Technological Forecasting & Social Change 166 (2021) 120574

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Technological Forecasting & Social Change

journal homepage: www.elsevier.com/locate/techfore

Social media-enabled healthcare: A conceptual model of social media

affordances, online social support, and health behaviors and outcomes
Xiaolin Lin a, *, Rajiv Kishore b
a
Assistant Professor of Computer Information Systems, Department of Computer Information and Decision Management, Paul and Virginia Engler College of Business,
West Texas A&M University, Canyon, TX
b
Professor and Chair, Management, Entrepreneurship & Technology, University of Nevada, Las Vegas

A R T I C L E I N F O A B S T R A C T

Keywords: Due to the popularity of social media, patients are increasingly using social media for the social support exchange
Social media to improve health outcomes. To understand this phenomenon of social media-enabled healthcare, we propose a
Social media affordance conceptual framework by integrating literature from three areas—social media affordance, online social support,
Online social support
and health behaviors and outcomes—with the goal of developing propositions on how social media can help
Chronic diseases
Self-care behavior
patients improve self-management of chronic diseases. We identified and distinguished three social media
Health outcomes affordances: affordance for community co-creation, affordance for social learning, and affordance for social
relationships. We also distinguish three kinds of social support and tailored them to the healthcare domain and
the social media context: informational support, emotional support, and experiential support. We posit the
following: (a) social media affordances foster social support, where co-creation facilitates informational support,
user interaction facilitates emotional support, and social learning facilitates experiential support; (b) informa­
tional support and experiential support are both linked to self-care; and (c) informational support and emotional
support are both linked to psychological health. Our work advances the literature in the area of social media-
enabled healthcare.

“The intersection of healthcare and social media represents a promising by providing suggestions and recommendations about healthcare
space for future IS research” (Fichman et al., 2011, 424) (Antheunis et al., 2013; Maloney-Krichmar and Preece, 2005). For
another example, online forums and online health groups have been set
up on social media by people with similar health conditions (in partic­
1. Introduction ular, chronic diseases) in order to collaborate with each other by sharing
their knowledge and personal experiences and by providing healthcare
Because of its popularity, social media greatly increases the volume advice (Greene et al., 2011). Health care professionals (e.g., clinicians)
of user-generated content and makes it available to anyone at any time, have been increasingly using social media to share their health-related
thus magnifying its impacts. It offers users a convenient venue to information and knowledge and answer patients’ health-related ques­
communicate with others quickly and inexpensively, and thus social tions (e.g., Matthews et al., 2002, Genuis, 2013, Von Muhlen and
media has become a popular platform for exchanging health-related Ohno-Machado, 2012). Such clinician-generated content can also help
information with each other. It is clear that social media has facili­ patients understand their health conditions and make appropriate
tated an efficient and low-cost approach to healthcare services, enabling health decisions. For example, health care professionals have found
patients with common health conditions to collaborate and interact with social-media-based discussion forums useful for educating patients and
one another and acquire support for self-care (Shuyler and Knight, 2003; facilitating their self-management of chronic diseases (De Angelis et al.,
Yan et al., 2015), thus improving health outcomes (Xiao et al., 2014; 2018). In this way, patients can effectively manage their chronic dis­
Yan and Tan, 2014). For example, patients use social media (i.e., Face­ eases and improve their health outcomes by interacting with clinicians
book and Twitter) to exchange social support with other patients who on social media.
have similar health issues and to assist with each other’s health decisions

* Corresponding author.
E-mail addresses: [email protected] (X. Lin), [email protected] (R. Kishore).

https://doi.org/10.1016/j.techfore.2021.120574
Received 21 February 2020; Received in revised form 31 December 2020; Accepted 2 January 2021
Available online 16 January 2021
0040-1625/© 2021 Elsevier Inc. All rights reserved.
X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

The foregoing discussion suggests that social media usually offer a health outcomes. Thus, we have integrated them with social support
large amount of health-related information contributed by multiple theory to explain how they can foster different forms of social support on
stakeholders, including health care professionals (i.e., doctors) and lay social media. Specially, we extend social support theory to a social
people (i.e., patients) (i.e., patients) (e.g., Li et al., 2018, Tremblay et al., media context, identify three types of social support (informational,
2016). The social support gained from the shared content helps patients emotional, and experiential), and introduce new relationships among
improve their self-care and health outcomes (Jadad et al., 2000). In them.
particular, patients who have chronic diseases, disabilities, or cancers Our work provides novel theoretical insight by integrating these two
can find social media particularly useful because social media enables theories into a fresh conceptual framework while also extending the
them to seek support from peers or experts to sustain their existing theory to understand the social media-enabled healthcare
self-management of such long-term diseases (Merolli et al., 2013). All of phenomenon more clearly. Specifically, we have combined social media
these cases illustrate the fact that patients have been increasingly using affordance and social support theories with the literature on self-
social media as an innovative technology approach for the social support management of chronic diseases to develop propositions on how social
exchange as well as to affect self-management of chronic diseases, indi­ media affordance can facilitate different forms of social support on so­
cating that patients’ self-management is changing because social media cial media, which could improve patients’ self-care behavior and
is involved. It is clear that social media is now playing a key role in the physical and psychological health. Our work makes original contribu­
self-management of chronic diseases and sits at the core of the social tions to the IT and healthcare literature. First, our work provides insights
support exchange between patients on various social media platforms. to the social media-enabled healthcare phenomenon that creates new
We name this phenomenon social media-enabled healthcare. Although values for social media in healthcare from a patient perspective by
some prior studies have recognized many benefits of using social media focusing on how patients can use social media to exchange social sup­
for self-management of chronic diseases (e.g., Partridge et al., 2018, port and improve health outcomes. It fills in the research gap of the
Bardhan et al., 2020), there is still little enhanced understanding of how implications of social media in healthcare from a patient’s perspective
patients can do that. Therefore, our work can address this research gap (Househ et al., 2014; Fichman et al., 2011). It provides theoretical in­
by explicitly explaining such a new phenomenon. sights about social media that can serve as an advanced
In this phenomenon, social support is central to improving patients’ technology-based approach for the self-management of chronic diseases
health behaviors and health outcomes because patients have been in the domain of social media-enabled healthcare. It advances the pre­
actively seeking or providing different kinds of social support on social vious literature by extending the use of social media in healthcare. The
media for self-management of chronic disease (Yan et al., 2015; Yan and multidisciplinary nature of this phenomenon can add great IT value to
Tan, 2014). There is considerable literature indicating that social sup­ healthcare because "IS needs to strengthen its ties with contributing
port is a multidimensional construct consisting of various forms of disciplines" (Power, 2003). Second, our work introduces social media
support, including informational support, emotional support, instru­ affordances from a technology affordance perspective. Drawing from the
mental support, and companionship (Berkman et al., 2000; House, previous literature, we identified and distinguished three primary types
1981). Social support has been demonstrated to have an impact on of social media affordance: affordance for community co-creation,
various health outcomes such as health behavior, psychological health, affordance for social learning, and affordance for social relationships.
and physical health (Uchino, 2006; Uchino, 2009). It is understood that We further proposed how they lead to different kinds of social support
social support has a positive impact on health outcomes, but there have on social media. These propositions are novel and provide a clearer
been few studies on how different forms of social support may lead to theoretical understanding of the application of social media in health­
different types of health outcomes. Indeed, more generally, there is scant care. Third, our work advances social support literature and identifies
literature examining the implications of social media in the healthcare three primary forms of social support on social media for the
domain (Fichman et al., 2011), suggesting that the phenomenon of so­ self-management of chronic diseases. We introduce new relationships
cial media-enabled healthcare is under-theorized. Markus and Silver among social supports by exploring the effect of different kinds of social
(2008) argued that “the continual emergence of new technologies support on different types of health outcomes.
inevitably requires ongoing conceptual development”, and thus a con­ The rest of the paper is organized as follows. First, we introduce
ceptual framework is essential to understand this emerging phenomenon social media affordance based on social media and technology afford­
that is currently under-development. Therefore, the objective of this ance literature. Second, we clarify three primary kinds of social support
study is to provide a conceptual framework for understanding the for the self-management of chronic diseases in the context of social
social-media-enabled healthcare phenomenon based on existing social media. Third, we present our conceptual framework of social media-
support and social media affordances. enabled healthcare by developing propositions for social media afford­
Social media affordance stems from technology affordance, which ance, social support, and health outcomes. Finally, implications, limi­
refers to the notion of “opportunities for action” provided to a user by a tations, and opportunities for future studies are discussed.
computerized system under particular circumstances (Argyris and
Monu, 2015; Gibson, 2014; Markus and Silver, 2008). The design fea­ 2. Relevant literature
tures of social media provide users the opportunity to share their
knowledge with others continually, thus increasing user engagement (e. 2.1. Social media affordance
g. Majchrzak et al., 2013, Treem and Leonardi, 2013). By taking ad­
vantages of technology affordance, social media has changed the process Interactivity and social presence, two primary design features of
of sharing information and knowledge online and created new channels social media, have facilitated users’ online collective action and social
for connecting users, thus allowing individuals to collaborate on various interactions, thus promoting social connectedness, information sharing,
tasks (Faraj et al., 2011). Technology affordance enables users to ex­ and collaboration among a large number of users on social media (Aral
change resources with others on social media, thus fostering different et al., 2013; Kaplan and Haenlein, 2010). Interactivity is generally
types of social support based on what information they exchange and considered to be a central characteristic of new media (McMillan, 2006),
with whom they exchange it. Based on the technology affordance the­ a core characteristic that empowers users to freely send, receive, and
ory, we have identified three types of social media affordance: afford­ process user-generated content for use in the social media environment
ance for community co-creation, affordance for social learning, and (Aula, 2010). Social presence is defined as “the salience of the other in a
affordance for social relationships. Although social media affordances mediated communication and the consequent salience of their inter­
can empower users to act in a technology-mediated environment, they personal interactions” (Short et al., 1976, p. 65). In the context of social
fail to address the effects of social media on people’s behaviors and media, social presence allows users to connect with one another more

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X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

effectively by improving their connectedness and resolving ambiguity perspective can be viewed a bridge between social media technical
(Kaplan and Haenlein, 2010; Rettie, 2003). These two primary social features and social impacts (Volkoff and Strong, 2013), and thus, it al­
media design functions play important roles in facilitating user inter­ lows us to explain how technologies can generate outcomes in a variety
action, thus creating an effective environment for user engagement in of research contexts (e.g., Leidner et al., 2018, Strong et al., 2014, Du
various aspects of social media. Therefore, social media design features et al., 2019). For example, Sæbø et al. (2020) found that social media can
have facilitated technology affordances that enable individuals to ach­ support people’s dynamic collective actions through a variety of affor­
ieve their goals through user engagement on social media, referred to as dances, such as making decisions collectively and circulating informa­
social media affordances (Cabiddu et al., 2014; Majchrzak et al., 2013). tion. Following this logic, social media affordances allow us to study the
Social media affordance aims to trigger user engagement, such as interactions between social media and users and explain how users may
information sharing and user interactions, on social media (Cabiddu take advantage of social media affordances to conduct self-management
et al., 2014; Majchrzak et al., 2013). Some prior studies have identified of chronic diseases and achieve health outcomes.
several kinds of social media affordances in various research contexts. Accordingly, in our study, we identify social media affordances based
For example, Treem and Leonardi (2013) identified four social media on social media features that can trigger online activities on social media
affordances that can provide an enhanced understanding of how social in general (not a specific type of social media). The rationale is that
media can affect organizational communication processes—namely, patients may engage on a variety of social media platforms to maximize
visibility, persistence, editability, and association. Visibility refers to their opportunities to acquire resources for supporting their health de­
“the ability to make their behaviors, knowledge, preferences, and cisions and behaviors (Li et al., 2018). Therefore, it is important to
communication network connections that were once invisible (or at develop new social media affordances that can deepen the understand­
least very hard to see) visible to others.” (Treem and Leonardi, 2013). ing of how patients use social media to support self-management of
Persistence refers to the ability to make the published content remain chronic diseases in the specific context of this study. The existing liter­
accessible in the same form as the original display. With editability, ature on social media affordances has not identified or conceptualized
social media allow users to modify, improve information, and change social media affordances in relation to healthcare from an individual
collaboratively before presentation. Association is the technology patient perspective. For that reason, in this study, we further develop
capability of social media that allow users to create and sustain re­ social media affordances based on the existing ones (see Appendix A),
lationships between individuals and between individuals and content, which reveal three key common features: collaboration on editing
and they further identified two types of association including association knowledge, interactions among users for socializing and developing
between people and association between people and information. close relationships, and learning from one another. Accordingly, in this
Majchrzak et al. (2013) theorized four social media affordances that study we have identified three types of social media affordances related
represent ways to engage in knowledge conversations: metavoicing, to those common features: the affordance for community cocreation, the
triggered attending, network-informed associating, and generative affordance for social relationships, and the affordance for social
role-taking. Metavoicing refers to “engaging in the ongoing online learning. These three social media affordances can be viewed as
knowledge conversation by reacting online to others’ presence, profiles, higher-order affordances that can be actualized from the basic affor­
content and activities” (p. 41). Triggered attending is “engaging in the dances identified in prior studies. For example, an affordance for com­
online knowledge conversation by remaining uninvolved in content munity cocreation can be facilitated by ongoing conversations between
production or the conversation until a timely automated alert informs patients (i.e., metavoicing) and collaboration. This is consistent with the
the individual of a change to the specific content of interest” (p. 42). work of Leidner et al. (2018), who suggested that first-order affordances
Network-informed associating is defined as “engaging in the online can actualize second-order affordances. For example, in that study, the
knowledge conversation informed by relational and content ties” (p. investigators found that interacting with peers and demonstrating
44). Generative role-taking is engaging in the online knowledge con­ leadership acted as first-order affordances to actualize building re­
versation by enacting patterned actions and taking on lationships with peers as a second-order affordance. We have defined
community-sustaining roles in order to maintain a productive dialog these three social media affordances in detail below. More specifically,
among participants (p. 45). Cabiddu et al. (2014) identified three for each social media affordance, we have identified the theoretical
distinctive social media affordances that support customer engagement mechanisms through which these affordances could be formed in social
in tourism: persistent engagement, customized engagement, and trig­ media.
gered engagement. In details, persistent engagement represents “the
possibility of maintaining an ongoing dialog with customers, even when 2.1.1. Affordance for community co-creation
they are not physically at the property” (p. 185). Customized engage­ Affordance for community co-creation provides users opportunities
ment represents “the possibility of interacting with customers based on to co-create values with others to produce knowledge about a specific
prior knowledge of individual-level information” (p. 185). Triggered topic (Raja-Yusof et al., 2016; Zhao et al., 2013). This affordance cap­
engagement represents “the possibility of instigating customer encoun­ tures how users can contribute their knowledge through engagement in
ters based on an external, customer-initiated event” (p. 185). conversations in social media such as online communities and online
Those studies have revealed that social media affordances improve groups (Cabiddu et al., 2014; Majchrzak et al., 2013). A user can post
user engagement via its features (e.g., information-sharing activities and questions, and many other users can review the questions and share
user interactions), which then enable users to create values and acquire their knowledge, ideas, and comments. Social media users can add
the resources they want. In this view, social media affordances are knowledge to the content already posted, thus providing an enhanced
closely linked to opportunities of actions provided by the design and understanding of a specific topic. This social media affordance mainly
socialization features of social media (Bradner, 2001; Hsieh, 2012). offers users the option of sharing content and collaborating to contribute
Consistent with some prior studies (e.g., Volkoff and Strong, 2013, knowledge that is available to other social media users.
Strong et al., 2014, Volkoff and Strong, 2017, Evans et al., 2017), social This affordance can capture the key elements of affordances identi­
media affordances emerge from the interaction between social media fied in the previous literature, such as those from the collaboration of
and users and explain how users can achieve specific goals via social Zammuto et al. (2007) and Zhao et al. (2013), of collective affordance
media features. Similarly, Karahanna et al. (2018) suggested that social and shared affordance by Leonardi (2013), of metavoicing and genera­
media features facilitate social media affordances, which allow users to tive role-taking by Majchrzak et al. (2013); and of the visibility,
generate outcomes. For example, Facebook features such as “sharing my persistence, editability, and association between people and content by
own photo” and “updating my new status” can facilitate the Treem and Leonardi (2013). These social media affordances can be
self-presentation affordance. With that being said, the affordance viewed as basic affordances that actualize community cocreation as a

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high-level affordance (Bygstad et al., 2016; Leidner et al., 2018). For associations between people.
example, metavoicing enables social media users to expand the
dissemination of content shared in social media and add their own 2.1.3. Affordance for social learning
content, thus cocreating the content. Social media offer the users the Social learning theory posits that new patterns of behavior can be
possibility of giving their shared content visibility, making it possible for acquired by people through either direct experience with or observation
users to cocreate through the possibility of collaboration and to achieve of others’ behaviors, attitudes, and outcomes of the behaviors (Bandura
collective understanding (i.e., shared affordance). and Walters, 1977). Social learning is a learning process involving
In the healthcare domain, people can collaborate on producing people who observe the behavior of one another in a common envi­
knowledge about a specific disease, addressing health conditions, ronment (Conte and Paolucci, 2001). This learning process can affect
generating potential solutions, and referring treatments. Co-creation users’ behaviors. With their advanced design features, social media are
could happen in different forms through a variety of technology capa­ online environments where people with common interests or concerns
bilities and collaborations in a social media-based community (Zwass, can interact with and learn from each other. For example, in social
2010; See-To and Ho, 2014; Füller, 2010). For instance, users have been media health groups, people may discuss how they cope with health
actively participating in knowledge contribution activities, such as problems and overcome a disease, and others can observe and learn from
facilitating enhanced understanding of a specific concept on Wikipedia. the experience. Such observation can probably modify patients’ be­
In social media-enabled communities, users may work together on a haviors, thus generating improved health outcomes. Therefore, it is clear
specific issue and generate potential solutions based on user-generated that social media empower users to learn from one another by observing
content, reflecting the co-creation values. In addition, social media of­ others’ behaviors and the resultant outcomes. We name it the affordance
fers social collective platforms that facilitate mass collaboration for for social learning, which mainly offers an individual user the option of
sharing and creating knowledge (Pettersen, 2014). Facilitators to interacting with others and learning from the experience-oriented con­
collaboration enable users to produce knowledge on social media, tent they shared.
assisting with the formulation of social support. This process of com­ Prior studies provided evidence that users have been increasingly
munity co-creation represents the way people create, modify, share, and using social media platforms for individual learning purposes, and social
discuss user-generated content on various social media platforms media platforms have evolved into social learning platforms (Dabbagh
(Kietzmann et al., 2011). Therefore, community co-creation could well and Kitsantas, 2012; McLoughlin and Lee, 2010). Social learning tasks
capture a primary affordance of social media, and it provides users the are usually self-regulated tasks, but they are also part of a collective
capability to participate in online activities such as contributing learning process; thus, social learning is learning from individuals’ re­
knowledge and exchanging resources (Raja-Yusof et al., 2016; Zhao actions to different online resources. This social media affordance can be
et al., 2013). actualized from some basic affordances identified in prior studies,
including individual affordance and collective affordance (Leonardi et al.,
2.1.2. Affordance for social relationships 2013). An individualized affordance is “an affordance that someone
Affordance for social relationships enables users to develop and enacts when using a technology’s features” (Leonardi, 2013). A collec­
maintain social relationships among individuals in social media. Social tive affordance is “an affordance that is collectively created by members
presence is considered an important design feature that makes social of a group, in the aggregate, which allows the group to do something
media a great venue where users may interact with others who have that it could not otherwise accomplish” (Leonardi, 2013). These two
common interests (Kaplan and Haenlein, 2010; Aula, 2010). With this basic affordances make it possible for an individual to enhance their
design feature, social media provides users with the capability to con­ learning in a social media system. Social media provide resources
nect to each other and facilitate social interaction (Treem and Leonardi, generated by members of different groups, allowing an individual to
2013; Kane et al., 2009). In such a scenario, users can have opportunities learn from another person. In this way, the affordance of social learning
to develop and maintain relationships with members of social can be also actualized by collaborative learning, which posits that in­
media-based communities. Accordingly, the affordance for social re­ dividuals can learn from each other via sharing experiences within a
lationships largely depends on users’ interaction with others and so­ collaborative group (Mitnik et al., 2009; Suthers, 2006). In such a state,
ciability in the social media environment. social learning is a learning process that benefits from diverse members
This affordance can be actualized from some existing affordances of and the resources they share. Therefore, we propose that social learning
social media that make it possible for users to develop and maintain can capture another primary social media affordance that provides op­
social relationships therein. For example, social affordance is defined as portunities and motivations for users to learn from each other
“the relationship between the properties of an object and the social collaboratively.
characteristics of a given group that enable particular kinds of interac­
tion among members of that group” (Bradner, 2001). Such interaction 2.1.4. Summary
with peer members can make it possible for people to connect with In summary, social media design features foster various social media
others and build relationships. Similarly, customized engagement and affordances that enable users to achieve different goals by engaging in
triggered engagement (Cabiddu et al., 2014) can enhance interaction online activities and interacting with others. In this study, we have
among peers in social media, which offers users the possibility of focused on social media affordances that offer users the opportunity to
developing social relationships. Accordingly, social media offer users gain knowledge, develop and maintain social relationships, and learn
the possibility of developing social relationships through the possibility from one another. We include three types of social media affordances in
of associations between people and people (Treem and Leonardi, 2013), Table 1.
in other words, social ties (Boyd and Ellison, 2008).
Therefore, affordance for social relationships could be made possible 2.2. Social support
on various social media platforms that support social interactions among
individuals, thus enabling them to exchange resources (Ellison et al., Social support refers to “information leading the subject to believe
2009; Kaplan and Haenlein, 2010). For example, users may build social that he is cared for and loved, esteemed, and a member of a network of
relationships and manage social ties on social networking sites such as mutual obligations” (Cobb, 1976). It is formed by the exchange of re­
Facebook and Twitter (Ellison et al., 2007; Madge et al., 2009; Boyd and sources (i.e., verbal and nonverbal messages) between two or more in­
Ellison, 2008). Empowered by social media design features, this dividuals (Shumaker and Brownell, 1984). Social support could be
affordance is popular among individuals engaged in bidirectional com­ facilitated by the transmission of information shared by individuals and
munications and ongoing resources exchanges, which can create the content of information determined by the type of social support. In

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Table 1
Summary of Social Media Affordances.
Constructs Definition Examples Primary features Actualized by existing affordances
(see Appendix A for details)

Affordance for Affordance of social media Users collaborate to produce This affordance focuses on features that Virtual collaboration and mass
Community provides users opportunities to co- knowledge on wiki. create an environment where users can collaboration (Zammuto et al., 2007);
Co-Creation create values with others via Users answer others’ questions share their knowledge on social media. Shared affordance (Leonardi, 2013);
sharing content and contributing in a social media-based group or With this kind of affordance, people Metavoicing and generative role-taking (
knowledge. discussion forum by sharing would be able to gain knowledge and Majchrzak et al., 2013); visibility,
their knowledge, opinions, and develop an enhanced understanding of persistence, editability and association
ideas. the relevant things they want to know. (between people and content) (Treem
and Leonardi, 2013)
Affordance for Affordance for social media User interact with each other It is mainly beneficial to users socializing Social affordance (Bradner, 2001);
Social enables users to develop and and develop close relationships on social media. With this kind of customized engagement and triggered
relationships maintain social relationships with others in social media. affordance, people would be able to find engagement (Cabiddu et al., 2014);
among individuals in social media. users with common interests or situations association (between people and people)
and maintain social relationships. (Treem and Leonardi, 2013); social ties (
Boyd and Ellison, 2008)

Affordance for Affordance for social media Users observe each other’s It is mainly beneficial to users in learning Individual affordance and collective
Social empowers users the capability to actions or habit by exchanging from one another in social media. With affordance (Leonardi, 2013);
Learning learn from one another by individuals’ experience. this kind of affordance, people would be collaborative learning (Mitnik et al.,
observing others’ behaviors and able to learn from others who have 2009; Suthers, 2006).
the resultant outcomes. relevant experience and model their
behaviors.

today’s information age, social media facilitates new channels for online health-related decisions and improving health-related outcomes(e.g.,
information-sharing activities (Kaplan and Haenlein, 2010; Ransbo­ Lin et al., 2016, Yan and Tan, 2014). In addition to these two types of
tham and Kane, 2011). People have been actively engaging on social social support, we are also interested in experiential support, which
media platforms, where they share, request, and acquire information to focuses on the exchange of direct experiences among patients who have
just have fun or address problems they have encountered. Social media similar health conditions.
has drastically changed people’s daily lives and provided innovative
socially mediated channels for people to acquire useful information and 2.2.1. Informational support
meet their social needs. Therefore, social media offers a large amount of Informational support refers to the provision of knowledge in the
user-generated content and has become a popular venue where people transmission of health-related information such as disease knowledge,
can acquire social support. Through online information-sharing activ­ medical or treatment regimen, healthcare-related advice and referrals as
ities, social support is available through various social media platforms well as other information that is useful for people to understand health-
such as wikis, social networking sites, and online communities (e.g., Lin related topics. Social media offers a large amount of health-related in­
et al., 2016). formation and knowledge posted by both healthcare professionals and
Prior studies have paid much attention to the positive impact of so­ nonprofessionals. Evidence suggests that social media has become an
cial support on people’s health conditions and outcomes. Researchers emerging means for patients to acquire informational support via the
have shown that social support benefits patients, including coping with online health information exchange (Fox and Duggan, 2013; Boulos
stressful life events (Thoits, 1982), increased adherence to prescribed et al., 2007). From this perspective, informational support could be
treatment regimens (McCorkle et al., 2008), and improved psychologi­ made possible for patients when shared health knowledge is accessible.
cal well-being (Cohen and Wills, 1985). In the self-management of For example, clinicians actively use social media to communicate
chronic diseases, social support is especially important for promoting with patients and answer their health-related questions by sharing
patients’ health behavior and achieving positive health outcomes. For concierge practice-oriented healthcare information and knowledge (Li
example, McCorkle et al. (2008) found that social support increases et al., 2018). The clinician-generated content is usually viewed as
people’s well-being and reduces psychiatric symptoms for people with instructional guidance by patients, particularly those with chronic dis­
serious mental illness. The findings of van Dam et al. (2005) also support eases, and it is helpful for patients to gain knowledge about the diseases,
the idea that social support has positive outcomes on diabetes control. A find potential solutions, and acquire advice. Further, this kind of
summary of the current literature on the consequences of social support user-generated content is usually viewed as the primary source of in­
(see Appendix B) reveals two underrepresented areas: (a) the different formation for patients’ learning and health-related decision-making
forms of social support and (b) the impacts of various forms of social because clinicians possess the knowledge (Matthews et al., 2002).
support on different types of health outcomes. To close the research gaps Having access to clinicians’ shared knowledge about chronic diseases,
and provide further insights, we have developed propositions that healthcare information, and treatment, patients could gain knowledge
elaborate on how different forms of social support affect patients’ and better understand their health condition. Therefore, the trans­
self-care and psychological health, and these proposition are essential mission of health-related information between patients and clinicians
for developing an enhanced understanding of the role of social support usually facilitates informational support because it enhances patients’
in the self-management of chronic diseases. To accomplish this goal, we health-related knowledge. For another example, social media provides a
first defined different forms of social support and types of health out­ wide variety of bidirectional communication tools that connect patients
comes, and we then developed propositions pertaining to the relation­ who have similar health concerns and provide a shared understanding of
ships among them. health information. Patients with similar health conditions create online
Social support has generally been categorized into different forms forums and groups on social media platforms (e.g., Facebook and
such as informational support, emotional support, instrumental support, Twitter) to communicate with one another and share health-related
and companionship (Berkman et al., 2000; House, 1981). In the social information (Greene et al., 2011). Patients may share their healthcare
media environment, informational support and emotional support are knowledge and post reviews about health products, medicines, and
considered the most common types of social support for assisting with doctors on social media platforms such as wikis, blogs, social networking

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X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

sites, collaborative tagging (folksonomies), and tag clouds (Boulos et al., “sharing happiness or sadness or of expressing caring and concern” (Yan
2007), which are all great sources for them to observe informational and Tan, 2014). More specifically, this kind of social support could be
support. The exchange of health-related information among patients obtained by patients through the expression of care, empathy, under­
also plays an important role in gaining knowledge, thus formulating standing, trust, respect, and even love between individuals aiming to
informational support (Antheunis et al., 2013). Therefore, informational express care and concern to one another. Social media facilitates a
support can be facilitated via the exchange of knowledge between pa­ supportive and interactive environment for patients to communicate
tients and clinicians as well as among patients and peers. In other words, with others who have similar health conditions, and it offers great op­
both patients and clinicians can provide informational support in the portunities for them to talk with and help each other and to develop
context of social media. This is consistent with the work of Li et al. trusting relationships (Bambina, 2007; Nambisan, 2011; Yan et al.,
(2018), who suggested that social support can be enhanced through 2015). For example, Facebook has become a venue for patients with
knowledge exchange among different stakeholders, including health chronic diseases to develop an emotionally supportive community
care professionals and lay people. (Greene et al., 2011). Social media makes it easy for patients to find
others with similar health conditions who can understand them and
2.2.2. Experiential support provide emotional support. Social media makes it possible for patients to
Experiential support refers to support perceived in the exchange of reach out to the right person and communicate their true feelings
individuals’ firsthand experience, including medical and treatment through the self-management process. In such a group, patients would
experience and experience coping with health problems as well as be eager to share personal feelings and express their emotional concerns
evidence-based health outcomes. Experiential support is generally as well as to provide feedback to others’ mood-related posts, thus
considered to be a subtype of informational support (i.e., Yan and Tan, releasing themselves from being alone in the long-term self-manage­
2014), and it is underrepresented in the current literature. Experiential ment of chronic diseases (Bender et al., 2011; Swan, 2009). Further,
support is more than someone providing health-related information and with the development of trusting social relationships in the group, pa­
knowledge about diseases, but rather it involves someone providing tients may also feel caring and concern, thus observing emotional sup­
firsthand insight into the process and experience of having a particular port (Cobb, 1976).
illness as well providing hope and serving as an example of someone in a Similarly, social media provides an alternative channel for patients
similar situation who was able to overcome the disease (Snyder and to connect with their family members and friends, who are more likely
Pearse, 2010). to express care and concern. When patients feel blue, they may express
Unlike informational support, experiential support comes in the form their emotions on their social networking accounts. Their significant
of sharing patients’ firsthand experience about managing diseases or others may express care and concern by responding to the posts and
effective evidence-based healthcare outcomes. It provides true examples encouraging them. In this way, patients are likely to receive emotional
that demonstrate the effectiveness of medical treatments and therapy as support from their family members and friends (Snyder and Pearse,
well as the helpfulness of actions patients take to cope with illnesses. The 2010). Therefore, an individual patient can acquire emotional support
basis for facilitating experiential support is the connections among pa­ from family members, friends, and other patients.
tients who have a similar illness and could tell others what they went
through, and they are the only persons who would be able to provide a 2.2.4. Summary
certain kind of social support. In this way, patients can acquire experi­ In summary, patients can obtain informational support, experiential
ential support from other patients who have similar health conditions. support, and emotional support depending on the content of the infor­
Therefore, informational support and experiential support are clearly mation and the people they share the information with on social media.
distinguished from each other in terms of the shared content and the Patients could acquire informational support from knowledge-featured
persons who share information. Thus, in this study, we argue that information shared by both professional and nonprofessional health­
experiential support is another primary type of social support made care workers. In contrast, experiential support could be acquired from
richer by social media, but it does not replace informational support. the experience-oriented information shared by people who live with
Social media creates an environment where patients who have similar health conditions and who have experience dealing with health-
similar health condition come Social media creates an environment related problems. Lastly, patients may receive emotional support from
where patients who have similar health conditions come together and information provided by family members, friends, and other patients
share their experiences and health outcomes resulting from their health who have expressed care and concern. Nowadays, people are increas­
behaviors. In our research context, experiential support could be made ingly active on social media, exchanging various kinds of information
possible on various platforms where people of similar health conditions and fostering different types of social support, because social media
can interact with each other and share their self-management experi­ overcomes geographic and temporal boundaries of user communications
ences. In such a group, patients would share their own experiences with and interaction. In Table 2 we have provided a summary of informa­
others about how they cope with health concerns, what they do to tional support, experiential support, and emotional support.
overcome health issues, and the outcomes of their self-management In addition, previous studies have suggested that patients could ac­
strategy. In this view, social media provides both informational and quire social support through both seeking information and providing
experiential support that assists patients’ self-management of diseases, information activities (Phang et al., 2009). In a more recent study, Yan
aiming ‘‘to reduce uncertainty regarding health status’’ and ‘‘construct a and Tan (2014) measured social support through two primary activities:
social and personal (cognitive) sense of health’’ (Tardy and Hale, 1998, giving and receiving social support, both of which were found to have
p. 338). Experiential support is valuable because it provides positively influenced patients’ health. Those studies confirm that social
evidence-oriented information and knowledge for patients to follow, support can be obtained in both seeking and giving activities. Therefore,
thus encouraging them to continue with their treatment therapies. For in this study, social support means the support patients obtain in both
example, Facebook provides a great platform for patients to share their giving and receiving activities. When patients engage in the giving
personal experiences with people living with similar chronic diseases support activities, they may also receive social support simultaneously
(Greene et al., 2011). Thus, social media becomes an attractive resource because they could learn from each other, which is considered passive
for patients to exchange experiential support. receiving support. Both actively seeking and giving actives activities
help people obtain social support on social media, which indicates that
2.2.3. Emotional support support given and received is likely to be formed at the same time in
Emotional support is another primary type of social support that relation to online activities.
patients seek to obtain on social media, and it comes in the form of

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Table 2
Summary of Social Support.
Type of Social Definition Examples People who share Attributes of the shared content
Support the content

Informational The provision of knowledge in the Patients can have a better understanding Health care Knowledge-featured information such
Support transmission of health-related information of health-related problems and professionals (e.g., as specific-disease knowledge, medical
such as disease knowledge, medical or treatments with access to information and clinicians) and information, treatment regimen,
treatment regimen, healthcare-related advice knowledge shared by others in social patients. healthcare-related advice, and referrals.
and referrals as well as other information that media.
is useful for people to understand health-
related topics.
Experiential Support perceived in the exchange of Patients observe the evidence about the Patients who have Experience-oriented information such
Support individuals’ firsthand experience, including effectiveness of treatments and health similar health as patients’ health habits and the
medical and treatment experience and habits with access to experience shared conditions. resulted consequences.
experience coping with health problems as by other patients. Patients’ experience about managing
well as evidence-based health outcomes. diseases, coping with illness, and
overcoming health issues.
Emotional Support perceived through the expression of Patients may not feel alone in a group of Family members, Emotion-featured information such as
Support care, empathy, understanding, trust, respect, members who have similar health friends, and other moods states, care, empathy, and
and even love between individuals aiming to conditions. patients. understanding.
express care and concern to one another.

2.3. Health behavior and outcomes understanding of health conditions and solutions as well as expected
health outcomes (Bandura, 2004), and it is a continuously
Clearly, self-management is essential for patients living with chronic self-regulating process that can be learned through cognitive responses
diseases to achieve better health outcomes and to improve their quality (Barlow et al., 2002; Clark and Dodge, 1999; Clark et al., 2014).
of life (Lorig et al., 1999; Barlow et al., 2002; Holman and Lorig, 2004). Therefore, we conclude that self-care is the care of an individual in a
Patients need to gain skills and self-confidence to better manage their cognitive sense and could change along with his or her gained knowl­
health conditions in the long-term treatment of chronic disease because edge about health problems and solutions.
the self-management of chronic diseases generally involves daily
self-care behaviors to reduce or control the diseases’ symptoms and to 2.3.2. Psychological well-being
cope with the psychosocial problems. Patients can improve their phys­ Psychological well-being has been considered to be another key
ical health through the self-care behavioral process and the psycholog­ factor that determines the success of self-management of chronic dis­
ical process (Clark et al., 1991; Uchino, 2006). Therefore, eases (Barlow et al., 2002; Uchino, 2006; Uchino, 2009). It is usually
self-management is essential for patients’ overall well-being. Barlow represented by patients’ emotional responses to chronic health condi­
et al. (2002) referred to self-management as “the individual’s ability to tions and self-beliefs, such as feelings of control, self-esteem, self-­
manage the symptoms, treatment, physical and psychological conse­ efficacy, stress, and anxiety (Cohen, 1988; Cohen and Wills, 1985).
quences and life styles changes inherent in living with a chronic con­ There is an emotional cost to long-term treatment because a consider­
dition” (p. 178). Further, Clark et al. (2014) posited that the ability of an able proportion of patients with chronic conditions can have affective
individual to achieve desired goals of self-management is disorders such as low mood, distress, depression, and anxiety (Zabora
self-regulating, and patients would need to effectively manage their et al., 2001; Linden et al., 2012). It can be difficult to diagnose and
diseases according to their health conditions. In such a state, effective address psychological problems; thus, psychological problems can be a
self-management depends on a patient’s cognitive understanding of and significant barrier to the achievement of the optimal psychic outcomes
emotional responses to a chronic condition as well as the use of health (Turner and Kelly, 2000). Therefore, it is essential for patients to
behaviors to cope with the disease’s symptoms and psychological maintain a healthy psychological state during long-term treatment
problems. In this view, we conclude that successful self-management of (Aalto et al., 1997; Van der Ven et al., 2003), and psychological care can
a chronic disease requires a patient to possess the sufficient self-care be an effective intervention to produce optimal moods and reduce psy­
habits and psychological well-being that are essential for improved chological distress (Turner et al., 2011). Therefore, we conclude that
physical health outcomes. psychological well-being captures individuals’ emotional reactions to
health conditions through moods and self-beliefs, thus playing an
2.3.1. Self-Care behavior important role in achieving optimal psychic health.
Self-care is essential for patients to cope with chronic conditions, and
patients usually struggle to carry out day-to-day tasks with clinicians’ 2.3.3. Physical health
guidelines for controlling disease symptoms over the long term. Self-care Physical health, which is critical for patients’ overall well-being, can
is a key form of care for patients living with chronic diseases, and it be measured in a variety of ways, including the disease symptoms,
requires individual effort to perform the tasks recommended by clini­ clinical outcomes, and disease-related morbidity and mortality (Berk­
cians, which typically consist of various actions done in compliance with man et al., 2000; Uchino, 2004; Uchino, 2006). To improve physical
a prescribed treatment regimen such as medicine adherence. Those health outcomes, patients struggle to control their disease symptoms and
health habits play an important role in controlling the chronic diseases’ improve their clinical outcomes. For example, diabetic patients may
symptom (Clark et al., 2014). For example, self-care for diabetes may want to reduce HgbA1C levels and maintain a low blood sugar level
involve a range of activities such as following a diet low in saturated fat, through a strict medicine regimen and healthy diet(Norris et al., 2001).
adhering to a strict medication regimen, regularly self-testing blood Patients living with chronic health conditions can have a high risk of
glucose, and exercising on a daily basis (Toobert et al., 2000; Norris disease-related morbidity and mortality (e.g., Johnson et al., 2014).
et al., 2001). Patients’ commitment to self-care is helpful for controlling Therefore, physical health outcomes can include disease-related symp­
diabetes and achieving better health conditions. Self-care is a function of toms and their consequences.
a patient’s “subject value of an outcome and the subjective probability
(or ‘expectation’) that a particular action will achieve that outcome” 2.3.4. Summary
(Rosenstock et al., 1988). Patients’ self-care can be enhanced by their Based on the above discussion, it is clear that self-care, psychosocial

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status, and physical health outcomes are essential for successful self- health communities on social media contain a considerable amount of
management of chronic diseases. The objective of our study is not to patient- and expert-contributed healthcare information. In this view,
replicate the relationships among those three components, but to elab­ community co-creation empowers patients to collect the health infor­
orate how various forms of social support are linked to health outcomes. mation and knowledge they need from social media. In the transmission
The existing literature provides substantial evidence that social of user-generated content on social media, patients would understand
support generates beneficial effects on health and well-being, including their health condition better and gain relevant knowledge about medical
physical health outcomes (Berkman et al., 2000; Uchino, 2009) and treatments, healthcare advice, and referrals, thus obtaining informa­
psychological health outcomes (Lakey and Orehek, 2011; Cohen and tional support.
Wills, 1985). Drawing on the different theoretical perspectives, Uchino With a stronger community co-creation norm in the context of social
(2006) outlined two pathways—physiological and behavioral—to media, patients would have more opportunities to receive social support
explain the influence of social support on physical health (i.e., morbidity in different forms to assist with their self-management of diseases. An
and mortality); these pathways promote changes in biological profiles example of the impact of co-creation on the exchange of different forms
such as cardiovascular, neuroendocrine, and immune system function. of social support is online health groups on social media platforms such
Specifically, Uchino explained how structural and functional measures as Facebook and Twitter, which allow users to co-create with others who
of support may ultimately influence disease morbidity and mortality via have similar health conditions by inputting their health-related knowl­
(a) behavioral processes involving health behaviors and adherence to edge and by sharing opinions (Greene et al., 2011), all of which provide
medical regimens and (b) psychological processes such as appraisals and deep understanding about health-related issues. Community co-creation
moods linked to emotional well-being. Social support has been increases the effectiveness of knowledge exchange among individuals;
demonstrated to promote health behaviors and improve psychological therefore, we argue that social media community co-creation affordance
well-being. In addition, social support may lead to better psychic health would encourage people to engage in knowledge-sharing activities, thus
via both cognitive processes, such as patients’ self-care behavior facilitating informational support on social media.
(DiMatteo, 2004; Uchino, 2009) and affective processes, such as a psy­ Proposition 1a. Affordance for co-creation mainly facilitates informa­
chological statement (Barrera Jr, 2000; Cohen, 1988) and mental health tional support on social media.1
(Lakey and Orehek, 2011). In a more recent study, Uchino explained the
impact of social support on physical health outcomes by highlighting the 3.2. The effect of affordance for social learning
factors that develop social support and their influence on mechanisms
such as effective coping and health behaviors (Uchino, 2009). All those As noted in the earlier discussion about the affordance for social
studies support the idea that social support is related to physical health learning, it offers patients the ability to learn from one another by
via both health behavioral processes and psychological processes. virtually observing others’ experiences of coping with health issues and
generating evidence-based outcomes. It is common to see people share
3. Propositions their personal medical histories and disease self-management experi­
ences on social media platforms such as Facebook and in online
3.1. The effect of affordance for community co-creation healthcare communities (Snyder and Pearse, 2010; Yan and Tan, 2014).
By discussing their personal experience, patients would learn about
Affordance for community co-creation empowers patients to co- effective self-management and approved treatment regimens. This kind
create knowledge with others by contributing their understanding, dis­ of social media affordance paves the way for patients to learn how to
cussing health-related issues, and exchanging opinions about treatment self-manage their illnesses from one another. With this kind of social
regimens. This kind of social media affordance offers great opportunities media affordance, patients would be eager to share their experiences
for patients to gain disease-specific knowledge and awareness of its with and to help each other, which is the base for experiential support in
relevant medical treatments, which serves as the base for informational social media.
support for self-management of chronic diseases. Briefly, it represents Social learning is an individual learning process that encourages
how patients may gain enhanced understanding of disease-specific people to engage in ongoing, interactive conversations with users who
health-related issues and the ways they cope with health concerns. It have similar conditions in a specific environment. With this kind of
is particularly important for patients living with chronic diseases to gain social media affordance, patients would have access to rich user-
enough knowledge to self-manage chronic diseases. generated content featuring individual experiences about self-
With affordance for community co-creation, people may contribute management of diseases. Meanwhile, patients who are aware that
to productive knowledge by focusing on those parts they have interest or experience sharing would be useful for others would be more likely to
expertise in, thus reducing the effort to co-create with others to develop share their experiences. Social media features provide users with the
knowledge about a specific disease on social media. Community co- capability to connect to others living with similar health conditions and
creation may also encourage more people to engage in ongoing con­ to seek support for approved medical regimens and self-management
versations by inputting knowledge from different perspectives. For activities for achieving better health outcomes. People with
example, a patient may post a question about his or her health concerns, experience-oriented shared information trigger social learning behav­
and many other users may respond and contribute their knowledge, iors on social media. Patient-driven experiential support is invaluable
ideas, and advice. Those responders could be healthcare professionals for people seeking to update their knowledge and gain further insights
providing knowledge about the disease and successful medical regi­ for coping with health concerns (Jadad et al., 2000). In addition, rela­
mens, or they could be patients providing their understanding of the tional ties are useful for people seeking to share their personal experi­
disease and sharing personal narratives. As such, community co-creation ences and express care for each other. As such, social media may trigger
fosters the exchange of knowledge among a large group of diverse users, those social behaviors and foster experiential support with this social
who could provide information and knowledge in different ways. media-enabled affordance for social learning. In this view, the afford­
Therefore, community co-creation may motivate people to productively ance for social learning pervades social media with an innovative
engage in online collaboration on the development of useful knowledge social-learning system where patients can perceive rich experiential
and information, which would facilitate different forms of social sup­
port. In the healthcare domain, cross-disciplinary users collaborate and
work on specific health-related problems, providing high-quality infor­ 1
Please note, we focus explicitly on explaining how a particular kind of social
mation and knowledge to the community for solutions (Adams, 2014; media affordance can facilitate a particular aspect of social support. This will be
Celi et al., 2014). Taking advantage of community co-creation, many applied to Propositions 1b and 1c.

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support facilitated by experience-oriented information sharing. decisions and behaviors. Bandura (2004) states that “specifies a core set
Proposition 1b. Affordance for social learning mainly facilitates experi­ of determinants, the mechanism through which they work, and the
ential support on social media. optimal ways of translating this knowledge into effective health prac­
tices” (p. 144). As one of the core determinants, knowledge of health
3.3. The effect of affordance for social relationships risks and benefits of different health practices can create the precondi­
tion for a change in patients’ health behaviors. In social media, patients
Affordance for social relationships offers patients the opportunity to have more channels than ever to exchange health information with
socialize and maintain social relationships on social media. Emotional other patients, fostering their understanding of health-related issues and
support is an important type of social support that users acquire on so­ potential health solutions. As such, in the exchange of informational
cial media, and it is mainly fostered by users’ social ties in a social media support, patients gain knowledge of both health risks and health bene­
community(Lin et al., 2016; Yan and Tan, 2014). With this social media fits, thereby leading to a better understanding of the effectiveness of
affordance, it is much easier than ever before for patients to develop heath practices and health habits and promoting a willingness to adhere
social relationships on line. Briefly, this social media affordance repre­ to treatment regimens and self-care behaviors (DiMatteo, 2004;
sents how patients acquire emotional support for self-management of McMullan, 2006; Kassirer, 2000).
chronic diseases. In addition, informational support benefits patients coping with
It is common for patients to share their personal feelings and moods uncertainty by promoting their self-care (Bandura, 2004; Yan and Tan,
in their personal accounts on platforms such as Facebook and to receive 2014). According to social cognitive theory, patients can acquire
emotional support from their “friends” (Greene et al., 2011). Patients knowledge and gain further insights into how to improve the long-term
may also acquire forms of emotional support such as understanding, management of chronic diseases via the activity of the informational
encouragement, affirmation, sympathy, care, and concern from other support exchange. In this view, informational support can play an
patients in the online healthcare community (Yan and Tan, 2014). Social important role to promote self-care behavior in the process of
networks and relationships among individuals largely determine pa­ self-managing chronic diseases.
tients’ willingness to talk to someone else about their concerns, feelings, Proposition 2a. Informational support in social media promotes self-care
and moods; thus, they are beneficial in accessing emotional support on behavior.
social media. Unlike with offline spaces, social media enables patients to In addition, informational support can also generate positive psy­
overcome geographic boundaries and to meet various patients with chological health outcomes (Uchino, 2006; Uchino, 2009). Self-efficacy,
similar diseases who are willing to talk about their struggles with as another core determinant of health promotion, is the belief that “one
self-management to overcome health concerns. In this review, the can exercise over one’s health habits” (Bandura, 2004). People of high
affordance for social relationships makes social media a great venue for self-efficacy are more confident when facing difficulties than those of
patients to develop a social relationship with someone who is willing to low self-efficacy, and they are more likely to remain in a healthy psy­
exchange mood- or feeling-oriented information and to encourage chological state during the self-management process. In our research
others to persist with their self-management regimen. Simultaneously, context, the knowledge gained from the exchange of information sup­
patients may also feel being valued and taken care of by others on social port can help patients better understand health concerns, locate various
media, thus leading to emotional support (Bambina, 2007; Bloom et al., informational resources about effective treatments, and track their
2001). self-management progress. With access to the vast wealth of shared
In addition, with this kind of social media affordance, patients would health knowledge on social media, patients can have a high self-efficacy
be able to develop trusting social relationships with other patients belief and become confident about controlling their disease. By
through their social interactions on social media (Cabiddu et al., 2014; becoming knowledgeable about the possible solutions of health con­
Majchrzak et al., 2013; Bradner, 2001; Zhao et al., 2013). When patients cerns, patients could perceive self-efficacy for controlling their health
have good social relationships with other patients with similar health problems and develop a positive belief in the self-management process
conditions, they are willing to talk to each other about their personal (Bandura, 2004). Patients are generally in a healthy psychological state
feelings and emotional states. In such a scenario, emotional support when they gain more knowledge about effective treatments and their
could be obtained by patients because they have more people with benefits in the exchange of information support. Further, informational
whom to talk about their disease self-management and true feelings. support such as advice and suggestions can also make patients feel less
Therefore, with this affordance, patients are likely to actively engage stressed and avoid other health-related risks, thus improving their
with and talk to someone else, thus achieving emotional support. In emotional moods and minimizing stress in the long-term management of
addition, the affordance for social relationships enhances interactions chronic diseases(Cohen, 1988), which also leads to better psychological
among patients and fosters the construction of a social network on social health.
media. When people have better relationships, they are more willing to Proposition 2b. Informational support in social media has a significant
talk about their personal moods and feelings as well as express their effect on psychological health.
concerns and care to others. Therefore, we propose the following:
Proposition 1c. Affordance for social relationships mainly facilitates 3.5. The effect of experiential support
emotional support on social media.
Experiential support is a kind of social support perceived by patients
3.4. The effect of informational support when they exchange individuals’ firsthand experience about coping
with health-related problems and effective medical or surgical treat­
As discussed above, informational support is beneficial to patients ments. In the context of social media, patients have access to experi­
gaining health-related knowledge, which can provide them with a better ential support through a variety of platforms such as discussion forums
understanding of their health conditions and effective medical or sur­ and online communities, where patients exchange their personal expe­
gical treatments. In this view, informational support can affect patients’ riences with others who have similar health conditions. We drew pri­
outcomes of self-management of chronic diseases through the knowl­ marily on the observational learning theory to develop the propositions.
edge gained in the exchange process. We primarily developed proposi­ The observational learning theory posits that individuals may change
tions from social cognitive theory, which posits that an individual’s their own behaviors or learn or replicate new behaviors by observing
knowledge acquisition can depend on observing others engaged in others’ behaviors and considering their consequences (Bandura et al.,
relevant activities such as social interactions and social exchange 1966; Bandura and Walters, 1977). Because of the popularity of web
(Bandura, 2001). This theory can be used to understand people’s health technology, patients have been increasingly engaging in the experiential

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information exchange and starting to realize the value of experiential Therefore, a commitment to self-care is linked to physical health.
support when coping with health-related problems (Ziebland et al., In addition, patients with better psychological health could have a
2004; Snyder and Pearse, 2010). The gained experiential information stronger feeling of control and healthier mood, which may improve
from others can provide a greater understanding of the expected costs physical health (Clark and Dodge, 1999; Uchino, 2004; Uchino, 2006).
and benefits of health behaviors; as a result, it can foster the outcome For example, psychological distress can lead to glucocorticoid resistance
expectations that promote self-care (Bandura, 2004). Social media has or worsen the disease’s symptoms (Miller et al., 2002). Maintaining a
opened networks for patients with similar health conditions to exchange healthy psychological state can help patients control the disease symp­
experiential information, which fosters evidence-based knowledge and toms more easily and reduce the risk of morbidity and mortality.
assists with self-management. For example, patients can share their Consistent with those studies, we posit that self-care and psychological
experiences about self-management and provide evidence-based health are both linked to physical health.
knowledge to help other members in online healthcare communities Proposition 5a. Self-care behavior is linked to physical health.
(Yan et al., 2015). The knowledge gained from other patients’ experi­ Proposition 5b. Psychological health is linked to physical health.
ences can provide a greater understanding of health-related issues and In summary, Fig. 1 shows the conceptual framework whereby social
solutions. Further, the firsthand experiences shared by patients are more media affordances foster social support and social support affects pa­
valuable and trustworthy than those from other stakeholders because tients’ self-care and psychological health, both of which are linked to
they can provide evidence-based health practices and health outcomes. physical health in the domain of social media-enabled healthcare. More
In such a scenario, patients pay attention to others’ behavior and specifically, different social media affordances facilitate different forms
recognize its consequences, thus motivating their own self-care. There­ of social support. Further, different forms of social support are linked to
fore, experiential support promotes patients’ self-care through obser­ self-care and psychological health: (a) informational support promotes
vation of others’ behavior and the comprehension of its outcomes. self-care behavior and improves psychological well-being, (b) experi­
Proposition 3. Experiential support in social media promotes self-care ential support is linked to self-care behavior, and (c) emotional support
behavior. is linked to psychological health. This theoretically grounded research
uncovers the importance of social media effectiveness in patients’ self-
3.6. The effect of emotional support care of diseases and demonstrates the process of social media usage in
affecting patients’ health behaviors and health outcomes.
In the long-term self-management process of chronic diseases, stress
is often a massive barrier to the achievement of positive health outcomes 4. Discussion
because patients suffer from various symptoms and feel depressed at
times (Davidson and Demaray, 2007; Thoits, 1995). Emotional support The existing literature provides substantial evidence that social
is especially important for helping patients to reduce stress and feel media is a novel technology for changing health practice (e.g., Fichman
relief because they may experience happiness, relaxation, and mean­ et al., 2011). However, few studies have attempted to provide an un­
ingfulness in the exchange of emotional support. We developed the derstanding about how social media could be adopted for
propositions from the affective process perspective (Mischel and Shoda, self-management of chronic diseases by patients. In this paper, we
1995). The affective process posits that individuals’ feelings and intend to fill this gap by proposing a conceptual framework that explains
emotional reactions to situations are related to their attitude and beliefs. the application of social media in healthcare from a patient’s perspec­
In the social media environment, emotional support is the foundation on tive. Our work reveals an emerging theme of social media-enabled
which patients have affective responses to themselves and others who healthcare that theorizes social media-enabled social support from a
engage in the exchange process. For example, in the online healthcare technology affordance perspective and explicates its links to self-care
community, patients exchange their emotions, such as happiness about and health conditions in the self-management of chronic diseases. It
successfully coping with health concerns, and moods, such as feeling also responds to the recent call for research on the implications of social
good, both of which can be seen as affective responses. In addition, media in the healthcare domain (Fichman et al., 2011) and is among the
patients’ self-esteem, self-efficacy, and feeling of control are helpful for first studies to offer insights into this new phenomenon. Our conceptual
patients to maintain a positive psychological perspective by reducing framework demonstrates how newly emerged web technology (here,
stress (Cohen, 1988; Uchino, 2009). In this view, emotional support social media) may create new values by leveraging it to our specific
makes patients not feel alone and feel cared for, which is helpful for research context—namely, self-management of chronic diseases.
alleviating blue moods (Yan and Tan, 2014). Meanwhile, patients can Our work is novel and different from previous studies in the
also develop and maintain trusting social relationships in such a group following aspects. First, we tailor social media affordances to healthcare
through affective responses for each other. With strong emotional sup­ and elaborate how those affordances can facilitate different types of
port on social media, patients can build social relationships and social support. Social media affordances are essential for user engage­
encourage each other when they are in blue moods, thus reducing stress ment in social media (e.g., Cabiddu et al., 2014), and thus serve a theory
and improving their psychological states (e.g., Nabi et al., 2013). for explaining how patients can perceive social support for
Proposition 4. Emotional support in social media has a significant effect self-management. Second, unlike previous studies examining the in­
on psychological health. fluences of social support as a general process, our work explicitly ex­
plains how a particular type of social support is linked to a particular
3.7. The effects of self-care behavior and psychological health type of health outcome. Thus, our propositions could serve as a foun­
dation to stimulate future research and pave the way to study the phe­
We have realized that physical health can be achieved through two nomenon of social media-enabled healthcare. More specifically, our
pathways: behavioral processes and psychological processes (Uchino, propositions could help to extend and expand technology affordance
2006; Uchino, 2009; Cohen, 1988; Cohen and Wills, 1985). Behavioral theory and social support theory to new research contexts such as
processes are linked to health behaviors and treatment adherence, and technology-based healthcare. Below, we discuss the theoretical and
psychological processes are linked to emotions, moods, feelings of practical contributions of our study.
control, and self-beliefs. Adherence to a self-care regimen can produce a
high adherence to medical treatment and health habits, which can exert
biological processes and lead to psychic health (Uchino, 2006). A high
adherence can exert an influence on physical health because it can
control the disease’s symptoms and improve biological functions.

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X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

Fig. 1. Conceptual Framework.

4.1. Theoretical contributions theory.

Informational support significantly increases patients’ knowledge
4.1.1. Advancing social media-enabled healthcare with social media about health problems, health risk and benefits, and possible health
affordance solutions, which promote self-care and psychological health via the
Our work suggests that the affordances social media provide are cognitive process. Emotional support improves patients’ emotional
essential in driving patients’ engagement in the exchange of resources states and moods through their emotional reactions to one another on
online. Technology affordances, in general, refer to “the mutuality of social media. Social media makes the world smaller for patients who
actor intentions and technology capabilities that provide the potential share a common illness, allowing them to get together and encourage
for a particular action (Majchrzak et al., 2013). In our work, social media each other during the long-term self-management of chronic diseases.
affordances refer to the capabilities that social media provide to patients Patients would have better psychological health because of this kind of
and enable them to offer and receive social support. More specifically, social support. Unlike some prior studies that posited that information
social media affordances empower patients and encourages them to and emotional support influence health outcomes (i.e.Yan and Tan,
engage in an online social support exchange (Cabiddu et al., 2014; Vaast 2014) or social support, in general, and have an impact on patients’
and Kaganer, 2013). We identified and distinguished three types of so­ health behavior and health outcomes (i.e., Uchino, 2006, Uchino, 2009),
cial media affordances from a patient’s perspective: affordance for our work uncovers new relationships: (a) information support is linked
co-creation, affordance for social learning, and affordance for social to self-care behavior and psychological health; and (b) emotional sup­
relationships. These social media affordances enable patients to port is mainly linked to psychological health. As such, our work con­
co-create on producing health-related knowledge, observe learning from tributes to advancing social support theory by revisiting its dimensions
others’ experiences, and develop and maintain social relationships for and exploring its different effects. These propositions are important for
the self-management of chronic diseases. Our work advances the liter­ the implications of social support theory in new research contexts.
ature in the arena of social media-enabled healthcare by identifying and Further, we introduce experiential support as a new dimension of
developing the three primary social media affordances, tailoring them to social support and distinguish it from informational support because the
the self-management of diseases in the domain of social media-enabled nature of social media empowers patients to exchange health-related
healthcare, and proposing effects of specific affordances on specific resources with multiple stakeholders. Informational support could be
types of social support that is provided online by the community of fostered when patients exchange health-related resources with stake­
patients and providers. holders such as doctors and patients on social media. It offers knowledge
about health-related topics. Experiential support, however, offers
4.1.2. Advancing social media-enabled healthcare with online social evidence-based knowledge with the experience exchange process among
support patients who have similar illnesses. Experiential support focuses on
We advance the literature on social media-enabled healthcare by patients’ firsthand experience in relation to their self-management of
reifying the three types of social support discussed in the literature and chronic diseases and sharing. Although prior studies have made expe­
by introducing new relationships between different types of online so­ rience exchange a subtype of informational support, our work pulled it
cial support and health behaviors and outcomes. Social support is a out and conceptualized it as a new social support. This argument is also
multidimensional construct and could consist of various kinds of social supported by social cognitive theory and observational theory that
support (Berkman et al., 2000; Cobb, 1976; House, 1981). The literature informational support tends to influence behavior from the cognitive
that focuses on exploring different consequences of various kinds of process (Bandura, 2004), whereas experiential support may affect
social support is limited. Our work fills in this research gap by clarifying behavior via the observational learning process (Bandura et al., 1966;
three primary social supports in social media for self-management of Bandura and Walters, 1977). Experiential support is particularly
chronic diseases: informational support, experiential support, and important for the self-management of chronic diseases and the
emotional support. Consistent with the prior studies, our work posits improvement of patients’ performance with regard to self-care. In
that informational support and emotional support are linked to health addition, we introduce the interaction effect of those two kinds of social
conditions in general. However, we deliberately explored the different support on self-care behavior: the effect of informational support would
impacts of these three kinds of social support on self-care and psycho­ be less effective if there is strong experiential support.
logical health. Below, we discuss how our work advances social support In summary, our work enriches social support theory by exploring

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X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

types of social support for self-management of chronic diseases and and validate the model in different empirical settings. The primary
developing propositions based on each type of social support. As our objective of this work is to articulate a conceptual framework that would
propositions illustrate, social media affordances allow patients to provide some basic guidelines to enable future researchers to take the
observe rich social support in online activities and achieve better first step toward validating the proposed model and generalizing its
physical health via both self-care behavior and psychological health findings. Our study also has some limitations that could lead to future
processes. We hope our propositions encourage scholars to revisit social research directions. The first limitation concerns the type of chronic
support and apply it to new research contexts. disease. Our work does not deliberately explore various types of chronic
diseases that may require different levels of self-care in the self-
4.2. Practical implications management process. It is possible that our conceptual model may be
better applied to some types of chronic diseases than others. Further
Our work offers insights into social media affordances that allow studies can extend our work by advancing it to different types of chronic
patients to exchange social support. With enhanced understanding of diseases such as diabetes and cancer. Second, our study context is gen­
social media affordances, social media providers might be able to eral social media tools, and it is not specific to a particular social media
improve design features to facilitate various kinds of affordances and platform. Design features can vary based on different social media
better alter various types of social support. Consequently, our concep­ platforms, so the three kinds of social media affordances identified in
tual framework can inform practitioners seeking to influence patients’ this study may or may not be representative of a specific platform.
health habits and improve their health outcomes. For example, given Future studies may attempt to develop new affordances based on the
that the affordance for co-creation fosters rich informational support in design features of specific platforms. In addition, the diversity and
social media, social media providers should create a user-friendly richness of social support may vary across different social media plat­
environment where people would be encouraged to co-create and forms. Future research can build on our conceptual framework by
contribute their knowledge. Thus, understanding the effects of different testing in only a specific social media platform. Future studies may also
types of social media affordances can help social media providers better attempt to explore the application of enterprise social media for health
design their platforms and engage their users. This process also helps care practices. Future studies may also pay attention to the negative
social media providers retain existing membership and attract new impacts of social media use on health outcomes (e.g., adherence to
users, which is essential to success. In addition, our work offers impor­ treatment) because social media can also convey fake news and spread
tant implications for healthcare practices. By understanding the various negative emotions.2
types of social support, healthcare providers could effectively engage
patients on social media and provide effective services based on pa­ CRediT authorship contribution statement
tients’ needs.
Xiaolin Lin: Conceptualization, Methodology, Writing - original
4.3. Limitation and future directions draft, Writing - review & editing. Rajiv Kishore: Conceptualization,
Methodology, Writing - original draft, Writing - review & editing.
Our work opens a new research area. Future research would refine

Appendix A

Summary of Affordances and the Characteristics Revealed

Construct Definition

Revealing the characteristics of social media affordance: co-creation

Virtual collaboration Share knowledge and integrate others’ knowledge when knowledge is mainly conveyed via virtual media (Zammuto et al., 2007)
Mass collaboration People interact on a many-to-many basis to have shared information seen and used by unknown others, thus enhancing co-creation (Zammuto
et al., 2007)
Shared affordance Perform nonindependent tasks using different technological features to achieve a collective objective (Leonardi, 2013)
Metavoicing Engaging in the ongoing online knowledge conversation by reacting online to others’ presence, profiles, content, and activities. (Majchrzak
et al., 2013).
Generative role-taking Engaging in the online knowledge conversation by enacting patterned actions and taking on community-sustaining roles in order to maintain a
productive dialog among participants. (Majchrzak et al., 2013)
Visibility Make users’ behaviors, knowledge, preferences, and communication network connections that were once invisible (or at least very hard to see)
visible to others (Treem and Leonardi, 2013).
Persistence Make the published content remain accessible in the same form as the original display (Treem and Leonardi, 2013)
Editability Modify, improve information, and change collaboratively before presentation (Treem and Leonardi, 2013)
Association (between people and Create and sustain relationships between individuals and content (Treem and Leonardi, 2013)
content)
Revealing the characteristics of social media affordance: know people better and develop relationships
Social affordance The relationship between the properties of an object and the social characteristics of a given group that enable particular kinds of interaction
among members of that group (Bradner, 2001)
Customized engagement Interacting with customers based on prior knowledge of individual-level information (Cabiddu et al., 2014)
Triggered engagement Instigating customer encounters based on an external, customer-initiated event (Cabiddu et al., 2014)
Association (between people and Create and sustain relationships among individuals (Treem and Leonardi, 2013)
people)
Social ties Maintain close relationships on online social networking sties (Boyd and Ellison, 2008)
Revealing the characteristics of social media affordance: learning from each other
(continued on next page)

2
We thank the reviewers for pointing out these interesting issues.

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X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

(continued )
Construct Definition

Individual affordance An affordance that enable an individual to learn using a technology’s features (Leonardi, 2013)
collective affordance An affordance that is collectively created by members of a group, in the aggregate, which allows the group to do something that it could not
otherwise accomplish” (Leonardi, 2013).
collaborative learning An individual can learn from each other in the sharing experiences process within a collaborative group or a community (Mitnik et al., 2009;
Suthers, 2006).

Appendix B: A Brief Overview of Social Support and the Consequences

Constructs Consequences Sample References Key Findings

Social Support Health behavior; Uchino (2006); Uchino (2009); Davidson and Demaray Social support can affect psychical health through two
Physiological health; (2007); McMullan (2006); Thoits (1995); van Dam et al. pathways: the physiological and behavioral processes.
psychical health (2005); Cohen and Wills (1985)
Informational Health conditions Yan and Tan (2014) Using the empirical study, the authors report informational
Support support in online health communities has a positive effect on
health conditions.
Emotional Health conditions Yan and Tan (2014) Using the empirical study, the authors report emotional
Support support in online health communities has a positive effect on
health conditions.
Experiential N/A Snyder and Pearse (2010) Using a qualitative approach, the authors identify experiential
Support support as an important form of social support.

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X. Lin and R. Kishore Technological Forecasting & Social Change 166 (2021) 120574

Volkoff, O., Strong, D.M., 2017. Affordance Theory and How to Use It in IS Research. The Xiaolin Lin is an assistant professor of computer information systems in the Department of
Routledge Companion to Management Information Systems, Routledge. Computer Information and Decision Management, Paul and Virginia Engler College of
Von Muhlen, M., Ohno-Machado, L., 2012. Reviewing social media use by clinicians. Business, West Texas A&M University. He received his Ph.D. in information systems from
J. Am. Med. Inf. Assoc. 19, 777–781. Washington State University. Dr. Lin’s research focuses on social commerce, healthcare
Xiao, N., Sharman, R., Rao, H.R., Upadhyaya, S., 2014. Factors influencing online health information technology (IT), information security, and gender differences in IT behavioral
information search: an empirical analysis of a national cancer-related survey. Decis. research. His-work has appeared in the Journal of Business Ethics, Decision Sciences, In­
Support Syst. 57, 417–427. formation & Management, International Journal of Electronic Commerce, Information
Yan, L., Peng, J., Tan, Y., 2015. Network Dynamics: how Can We Find Patients Like Us? Systems Frontiers, and International Journal of Information Management, among others.
Inf. Syst. Res. 26, 496–512.
Yan, L., Tan, Y., 2014. Feeling blue? go online: an empirical study of social support
Rajiv Kishore is currently a professor and the chair of the Department of Management,
among patients. Inf. Syst. Res. 25, 690–709.
Entrepreneurship, and Technology, University of Nevada, Las Vegas, Nevada. His interests
Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., Piantadosi, S., 2001. The
are in IT and firm governance, healthcare IT, corruption and ethics, social media, and
prevalence of psychological distress by cancer site. Psychooncology 10, 19–28.
innovation and knowledge management. Rajiv has published or has forthcoming papers in
Zammuto, R.F., Griffith, T.L., Majchrzak, A., Dougherty, D.J., Faraj, S., 2007.
premier journals including MIS Quarterly, Strategic Management Journal, Journal of the
Information technology and the changing fabric of organization. Org. Sci. 18,
American Medical Informatics Association, Journal of Management Information Systems,
749–762.
Information & Management, Decision Support Systems, Journal of Strategic Information
Zhao, Y., Liu, J., Tang, J., Zhu, Q., 2013. Conceptualizing perceived affordances in social
Systems, and IEEE Transactions on Engineering Management, among others. Rajiv’s
media interaction design. Aslib. Proc. 289–303. Emerald Group Publishing Limited.
research was funded by various federal and other funding agencies including the presti­
Ziebland, S., Chapple, A., Dumelow, C., Evans, J., Prinjha, S., Rozmovits, L., 2004. How
gious National Science Foundation and the federal Agency for Healthcare Research and
the internet affects patients’ experience of cancer: a qualitative study. Bmj 328, 564.
Quality. He has also presented numerous papers at international and national conferences.
Zwass, V., 2010. Co-creation: toward a taxonomy and an integrated research perspective.
He has served and currently serves in editorial leadership roles at leading scholarly
Int. J. Electron. Commerce 15, 11–48.
journals and major international and national conferences. He has served as a guest editor
for Journal of the Association for Information Systems and currently serves as an Associate
Editor for Information & Management, both premier journals in the IS field.

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