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Health Care for Women

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THE HEALING WEB

a
Mary Jiang Bresnahan & Lisa Murray-
b
Johnson
a
Department of Communication, Michigan
State University, East Lansing, Michigan,
USA
b
School of Journalism and
Communication, Ohio State University,
Columbus, Ohio, USA
Published online: 10 Nov 2010.

To cite this article: Mary Jiang Bresnahan & Lisa Murray-Johnson (2002) THE
HEALING WEB, Health Care for Women International, 23:4, 398-407

To link to this article: http://dx.doi.org/10.1080/0739933029008964

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DOI: 10.1080 /073993302900896 4

THE HEALING WEB

Mary Jiang Bresnahan, PhD

Department of Communication , Michigan State University,
East Lansing, Michigan, USA

Lisa Murray-Johnson, PhD

School of Journalism and Communication , Ohio State University,
Downloaded by [Michigan State University] at 18:25 23 August 2013

Columbus, Ohio, USA

We focused on the computer-mediate d communicatio n (CMC) of social support in

an electronic health discussion group dealing with menopaus e and midlife transition
to show how vital support is to women who are trying to make sense of the change
in their lives. We analyzed 2,000 messages, examining the type and frequency of
support messages, how support was demonstrated , and how support was recognized
by participants. We then provided evidence to show that a community of support had
developed.

Increasingly, there has been recognition of the need for information and social
support by women experiencing midlife transition and the passage into menopause.
In this study we focus on the computer-mediated communication of social support
(CMCSS) in a women’s health discussion group dealing with menopause and midlife
change. Our aim is to examine the importance of social support for participants in
this discussion group as they try to make sense of changes that they are experiencing.
Although the potential beneŽ ts of having someone to talk to are clear, until
recently, the experience of menopause was treated with silence compounded by a
lack of information (MansŽ eld & Voda, 1993). Today, the information deŽ cit is
clearly changing with the availability of electronic libraries, women’s health web
pages, and discussion groups on the Internet.1 Free access to the Internet is available

Received 16 October 1999; accepted 17 December 2001.

We owe “the healing web” metaphor to the Mayo Clinic HealthQuest newsletter. The kind
of “healing” that we refer to here is personal validation derived from being supported.
Address correspondence to Mary Jiang Bresnahan, Ph.D., Professor, Department of Com-
munication, Michigan State University, 470 CAS Building, East Lansing, MI 48824-1212 , USA.
E-mail: bresnah1@msu.edu
1 Some sample on-line health discussion groups include Women’s Health, Women’s Spiritu-
ality, Feminism Digest, Power Surge, FIBROM-L, FEMINSA, MEDLARS, TOXNET, Women’s
Health Advocate, Menopause, Alternative Pharmacies Newsletter, Cyber Health Newsletter,
Birthing the Crone website, Menopause Online, MenoTimes, Women’s Health Hot Line, the
North American Menopause Society homepage (www.menopause.org), and so on. This list is
by no means exhaustive.

398
 The Healing Web 399

in many locations worldwide such as public health clinics, libraries, coffee shops,
schools, and church and community centers. Now as never before, many women
have access to multiple sources of information about menopause.

OVERVIEW OF THE STUDY

Four questions motivated the current study. First, we wanted to know what kinds
of support women seek. Second, what factors contributed to the perception of
messages as supportive? Third, we wanted to know why women go to computer
sites for support instead of other sources. Finally, we considered what advantages
there were in seeking support via the computer medium.
We begin by summarizing the results of previous research examining the connec-
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tion between social support and health. Following this, we present the theoretical
framework used to conceptualize social support and the speciŽ c research questions
to be investigated in this study. We then discuss the method of content analysis
(Krippendorff, 1980) that was used to classify the messages. Finally, the results of
the current investigation are presented and discussed.

PREVIOUS RESEARCH ON SOCIAL SUPPORT AND HEALTH

Numerous studies have provided empirical evidence that the perception of being
supported has a measurable effect on physical well-being. Several studies have shown
that the availability of social support is a critical factor lessening susceptibility to
disease (Bond, 1991; Cassel, 1976; Kulik & Mahler, 1989; Wethington & Kessler,
1986). For example, Krishnan and colleagues (1998) found that elderly cardiac
patients experienced signiŽ cantly less depression and recovered more quickly when
they had a spouse or some other family member to provide homecare for them after
heart surgery.
Several other studies have shown that the perception of being supported also
affects psychological well-being (e.g., Defey, Storch, Cardozo, Diaz, & Fernandez,
1996; Ell, 1996; Theisen, MansŽ eld, Seery, & Voda, 1995; Sarason, Sarason, &
Pierce, 1994). For example, Knight, Williams, McGee, and Olaman (1998) found
that middle-aged caregivers who worked on their own experienced higher levels of
depression compared with caregivers who worked in teams or who met to discuss
their experiences. In a similar vein, West, Edwards, and Hajek (1998) demonstrated
that smokers trying to quit who participated in a buddy smoking cessation program
were still abstinent from cigarettes at the end of the treatment period compared with
smokers who tried to quit by themselves.
It is in the context of this body of research that we have titled this study “the
healing web.” Participants in this discussion group were seeking answers for healthier
living and trying to regain control over their personal health as they tried to articulate
the chaos they were experiencing with the onset of the midlife change.

THEORETICAL BACKGROUND—A DEFINITION OF

SOCIAL SUPPORT
Goldsmith and Albrecht (1993) explained that supportive acts of communication
include these features: “(1) conveying acceptance and assurance, (2) providing oppor-
tunities for ventilation of frustration, (3) suggesting new perspectives on problems,
 400 M. J. Bresnahan and L. Murray-Johnson

(4) giving information or assistance in skill acquisition, and (5) offering tangible
assistance” (p. 142). This deŽ nition suggests that social support involves reducing
uncertainty, building personal validation and esteem, providing information, empow-
ering both support giver and receiver, providing empathy and nurturance, and giving
advice. Along these same lines of thinking, the current study deŽ nes social support
as the sense of well-being and comfort that women derive from participation in
a discourse community devoted to health issues as well as the speciŽ c interactive
exchanges with other participants that are used to conduct social support.
To determine what kind of messages are perceived as supportive, Cutrona and
Suhr (1994) identiŽ ed three categories of support, including action-facilitating sup-
port, nurturant support, and esteem support. Action-facilitating support includes giv-
ing advice and feedback on actions and offering to provide needed goods and ser-
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vices. Nurturant support includes expressions of caring, concern, empathy, commis-

eration, and social network support. Esteem support emphasizes and bolsters one’s
value as a person. Often messages show a mixture of these forms of support. For
example, a typical message that might be posted in this discussion group is: “Don’t
let your doctor push you around. You are a good person and deserve better (esteem
support)! I know exactly how you feel because this happened to me too (nurturant
support). Here’s a website where you can Ž nd a listing of other physicians in your
area” (action-facilitating support). Cutrona and Suhr’s categories provide a useful
framework for describing and coding the content of socially supportive messages.
Finally, most models of social support assume that in order for support to be
effective it must be based on face-to-face interaction between individuals who have
learned to trust one another. Channels other than face-to-face communication are
described as less effective in delivering support because they are thought to be
hampered by lack of nonverbal cues and paralinguistic information such as the rate of
speech or the tone of voice of the person seeking support (McGrath & Hollingshead,
1993; Parks & Floyd, 1996).

RESEARCH QUESTIONS
For most women, menopause is a normal transition with only minimal physical
discomfort, while for other women incapacitating symptoms often interrupt their
normal life. This subset of women is additionally disadvantaged because, in spite of
their very real difŽ culty, the prevailing ideology discourages them from saying that
at least for them menopause is not a healthy, normal natural event. Even some other
age-cohort women who have not experienced any personal difŽ culty with menopause
might be unsympathetic to their situation. This lack of support and understanding
often causes women who are experiencing difŽ culty to suppress discussion of their
legitimate concerns.
This silence is compounded because women often are uncomfortable talking
with their physicians about menopause (Bell, 1987; Rostosky & Travis, 1996).
Biomedical models have largely framed menopause negatively (Trobst, Collins, &
Embree, 1994). In addition, research has shown that a generally unfavorable image of
aging is reinforced by pharmaceutical advertisements in medical journals and patient
images in medical textbooks that often portray menopausal woman negatively (Avis
& McKinlay, 1991; Hemminki, Topo, Malin, & Kangas, 1993; Theisen et al., 1995).
While earlier studies showed that women had no sense of achievement in the
transition to menopause (e.g., Gannon & Ekstrom, 1993; MansŽ eld & Voda, 1993),
 The Healing Web 401

a recent survey conducted by the North American Menopause Society (1998) in-
dicated that women are beginning to view menopause positively. Theisen and col-
leagues (1995) found that Ž ve factors were related to women’s attitudes toward
menopause: “(1) the number of menopausal changes, (2) women’s menopause status,
(3) women’s ease of talking with others about menopause, (4) women’s emotional
health, and (5) the number of family members with whom they could talk about
menopause” (p. 27).
Based on these previous studies, the following Ž ve research questions provide
a framework to study how socially supportive interactions contribute to the efforts
of participants in this discussion group to regain control over their personal health
during the transition to menopause.
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Research Question 1: What factors prompted women to seek CMC about menopause?
Research Question 2: What kinds of messages were exchange d about menopause?
Research Question 3: What kinds of support did women provide to one another?
Research Question 4: What kinds of messages were perceived as supportive ?
Research Question 5: What were some advantages of computer support?

METHOD
Participants
The data analyzed in this study were drawn from a listserv, asynchronous women’s
health discussion group. This group consisted of several hundred participants (al-
though the exact number changes regularly) that included women from several coun-
tries, representatives of pharmaceutical companies, physicians and other medical
personnel, and some men. Identities of participants in this group are unknown. As
a further protection, names of participants given as examples in this analysis are
entirely Ž ctional. As an additional safeguard, any example that had overly speciŽ c
information that potentially could identify someone was not included in the text of
this study. As in Costigan (1999) and Gurak (1999), the authors were concerned
with issues of conŽ dentiality and fair use of information disclosed in this discussion
group. No demographic data were solicited from members of the discussion group
as they were disclosing potentially sensitive material. Human subjects permission
was obtained to conduct this research.

Procedures
Two thousand messages were collected between 1999 and 2001.2 The method
of content analysis (Krippendorff, 1980) was used to classify the data. In content
analysis, thematic content categories are Ž rst identiŽ ed. Eight content categories
were identiŽ ed in the corpus of messages, including doctor–patient relationships,
hormone/estrogen replacement therapy, alternative therapies, menopause symptoms,
health problems unrelated to menopause, issues of healthy living, family relation-
ships, and spiritual coping. In addition, the Cutrona and Suhr (1994) social support
categories were also used to classify the data. A pair of coders, independent of each
other, each coded 750 messages for content and type of social support. To check the

2 Fifteen hundred messages were collected in August 1999 and August 2000. Five hundred
additional messages were collected in August 2001.
 402 M. J. Bresnahan and L. Murray-Johnson

accuracy of their message identiŽ cation, both coders independently coded a subset
of 500 messages to obtain a measure of intercoder reliability. Using the formula
from Holsti (1969), intercoder reliability was calculated at .96 for content categories
and .87 for the social support typology. These are acceptable levels of intercoder
accuracy.

FINDINGS
Overview of the Most Frequent Messages about Menopause
Content Categories
The three most prevalent messages about menopause included participants’ prob-
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lems in communicating with their physicians, discussion about problems with hor-
mone replacement therapy, and participants’ identiŽ cation and discussion of the
advisability of alternative treatments. These three content categories accounted for
the majority of messages exchanged. Fifteen percent of the messages in the sample
dealt with communication problems with physicians. Forty-Ž ve percent of the mes-
sages discussed difŽ culties experienced with hormone replacement therapy, while
30% of messages discussed alternative treatments. The remaining 20% of messages
dealt with the other Ž ve topics.
Types of Support
When coded for the type of support, most messages (65%) exchanged in this dis-
cussion group were combined messages. Almost all of the messages (80%) included
action facilitative support, focusing on speciŽ c advice in response to questions that
had been asked. Participants showed a clear preference for internal information ex-
change within their discussion group rather than use of any outsourcing such as
contacting outside experts or seeking additional reference materials beyond the dis-
cussion group. Esteem and nurturant support were found equally in 50% of the
messages. Finally, it is important to note that even though most messages in this
discussion group were supportive, some postings were argumentative and took issue
with other’s opinions and positions.

CONTENT ANALYSIS
Content Category 1: Communication Problems with Physicians
Women complained about four kinds of communication problems with physicians.
Women often believed that physicians were dismissive about the women’s problems
(e.g., hot  ashes, irritability, sleeplessness, and so on), they were reluctant to share
health information, and that sometimes physicians used fear appeals to pressure
them into a particular course of action. Finally, women discussed whether female
physicians were more sympathetic than males.
Women resented physicians who dismissed their legitimate health concerns. For
example, participants reported that doctors minimized these concerns with state-
ments such as, “You’re suffering from stress” or “You’re too emotional” or “You’re
just depressed.” One participant expressed her exasperation with such comments:
“Doctor, please don’t pat me on the head and tell me ‘women your age are just a
bit tired.’ ”
A second communication problem occurred when doctors exhibited reluctance to
share important health information. One woman complained that her physician did
 The Healing Web 403

not even tell her that he was about to perform a biopsy on her. Another participant
described that when she expressed reluctance about using hormones, her doctor
waved his arms around and threatened that any woman who refused to take hormones
had no sense at all and should be prepared to suffer the consequences of such a
decision.
Many participants expressed the opinion that there was an over-reliance on surgery
to treat female problems. One participant cautioned: “It may be unavoidable, but if
at all possible tell your friend to get her doctor to keep those ovaries in or even
one. This may alleviate some of the symptoms that yanking both ovaries out will
produce.” This same concern was expressed in another message: “Actually I’m very
surprised that you didn’t end up with a hysterectomy. Many doctors think that the
only way to deal with heavy bleeding is to remove organs, often including the ovaries
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while they’re at it.”

Women were told that they would end up with heart disease or a broken hip
that would put them permanently in the nursing home if they did not use estrogen.
At the very least, use of scare tactics suggest that there is a problem of trust and
communication between physicians and patients.
Women more or less expected male physicians to not really appreciate menopause.
The real shock occurred when female physicians also dismissed their complaints.
One woman wrote that she had a very difŽ cult time making her female gynecologist
understand the symptoms she was experiencing. When she went back one year later,
the doctor who herself was beginning to experience similar difŽ culties, then fully
understood what she was talking about. Participants expected female physicians to
be more supportive of their situation.
If they mentioned the physician at all, women generally expressed dismay about
the physician’s apparent reluctance to listen to them and to really attend to what
they were saying about their lives and their efforts to regain control over the often-
unpredictable changes they were experiencing.

Content Category 2: Problems Experienced with

Hormone Replacement
Participants had many questions about hormone replacement: What are the best
hormones to take and in what combination? Who should take hormones? Who
shouldn’t? What are the risks and beneŽ ts? In what form are hormones best absorbed
(oral medications, creams, patches, injections)? What results and side effects can be
expected? How long do you have to take them? What happens if you stop taking
them—what can you expect? If you don’t take hormones, what else is available?
What is a natural hormone? Are natural hormones better than chemical hormones?
Women agreed that Ž nding the right type, combination, and dosage of hormones
was often problematic.
Participants expressed a lot of uncertainty about use of hormones. One women
advised, “I know how worried you are about the Provera dosage. I had my doctor
switch me to a more natural progesterone and I feel it is much better for my body.”
Another participant commiserated with someone who had just received bad news
about a bone density test: “I know exactly what you’re feeling. I just found out that
I have mild osteopenia in my hips but severe in my arms. I am still in shock.” A
third participant encouraged, “Depression is pretty normal under these circumstances.
Keep trying. You’re bound to Ž nd the right combination of hormones that works for
you. Don’t give up!” Finding the right mix of hormones was not easy. “Just knowing
 404 M. J. Bresnahan and L. Murray-Johnson

that most of you are having similar problems with hormones makes me feel less
like a freak of nature and gives me courage to get on with it knowing that better
times will come.” While there was hesitancy to use hormones, participants often felt
that they needed to do something to deal with the unpleasant symptoms they were
experiencing. They asked what alternatives were available to hormones.

Content Category 3: Discussion of Alternative Treatments

Women in the discussion group talked about numerous alternative remedies. Some
advice re ected recommendations of the American Medical Association—eat less
red meat, reduce saturated fat, salt, caffeine, and alcohol intake, do weight-bearing
and other exercises, and take vitamin supplements. Other suggestions were not at
all conventional—eat Mexican yams to prevent bone loss; use dong quai for hot
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 ashes; and take ginseng, false unicorn, black cohosh, and chasteberry to ease other
symptoms. For example, the following action facilitative message was offered to a
question about how to lessen heart palpitations: “Have you ever tried a homeopathic
remedy for the thyroid—hawthorne berry or motherwort?” Another participant tried
valerian root for relaxation: “I followed your advice and took valerian root. I felt
very relaxed within a half an hour. Thank you so much. Valerian root really worked
for me.”
There was a mixture of science and myth in the discussion of alternative treat-
ments. For example, some women suggested that fatter is better because estrogen is
stored in fat cells even after menopause. While this may be true, this information
is contrasted against morbidity statistics that show heavier women are more likely
to have type 2 diabetes and heart disease. Although women received information
support from this discussion group, they discussed the importance of evaluating it
critically: “I appreciate the opinions expressed here, but women on this list need to
consider that any remedy suggested whether hormonal or herbal has advantages and
dangers. Be aware of these!”
These examples illustrate that participants were very concerned about and wanted
to encourage one another to make informed decisions regarding their own health.
Discussion of alternative treatments, like the discussion of how to communicate
effectively with a physician or what to do about hormones, showed that these women
were considering multiple options in their efforts to regain control of their personal
health, which was challenged by problems as they moved into menopause.

Are There Any Advantages in Obtaining Support in a Computer

Discussion Group?
Theisen and colleagues (1995) concluded that “research attests to the power of
a supportive community in mitigating stress and coping with the uncertainty of
menopausal changes” (p. 22). Sometimes this support group is a virtual community
(Baym, 1995). Communication in cyberspace, stripped of social and nonverbal cues,
creates some advantages for the development of relationships and communication
satisfaction. Walther (1996) suggested that “when users have ample opportunity for
interaction and anticipate ongoing involvement, the computer medium facilitates
more thoughtful and deliberative self-presentations, interpersonal perceptions, and
instrumental communication than is normally undertaken in parallel face-to-face
interactions” (p. 25). Parks and Floyd (1996) similarly observed that “cyberspace
creates an ‘identity workshop’ in which people learn and test social skills, providing
ways for people to transcend the limitations they experience in face-to-face settings”
 The Healing Web 405

(p. 83). The analysis of messages exchanged by women in this study has shown it
is possible to develop meaningful, socially supportive relationships in the context of
a computer-mediated discussion group.
While these are advantages that might be true in any computer community, how
do we know that participants in this discussion group saw themselves as being
supported by the messages that they exchanged? What evidence did women offer to
demonstrate that they understood their exchanges to be supportive?

Evidence of Support
There were numerous examples of participants commenting on the social support
that they received from this group. For example, one woman wrote, “I know where
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you are coming from and I have a lot of empathy for you. It was really hard
for my head to adjust to my changing body. I think informing yourself, being
active, laughing, being positive and having support groups like this one really helps.”
Another participant echoed a similar sentiment: “I will seek out the book that you
suggested. Sounds like good information to start my journey into menopause. I
appreciate all the positive responses and support that I have received from this
group.” Another woman wrote, “Your humor is such a great tonic. I’m so happy to
be a part of this list!”
The sense of uplifting and renewed optimism that women experienced from their
participation in this group was a common theme: “I was thinking about how I felt
when I Ž rst joined this list about seven months ago. I was having insomnia, irritability
and moodiness, irregular periods, the beginning of night sweats, itchy crawly skin,
and fatigue. Hey, you guys are miracle workers!” Another woman added, “I think
the best thing about this list is that it gives you hope. There are so many success
stories here and so much information that you’d probably never be able to dig up
on your own. Now we have options, and we can keep trying until we succeed. And
the support is wonderful!”

Evidence of Community
There was also evidence that friendships begun on the Internet spilled over from
cyberspace into real space. Several social events occurred during the period of data
collection in various regions of the United States, including meeting at health confer-
ences and getting together for brunches and weekend retreats. A typical discussion
included reference to upcoming events. One participant announced, “There still are
a couple of spaces available for the upcoming get-together.” One woman who lived
in another country responded, “Sob sob! Why am I so far away? Can’t we have a
virtual get-together?”
After the retreat had occurred, participants not able to attend learned that they
had missed “morning walks, a hot dog and tofu roast, and a ceremonial bonŽ re
where we could write things down and throw them in the bonŽ re to clear out our
lives.” Another person described, “The retreat was everything I expected and more.
I felt so lucky to be part of this terriŽ c group of caring, giving, sharing women.
Thanks to each and every one of you for being there for me!” Still another woman
commented, “I returned home overfed, somewhat sleep-deprived and a little sad
that it was over but also very happy to have been a part of a great weekend with
a lot of other wonderful people. It was fun to meet new people and to see old
 406 M. J. Bresnahan and L. Murray-Johnson

friends from previous brunches.” These example show that participants recognized
that they belonged to a caring support community—not just some distant, impersonal
computer discussion group.

Discussion
The messages that participants exchanged showed that they saw themselves as
receiving social support from others in this discussion group. Participants explicitly
talked about the support that they received, how wonderful the people in this
discussion group were to them personally, and how they were made to feel validated
and accepted. Real friendships developed beyond the Internet, and face-to-face
meetings had occurred. It was also clear from the messages that women exchanged
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that stressful events often had prompted them to seek advice and solace from similar
others. Pierce, Sarason, and Sarason (1990) identiŽ ed three criteria that are central
to supportive behavior: the personal perception of support, the existence of a social
support network, and a stressful event that prompts people to seek support. The
messages that we have presented in this article exemplify these three basic criteria
for supportive interactions.

CONCLUSION
There is much value in sharing accounts of difŽ cult experience with appreciative
others whether that value be validation, advice, information, empowerment, or just
some different perspective on the experience. MansŽ eld and Voda (1993) observed
that “Women can be empowered through education and support. Women demon-
strated that discussion groups do result in the emergence both of new knowledge
and strategies for action” (p. 102). Health discussion groups provide participants with
information and a supportive environment. One woman wrote that she had learned
to savor the plusses of her midlife status in a way that she had not savored those of
youth. The passage to menopause can be fraught with difŽ culty for some women,
but as shown in this study, health support in the form of a computer discussion
community is available for women who desire to regain control over their midlife
change.

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