Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 9, 2019
Date Accepted: Feb 2, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Design, effectiveness and implementation of peer-to-peer online support groups for people with chronic musculoskeletal disorders: a systematic review
ABSTRACT
Background:
Online support groups (OSGs) are one way for people with chronic diseases, their family or friends and health professionals to communicate, gain information and provide social support. As the number of OSGs grow, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective and what strategies are being used to implement or increase consumer engagement.
Objective:
The four objectives of this systematic review were to: i) describe the design features of peer-to-peer OSGs; ii) describe the characteristics of individuals involved in peer-to-peer OSGs; iii) synthesise the evidence on the effectiveness of OSGs and; iv) identify implementation strategies used in the delivery of OSGs.
Methods:
A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer online support) was conducted in six different databases. Results were filtered from 1990 (inception of the internet) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a two-step process. Quantitative studies were appraised by two reviewers using the Risk Of Bias In Non-Randomised Studies of Interventions tool (ROBINS-I). Qualitative studies were appraised by two different reviewers using the Critical Appraisal Skills Programme (CASP) checklist. Extracted data were synthesised narratively.
Results:
Twenty studies, with low to moderate risk of bias, were examined. Thirteen studies included OSGs hosted on public platforms. Eleven studies examined OSGs that were conducted in English. Studies either measured the number of OSG members (n=1370 across all studies) or number of posts (range: 223 to 200,000). The majority of OSG members were females who were not full time employed and had a range of education levels. There were no randomised control trials measuring the efficacy of the OSG groups to change any outcome. A mixture of qualitative and quantitative studies identified empowerment, social support, self-management and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. However, sharing experiences and level of engagement appeared to have an important influence on OSGs efficacy. Six studies used moderators or peer-leaders to facilitate engagement. Two studies found that group engagement was influenced by the role of people posting to the OSG.
Conclusions:
Across a diverse range of designs, languages, included features and delivery platforms, OSGs attract predominantly female participants of all ages and education levels. The amount a member participates appears to be related to their perceived benefit in health literacy and empowerment. Future studies are needed to identify whether and implementation strategies have superior efficacy and whether there are concomitant changes in clinical outcomes of chronic musculoskeletal diseases resulting from participation. Clinical Trial: PROSPERO (CRD42018090326).
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