Social Support within Online Communities:
Internet Reach and Content Analysis of a
Cancer Anti-stigma Facebook Page in Mexico
Xinlin Chen1 and
NYU School of Medicine, Columbia
University, United States
Associate Professor of Epidemiology,
Columbia University, United States
- *Corresponding Author:
- Lawrence Yang
Associate Professor of Epidemiology,
Columbia University, United States
Received date: November 02, 2015; Accepted date: January 03, 2016; Published date: January 10, 2016
Citation: X Chen, Yang L. Social Support
within Online Communities: Internet Reach
and Content Analysis of a Cancer Antistigma
Facebook Page in Mexico. Global
Media Journal. 2016, S1: 1.
Visit for more related articles at
Global Media Journal
Social networking sites (SNS) can serve as modern platforms to address diseasespecific stigma, especially in Mexico where cancer stigma impedes healthcare access. This study examines the Facebook Page administered by the Livestrong Foundation in Mexico addressing cancer stigma, in order to elucidate key features of social media regarding the experience of cancer and cancer stigma in Mexico. The study is unique for its focus on a public online platform involving both support and outreach, as existing studies examine more exclusive forums for social support alone. We employ a mixed-methods approach involving qualitative analysis of posts and quantitative analysis of usage trends, focusing on January 1 to June 30, 2013 to encompass Livestrong Day. The 28 posts during this time period reached a total of 28,049 viewing users and 230 interacting users. As hypothesized, most support arose from strangers, consisting of primarily emotional and informational support, with most emotional support from women compared to men. The theme of empowerment appeared frequently within cancer narratives. Emotional support and narratives garnered the most user responses. Anti-stigma campaigns might further leverage users’ primary interest in emotional support by featuring narratives of recovery and empowerment to reach a broader and more interactive audience.
Mexico; Cancer; Social support; Stigma; Social media; Social networking
Cancer and stigma in Mexico
Due to disparities in healthcare, more than half of the global
cancer burden is within low and middle income countries
(LMIC) . In particular, Mexico has significant cancer mortality
accounting for 12% of all deaths in 2010 . Studies suggest
that in many LMIC such as Mexico, stigma of cancer is a principal
barrier preventing effective intervention . Within Mexico,
common stereotypes of cancer include that the disease is equal
to death, and people with cancer are less able to work. Fear of
diagnosis and subsequent labeling may prevent an individual from
seeking medical attention. Even after diagnosis, individuals may
cope with stigma through denial, refusal to take medications, or
social isolation, cutting off important emotional support systems. Culturally-appropriate interventions to address stigma of cancer,
decrease isolation, and increase social support networks are
crucially needed to complement existing efforts targeting cancer
prevention within Mexico .
Social support via social networking sites
Withdrawal from social engagement is a common coping
mechanism against stigma, resulting in isolation as a major
negative consequence [5,6]. Social support ameliorates these
negative results, countering stigma’s “othering” effects by
marking individuals as full-status participants in society . Social
networking sites (SNS) can serve as novel platforms through
which these mechanisms can take place towards addressing
disease-specific stigma [7,8]. One study of online support groups
for medical diseases found that decreased stigma was the most frequently mentioned benefit . Another study showed a
correlation between online interaction with Facebook friends
and greater self-reported well-being and less physical illness.
However, few studies analyze mechanisms through which social
support is conferred online [10,11]. Existing research focuses
on local and exclusive disease-specific online communities,
conducted before the popularity of Facebook expanded social
networking to a global scale. Facebook Pages is a unique SNS
platform for its global visibility, ease of access to social support,
and use for activism reaching an audience beyond the targeted
group receiving social support. This equal emphasis on social
support and activism makes Pages particularly useful for nonprofits
aiming to address disease-specific stigma, as well as a rich
source for examining the nature of modern online social support.
Patterns of social support and user interactions
Existing research focusing on online disease-specific groups show
that online social support is primarily in the form of emotional
support and informational support [12-17]. In particular,
emotional support and narratives draw more user engagement
than informational support. Studies of online cancer groups show
that emotional support and narratives around the process of
diagnosis solicited more user engagement [18,19]. Gender may
shape the prevalence of emotional versus informational support
in online communities, with social expectations of gender
performance affecting both men and women’s preferences for
online communication and narrative expression [20,21]. Studies
with online cancer support groups showed that more women use
a communication style prioritizing emotional support compared
to men [22,23]. Empowerment is a crucial component in reducing
cancer stigma, as it protects against internalized stigma and the
negative effects of labeling. Through telling one’s own story,
narratives allow reframing of suffering as opportunities for insight
and action, which may lead to increased emotional resilience
and empowerment . Some studies on disease-specific online
social support document increased self-reported empowerment
among group users [25-27] however few studies examine themes
of empowerment within cancer narratives. Analyzing themes
of empowerment within users’ cancer narratives may help us
understand how users navigate, challenge, and cope with existing
stigma against cancer.
Existing studies focus on relatively small online groups dedicated
to social support, which differ from larger multi-purpose
platforms such as Pages combining social support with activism
targeting a broader audience. This study expands upon previous
research with a case study of a Facebook Page administered by a
campaign in Mexico addressing stigma of cancer. We hypothesize
that the Facebook Page replicates findings in smaller disease-specific
online communities. We test hypotheses through a
mixed methods approach, synthesizing quantitative analysis of
user and post trends with qualitative analysis of user-generated
content. We first hypothesize that most instances of support
come from strangers previously unknown to the support recipient
and who infrequently interact online, magnifying effects seen
in more private online groups [12,28]. Second, we hypothesize that emotional and informational support will appear most
frequently as forms of social support, with women providing
more emotional support compared to men. Third, we expect to
see emotional support and narratives as more effective elicitors
of user engagement, even within a Page platform that equally
prioritizes support and activism. Fourth, we explore whether
empowerment themes arise within user generated content and
how it might relate to cancer stigma. While we are unable to
provide formal statistical tests for these hypotheses, we make
descriptive observations based on these analyses. This in-depth
study highlights key features of social media, with implications
for SNS-based health communication efforts to decrease cancer
stigma in Mexico.
Comparte tu Historia (a program of the Livestrong Foundation) is
a Mexico-wide campaign aiming to decrease cancer stigma. This
program created a Facebook page to encourage social support
(featuring volunteers’ cancer narratives and the dedication
cards photo campaign) and to promote information and
events (especially Livestrong Day, a major annual event). As of
November 2014, the Facebook page has >1400 fans via Facebook
“likes”. Joining the page is free and open to anyone. Because
Comparte tu Historia administrators create posts, we focused
on the Comparte tu Historia Facebook community because of its
Mexico-wide reach. Study data consisted of posts and messages
(on the Facebook page), and page trends and demographics
(from Facebook administrator data) from January 1, 2013 to
June 30, 2013 to assess coverage of sufficient time and because
this period encompassed Livestrong Day (May 16-17, 2013). This
time period also highlights the page’s dual purpose to provide
informational support for activism and emotional support for a
user-dominated support community, thus serving as a naturalistic
test of the predominance of these types of support. This study
was approved by Columbia Medical Center’s Institutional Review
Quantitative analysis of posts and users
For each post, three MA-level students recorded quantitative
data regarding the type, date, and author and all modes of
interaction with that post, consisting of: 1) likes, 2) comments,
3) shares, and 4) likes on comments (Table 1). Type, date, and
author information for all posts and interactions were recorded
to assess quantitative information related to demographics, post
type, and trends in content. Using these metrics, posts were
organized based on popularity. Unique Facebook users were
identified, and patterns of use assessed based on demographic
information including gender, cancer status (self-identified vs not
self-identified), and relation to Comparte tu Historia (as cancer
survivor volunteer, staff, or family member of a survivor). The
“Like: Comment ratio”–the average number of “likes” recruited
by each user’s comment-was calculated for each unique user.
A higher ratio indicated more successful average recruitment
of “likes” (and therefore more user interaction solicited by one
user’s comments, or “higher popularity”). Some users were Page
administrators, in particular the “Comparte tu Historia” account, and were included in the analysis with public users, since staff and
volunteers may contribute as individuals with unique experiences
with cancer, in addition to posting campaign information.
||Publicly visible text, picture, or video created by the Page moderator (CompartetuHistoria). Users can interact with posts via Likes, Comments, Shares, or Likes on Comments.
one-click affirmation of support for a post, which allows users to receive updates on the “liked” post in their personal news feed
|| publicly visible message, picture, or link that a user attaches directly to the post
|| a method for users to disseminate the post through their own friends or page, with the option of adding a personal message
| Like on Comment
|| one-click affirmation of support attached to a comment
Table 1: Facebook interaction terms.
Page administrator data
Comparte tu Historia page administrators can utilize Facebook
statistics to monitor trends in page usage. Using these statistics,
we exported both page and post level metrics, and utilized further
information such as total number of non-interacting viewers
by post, and user demographic information such as preferred
language, age, and location according to users’ profiles.
Qualitative analysis of posts and comments
Qualitative data consisted of Facebook posts and comments
to the posts, which were translated from Spanish to English by
a bi-lingual MA student (J.T.). Our qualitative analyses adapted
a prominent social support framework , which posits that
one's "primary support source" (intimate others) and "secondary
support source" (experientially similar others) provide different
types of social support via unique mechanisms. We utilized the
directed content analysis described by Hsieh and Shannon .
This method allows extensions of existing conceptual frameworks
to novel domains: i.e., an online cancer support community for
which no unique social support framework currently exists.
We identified initial coding classifications based on Thoits’
mechanism of social support, which included emotional support,
informational support, and instrumental support. When
implemented with the qualitative data, social support categories
were modified, elaborated, or replaced according to consensus
within the research group to account for the unique context of
our online dataset.
Analysis began with identifying initial coding categories and
creating operational definitions based on the theory. This initial
set of codes includes emotional support, informational support,
and instrumental support. Posts and comments were coded
independently by three MA-level students using these categories.
The research team met extensively to discuss discrepancies (16 meetings, including 8 to reach consensus with the principal
investigator (LY), lasting 60 minutes each, over 3 months). All
final codes were consensus codes between the three RAs. These
classifications were refined by the narrative data and expanded
to include additional codes, including support request (requests
for empathy, participation, or information), and empowerment
(motivation towards agency, social activism, and advocacy) (Table 2).
| Emotional support
|| demonstrations of caring, encouragement, and sympathy
| Informational support
|| provision of facts, advice, or guidance
| Instrumental support
|| behavioral assistance with practical tasks or tangible material assistance, such as gifts, blood donations, etc.
| Support request
|| requests for empathy, participation, or information
|| motivation towards agency, social activism, and advocacy
| Social Influence
|| Setting of norms among others with similar experiences
|| Explicit mentions of cancer stigma
Table 2: Codes for qualitative analysis.
Synthesis of qualitative and quantitative
Qualitative and quantitative analysis of posts were synthesized
to assess patterns of social support conferral and relations
to gender. To determine the most frequent types of support
exchanges, post popularity according to quantitative analysis
was matched with the post’s ‘most salient’ social support
codes according to qualitative analysis. ‘Most salient’ code was
determined by frequency of the code (or RA consensus in cases
of tied frequencies). In addition, users’ gender was matched with
the type of social support conferred via comments, according to
Table 3 shows demographic information for the people reached
via the Facebook page (viewers) and people who interacted with
the page (via likes, comments, shares, and/or likes on comments;
henceforth referred to as “interactive users”). There were 230
unique users who interacted with the Facebook page; 67% were
women, 27% were men, and 7% were of unspecified gender.
There were a total of 28 posts. In addition to interactive users,
additional users were reached via viewing posts alone (henceforth
referred to as “viewers”). In total 28,049 unique people viewed
the page. 84% of viewers were from Mexico, 8% from USA, and
8% from all other countries combined. Within Mexico, the city
with the most people reached was Mexico City (52% of viewers
in Mexico), followed by Guadalajara (11%), and Merida (7%). Of
all viewers, 85% used Spanish, and 14% used English; 56% were women, and 42% were men, a more equal gender distribution
compared to the subset that actively interacted. Additionally,
38% of viewers were between 25-34 years of age, the most highly
represented age group (Table 3).
| 837 (3)
| 15707 (56)
| 23561 (84)
| 23842 (85)
| Interacting Users
| 230 (< 1)
153 (< 1)
61 (< 1)
16 (< 1)
Note: Interacting users refers to the subset of viewing users who actively engaged via likes, comments, shares, or likes on comments.
Table 3: user demographics.
Quantitative patterns of user interaction
64% of interactive users did so only once. Therefore most
were infrequent contributors, with the number of contributors
decreasing with increased frequency of interaction (Figure 1).
The most frequent form of interaction was “likes,” followed
by comments, and shares. As expected, the most frequent
contributor was Comparte tu Historia as the page moderator.
Even when removing consideration of Comparte tu Historia, the
general trend of user interaction still reflects more infrequent
contributors. Compare to Historia as a contributor had a “Like:
Comment instance” ratio (the number of likes per comment,
signaling ‘popularity’ of a comment via more recruited
interaction) of 1.625. Comparte tu Historia commented 8 times,
while all other commenters did so either once, twice, or three
times, with a range of “Like: Comment instance” ratio of 0.333
to 2. 14% of interactive users commented at least once to a post.
Posts and qualitative analysis
Figure 1: Total user interactions.
Figure displays user interactions solicited by each post (28 total
posts) (Figure 2). Posts solicited a total of 576 interactions, with
the most popular post soliciting 68 interactions, and the least
popular post soliciting 3 interactions. Including viewers, posts
reached a total of 13,886 people, with the most popular post
reaching 2100 people and least popular post reaching 20 people.
Most support came from unaffiliated users with no relation to the support recipient and no self-identified cancer status. Figure
2 also displays the most salient code for each post. The most
salient code was emotional support (8/28), while second was
informational support (5/28) and support request (5/28) (Table
2). Emotional support posts were most popular; 7 of the 8 total
emotional support posts were among the top 11 most popular.
More female users provided emotional support compared to
men. 20 women offered emotional support via comments, while
only 3 men did so. Two of these men were volunteers through
Comparte tu Historia, and one was a cancer survivor. The
predominance of women extended to informational support, but
to a lesser extent; 6 female users provided informational support
via comments, compared to 3 male users. There were 13 total
narrative posts, 6 from survivors sharing their story and the rest
from volunteers or family of survivors. 6 were from women, 5
from men, and 2 from users of unknown gender. Narrative posts
were popular. Of the 10 most popular posts, 6 were narratives,
with 3 from survivors. In addition to the narrative posts, 2 more
narratives came from unaffiliated users through commenting
upon a post by sharing their own story. All survivors’ narratives featured either empowerment (3 of 6) or emotional support (3 of
6) as the most salient code.
Themes from qualitative analysis
Figure 2: User interactions per post.
Table 4 displays examples of emotional support, informational
support, and empowerment with their associated themes. The
most frequent form of support was emotional support, most
often directed towards cancer survivors. Emotional support
consisted of well wishes, expressions of sympathy, and tended
to be less than a sentence in length. Cancer survivors also shared
longer personal narratives, with many of these testimonials
seeking to shed light on the reality of living with cancer and
helping others feel less alone. Not all of these anecdotes were
solicited by Comparte tu Historia; spontaneous sharing occurred
via comments in direct response to another individual sharing
their story. For example, one survivor responded to another's
experiences with cancer treatment by sharing her own healing
process. Survivors frequently cited their family members and God
as sources of emotional support and motivation.
||I understand how you feel. As of three years I passed through a similar process, they extrapolated my uterus and I also do not have the opportunity to be a mother. And like you said well, only those people who have experienced all this process understand what happens not only to our body, but in our soul and our heart…We are fighters and nothing holds us down. God bless you.
|Family members and God
||My secret is the love of all my family who has always been with me in the most crucial moments, and the hand of God which I don’t let go of. God would allow others to have the same opportunity and the desire to live that I have.
||Remember to spread the word about this event: in the XXX [city] we are located within the XXX Hospital in the Cancer wing (on May 15, 16, 17, from 10:00am to 2:00pm),
Friends we want to share with you all the page that reports information regarding the stigma associated with cancer and the actions and impact in the countries where we are working to diminish it, as is the case in Mexico… spread the word… www.livestrong.org/stigma
Encouraging information from survivors
Cancer does not mean death, if detected on time they are stories of success.
|Speaking out as activism against discrimination
||it is important to bring awareness to society…That is why I am here as a volunteer…so that we can finish with discrimination in regards to the illness called cancer.
|Speaking out as helping other survivors
||If we share our stories (histories), we are giving more emotional support to people who, like you and I, need to feel that they are not alone and to share their life stories.
|Inspiration from recovery
||…not everyone has three relapses and three opportunities for re-birth. Now I ask myself which is the mission I have in life, my fear is not the cancer, but to guide my steps and give a true meaning to life.
||Individually we will fight our own fight, but we are not alone. You can’t have life without death but you can leave a mark. You can live (exist) and the way to live is to fight it [cancer], and above all, search for happiness.
Table 4: The mes from qualitative analysis.
The second most frequent form of support through the Facebook
page was informational support. The majority of informational
support was provided by the moderator, Comparte tu Historia,
through event announcements for socializing or campaign
involvement, and information about cancer and stigma. Cancer survivors also offered informational support via encouraging
facts about cancer, often through cancer narratives (Table 4).
Empowerment was a prominent code, especially within the
cancer narratives, appearing as the fourth most frequent code.
Those who chose to share their story mentioned deriving strength
from their condition, desire for activism, and concern for other
survivors. Survivors who spoke about empowerment mentioned
the need to speak out to educate others about cancer, as a way
to address discrimination against cancer survivors. In addition to
activism towards cancer stigma, participants mentioned allowing
one’s story to impact other survivors as another reason to speak
out. Participants stressed that recovery from symptoms can be a
great source of inspiration allowing one to see life in a different
way, and that recovery is possible. The language of “fighting”
cancer commonly appeared in user contributions featuring
empowerment (Table 4).
Summary of main results
The Comparte tu Historia Facebook page aimed to decrease
stigma of cancer in Mexico, engaging 230 unique interactive
users who contributed via likes, comments, shares, or likes
on comments, and reaching 28,049 total viewers in a 6 month
period. The majority of participants were adult females, who spoke Spanish and resided in Mexico. More female participants
actively interacted with the page compared to male participants
but this distribution became more balanced when considering
non-interacting viewers. Unlike prior research focusing on more
closed online groups, this campaign’s Facebook page prioritizes
both social support (e.g. dedication card photos, featured cancer
narratives), as well as education and awareness (e.g. Livestrong
Day). As hypothesized, most interacting users did so one time via
low-commitment actions such as a “like”, with the vast majority
of users viewing without interacting. In addition, most support
arose from unaffiliated strangers. Social support was conveyed
primarily through emotional support and informational support,
with emotional support appearing most frequently and primarily
from women users. This supports our hypothesis based on prior
studies with more closed, private online groups. Consistent with
current research emphasizing the importance of emotional
support and story-sharing in online environments, our study
showed that emotional support and narratives garnered the
most user interactions. In addition, the theme of empowerment
appeared frequently, especially within cancer narratives. This is
a unique finding, as few studies have examined empowerment
within user-generated online content.
Patterns of user interaction
Quantitative patterns of user interaction replicate existing
literature on online communities, where most users infrequently
interact. Our results support this finding, with 64% of interacting
users doing so one time and the vast majority of users viewing
without interacting. In addition, most social support came from
strangers, emphasizing the page as a means for unaffiliated
survivors and community members to come together as “weak
tie” networks. These results are expected, given the public
nature of the Facebook Page. The page moderator was the
most frequent contributor and commenter, with a high “Like:
Comment instance” ratio, highlighting the Page platform as the
organization’s interface with its online community. At the same
time, many individual users had high “Like: Comment instance”
ratios, with 14% of interacting users contributing comments to
posts. This demonstrates the active presence of individual users
creating a supportive community amidst the organization’s
informational support and education.
Social support and cancer narratives
Although prior research on disease-specific online support
focus on more private groups intended for social support, our
results suggest that effective social support is possible on public
groups that also emphasize activism. The Facebook page used
for analysis in our study is a unique platform, as studies show
that cancer-specific online groups are mostly intended either for
social support, or awareness and fundraising [18,31]. Although
one might expect an organization-run public page to contain few
instances of emotional support and narrative sharing, the relative
anonymity, ease of access, and de-stigmatized norm may facilitate
the exchange of emotional support . In addition, activism and
social support may complement each other. We speculate that
activism may serve as a buffer, as the vulnerability of individual
users sharing their story is decreased under an overall message of empowerment and education. Therefore, the campaign’s general
mission diffuses the risk for any individual who chooses to share
their personal story. Our results reveal that women represent
the majority of users and provide most of the emotional support
compared to men, disproportionate to their representation in
the total reached population. The relative lack of male presence
might be explained by previous research noting that the norm of
online social support communication differs from that preferred
by men, involving a level of emotional communication which may
be unsettling for many male users . The female-dominated
emotional support and user population in our study raises
questions about women’s “cyber-agency.” As Pitts  discussed
within a study on breast cancer survivors’ websites, womendominated
online platforms may be opportunities to invent selves
and define one’s embodiment of disease. In addition, our study’s
finding of frequent empowerment themes further highlights
SNS as potential facilitator of women survivors’ empowerment.
However, SNS is not inherently empowering, and critical analysis
of power relations, gendered norms, and individual cancer
experience is needed to prevent reinforcement of hegemonic
messages. Posts that solicited the most user interactions featured
emotional support and narratives. This result is especially relevant
to health communication, as existing studies show that SNS users
with more frequent interaction report closer relationships and
social capital [10,11]. Therefore, users’ interaction and sense of
support may be maximized through cultivating more emotional
support and story-sharing. This echoes existing literature on
disease-specific online communities, where users may be more
interested in empathy rather than information which can be
obtained from other sources such as doctors . Narratives
and the experience of cancer may be of primary concern, rather
than informational support such as advice and facts about cancer.
This result supports existing research in narrative medicine,
which posits that “the capacity to recognize, absorb, metabolize,
interpret, and be moved by stories of illness” is crucial to
healthcare practice and understanding patient perspectives .
Implications for cancer stigma reduction in
As SNS become increasingly utilized for maintaining social
connections, creation of social support pages may serve as an
effective medium to address disease-specific stigma. In particular,
online social support can alleviate stigma’s major consequence of
social isolation, which may take different forms across cultures
[34,35]. Social support from primarily unaffiliated strangers adds
new ties, albeit transiently, to a user’s social network. Receiving
encouragement to speak out may counteract harmful coping
mechanisms such as secrecy, which can delay diagnosis or
treatment. We speculate that online communities may serve as
non-stigmatizing cultural alternatives, through which users might
compare, resist, and gain insight into cancer stigma in their local
cultural worlds . The online page may elucidate alternatives
to cancer stereotypes and labeling, providing models for sharing
via cancer narratives, and allowing direct opportunity for action
and engagement via comments. Instances of emotional support
frequently mentioned family members and God, suggesting
that cancer stigma reduction efforts in Mexico may benefit from increased attention to these support sources. Emotional support
and narratives elicited more user engagement, suggesting that
future online initiatives might reach a more interactive audience
through featuring stories of recovery and emotional support .
Empowerment frequently appeared in cancer survivor narratives,
which described finding new meaning in life with cancer, social
activism, and a desire to support others. Campaigns might further
leverage the existing common theme of empowerment within
narratives to promote a culture of activism, prognostic optimism,
and survivors’ agency. In particular, a culture of empowerment
might further improve from moderators who self-identify as
cancer survivors and actively participate with their own story.
Study limitations and future directions
This study is limited by its analysis of a single Facebook Page on
a single health topic, hence cannot be generalized to all disease-specific
Facebook Pages. In addition, our results do not distinguish
between the various types of cancer; the experience of living with
various types of cancer differs, as does the stigma associated with
each condition. Given that SNS content and features continually
evolve, our results are not directly replicable, although general
trends should be replicable in similar Facebook Pages. The page
administrators were included as users in the analysis, since
we could not distinguish their personal posts from their posts
representing the program. However, including the administrators did not skew overall trends in user interaction and qualitative
analysis of social support. Most participants were female and
the most represented age group was 25-34, hence our results
are not representative of general SNS users or cancer survivors
in Mexico. The majority of female users may additionally impact
our interpretations of the conferral of empathy and emotional
This study’s strengths include analysis of an online platform
with national reach in Mexico and with international recognition
via Livestrong Foundation, coinciding with Livestrong Day. We
employed a context-specific, inductive qualitative coding method
which is applicable to a social support via SNS. To our knowledge,
our study is one of the first exploring online social support and
cancer stigma in Mexico or any other LMIC. Further research in
disease-specific online communities might continue exploring
the role of dual awareness and support platforms, assessing the
potentially complementary role of activism with survivor support.
Additional work with user interaction patterns may explore how
individual characteristics such as gender, age, and cancer status
impact methods of user interaction. Future qualitative work with
user-generated content might investigate culture-specific ways
through which users may express cancer narratives, which may
inform appropriate online support platforms and health-care
practices in Mexico.
- Farmer P (2010) Expansion of cancer care and control in countries of low and middle income: a call to action. The Lancet 376: 1186-1193.
- (2010) Instituto Nacional de Estadistica y Geografia (INEGI).
- Walsh C (2009) Breast cancer: scourge of developing world. Harvard Gazette.
- John Snow Inc (2012) Comparte tu Historia Mexico: Final Report.
- Link BG, Phelan JC (2001) Conceptualizing Stigma. Annual Review of Sociology 27: 363-385.
- Link BG, Cullen FT, Struening E, Shrout P, Dohrenwend BP (1989) A modified labeling theory approach in the area of mental disorders: An empirical assessment. American Sociological Review 54: 400-423.
- Sigurdardottir AO, Svavarsdottir EK, Rayens MK, Gokun Y (2014) The impact of a web-based educational and support intervention on parents’ perception of their children’s cancer quality of life: An exploratory study. Journal of Pediatric Oncology Nursing 31: 154–165.
- Mercado-Martinez FJ, Urias-Vazquez JE (2014) Enfermos renales hispanoamericanos en la época de las redes sociales virtuales: análisis de contenido de sus publicaciones, 2010–2012. Rev Panam Salud Publica 35: 392-398.
- Wright KB, Bell SB (2003) Health-related Support Groups on the Internet: Linking Empirical Findings to Social Support and Computer-mediated Communication Theory. Journal of Health Psychology 8: 39-54.
- Burke M, Kraut RE (2014) Growing Closer on Facebook: Changes in Tie Strength Through Social Network Site Use. In Proceedings of the 32nd annual ACM conference on Human factors in computing systems. ACM pp 4187-4196
- Ellison NB, Vitak J, Gray R, Lampe C (2014) Cultivating Social Resources on Social Network Sites: Facebook Relationship Maintenance Behaviors and Their Role in Social Capital Processes. Journal of Computer-Mediated Communication, 19: 855–870.
- Hwang KO, Ottenbacher AJ, Green AP, Cannon-Diehl MR, Richardson O, et al. (2010) Social support in an Internet weight loss community.International Journal of Medical Informatics 79: 5–13
- Coulson NS, Buchanan H, Aubeeluck A (2007) Social support in cyberspace: A content analysis of communication within a Huntington’s disease online support group. Patient Education and Counseling 68: 173–178.
- Coulson NS (2005) Receiving social support online: an analysis of a computer mediated support group for individuals living with irritable bowel syndrome. Cyberpsychology Behavior 8: 580–584.
- Ravert RD, Hancock MD, Ingersoll GM (2004) Online forum messages posted by adolescents with Type I diabetes. Diabetes Educator 30: 827–834.
- Gooden RJ, Winefield HR (2007) Breast and prostate cancer online discussion discussion boards. A thematic analysis of gender differences and similarities. Journal of Health Psychology, 12, 103–114.
- Mo PKH, Coulson NS (2008) Exploring the communication of social support within virtual communities: A content analysis of messages posted to an online HIV/AIDS support group. Cyber psychology & Behavior 11: 371-374.
- Chou WS, Hunt Y, Folkers A, Augustson E (2011) Cancer Survivorship in the Age of YouTube and Social Media: A Narrative Analysis. Journal of Medical Internet Research 13: e7.
- Bender JL, Jimenez-Marroquin M, Jadad AR (2011) Seeking Support on Facebook: A Content Analysis of Breast Cancer Groups. Journal of Medical Internet Research13
- Harrison J, Maguire P, Pitceathly C (1995) Confiding in crisis: Gender differences in pattern of confiding among cancer patients. Social Science & Medicine 41: 1255–1260.
- Pitts V (2004) Illness and Internet empowerment: writing and reading breast cancer in cyberspace. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine8: 33–59.
- Seale C (2006) Gender accommodation in online cancer support Groups. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 10: 345–360.
- Seale C, Ziebland S, Charteris-Black J (2006) Gender, cancer experience and internet use: A comparative keyword analysis of interviews and online cancer support groups. Social Science & Medicine 62: 2577–2590.
- Keshet Y, Schiff E, Samuels N, Ben-Arye E (2014) Giving voice to cancer patients: assessing non-specific effects of an integrative oncology therapeutic program via short patient narratives. Psychooncology.
- White M, Dorman SM (2001) Receiving social support online: implications for health education. Health Education Research 16: 693-707.
- Johnston AC, Worrell JL, Di Gangi PM, Wasko M (2013) Online health communities: An assessment of the influence of participation on patient empowerment outcomes. Information Technology & People 26: 213-235.
- Yli-Uotila T, Rantanen A, Suominen T (2014) Online social support received by patients with cancer. Computers, Informatics, Nursing. 32: 118-126.
- Han JY, Hou J, Kim E, Gustafson DH (2014) Lurking as an Active Participation Process: A Longitudinal Investigation of Engagement with an Online Cancer Support Group.Health Communication 29:911-923.
- Thoits PA (2011) Mechanisms linking social ties and support to physical and mental health.Journal of Health and Social Behavior 52: 145-161.
- Hsieh H, Shannon SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research, 15: 1277-1288.
- Farmer AD, Bruckner Holt CEM, Cook MJ, Hearing SD (2009) Social networking sites: a novel portal for communication. Postgraduate Medical Journal 85: 455-459.
- Preece J, Ghozati K (1998) Empathic communities: Offering support and sharing information in a bulletin board community. Paper presented at the CVE Conference in the UK.
- Charon R (2007) What to do with stories: the sciences of narrative medicine. Canadian Family Physician, 53: 1265-1267.
- Yang LH, Kleinman A, Link BG, Phelan JC, Lee S, et al. (2007) Culture and stigma: adding moral experience to stigma theory. Social Science & Medicine 64: 1524-1535.
- Yang LH, Chen FP, Sia KJ, Lam J, Lam K, et al. (2014) "What matters most:" a cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma. Social Science & Medicine 103: 84-93.
- Yang LH, Thornicroft G, Alvarado R, Vega E, Link BG (2014) Recent advances in cross-cultural measurement in psychiatric epidemiology: Utilizing 'what matters most' to identify culture-specific aspects of stigma. International Journal of Epidemiology (special issue on Mental Health)
- World Health Organization (2008) World Cancer Report 2008. International Agency for Research on Cancer, World Health Organization: Lyon, France.