Online support groups (OSGs) are potentially useful resources for individuals with chronic health problems who often face challenges in receiving desired support from similar others. Barriers such as limited mobility, time, distance, and desire for anonymity limit access to this support in traditional face-to-face groups. However, engagement in OSGs are well documented to have low user activity, despite the barriers they help to overcome. Several reasons for this low engagement are discussed. Study into engagement is limited by the fact that there are many different ways of measuring engagement, which are not consistent across studies. Furthermore, interventions to specifically improve engagement are limited and varied. Breast cancer is a chronic, potentially fatal, health problem that is the most frequently reported cancer among women. Because of the distress experienced by many women with breast cancer, several OSGs exist to help meet the support needs of people with breast cancer. Although participants report experiencing improvements in psychosocial outcomes, these OSGs also suffer from low engagement. This randomized control longitudinal study seeks to improve engagement by increasing contact and utilizing different methods of contacting participants (e.g., postal mail, email, and phone call) to help improve engagement in a small sample of breast cancer survivors in an OSG. Various methods for measuring engagement are also utilized. Results indicate that the intervention was successful in improving engagement in the intervention group. However, the intervention did not decrease the amount of time to engage in the website. Furthermore, although there was a significant improvement in psychosocial outcomes in both groups over time, the intervention did not result in significantly more improvements on these measures. Limitations and directions for future study are also discussed.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Owen, Jason E.

Second Advisor

Bantum, Erin O.

Third Advisor

Boyd, Kendal C.

Fourth Advisor

Vermeersch, David

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Mental Health - Computer Network Resources; Online Social Networks; Cancer; Human Behavior Models; Mental Health Services - Utilization; Patient Participation; Social Support; Social Media; Social Networking; Self-Help Groups; Neoplasms

Subject - Local

Chronic Health Problems; Breast Cancer; Psychosocial Outcomes



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives