Social Networking in Health Care Part I: Designing Trusted Peer to Peer Support Groups using Social Networks

by Marc Resnick, Professor of Human Factors at Bentley University

Social Networks have become popular web services because they can satisfy any one of a number of objectives for users. They can connect people who already have connections in the physical world, but desire another venue for communication. They can connect people who have no prior connection, but have something in common such as a hobby or physical malady and wish to share information, ideas, and attitudes. Each of these two approaches engenders different functional and design needs. This series of two articles will focus on the latter case, the design of peer to peer support groups using a social network platform.

The most important tradeoff that must be considered in the generation of trust for this domain is the tradeoff between trust and privacy. Trust is often established through rich profiles where members present details of their identity and their expertise. The more one knows about an online contact, even when it is not specifically relevant to the topic of the social network, the more initial trust that emerges at the beginning of the relationship. Homophily, the sharing of similar traits, is the basis for most initial trust.

But support groups often involve sensitive topics, such as medical condition or personal trauma. Users may not be comfortable revealing their identity, or enough peripheral information that their identity can be determined by a motivated seeker. The site needs to have a profile interface that allows users to create pseudonym-based personas in which users can select avatars and list personal information that is not self-identifying or sensitive. This could include hobbies, interests and general categories for geographic location and occupation. These profiles allow members to feel like they know each other without knowing anyone’s actual identity. Initial trust can also be created by having clear and strict rules about what information can be posted and an invisible moderator who can immediately terminate any negative interactions. Just knowing this protection exists will increase initial trust.

Because of the limitations to initial trust, it is critical that the network design also facilitates the development of emergent trust. Emergent trust develops through frequent one-to-one and one-to-many interactions that provide personal or informational value. Peer to peer support groups should have a discussion forum through which members can post information, questions, anecdotes, and concerns. At first, this forum may need to be seeded until it reaches a critical mass of member contribution. Critical mass is important because it is through repeated communication between individual members on a public forum that begins the process of emergent trust.

There should also be several venues for private communication. This allows the further develop of one-to-one relationships between members and emergent trust between them. These channels must be clearly privacy protected because of the sensitive nature of the network subject matter. Members should be able to connect to individuals in one-to-one links (“friending”) based on interactions that may start on the discussion forum. The one-to-one communication could include both private asynchronous messaging and live chat. This way, when trust develops between two members on a public forum, it can be leveraged through additional and private interaction.

Designing to maximize initial trust and facilitating the development of emergent trust create an environment that provides the most valuable peer to peer support network. However, there is nothing that can destroy this value faster than the spread of harmful information, exploitive behavior, or disrespectful interactions.