health care resources is much higher than is manageable. however, implementations of online health communities are shown to result in a reduction of traditional in-person health care utilization. health care cost in parallel with increased health care utilization, the cost of providing health care also continues to rise and may become unaffordable as a result of advancement cost and over treatment. similarly, implementations of online health communities have resulted in both health care cost reductions. illness benefits there are a wide variety of online health communities. some of these communities target vary specific conditions, while other are more open ended. that said, patients with certain conditions are shown to specifically benefit from these communities. broadly, patients with conditions that are more rare or severe may garner stronger benefits given that the online health communities can provide resources they would likely not get elsewhere. more specifically, benefits of these communities have been seen in a variety of conditions such as cancer, hiv/aids, infertility, diabetes, and other rare illnesses. who benefits most? while online health communities can provide general benefits. there are also particular individuals who may benefit most from them. in particular, online health communities are especially beneficial when they are used in a way that allows for connections and resources that would otherwise be unavailable. for example, while members of an online health community may know one another, a real strength and benefit of them is that they can connect people who would have otherwise been unable to do so. there are certain individuals who may have smaller in-person networks who can adequately address their medical needs. therefore for these individuals, online health networks may be particularly beneficial. specifically, the availability of online health communities is especially appreciated by individuals with impaired mobility, potentially embarrassing medical conditions, or caretaker responsibilities that may prohibit them from receiving adequate face-to-face medical and emotional support. beyond this, there are several factors that have been identified for evaluating patient experiences with online health communities and evaluating who they benefit. the four main dimensions that contribute to a patients experience with online health communities include: pragmatic, empathic, sociability, and usability. the pragmatic dimension refers to the goals of a user, and if the use of the community aids achievement of those goals. the empathic dimension refers to the feelings and emotions of empathy that are felt when interacting with the community. the sociability dimension refers to the overall social experience that a patient feels when interacting with the community. finally, the usability dimension refers to the experience a patient has when navigating the features of the community. together these features can help identify for which patients and on what platforms the largest benefits will be seen. complications despite the benefits that online health communities may provide, there are also several complications that they may pose. misinformation given that one of the primary uses of online health communities is the exchange of health information between untrained individuals. in many cases, people do not use the best judgment when sharing and relying on information in online communities, but the consequences of poor information depends on what the information is and how it is used. medical information can have grave consequences when poor advice is taken or is erroneously applied; or when professional treatment is not sought. the criticality of health-related information necessitates careful consideration of how to design for usability and sociability. furthermore, patients and their families may be under stress and the emotional burden, which can diminish health literacy, necessitates more careful design and evaluation. in addition, disease and illness have no boundaries, and participants in online health communities can vary considerably in their medical expertise, health literacy, and technological literacy, as well as in their need for education and support about a disease or condition. to combat misinformation in these communities, some communities have incorporated health experts to moderate content for accuracy. while such steps may be beneficial, they